Nov. 20 (UPI) -- Following recent mass shootings in Santa Clarita and Fresno, Calif., much of the focus has been on those who died -- and rightfully so. But what about the people who survive these horrific events?

An analysis published Wednesday in the journal JAMA Surgery provides insight into the challenges faced by those who survive gunshot wounds, showing that rates of alcohol and substance abuse, unemployment and post-traumatic stress disorder, or PTSD, are higher among survivors than in the general population.


"We have shown that the devastating effects of gunshot injuries go beyond mortality -- survivors are negatively impacted years after injury," study co-author Michael Vella, fellow in trauma, surgical critical care, and emergency general surgery at Penn Medicine, where the study was conducted, told UPI. "This implies a need for better long-term follow-up and care for these patients, even those with seemingly minor injuries. We hope that we have helped give a voice to survivors of these devastating injuries."

According to Vella, Penn Medicine, located in Philadelphia, treats roughly 300 gunshot injuries annually. Some 70,000 Americans survive firearm-related injuries each year, he added.

To assess what their lives are like following these traumatic events, Vella and his colleagues surveyed 183 patients treated for gunshot wounds at Penn Medicine over a 10-year period, asking them about their lives before and after being shot.

Some of those surveyed were treated for minor injuries and released, while others were admitted to the hospital for surgery. Most of the respondents were surveyed several years after their injuries -- suggesting they face effects that can persist for many years after they've healed.

Among all respondents, the researchers found that use of alcohol and drugs increased by 13 percent among shooting victims, and that nearly half, or 49 percent, reported PTSD. Although 76 percent of those surveyed were employed prior to getting shot, only 62 percent of the respondents remained so following their injuries.

In general, shooting victims also had lower scores on scales designed to measure physical and mental health than the general population. And, perhaps most notably, respondents' struggles after getting shot were independent of the severity of their physical injuries.

In all, "one third of patients with seemingly minor injuries who were not even admitted to the hospital screened positive for PTSD," Vella said. "This is significant. These people may be okay physically, but are still at high risk of debilitating long term mental health issues including PTSD."