The Impact of Gun Violence on Children and Adolescents

Firearm injuries and deaths in the United States have increased in recent years and adversely affect many children and adolescents. Firearms now kill more children and adolescents than any other cause, surpassing motor vehicle crashes. Additionally, the U.S. has by far the highest rate of child and teen firearm mortality compared to peer countries. Beyond deaths, there are many more youth who survive gunshot wounds or are otherwise exposed to gun violence. These exposures can lead to negative behavioral health outcomes among youth and their family members. This brief explores the impacts of gun violence on children and adolescents (ages 17 and below) by answering the following key questions:

• How have firearm deaths changed in recent years among children and adolescents and how do these deaths vary by demographic characteristics?
• What is known about nonfatal firearm injury and gun exposure among children and adolescents?
• How does gun violence affect the mental health and well-being of children and adolescents?
• What policies are in place to address youth exposure to gun violence?

How have firearm deaths changed in recent years among children and adolescents?

Firearm-related deaths have increased among children and adolescents since the pandemic began, with seven children per day dying by firearm in 2022. From 2012 to 2022, nearly 19,700 children ages 17 and younger died by firearm. During this period, firearm death rates gradually rose until 2017, then slowed through 2019, before sharply rising with the onset of the pandemic and holding steady in 2022 (Figure 1). From 2019 to 2022, the firearm death rate among children and adolescents increased by 46% (from 2.4 to 3.5 per 100,000). This translates to seven children per day dying by firearm in 2022.

Recent increases in firearm deaths were driven by gun assaults, which accounted for two out of three firearm deaths among children and adolescents in 2022. Gun assault deaths among children and adolescents have increased over the past decade, resulting in 1,674 deaths in 2022 (Figure 2). Leading up to the pandemic, gun assaults made up about half of all child and adolescent firearm deaths. However, from 2019 to 2022, the share of these firearm deaths attributed to gun assaults grew from 54% to 66%.

Among child and adolescent firearm deaths in 2022, 27% were due to suicides and 5% were accidental. Suicides by firearm have increased over the past decade among children and adolescents, peaking in 2021 with 827 deaths before declining to 686 deaths in 2022. Despite this decline, firearm suicides made up 27% of all child and adolescent firearm deaths. Further, 43% of total suicide deaths among children and adolescents in 2022 involved firearms. Accidental firearm deaths have shown little variation over the past decade and continue to account for roughly 5% of all child and adolescent firearm deaths.

How do youth firearm deaths vary by demographic characteristics?

Firearm death rates have sharply increased among Black and Hispanic children and adolescents since the pandemic began. In 2022, the rate of firearm deaths among Black youth was 12.2 per 100,000 – substantially higher than any other racial and ethnic group and six times higher than White youth (Figure 3). Additionally, from 2018 to 2022, the rate of firearm deaths doubled among Black youth and increased by 73% among Hispanic youth. While firearm death rates for American Indian and Alaska Native (AIAN) youth fluctuated over the same period, they remained higher than the rates of their White, Hispanic, and Asian peers throughout the period. White youth experienced relatively stable and lower firearm mortality rates from 2018 to 2022 (2.0 per 100,000), while Asian youth had the lowest firearm mortality rates across the period (Figure 3).

The recent increases in firearm deaths among Black and Hispanic children and adolescents were primarily driven by gun assaults. Since the onset of the pandemic, the gap in gun assault death rates between Black and White children and adolescents has significantly widened. While the gun assault death rate among Black youth grew from 4.9 to 10.3 per 100,000 between 2018 and 2022, the death rate remained steady and below 1.0 per 100,000 among White youth (Figure 3). The gun assault death rate among Hispanic youth doubled during this period, from 0.9 to 2.0 per 100,000 between 2018 and 2022. Firearm suicide rates have also increased among Black youth in recent years, from 0.7 to 1.1 per 100,000 from 2018 to 2022. Meanwhile, firearm suicide rates have remained steady among White youth and by 2022, rates were similar between White and Black youth (1.2 vs. 1.1 per 100,000). Firearm suicide and assault rates were not available for other non-Hispanic race groups.

As a result of worsening trends in firearm deaths, in 2022, Black youth accounted for 48% of all youth firearm deaths although they made up only 14% of the U.S. youth population (Figure 4). From 2018 to 2022, the share of firearm deaths attributed to Black children and adolescents grew from 35% to 48%; and the share attributed to Hispanic children and adolescents grew from 16% to 19%.

Firearm death rates for male children and adolescents are over four times higher than their female peers. From 2018 to 2022, the rate of deaths due to firearms increased by 50% among male children and adolescents but remained lower and stable among females (Figure 5).

Among firearm deaths, suicides by firearm are more common among adolescents compared to younger children; and accidental gun deaths are more common among younger children than adolescents. Gun assaults accounted for roughly two-thirds of firearm deaths among both adolescents and younger children in 2022 (Figure 6). The second most common type of firearm death among adolescents was firearm suicides (31%), and among younger children was accidental gun deaths (19%).

Firearm death rates among children and adolescents vary considerably by state; however, almost all states have seen a growth in these death rates in pandemic years. During the pandemic years, the states with the highest firearm death rates among children and adolescents were Louisiana, Mississippi, and the District of Columbia (8.8, 8.8, and 8.4 per 100,000 respectively for combined years, 2020-2022). The states with the lowest firearm death rates were Massachusetts, New Jersey, and New York (0.6, 0.9, and 1.1 per 100,000 respectively for combined years, 2020-2022). Almost all states experienced an increase in firearm death rates from pre-pandemic to pandemic years, with the largest changes seen in North Carolina, Wisconsin, and Montana (104%, 100%, and 84% respectively) (Figure 7).

What do we know about nonfatal firearm injury and exposure among children and adolescents?

The number of nonfatal firearm injuries far exceed the number of firearm fatalities among children and adolescents. However, estimates vary, with research suggesting nonfatal firearm injuries occur anywhere from two to four times more often than firearm fatalities. Recent data also indicates that since the pandemic began, nonfatal firearm injuries among children and adolescents have increased. The majority of youth nonfatal firearm injuries are a result of assaults.

Many children and adolescents are exposed to gun violence, even if they are not directly injured. Data on exposure to gun violence among youth is generally limited. However, a recent analysis found that in 34% of unintentional child and adolescent firearm deaths, at least one other child was present during the incident. Prior data from the National Survey of Children’s Exposure to Violence found that 8% of children and adolescents were exposed to a shooting in their lifetime, with a higher share (13%) reported among adolescents (ages 14-17). Further, in a recent KFF poll, 17% of adults in the U.S. reported witnessing someone being injured by a gun.

Black children and adolescents are more likely to experience firearm injuries and exposures than their White peers. Leading up to the pandemic, Black and male children and adolescents were more likely to experience nonfatal firearm injuries than their peers. This disparity among Black youth firearm injuries and exposures has been exacerbated since the pandemic began. In general, children of color are more often exposed to gun violence than their White peers. Children living in areas with a high concentration of poverty are more likely to experience firearm-related deaths and poverty disproportionately affects children of color.

How does gun violence affect the mental health and well-being of children and adolescents?

Gun violence can adversely affect the mental health and well-being of children and adolescents. Exposure to gun violence is linked to post-traumatic stress disorder and anxiety, in addition to other mental health concerns among youth. Gun violence may also lead to challenges with school performance, including increased absenteeism and difficulty concentrating. Children and adolescents are exposed to gun violence in a number of ways, outlined below.

• Neighborhood and community violence. Many children and adolescents experience violence within their communities. Firearm homicides occurring within an adolescent’s community have been linked to anxiety and depression among adolescents, particularly for females. Other analyses have similarly found an association between incidents of neighborhood firearm homicides and poor mental health outcomes among youth.
• Suicide. Suicides are the second leading cause of death among adolescents and many suicides involve a firearm. Research has found that access to firearms, particularly in the home, is a risk factor for suicide deaths among children and adolescents. Nearly half of suicide attempts occur within 10 minutes of the current suicide thought, further underscoring access to firearms as a risk factor for suicide.
• Domestic or intimate partner violence. Women and children are often the victims of intimate partner violence, which may involve firearms. The presence of a firearm in the home is linked to the escalation of intimate partner violence to homicides. Even when firearms are not used, they may serve as a means to threaten and intimidate victims of domestic violence.
• Mass shootings. Although mass shootings, including school shootings, account for a small portion of firearm-related deaths, they can negatively impact the mental health of children and communities at large. Research has found that youth antidepressant use and suicide risk increased in communities with exposures to school shootings. Additionally, a survey prior to the pandemic found that the majority of teenagers and their parents felt at least somewhat worried that a school shooting may occur at their school. In response to school shootings, nearly all schools practice active shooter drills, which may have a negative psychological impact on participants. Although research is limited on how mass shootings affect individuals not directly exposed to them, current literature suggests that information and knowledge of mass shootings may be linked to increased levels of fear and anxiety.

Youth survivors of firearm injuries are at increased risk of mental health and substance use issues, in addition to chronic physical health conditions. An analysis of commercially insured children and adolescents found that, in the year following a firearm injury, survivors were significantly more likely to experience psychiatric and substance use disorders compared to their peers. Additionally, the increases in psychiatric disorders were more pronounced among youth with more severe firearm injuries compared to youth with less severe firearm injuries. Youth gunshot survivors are more likely to utilize mental health services following their injury compared to their uninjured peers. However, a study of youth survivors enrolled in Medicaid found that more than three out of five survivors had not received mental health services within the first six months following their injury.

Negative mental health impacts can extend to the family members of youth gun violence victims. Parents, particularly mothers, of youth firearm-injury survivors had an increase in psychiatric disorders and mental health visits in the year following the firearm incident, based on an analysis of commercially insured individuals. These increases in psychiatric disorders and mental health visits were more pronounced among families of youth firearm fatalities.

Gun violence disproportionately impacts Black children and adolescents, leaving them more vulnerable to negative mental health outcomes. In addition to increased assaults, firearm suicides, and exposure to community violence, Black communities are disproportionately exposed to police shootings. Research found that Black people living near the scene of a police killing of an unarmed Black individual experienced worsened mental health in the months that followed. Separately, despite mental health concerns among Black youth injured by gun violence, research on mental health service utilization in the months following a firearm injury is mixed, with one study finding higher utilization among Black youth compared to their White peers, and another study finding the reverse. Historically, Black individuals are less likely to receive mental health treatment and face additional barriers to care, such as the lack of culturally competent care.

What policies address child and adolescent exposure to gun violence and poor mental health?

Gun control debates are deeply divided politically in the U.S.; but beyond gun control, other approaches seek to reduce the impact of firearms on health, for example, through safe storage practices. Safe storage and child access prevention provisions have been linked to a reduction in adolescent firearm homicides and non-fatal gun injuries. These provisions vary widely across states; some states have multiple provisions, while others have none. Some states have also enacted unique approaches to promote gun safety. For example, beginning with the 2023-2024 school year, local education agencies in California are required to notify parents annually on the safe storage of firearms; and some states provide tax rebates on safe storage devices. In January 2024, the Biden-Harris administration put forth additional steps to promote safe storage of firearms, including the U.S. Department of Justice providing guidance on safe storage. A recent KFF poll found that 44% of parents with children under the age of 18 have a gun in their household. Among parents with guns in their home, about one-third said a gun is stored loaded (32%) or stored in an unlocked location (32%) (Figure 8). More than half of parents (61%) said any gun in their home is stored in the same location as ammunition. The KFF poll also found that only 8% of parents said their child’s pediatrician talked to them about gun safety.

Recent policies address gun reform and expand mental health services for children and adolescents. The Bipartisan Safer Communities Act was passed in 2022 in response to increasing gun violence. This legislation introduced several gun reform provisions, such as strengthening background checks for young adults and reducing gun access for individuals with a history of domestic violence. The legislation also focused on youth mental health, including expanding school-based mental health services and providing trauma care to students in need. In 2023, the White House detailed several new actions to maximize the Safer Communities Act, including developing more resources to inform states and schools on how they can use Medicaid to fund school-based behavioral health services, and highlighting effective examples of communities using Safer Communities Act funds to address gun violence trauma. While many funds have been dispersed through the original legislation, some school districts in need are still waiting to receive their mental health funding. Separately, other measures that may address youth mental health and gun violence trauma have been introduced, including the rollout of 988, the federally mandated crisis number that can connect individuals experiencing suicidal thoughts to crisis counselors. Additionally, federal funding freezes on gun violence research were lifted. Since the unfreezing, some initial research from the CDC and NIH includes a focus on youth gun violence prevention.

Gun violence disproportionately affects many children and adolescents of color, particularly Black children and adolescents, and this disparity has grown since the pandemic. Children and adolescents of color may also face added barriers to mental health care in light of long-standing cultural inequities and a lack of culturally informed care. In 2022, the Department of Health and Human Services announced an initiative aimed at promoting Black youth mental health in response to sharply rising suicide rates among Black youth. In 2023, the Mental Health for Latinos Act was introduced in Congress to address disparities and cultural stigma Hispanic individuals experience with mental health care. In the same year, SAMHSA announced funding opportunities to create a Behavioral Health Center of Excellence aimed at improving behavioral health equity for Hispanic and Latino communities.

Gun violence can lead to increased mental health and substance use concerns. The recent increase in child and adolescent firearm injuries and deaths come at a time when concerns about youth mental health have grown but access to and utilization of mental health care may have worsened.