I.V. Bonner1, D. Garofalo1,2, V. McCarthy1,2, C. Velopulos1,2, Q. Myers1,2 1University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA 2University Of Colorado Denver, Firearm Injury Prevention Intiative, Aurora, CO, USA
Introduction: In 2022 more than half of firearm related deaths were due to suicide. Self-inflicted firearm injuries are more likely to be higher in severity. Exposure to Adverse Childhood Events (ACEs) has been associated with higher risks of depression, substance use, suicide, and firearm exposure. ACEs contain both direct and indirect measures and exposure to more than four ACEs doubles the odds of firearm exposure as well. While direct ACEs (e.g. emotional or physical abuse) are commonly thought to be the primary drivers of adverse events later in life, the impact of indirect ACEs (iACEs), particularly the relationship between (iACEs) and self-inflicted firearm injury, has not been well characterized. This study aims to evaluate the relationship between iACEs and self-inflicted firearm injury.
Methods: We examined all patients within the American College of Surgeons Firearm Study Database during 2021-2022, comparing those who were exposed to indirect ACEs to those who did not experience ACEs. Indirect ACEs include: household substance abuse, household mental illness, parental divorce, household incarceration, and exposure to intimate partner violence. Bivariate analyses included chi-square tests for categorical variables and Mann-Whitney U test for categorical variables. A multivariable logistic regression determined independent risk factors for self-inflicted injury.
Results: In 9,182 patients, the median age was 28 [IQR 21-37] including Black (59.2%), non-Hispanic (81.5%) males (84%). Of those exposed to iACEs (6.5%), 4.7% had a self-inflicted firearm injury. Black individuals (61.7%, p=.008) and women (20.8, p<.001) had higher rates of iACEs. iACE exposure was associated with higher proportions of prior suicide attempts or self-harm compared to those without iACEs (8.1% to 3.1%, p <0.001). There was no association between self-inflicted injuries and iACEs despite a higher proportion of self-inflicted injuries (5.3 to 4.7, p=0.488). Additionally, individuals with iACE were more likely to have severe firearm injury (27.4% 23.5%, p=.008). Interestingly, exposure to indirect iACEs increases the odds of self-inflicted injuries when only controlling for demographic factors (OR=1.26 not significant) but decreases the odds of having a self-inflicted injury in our full multivariable model (OR 0.89, not significant). A history of mental illness (OR 7.75, p<.01) and having prior suicide attempts or self-harm (OR 8.09, p<.01) were the two factors most associated with an increase in self-inflicted injuries.
Conclusion: Our study suggests that exposure to iACEs increases the proportion of self-inflicted injuries and is associated with more severe injuries. Our findings highlight the importance of screening for iACEs in clinical practice and providing resources to address the risks associated with mental health illness and firearm access and storage, with the goal of reducing self-inflicted injuries.