Retained Bullets and Psychological Wellbeing Open Access

Nedergaard, Rikke (Spring 2021)

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Objective: Every year 75,000 people in the United States obtain retained bullets or fragments after firearm injury.[1] There is limited research on the psychological health effects of retained bullets or fragments. In this study, we aim to determine how retained bullets for firearm injury impacts the psychological wellbeing of survivors.

Methods: We conducted qualitative in-depth interviews with 24 survivors who had retained bullets or fragments in their body after firearm violence. These participants were recruited from Grady Memorial Hospital in Atlanta, GA, which specializes in treatment of firearm injuries. We conducted a robust thematic analysis to identify psychological effects on survivors.

Results: Our findings show four elements of psychological wellbeing were influenced by retained bullet fragments, including: 1) Physical wellbeing 2) Emotional wellbeing 3) Social wellbeing 4) Occupational wellbeing.  These elements are interconnected and coincide to amplify psychological impact on individuals with retained bullets or fragments.

Conclusions: This study highlights the importance of considering the psychological consequences of retained bullet fragments. Implications for this study include: educating clinicians about psychological impacts of retained bullets or fragments, counseling patients on bullet removal, and considering psychological wellbeing in the decision about whether to remove the retained bullets or fragments at index hospitalization and follow-up appointments.

[1] Author calculations based on data from Smith et al. (2018), CDC (2020) and Nee at al. (2021).

Table of Contents

Table of Contents

Introduction 8

Literature Review 9

Retained Bullets and Mental Health 10

Lead Toxicity from Retained Bullets 11

Migrating Bullets 12

Theories on Psychological Wellbeing 12

Experiencing and Recovering from Psychological Trauma 13

Student Contributions 16

Manuscript 17

Introduction 18

Methodology 19

Study Design 19

Study Population 20

Participant Recruitment 20

Data Collection 21

Data Analysis 21

Ethics Approval 22

Results 23

Physical Wellbeing 24

Emotional Wellbeing 25

Social Wellbeing 28

Occupational Wellbeing 30

Coping Mechanisms 31

Discussion 32

Key Findings 32

Developing a Model for Psychological Wellbeing after Trauma 34

Significance of Study for Clinical Practice 35

Limitations 36

Conclusion 36

Public Health Implications 36

Public Health Implications 38

References 40

Appendix 45

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