Police violence continues to be a significant public health problem, especially in the United States. A limited but growing body of research has explored the relationship between police violence and health outcomes. Emerging evidence suggests that exposure to police violence may be a contributing factor to health inequities, particularly among Black Americans. Yet, there remains a lack of consensus on a conceptual and operational definition of police violence within health disciplines. This scoping review aims to address this gap by mapping the definitions and measures for assessing police violence in health literature. We comprehensively searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and APA PsycInfo databases. We included studies published as peer-reviewed primary research in health journals and in the English language. Eligible studies measured police violence. Of the 1692 references identified, 204 references were retained for full-text review, and 114 references reporting on 98 studies met the inclusion criteria. We identified over 100 terms for police violence, which we clustered into 22 categories including abuse, assault, harassment, killing, and violence. The most common terms were "police violence," "police abuse," and "police brutality." Only two-thirds of studies (n = 76) included a definition of police violence. Police violence was most frequently defined as "police killings" (n = 23) and excessive use-of-force (n = 10). Self-reports of police violence were the most common measure (n = 48). Other measures included counts of fatal police violence from open-source and governmental databases, as well as counts of deaths/injuries classified as "legal intervention" in medical records. The health literature lacks a clear and consistent definition of police violence. While multiple measures show some potential for surveillance of police violence, few studies have conducted in-depth psychometric analyses. Recommendations for future research include developing an explicit definition of police violence and reporting psychometric data for measures. Additionally, there is a need for systematic data collection of police violence in health settings and the establishment of a federally supported and accessible public database of police violence to address underreporting and undermeasurement of police violence.
Maxillofacial injuries are commonly observed among women who have experienced domestic violence. The prevalence and characteristics of these injuries in Jordan remain underexplored. This study aimed to evaluate the frequency and patterns of maxillofacial injuries among females affected by domestic violence in Jordan. A total of 2643 records of domestic violence-related maxillofacial injuries in females were retrieved from the Family Protection and Juvenile Department and the Accident and Emergency (A&E) departments of two major hospitals in Jordan. Descriptive statistics were computed, and associations were evaluated using Chi-square and Kruskal-Wallis tests. Significance was set at p ≤ 0.05. The mean age at the time of injury was 29.19 years (SD: 11.8). The spouse was responsible for violent acts in 20% of cases. In 89.9% of cases, injuries were caused by direct blows. Soft tissue injuries were observed in most cases (98.1%), followed by midfacial fractures (5.6%), dentoalveolar injuries (1.7%), upper face fractures (1.2%), and lower face fractures (0.9%). The vast majority did not require surgical intervention (98.9%). Concomitant injuries to other body regions were identified in 70.6% of cases, with the upper extremities the most frequently affected (50.4%). Trauma to the upper extremities showed a significant inverse association with midfacial fractures (p < 0.001). Recurrent trauma was documented in 7.6% of cases. Individuals with recurrent trauma were more likely to present with concomitant injuries to other body regions (84.2%) than first-time trauma victims (69.5%). Facial soft-tissue injuries were the most frequent. Midfacial fractures were the most common facial fracture type, though they were rare and less likely when an upper-limb injury occurred. Repeated trauma increases the likelihood of multiple fractures, emphasizing the need for early detection, reporting, and referral by healthcare professionals including oral & maxillofacial surgeons and dental health professionals.
The National Danish Injury Cohort (NDIC) is a nationwide, register-based cohort established to examine the incidence of total and specific injuries in Denmark and to provide insights into causes and consequences. Comprehensive individual-level information for this cohort is stored in the NDIC dataset, serving as a foundation for analyses of injury determinants and supporting the planning and evaluation of preventive measures aimed at reducing injury-related harm. Individuals registered in the Danish National Patient Register with an injury from 2010 onwards are included in the dataset. Additionally, it comprises persons in the Cause of Death Register whose deaths was attributed to accidents, violence, or suicide. The cohort is currently updated through 2022 and contains information on more than 7.2 million primary injury contacts and 26 thousand accident-related deaths. Analyses based on NDIC demonstrated substantial demographic and geographical disparities in the incidence rates of injuries. Overall, men exhibited higher rates of both injury incidents and injury‑related mortality compared with women. Marked differences were observed when stratifying by sex and age, as well as by region of residence. NDIC offers a solid data foundation facilitating research into injury trends, causes, and impacts, including disparities across social groups and geographic areas. It presents unique opportunities to explore novel research ideas to boost injury prevention, improve targeting of interventions, and reduce health inequalities. Strengthening this research area will help further reinforce NDIC's role in injury surveillance and evidence‑based policymaking.
Intimate Partner Femicide (IPF) is the lethal result of prolonged gender-based violence, often driven by control, jealousy, and emotional instability, while psychiatric disorders or substance abuse are reported in only a minority of cases. Victims typically endure years of abuse, facing significant barriers to escape due to fear, isolation, or dependency. Unlike IPF, Non-Intimate Partner Femicide (NIPF) involves perpetrators without close ties to the victim. Cultural and regional factors influence the occurrence and handling of femicides.The aim of this narrative review with systematic literature search is to synthesize the epidemiological, criminological, and forensic patterns of intimate partner femicide (IPF) across different countries, focusing on victim and perpetrator profiles, common autopsy findings, risk factors, and cultural variations. Following the PRISMA statement, sixteen studies were retrieved on the epidemiology and criminology of femicide across several countries. In the U.S., most IPF cases involve prior abuse, with firearms being the most common weapon. Strangulation, blunt-force trauma, and poisoning are more common in low-middle income countries, where stricter gun laws exist. Psychiatric issues and substance abuse, particularly alcohol, are major risk factors, with mental disorders affecting 5-10% of perpetrators and 15-20% struggling with chronic substance use. Risk factors for IPF include young women (30-50), often employed, killed by long-term partners, with prior violence. The risk is highest after a relationship ends, especially in the first year. Violence often occurs in the victim's home, where the abuser asserts dominance. Jealousy is a key motivator, escalating to violence as a tool of control, and is often seen as justified in patriarchal societies. The review stresses the need for prevention strategies that address these risks, including better mental health care, substance abuse treatment, and support for victims. Autopsy findings highlight common injuries in femicide cases, such as stab wounds, head injuries, and defensive wounds. These injuries, combined with other violent methods like strangulation, indicate an escalation of violence and are key to understanding femicide dynamics. The study emphasizes the importance of continued research and data collection to improve prevention and support systems for victims, aiming to reduce IPF rates globally.
Interpersonal violence and intimate partner violence remain public health challenges in sub-Saharan Africa, yet the role of emergency departments (EDs) in addressing these issues is understudied. This research evaluates prevalence and predictors of interpersonal violence and intimate partner violence among adults presenting to a large public ED in Nairobi, Kenya, and to evaluate the prevalence and predictors of interpersonal violence and intimate partner violence. This was a cross-sectional secondary analysis of prospectively collected data from adults continuously presenting to the Kenyatta National Hospital ED between July and August 2024. Descriptive statistics and forward stepwise logistic regression were used to assess demographic and other variable risks for interpersonal violence and intimate partner violence. Among 325 participants, over half (n = 176, 54.2%) reported lifetime interpersonal violence, and 117 individuals (36%) reported past year interpersonal violence, intimate partner violence, or both. Violence was more common among those presenting for traumatic injuries. HIV-positive status (aOR = 10.15, 95%CI 2.39-43.17), homelessness (aOR = 2.57, 95%CI 1.22-5.44), and ever paying for sex (aOR = 3.84, 95%CI 1.39-10.65) were associated with increased odds of interpersonal violence, while higher education (aOR = 0.51, 95%CI 0.26-0.99), higher income (aOR = 0.49, 95% CI 0.27-0.89), and female sex (aOR = 0.43, 95%CI 0.21-0.85) were associated with lower odds. Commercial sex work showed a strong but non-significant association with interpersonal violence (aOR = 2.86, 95%CI 0.95-8.67) and a significant association with intimate partner violence (aOR = 10.44, 95%CI 3.54-30.83). Findings highlight the significant burden of violence among ED patients and the influence of structural and socioeconomic vulnerabilities. ED-based care strategies may offer important opportunities to identify and support individuals at heightened risk.
Domestic abuse (DA) is a public health problem with wide-ranging impacts for victim-survivors and services responding to it. The purpose of the current study was to explore relationships between victim-survivors' experiences of abuse, additional needs/vulnerabilities and sociodemographic characteristics, and physical and mental health outcomes and health care help-seeking behaviours following DA. Secondary analysis was conducted using Women's Aid Federation of England's (Women's Aid) case management and outcomes measurement system, On Track, the largest national dataset on DA. To understand the relationship between abuse types (physical, sexual, emotional, financial, coercive control, technology-facilitated abuse (tech abuse) and threats to kill), needs/vulnerabilities (disability; offending, drug and alcohol-related support needs; pregnancy, recourse to public funds and accessing by-and-for services) and health outcomes (perpetrator caused harm to or loss of unborn child, attempted strangulation, self-harm (disclosed), feeling depressed or suicidal, injury requiring GP treatment and injury requiring Accident and Emergency (A&E) treatment), we used a series of logistic regression models, controlling for potentially confounding variables (including accommodation status, sexual orientation and ethnicity). Stakeholders from Women's Aid and five other third sector organisations input into the study design and interpretation of results. Ninety-six percent of victim-survivors accessing DA services (n = 77,785) were female. Almost half (41.24%) had felt depressed/suicidal, while 5.59% disclosed having self-harmed. Almost one quarter (23.41%) had suffered a strangulation attempt, and 2.54% had suffered harm to or loss of their unborn child caused by the perpetrator. Just under 10% had an injury requiring A&E treatment and slightly less (7.33%) had an injury requiring GP treatment. Associations with the type of abuse varied by health outcome, for example physical abuse followed by threats to kill were most strongly associated with attempted strangulation and injuries requiring GP and A&E treatment, whilst tech abuse was most strongly associated with self-harm and feeling depressed/suicidal. Vulnerabilities/needs were more consistently associated with health outcomes, with those with a disability; drug, alcohol or offending support needs, or living in temporary/unstable accommodation more likely to experience negative outcomes across the board, and almost all needs/vulnerabilities being associated with adverse mental health outcomes (with the exception of pregnancy and accessing specialist by-and-for services, which appeared to have a protective effect). Our findings highlight the almost inevitable harms to mental health for victim-survivors of DA, the dangers of non-physical types of abuse such as threats to kill and tech abuse and the heightened risk of attempted strangulation. These findings have particularly important and timely implications for the training of health care professionals. Alongside improvements in health care settings, health care professionals, specialist support workers, researchers and policymakers must continue to explore more integrative and collaborative ways of working to further improve the response to DA and intervene before irreversible damage is done.
The purpose of this study was to evaluate four novel measures of firearm-related attitudes and beliefs developed through participatory action research, and to determine their associations with firearm-related practices and violence exposure. Participants were a pilot sample of 550 U.S. adults (51% female; 65% White; 16% Latine; 13% Black; Mage = 48.3) and a nationally representative cross-validation sample of 1,674 U.S. adults (52% female; 61% White; 18% Latine; 12% Black; Mage = 47.4). Competing models of the structure of each measure were evaluated based on analyses of data from the pilot sample. This identified a single factor for General Attitudes Toward Firearms measure, three factors for a Beliefs About Defensive Firearm Use measure (Respect Enforcement; Defensive Escalation; and Compensatory Force); two factors for a Prescriptive Norms for Threat Response measure (Defense and Protection; Reputation and Respect); and two factors for an Attitudes Toward Firearm-Related Policy measure (Negative Attitudes Toward General Firearm Policies and Positive Attitudes Toward Specific Firearm Policies). Analyses of the cross-validation sample replicated this structure and provided support for strong measurement invariance across sex and ethnicity. The construct validity and utility of these measures was supported by their patterns of relations to firearm-related practices (ownership, carrying, and storage); involvement in firearm-related violence; and family and friend firearm-related influences (e.g., friends' firearm carrying; household presence of a firearm; close family members' and friends' injury or death due to violence or suicide). These new measures provide promising tools to advance firearm-related injury prevention research.
Violent crime is a prominent cause of injury in the United States and a significant public health issue. Hospital-Based Violence Intervention Programs (HVIPs) have emerged as multidisciplinary programs that improve wellbeing of violent assault victims and minimize recidivism through culturally competent bedside and post-discharge mentorship, connection to mental health and social services, and follow-up care. Because victims are prone to develop post-traumatic stress disorder (PTSD), it is important for HVIPs to engage in early PTSD screening and mental health interventions. Current research describing HVIP impacts on PTSD symptoms has not been aggregated; therefore, a systematic review was performed answering to what extent HVIP participation affects PTSD symptoms of violent assault victims. A literature search was performed on five databases on 07/21/2025. Inclusion criteria were studies that used valid measurement tools to report PTSD symptoms over time of U.S. violent assault victims who participated in an HVIP. Exclusion criteria were studies without hospital-based or hospital-linked violence intervention programs; studies including victims of violence other than interpersonal assault; and non-primary, non-peer-reviewed, or non-English sources. Articles were screened by title and abstract, then by full text using Rayyan software. Eligible articles were appraised using the Strengthening the Reporting of Observational studies in Epidemiology checklist. 616 non-duplicated articles were identified, of which four were included for final analysis. Two studies were single arm field trials, one was a quasi-experiment, and one was a pilot randomized controlled trial. Studies showed inconsistent effectiveness of HVIPs on PTSD symptoms, though two studies that tested a specific mental health intervention incorporated into an HVIP found significant symptom reduction. Sample characteristics, intervention components, and methodology were heterogenous across studies, impacting result comparability. While these studies show promise for PTSD symptom reduction, this review warrants more research to further elucidate the association between HVIP interventions and PTSD symptoms to better inform HVIP practices. Only 4 studies met inclusion criteria, indicating a lack of research evaluating this association, especially studies not testing an added specific mental health intervention. Moreover, findings support consideration for adding targeted mental health treatments within HVIPs to increase impact on PTSD symptoms.
Policy Points For half a century, firearm-related deaths and injuries have been endemic in the United States, with COVID-19 contributing to a record high of 48,830 deaths in 2021, an epidemic rate increase. By 2023, national trends masked a significant 10-fold difference in firearm-related death rates among states. Over decades, some states have experienced large, sustained reductions in firearm-related death rates, while others have experienced increases. Firearms are a consumer product that fit the definition of a market-driven epidemic (MDE), with the firearms industry having successfully marketed gun ownership through strategies that include fear, predatory tactics, and emphasis on lethality; stalling public health research for decades; and employing strategies used in other industries to promote potentially harmful products. Evidence from classic MDEs, such as tobacco and prescription opioids, demonstrates that large-scale, long-term reductions in harmful use can be achieved through a combination of focused, effective interventions and engaged governments, nongovernmental organizations, academia, media outlets, and, at times, companies themselves. The United States has developed a robust array of evidence-based mitigation strategies to reduce firearm-related harm, including gun safety laws, focused hospital and mental health programs, community and environmental programs, and social and economic policies. Applying insights from classic MDEs, building on what has worked, and increased active engagement among stakeholders are needed to reduce preventable firearm harm. The United States has among the highest firearm-related deaths in the world. In 2023, suicides accounted for 58% of firearm-related deaths and 38% of homicides. Firearms have become the leading cause of death among those under age 19. Nonfatal injuries, outnumbering deaths over two-to-one, often lead to lifelong physical and mental health sequelae. The firearms market, valued at around $40 billion per year, is one-tenth the estimated $500 billion cost of the epidemic due to medical costs, work loss, and quality-adjusted life years lost. Peer-reviewed literature, government documents, and media reports were used to analyze the firearms epidemic according to the market-driven epidemics (MDE) definition and framework of five often overlapping phases: (1) market development; (2) evidence of harm; (3) corporate resistance; (4) mitigation; and (5) market adaptation. The MDE framework emerged from the analysis of efforts that reduced cigarette, sugar, and prescription opioid use. The central question for mitigating the firearm MDE is: What combination of interventions and actors will achieve large-scale, long-term reductions in firearm-related deaths and other harm? The epidemic of firearm harm fits the MDE definition and is progressing through the five stages of an MDE. Phase 1. Firearms marketing accelerated rapidly when the focus shifted from marksmanship, sportsmanship, and hunting to themes of self-defense, home protection, patriotism, and masculinity. Phase 2. Evidence of harm at the population level has linked firearm ownership or possession to significant increases in suicide deaths, homicide, femicide, and gun-related injuries. Phase 3. Firearms industry resistance has used "corporate playbook" strategies to downplay the evidence of preventable harm, discredit public health, and influence the passage of favorable legislation. Phase 4. Decades of action by government, academia, and civil society have produced an array of mitigation interventions shown to reduce firearm-related suicides, homicides, and other harm. Jurisdictions that have implemented these measures have been able to achieve significant, sustained decreases in firearm-related deaths, while some high-burden areas that have declined to implement such measures and have enacted permission policies have experienced notable increases in firearm-related deaths. Phase 5. The firearms market has evolved through consumer demand for "non-lethal" alternatives (i.e., TASERs, rubber bullets) and through company expansion of overseas sales and pursuit of new technologies (i.e., "smart guns," magazine safeties). High rates of firearm-related deaths and injuries are not inevitable. By treating the firearm harm epidemic as the market-driven problem it is, drawing on insights from other MDEs strategies, substantial reductions in violence may be achievable across the United States. States and cities have significantly reduced gun violence without infringing Second Amendment rights. The greatest unmet challenge now is generating increased engagement in gun safety among states and communities still experiencing high levels of preventable firearm deaths and related harms.
Targeted violence (i.e., violence against a preidentified target intended to influence the broader population and/or generate publicity for the perpetrator or their grievance) is a national security threat and an urgent public health problem affecting individual and community well-being. Drawing on decades of experience and examples from the U.S. Centers for Disease Control and Prevention and the public health field, this article illustrates how the four-step public health approach to violence prevention (i.e., define and monitor the problem; identify risk and protective factors; develop and test prevention strategies; ensure widespread adoption) can be applied to accelerate advancements in evidence-based practice for the primary prevention of targeted violence. In this narrative review, examples of risk and protective factors and evidence of what works to prevent violence and suicide are compared with the targeted violence literature to identify shared risk and protective factors, promising prevention approaches, and key research gaps. This article highlights opportunities to enhance consistency in measurement and expand public health data systems, identifies an initial set of 20 shared risk and protective factors, highlights evidence-based violence and suicide prevention approaches with potential for preventing targeted violence, and suggests focus areas for advancing research. Select ongoing efforts by the Department of Homeland Security illustrate the public health model in action. Applying the Centers for Disease Control and Prevention's public health approach to violence prevention can bridge efforts by the Centers for Disease Control and Prevention, Department of Homeland Security, and communities to build a violence prevention infrastructure connecting science and action across multiple forms of violence, including targeted violence.
Adolescents face co-occurring health risk behaviors contributing synergistically to adverse health outcomes. Evidence on these patterns of co-occurrences in low- and middle-income countries is limited. This study aimed to identify latent classes based on patterns of substance use, suicidality, and violence-related behaviors among Moroccan adolescents and examine sociodemographic, risk, and protective factor correlates of class membership. We conducted a secondary analysis of the 2016 Morocco GSHS, which included 6,745 adolescents aged 13-17 years. Latent class analysis was performed using 12 binary indicators of violence, bullying, injury, suicidality, and substance use. Multinomial logistic regression assessed the associations between latent class membership and covariates, including sociodemographic factors, risk behaviors, and protective factors. A four-class solution provided the best fit. Class 1 ("low engagement in risk behaviors" 54.2 %) showed minimal involvement in all risks. Class 2 ("high violence, low suicidality and substance use" 21.3 %) was marked by elevated violence. Class 3 ("moderate violence and high suicidality" 12.5 %) was dominated by suicidality coupled with moderate violence. Class 4 ("high violence, moderate suicidality and high substance use," 12.0 %) reflected poly-risk engagement. Rural residence, parental tobacco use, secondhand smoke exposure, and having no close friends significantly increased the odds of poly-risk class membership. Consistent school attendance emerged as a significant protective factor. Distinct clusters of adolescent health risk behaviors were identified. Integrated, context-specific interventions that enhance family engagement, school connectedness, and multi-component prevention could mitigate compounded risks and improve adolescent health in Morocco.
To examine demographic and injury characteristics of new traumatic spinal cord injury (tSCI) cases from 1972 to 2024, contextualized by US population trends. Cross-sectional analysis of a longitudinal database. Thirty-one Spinal Cord Injury Model Systems (SCIMS) centers throughout the United States. A total of 37,866 SCIMS database participants grouped into 6 injury cohorts (1972-1979 to 2020-2024). Not applicable. Demographics (age, sex, race/ethnicity, education, employment, marital status) and injury characteristics (cause, level, completeness). Mean age at injury increased from 28.7 years in the 1970s to 44.7 years in 2020-2024, with individuals aged ≥65 years rising from 3.1% to 19.9%. This trend was consistent across sexes, race/ethnicity groups, and injury causes except violence. Hispanic ethnicity increased from 6.0% to 16.1%, and postsecondary education from 7.5% to 31.7%. The proportion retired, married, and widowed rose, while student and single status declined; however, within age groups, single/never-married proportions increased, mirroring US population trends. Vehicular crashes, though still the leading cause, declined from 47.0% to 36.0%, whereas falls nearly doubled from 16.5% to 32.5%. Violence-related injuries increased in 2020-2024, especially among individuals aged 15-44 years. High cervical injuries rose from 14.8% to 33.9%, and motor-incomplete injuries increased from 36.6% to 57.3%. Subgroup analyses of 4 continuously contributing centers confirmed these trends. Study findings highlight the need to integrate geriatric care into acute and rehabilitative services and to prioritize fall-prevention among older adults. The recent increase in violence-related injuries warrants targeted surveillance and intervention. Rising education and motor-incomplete injuries may improve long-term outcomes. Monitoring marital status trends is important for understanding social participation and quality of life after tSCI.
Intimate partner violence (IPV) impacts both females and males with long-lasting consequences. The study investigated changes in IPV, co-occurrence of multiple forms of violence, and factors associated with IPV among females and males in Kenya. We used secondary data from the 2014 and 2022 Kenyan Demographic Health Surveys. Logistic regression analysis was used to estimate changes in IPV and the association with explanatory factors stratified by sex. Among females, lifetime prevalence of any IPV was stable in 2014 versus 2022 (47.1% vs. 46.3%; OR = 1.09, 95% CI [0.98, 1.22]), and in the past year (32.6% vs. 31.1%; OR = 1.05, 95% CI [0.94, 1.18]). Psychological IPV among women increased modestly (lifetime OR = 1.31, 95% CI [1.17, 1.47]; 12-month OR = 1.18, 95% CI [1.04, 1.34]). Among males, lifetime prevalence of any IPV rose from 23.4% to 29.7% (OR = 1.78, 95% CI [1.50, 2.12]), psychological IPV from 20.4% to 26.5% (OR = 1.77, 95% CI [1.48, 2.12]), and sexual IPV from 3.8% to 4.9% (OR = 1.68, 95% CI [1.16, 2.45]). Past‑12‑month any IPV (OR = 1.38, 95% CI [1.14, 1.66]) and psychological IPV (OR = 1.43, 95% CI [1.18, 1.73]) also increased. Across both sexes, older age, father beat mother, and perpetration of physical violence were associated with higher odds of IPV, while higher education was associated with lower odds of IPV among women but higher odds among men. Lifetime co-occurrence of three forms of IPV were reported at 8.5% versus 7.9% in women, and 1.4 versus 1.1% in men (2014 vs. 2022). While overall IPV among women remained unchanged in 2014 and 2022, psychological violence rose, and men reported significant increases in both lifetime and recent IPV. Distinct sex-specific patterns in associated factors underscore the need for sex-responsive and inclusive IPV prevention strategies, particularly interventions addressing psychological abuse and intergenerational violence.
Evaluating and addressing the mental and behavioral health issues of patients with spinal cord injury (SCI) during the rehabilitation process is essential. This systematic review and meta-analysis investigated the prevalence of mental disorders post-traumatic SCI and evaluated psychosocial interventions, leveraging a Knowledge Graph of Spinal Cord Injury (SCIKG) to overcome limitations of traditional literature searches. The SCIKG integrated structured ontologies (SNOMED CT, UMLS, MeSH) to enable hierarchical semantic reasoning across mental disorder subconcepts. SPARQL queries identified literature from PubMed, Embase, PsycINFO, Web of Science, and Cochrane Central up to July 2025, supplemented by citation tracing. Two researchers independently screened studies against predefined criteria. Prevalence was pooled using DerSimonian-Laird random-effects models (RevMan 5.4; Stata metaprop) to account for heterogeneity (I4 > 50%). SCIKG quality was assessed across Coverage, Accuracy, Freshness, and Consistency dimensions RESULTS: From 16,861 screened records, pooled prevalence estimates of anxiety, depression, post-traumatic stress disorder (PTSD), cognitive impairments, suicide ideation, drug abuse, and sleep dysregulation post-SCI were 23% (95% confidence interval (CI), 21%-26%), 24% (95% CI, 22%-26%), 25% (95% CI, 21%-29%), 55% (95% CI, 27%-82%), 18% (95% CI, 12%-24%), 36% (95% CI, 30%-42%), and 41% (95% CI, 8%-73%), respectively. Subgroup analyses revealed significant variations: Western cohorts reported 30% higher anxiety than Asian populations; self-report tools overestimated depression by 40% versus clinical interviews; violence-related SCI increased PTSD risk by 75%. Psychosocial interventions mainly focused on specific subgroups in SCI patients with increased levels of pain, psychological distress, or pressure ulcers. Studies indicated inconsistent enhancements in participants' psychosocial adaptation, cognitive appraisal, and mental health. However, no significant effect was observed on their coping abilities. Mental disorders are prevalent and heterogeneously distributed post-SCI, influenced by cultural, methodological, and injury-phase factors. Knowledge graphs enhance evidence synthesis precision, revealing critical gaps in assessment standardization. Routine screening with validated, culturally adapted tools is warranted. Future research must prioritize phase-stratified designs, SCI-specific diagnostic thresholds, and large-scale trials of tailored psychosocial interventions. Not applicable.
Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States. Hispanic children face disproportionate socioeconomic disadvantage, underinsurance, and language barriers, yet disparities in their TBI outcomes remain under-investigated. This systematic review aims to (1) synthesize existing evidence on the epidemiology, mechanisms of injury, and outcomes of TBI among Hispanic children in the United States; (2) evaluate disparities in healthcare access, diagnostic evaluation, and access to rehabilitation services; and (3) identify gaps in the literature to inform culturally responsive prevention and intervention strategies. A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was conducted in accordance with PRISMA 2020 guidelines. Eligible studies included those reporting primary data on TBI among Hispanic children (< 18 years) in the United States. Data were synthesized qualitatively given heterogeneity in study design, outcome measures, and population characteristics. Fifteen studies met the inclusion criteria and were evaluated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Hispanic children sustained TBIs at younger ages and were disproportionately affected by severe mechanisms of injury, including falls from buildings, motor vehicle accidents, and violence. Helmet use was markedly lower among Hispanic children compared to their White peers. Across studies, Hispanic children exhibited higher rates of mortality (13.3% vs. 8.9% in White children). The payer-related barriers correlated with reduced access to inpatient rehabilitation and higher unmet post-discharge needs. Longitudinal studies demonstrated persistently poorer functional outcomes for Hispanic children, particularly in Spanish-speaking families, underscoring the amplifying role of language discordance. Hispanic children experience cumulative disparities in TBI that span exposure, acute care, and long-term recovery. These inequities are driven by structural determinants, including socioeconomic disadvantage, underinsurance, and language barriers, which transform an acute injury into a chronic disability. Interventions to mitigate these disparities must include culturally tailored prevention strategies, expansion of telemedicine, and integration of bilingual services. Further research is needed to disaggregate Hispanic subgroups and evaluate targeted interventions to achieve equity in pediatric TBI outcomes.
Injuries are a leading public health priority within adolescent populations; however, few cross-national studies have examined their epidemiology over time. We described time trends in adolescent self-reported medically treated injury across 31 mainly European countries over 20 years, then explored whether observed temporal trends varied according to the prevalence of known behavioral risk factors. The data source included six cycles of the Health Behavior in School-aged Children study (2002-22; weighted n = 954 298, participants aged 11-15 years). Outcomes included self-reports of any and multiple medically treated injuries. Measures of behavioral risks included indicators of violence, substance use, and physical activity. Within countries reporting increases in injuries, variations in reported engagement in known behavioral risk factors were examined. Nearly half of adolescents reported at least one medically treated injury (47%-53% of boys; 38%-44% of girls) and nearly one quarter reported multiple injuries (23%-30% of boys; 16%-22% of girls). In the pooled analysis, temporal trends included increases in any medically treated injury for girls (all age groups) and boys (11 years only) and multiple injuries (boys and girls, all age groups). At the country-level, we observed more temporal increases than decreases. Increases in physical activity were observed coincident with observed injury trends. In one of the largest European analyses of its kind, we demonstrated the ongoing burden of adolescent injury. Persistently high rates of adolescent injuries are concerning, and the origins of temporal increases require an initial focus on sport and physical activity.
Violence against healthcare workers (HCWs), especially in emergency departments and trauma centers (TCs), is a significant and growing problem. HCWs have the highest numbers and annual rates of workplace violence (WPV) compared with any other private industry sector. There is less information about the rates of violence and stalking against trauma providers in TCs. We hypothesized that a majority of trauma surgeons and team members have experienced deliberate assaults in their TCs. Our secondary hypothesis was that a majority of trauma providers consider WPV a significant issue in their workplace. The American Association for Surgery of Trauma Disaster Committee invited 2,100 members to participate in an online survey in May and July 2024. Questions evaluated practice type, TC characteristics, training, experience with WPV, beliefs about WPV prevention, and potential WPV prevention strategies interventions. The survey response rate was 10.9%, yet the prevalence of WPV in TCs was reported to be high. 63.9% of respondents were aware of a deliberate assault on an HCW in their TC or system. 42.5% had been assaulted personally, and 7.5% suffered injury as a result of a deliberate assault. Respondents generally agreed on the need for WPV prevention measures such as prevention education, metal detectors, armed police, or security, and were aware of deaths and disabilities among HCWs after assaults. However, they did not personally see WPV as a significant issue in their TCs. There is a high prevalence of WPV with significant effects on the entire trauma workforce, including elevated levels of emotional distress, burnout, post-traumatic stress disorder, and long-term irreversible physical injuries and deaths. Respondents agreed on the need for preventive measures but did not view WPV as a major issue in their own TCs. Research into this discrepancy, as well as effective strategies to reduce WPV in TCs, would support advocacy for improved legislation and policies aimed at preventing WPV in healthcare. V - Survey of expert opinion.
Interpersonal and self-directed violence share many common risk factors, yet most studies examined the two forms of violence separately. To date, no research has investigated the mutually interactions between these shared and distinct features of the two forms of violence. A total of 2,223 men aged 18-34 were recruited via community-based random sampling in Chengdu, China. Assessments covered sociodemographic factors, psychiatric symptoms (depression, anxiety, psychosis), child maltreatment, adulthood stress, impulsivity, substance use, interpersonal and self-directed violent behaviors. Ising model was used to construct a violence network. Community detection was used to identify clusters of violence related factors. Simulated interventions were used to determine potential intervention targets of interpersonal and self-directed violence. A stable socio-psychological network was established among the interpersonal and self-directed violence, which encompassed externalizing, internalizing and social isolation communities. Externalizing community included interpersonal violence, adulthood stress, impulsivity, child maltreatment and victim of stalking, while internalizing community encompassed self-directed violence, chronic illness/disability, anxiety, depression, and psychosis. Psychosis exhibited the highest bridge centrality. Child maltreatment presented the highest direct and indirect expected influence of the network. Child maltreatment and anxiety were identified as the most effective statistical leverage points of interpersonal and self-directed violence, respectively. This study highlights that interpersonal violence and self-directed violence tends to gather with stress factors and mental disorders, respectively. Psychosis is the vital bridge, while child maltreatment is a critical covariant of the network.
Women with a history of intimate partner violence (IPV) are at risk for post-traumatic stress disorder (PTSD). The effectiveness of aerobic exercise in reducing PTSD symptom burden has been established in other patient populations; however, its utility in the context of IPV victim-survivors has received little investigation. Therefore, the primary aim of this study is to determine if 4 weeks of daily structured aerobic exercise compared to daily stretching can reduce PTSD symptom burden in women IPV victim-survivors, offering a potential accessible and self-directed treatment avenue. The target sample size of 120 women (aged 18-70) with a history of IPV (last instance > 3 months ago) and probable PTSD (via the PTSD Checklist for DSM-5; PCL-5) will be recruited via community advertisement in Melbourne, Australia. The trial will be completed at the Alfred Centre, Monash University. Participants will complete an exercise tolerance test via the Buffalo Concussion Bike Test and then will be randomised into either aerobic exercise or passive stretching. Participants will be instructed to complete 20 min of allocated aerobic exercise or stretching for 4 weeks and given a written diary and a Fitbit smartwatch to track program adherence. The primary outcome, PTSD symptoms via the PCL-5, will be collected at baseline, 1, 2, 3, and 4 weeks (primary endpoint). Secondary outcomes, including additional determinants of health (i.e. sleep, pain, substance use), cognitive testing, concussion-like symptoms in participants with a history of IPV-related brain injury, blood-based biomarkers, and feasibility and adherence to the prescribed program, will also be collected weekly at baseline, 1-, 2-, 3-, and 4-week follow-ups. This trial is an open-label randomised controlled trial to compare the effectiveness of a structured aerobic exercise program to passive stretching in women victim-survivors of IPV with probable PTSD. Results from this trial will help guide the development of individualised, financially accessible, and self-directed care plans for women living with PTSD and other persisting mental and physical health impacts of IPV. ACTRN12624000893505. Trial registered retrospectively. Registered on 22/07/2024. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12624000893505.
Background checks aim to prevent illegal firearm transfers. Existing research has shown little evidence for the effect of point-of-sale comprehensive background check (CBC) policies on firearm-related violence at the state level, but state-level estimates may mask local variation. To estimate the association between state-level point-of-sale CBC policies and county-level firearm homicide rates in the US. This cross-sectional study used a difference-in-differences analysis with synthetic controls. Six US states that implemented a point-of-sale CBC policy between 2013 and 2019 and did not have a permit-to-purchase policy from 2000 to 2021 (Colorado, Delaware, New Mexico, Oregon, Vermont, and Washington) and 8 eligible control states that did not have a CBC or permit-to-purchase policy from 2000 to 2021 and were similar to treated states in terms of state partisanship (Alabama, Arkansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, and West Virginia) were included. The unit of analysis was county-years from January 1, 2000, to December 31, 2021. Analyses were conducted from April 1, 2023, to December 15, 2025. Implementation of point-of-sale CBC policies (that applied minimally to handguns) between July 1, 2013, and July 1, 2019. Annual county-level firearm homicide rates per 100 000 population were directly standardized to the age (<5 years, 10-year age bands from 5-84 years, and ≥85 years) and sex (female or male) distribution of the US population in 2000. The synthetic control method was used to estimate counterfactual posttreatment means. The study population included 750 counties: 59 from Colorado, 3 from Delaware, 33 from New Mexico, 36 from Oregon, 14 from Vermont, 39 from Washington, and 566 from states that did not have a CBC policy (ie, eligible controls). In unadjusted models, state-level CBC implementation was associated with a mean of -2.13 (95% CI, -3.19 to -1.04) firearm homicide deaths per 100 000 population across counties; after adjusting for covariates, a mean of 0.13 (95% CI, -0.88 to 1.13) deaths per 100 000 population were found. While there was some heterogeneity in county-specific estimates in adjusted models (with point estimates ranging from -13.2 to 20.5 deaths per 100 000 population), nearly all 95% CIs crossed the null. This cross-sectional study of the association between state-level CBC policies and county-level firearm homicide rates assessed county-level heterogeneity that may have been masked in prior state-level studies. As in prior state-level studies, no associations were found for adjusted results. Findings suggest opportunities for further research on the design, implementation, and enforcement of CBC policies.