> ## Content Index > Fetch the complete content index at: https://www.vitalcitynyc.org/llms.txt > Use this file to discover other available public pages before exploring further. # The Ones Left Standing - URL: https://www.vitalcitynyc.org/firearm-violence-victim-mothers-consequences/ - Published: 2026-09-30T16:00:06.000Z - Updated: 2026-09-30T16:00:06.000Z - Description: How firearm violence falls on mothers - Author: Nelba Márquez-Greene - Tags: #women-and-guns, Gun Violence, When Guns Harm Women Firearm injuries are often described as single events that happen to individuals. In reality, when one family member sustains a firearm injury, the trauma is shared and experienced by others in the family. Mothers who have lost children to firearm injury endure especially painful effects. The club of grieving mothers, a club no mother wants to be in, is growing. Firearms have been [the leading cause of death](https://www.nejm.org/doi/full/10.1056/NEJMc2201761?ref=vitalcitynyc.org) for children ages 0-19 in the United States since 2020\. We use the terms “child” or “children” to denote a relationship, not an age or developmental stage. A mother’s child may age out of childhood, but not out of that relationship — so the emotional, physical and economic tolls of a child’s death or serious injury still apply. To date, those tolls remain poorly understood. Data and evidence can tell us part of the story, but there is also much to be learned from the stories of women who have lived with this grief and trauma. Here we have woven together two unique perspectives — a mother’s lived experience and the evidence-based perspective of a researcher — allowing each to speak on its own terms instead of blending them into a single narrative, as each is equally necessary to understand the challenges we face and their potential solutions. ### In the mother’s words *I even felt like I failed … or failed as a mom. I felt like I failed as a wife. Failure might not be the correct word but at that point I was completely hopeless … broken. Broken. I mean … just all the above. So … how could I help you? I couldn’t help me.* — Celeste Robinson Fulcher These words are taken from [Celeste’s episode](https://ysph.yale.edu/media-player/shared-humanity-03-the-mass-shooting-that-never-made-the-news/?ref=vitalcitynyc.org) of [“Shared Humanity,”](https://ysph.yale.edu/about-school-of-public-health/communications-public-relations/podcasts/shared-humanity/?ref=vitalcitynyc.org) a podcast I host. The podcast is designed to showcase stories of those most impacted by gun violence and those in the prevention ecosystem. Robinson Fulcher was one of my first guests. We met one year after the shooting that ended my daughter’s life at Sandy Hook School in 2012\. I had read an article in the paper about the loss of Celeste’s 26-year-old daughter in a [2013 mass shooting](https://www.newhavenindependent.org/2013/10/26/1%5Fdead%5Fin%5Fclub%5Fshooting/?ref=vitalcitynyc.org) at a Connecticut nightclub. Unlike my story, Celeste’s loss barely made a dent in our collective consciousness. Despite the disparity in news coverage, I knew that, as mothers, we would have something in common: a seat at the intersection of grief, trauma and injustice. On my podcast, Celeste described the challenges of being a mom to surviving children and wife to a grieving husband while trying her best to stay alive. She described with pointed clarity the expectations from extended family, the prevention ecosystem and society at large for mothers to advocate for change while in their most vulnerable state. At the time of this writing, our friendship spans more than a decade. The survival is a miracle born of sheer grit — because neither the realities nor the truths of this experience are sufficiently researched or supported. Whether loss or injury stems from suicide, domestic violence, unsafe storage, community violence or mass shooting, and regardless of ZIP code or socioeconomic class, mothers and women bear much of the burden of familial recovery. Just as women disproportionately shoulder childcare, home care and eldercare, they often become the fulcrum of care after gun violence. Caregiving depends on our mental, physical and emotional well-being, yet we often ignore these things while trying to save our families, putting ourselves at greater risk for health issues. The advice to “put on your own oxygen mask first” doesn’t apply to women caregivers after gun violence. I know this firsthand. The first call I made while in the firehouse waiting to confirm my daughter’s murder on the morning of Dec. 14, 2012, was to a family member to ensure my own mom would be safe when she got the news. The second call I made was to my job. A clinical supervisor on a multidisciplinary team of a community outpatient organization, I called to ask how to make sense of what my son (who was also in Sandy Hook Elementary during the shooting) may have potentially witnessed so that I might care for him and help him through his trauma. I made sure I had the necessary formula for the best possible outcome in the worst possible scenario. I spoke with a psychiatrist about possible medications and immediate steps *for my son*. My third call was home to explain to friends how to keep my surviving son safe until my husband and I returned. My instructions: Stay as calm as possible, keep him away from any news, pack a small bag, and take him to someone else’s home until we call you. As I explained that we needed time to figure out how to tell him his sister was dead, I heard a loud noise. It was my friend dropping to her knees. Because everyone can drop except the mother. In the short- and long-term postincident survival, Celeste’s words are the prophetic witness of mothers after gun violence. “We may not always know ‘how’ we are going to survive — we just know we have to.” And mothers must not only survive but carry out the survival plan for and because of the number of people who depend on them. In the absence of responsible and responsive systems, mothers aren’t just left standing; they are left standing alone and unseen. Celeste and I are just two among hundreds of thousands of mothers who were and are called upon to survive. ### From the researcher In many respects, a mother’s loss cannot be quantified, but research can help us understand broader patterns. I used a large dataset of insurance claims that included information on both injury and the family relationship to the firearm-injury victim. I looked at a range of outcomes, such as mental health conditions, pain, substance use disorders, and health care utilization and spending to capture both the quantity of medical services used and what patients and insurers actually paid. What I found (through my own calculations) was revealing as to the health costs of mothers whose child has suffered a firearm injury or death. **Female child and adolescent survivors** First, consider a 14-year-old girl who survives a gunshot wound. In the year that follows, the data show she is far more likely to develop chronic pain, a psychiatric condition or a substance use disorder than a girl of similar age and health history who is growing up in the same area and who was never shot. Across female child and adolescent survivors in this research, rates of pain disorders more than doubled — rising 115% — after a firearm injury. Psychiatric conditions, including depression and anxiety, climbed 65%. Substance use disorders surged 264%, more than tripling from an already low baseline. These are not marginal shifts; they represent a cascade of new medical burdens descending on young survivors and their caregivers. The financial toll is equally striking. In the year before injury, the average female child or adolescent survivor incurred just $182 in annual health care spending. In the year after, that figure rose to roughly $2,445 — a more than twelvefold increase. Out-of-pocket costs to families tripled. Emergency department visits, hospitalizations, outpatient care, imaging and lab tests all increased, as did prescriptions for pain and psychiatric medications. ### How mothers handle it The effects of a surviving child’s firearm injury do not stop at the hospital door — they travel home. Mothers of children who survived shootings were significantly more likely to be diagnosed with a mental health condition in the aftermath, with rates rising 30%, and their use of mental health services climbed 75%. Yet, at the same time, their routine health care quietly fell. Office visits dropped 6%, imaging (like MRIs, X-rays, etc.) 14%, and laboratory tests 9%. Once a mother begins caring for her child firearm-injury survivor, she is at risk of stopping her own medical care. She might stop going to her annual checkup, skip the lab or defer the imaging her doctor recommends. The data suggest this story at scale. These two trends together reveal a pattern of displacement. When a mother is caring for her family, either an injured child’s ongoing needs or a child who has experienced family loss, her capacity to maintain care for her own physical health likely gets absorbed by others’ ongoing needs. An exception seems to be her mental health needs. After the death of a child from firearm injury (as opposed to a nonfatal firearm injury), mothers demonstrated a 350% increase in mental health disorders. Similarly, their use of mental health visits increased by 15 times, and their use of psychiatric medication days increased by 112%. To be clear, these data reflect only the employer-sponsored insurance population and may not generalize to those with Medicaid, Medicare or other coverage. This matters, because much of firearm-injury health care spending falls on Medicaid, and Medicaid enrollees are far more likely to live in female-headed households, particularly single-mother households. Medicaid populations are more likely to have low incomes, face greater barriers to care and have difficulties managing their child’s firearm-injury aftermath alone. These intersections deserve their own examination and are more than we can sufficiently address here. ### A path for policy paved by lived experience and evidence Because women who are impacted by firearm violence live at the intersection of grief, trauma and injustice, solutions need to address all three. U.S. systems of care rarely understand that grief born of injustice — death caused by another’s action or a preventable, dangerous situation — behaves differently. Non-trauma-informed clinical care compounds harm rather than treating it. Support systems ignoring this distinction — in prevention, access or service delivery — are insufficient by design. As illustrated in the diagram below, survivors are often met with unrealistic or myopic expectations of survivorship, often summarized by this two-legged stool. Through conversations with survivors, Nelba has observed that “society either pathologizes symptoms of distress (especially beyond six months to one year) or expects heroics (turning tragedy into triumph).” These extremes reveal a misunderstanding of grief timelines and the evidence base. A culture that sees the needs of survivors (especially women after firearm injury) should instead include systems of care that are grounded in normalizing grief, mitigating trauma and addressing systemic injustice. ## Two- and three-legged stools Two ways of thinking about what holds a survivor up and what each model asks of them. Two legs Survivor Pathology Post-traumaticgrowth Timeline Demand /expectation Three legs Survivor Normalizing /integrating grief Mitigating trauma Addressing injustice /challenge systems Equity &opportunity Research &resource Partnership &policy What does this mean in practice? A world that supports mothers should recognize that grief perpetuates well beyond the acute aftermath of trauma. That means building routine mental health screening for mothers and siblings into the follow-up pathway after a child’s firearm injury. Bereaved mothers especially would benefit from an active service referral pathway. To facilitate ongoing care, mental health services for mothers whose children are victimized require more financing. Current billing and coverage structures center the injured individual. But data from Song et al. show that injury has ripple effects on mothers. A reimbursement structure that only follows the injured misses a significant portion of the gun violence survivor population. To address the gaps in what we know about those covered by public health insurance, more research in Medicaid-specific data is needed. Policy built on employer-insurance findings may not fully reflect the realities in other segments of the population. Finally, we should recognize that mothers are acutely attuned to the grief of others and seek to address it. Responsive systems should honor grief and help families integrate this “new reality” into everyday life. Prevention research can help identify the integration support(s) grieving families need, test interventions to mitigate trauma and document the injustices that require redress. We currently have a long way to go.