Fewer Teenagers Carry Weapons After Counseling Intervention

Steven Fox

April 22, 2014

A collaborative care intervention helped cut the risk for teenagers carrying weapons during the year after hospitalization for traumatic injuries, according to findings from a randomized study.

The study was published online April 14 in JAMA Pediatrics.

"Estimates suggest that each year about 4.3 million adolescents present to acute care medical emergency department and trauma center settings after incurring traumatic physical injuries," write Douglas Zatzick, MD, from the Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, Seattle, Washington, and coauthors. They add that results from a series of studies suggest that violence and injury risk behaviors, plus alcohol and drug use, are endemic problems among adolescents presenting with those sorts of injuries. So are posttraumatic stress disorder (PTSD) and depressive symptoms.

Aiming to stem those trends, the investigators tested whether a stepped collaborative care intervention might help reduce risky behaviors, alcohol and drug use, PTSD, and depressive symptoms in a cohort of teenagers.

That cohort was composed of 120 teenagers who were hospitalized as the result of traumatic injuries at a level 1 trauma center in Seattle. The participants ranged in age from 12 to 18 years. They shared most of the same demographic characteristics as other teenagers admitted to the hospital.

The researchers randomly assigned the teenagers to 1 of 2 groups. The first group received 12 months of care from social workers and nurse practitioners. That intervention included motivational interviews that targeted risk behaviors and substance abuse. It also included appropriate pharmacotherapy, as well as elements of cognitive behavioral therapy focused on reducing PTSD and depressive symptoms. Fifty-nine of the teenagers received the intervention. The remaining 61 participants received standard care and served as controls.

The researchers used several standardized assessment tools to evaluate the teenagers for risky behaviors related to violence, substance use, PTSD, and depressive symptoms. The evaluations took place at baseline and then again at 2, 5, and 12 months after hospitalization. Ninety-five percent of patients completed the 12 month study.

At baseline assessment, 64.2% of the adolescents reported alcohol or drug use or symptoms of PTSD or depression, the investigators report. The specific risk behavior with the highest prevalence at baseline was carrying a weapon, which 32.8% of the teenagers said they endorsed.

At the 12-month mark, only 7.3% of teenagers in the intervention group reported carrying a weapon compared with 21.3% in the control group. Teenagers who had traumatic brain injuries (nearly half of the cohort) appeared to respond to the intervention just as well as those without such injuries.

"Intervention patients had clinically and statistically significant reductions in self-reports of carrying a weapon during the year after injury compared with controls (group × time effect, F 3.344 = 3.0; P = .03)," the authors write, and they said this trend was seen at each follow-up point.

Reports of substance use showed some improvement, the researchers said, but did not attain statistical significance. Elevated PTSD and depressive symptoms also improved, but the changes did not appear to be related to the intervention, the investigators said.

The authors emphasize that their results need to be confirmed. However, they added, "If the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at US trauma centers."

This work was supported by the Health Resources and Services Administration and the National Institute of Mental Health. The authors have disclosed no relevant financial relationships.

JAMA Pediatrics. Published online April 14, 2014. Abstract

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