Years after being shot, a large proportion of gun victims continue to suffer from increased unemployment, alcohol and drug abuse, and post-traumatic stress disorder, a new study shows, and the effects persist even when the injuries were minor.

The authors point out that treatment for gun injuries may need to change: Currently, patients may be discharged quickly from the hospital, often with no checks on their mental health or follow-up care. And they say growing evidence suggests that gunshot trauma is harder to recover from than other types of injuries.

“When it comes to guns, we as a society and as researchers pay a lot of attention to deaths. That’s what the public outrage often focuses on. But what’s not captured are the people who survive,” said Michael Vella, lead author on the study who began the research as a fellow at University of Pennsylvania and is now a trauma surgeon at University of Rochester. “What we found is these patients are facing long-term physical and mental health problems that just don’t go away over time.”

Almost 40,000 people in the United States were shot to death in 2017 — more than any year since at least 1968, when federal agencies began counting. As horrifying as that number is, the number who were shot by guns and survived was even greater — as many as three times more people by some estimates.

To track the long-term effects on shooting survivors, researchers at the University of Pennsylvania waded through 10 years of medical records to find the 3,088 gunshot wound patients who had been brought to the university’s trauma center in Philadelphia. Of those who survived, they tracked down and surveyed 183, comparing their life before and after being shot.

One of the most alarming findings came from screening the patients for post-traumatic stress disorder (PTSD). Even years later, almost half of the patients screened positive for probable PTSD. And among those who had been discharged from the hospital for seemingly minor injuries, 33 percent screened positive for PTSD.

“These are patients we are routinely discharging from the emergency room and sending out into the world often with no follow-up or assessment of the long-term mental injuries they may be facing in the months the follow,” Vella said.

One weakness of the study is the relatively small proportion of gunshot victims researchers were able to track down and survey.

“If anything, it may understate the severity of the long-term effects because those most affected may not have been as reachable or willing to talk about it,” said David Studdert, a gun researcher at Stanford University who was not involved in the new study.

The report, published Wednesday in the journal JAMA Surgery, is part of a new wave of gun research that has grown after a decades-long drought of funding, data and political support. Recent mass shootings have injected energy into the long beleaguered field, and a new generation of gun researchers are trying new approaches to understanding and reducing gun violence. And in the continuing absence of substantial federal funding, new sources of money are popping up — from private donors and foundations, insurance companies and state-funded initiatives.

Doctors — like the University of Pennsylvania surgeons behind Wednesday’s study — have also been increasingly vocal and willing to wade into a field of research many in the past avoided because of its politically charged nature.

“More and more, I think physicians are realizing that we can’t save all the gunshot wound victims, no matter how good the medical care gets. And the best way to save patients is to prevent them from being shot in the first place,” said Mark Seamon, co-author of the new study and a trauma surgeon who supervised the University of Pennsylvania research. “Part of that involves doing the research so that we understand the full effects of gun violence.”

Because so much of gun research has focused on deaths, the research into the long-term effects of gun injuries is relatively scant.

“It’s worthwhile work because it’s a piece of the puzzle that simply has not been well-studied,” said Studdert, the Stanford researcher. “We don’t know that much about long-term effects on those who survive. And these kinds of analyses help us understand the full burden of firearm violence.”

The next step, the University of Pennsylvania researchers said, is to develop interventions that allow hospitals to help gunshot victims deal with the long-term consequences, such as PTSD and increased risks of substance abuse.

“We also just don’t know enough about gun violence and what makes it so different than other injuries,” said Seamon, who has begun new research comparing the long-term effects of shootings to other traumas, like car crashes. “I see it in my work as a trauma surgeon. Patients who can’t sleep, who say they can’t get it out of their heads. Other traumas may cause greater physical injury, but the mental toll from gun shots is deeper for some reason.”

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