Statement of purpose Community violence exposure is known to have adverse effects on children’s long-term mental health. We aimed to examine the association between episodes of neighborhood gun violence and subsequent acute mental health-related pediatric emergency department (ED) utilization.

Methods/Approach This location-based neighborhood study included children living in Philadelphia, PA who presented to a children’s hospital ED from 1/1/2014–12/31/2018. We included children in the study if they had one or more ED visits within 7, 30, and 60 days of a neighborhood shooting and lived within 660 feet (2–3 city blocks) of where the incident occurred. Mental health-related presentations were identified using ED chief complaint data. We used multivariable logistic regression to compare odds of mental health-related ED utilization before and after neighborhood shootings.

Results There were 4,217 episodes of gun violence in the study area from 2014–2018, and 54,465 children living near a shooting had one or more ED visits in the 60 days before or after this shooting. Most of these children were Black (84.5%) and Medicaid-insured (78.2%). After adjusting for age, race, ethnicity, insurance status, and zip code, children residing within 660 feet of an episode of gun violence had greater odds of mental health-related ED presentations in the subsequent 7 days (aOR 1.49, 95% CI, 1.08–2.04), 30 days (aOR 1.25, 95%CI 1.05–1.48), and 60 days (adjusted odds ratio (aOR 1.14, 95%CI 1.01–1.29). In stratified analyses, this effect was strongest for Black children (7-day aOR 1.52, 95%CI 1.08–2.14) and children ages 11–19 (7-day aOR 1.60, 95%CI 1.08–2.39).

Conclusions and Significance Neighborhood gun violence has immediate adverse effects on children’s mental health. Recognizing the potentially triggering event and mitigating these health impacts will require both community-based support for children exposed to violence, and trauma- informed approaches during and after ED visits.