Surviving not Thriving After Gunshot Wound: Prospective Study of Quality of Life, PTSD, and Employment

Abstract

Introduction

Psychosocial morbidity, including posttraumatic stress disorder (PTSD), depression, and failure to return to work, is common following gunshot wounds (GSWs). GSW victims with retained bullets experience increased rates of elevated blood lead, putting patients at risk for toxic effects on cognition and mood. This pilot study was performed to examine associations between retained bullets and employment and psychosocial outcomes after GSW.

Methods

Adult victims of interpersonal intentional GSW completed surveys using validated instruments to measure quality of life, PTSD, resilience, and substance use, and questions regarding employment during index hospitalization and at 1 and 3 mo. Survey data was linked to clinical records regarding injury severity and hospital course.

Results

Sixty-three patients completed the baseline survey; 43 completed all 3 surveys. Median age was 29 (interquartile range, 21-40), injury severity score 13 (9-17), and hospital length of stay 6 d (4-10). The patient population was overwhelmingly Black and male (both 87.3%). Laparotomy was performed in 28 patients (44%). Forty-nine patients (77.8%) were working prior to injury, 1 (2%) at 1 month, and 34 (54%) at 3 months. Eight (12.7%) screened PTSD + at baseline; 38 (60.3%) were PTSD + at 3 months. Three-month PTSD + patients were similar to PTSD-patients in all clinical and demographic variables. For 3-month PTSD + patients, all quality of life component scores were worse than for PTSD-patients. Presence of retained bullets was not associated with any differences in psychosocial outcome at 3 months.

Conclusions

GSW is associated with significant psychosocial morbidity, including a large decline in employment. PTSD affects approximately half of patients, consistent with prior reports. In this pilot study, PTSD + patients suffered from reduced quality of life.