The aftermath of mass shootings like those in Uvalde (Texas) and Buffalo (N.Y., have made it all too easy to see the faces of devastated families, children, and grieving relatives. What psychological wounds can linger after the cameras have gone and the dead have been laid to rest. What are the long-term effects on mental health for survivors, their families, and the wider community? What steps can be taken to minimize the damage?
For research-based answers to these queries, Scientific American talked with Sandro Galea (dean of Boston University School of Public Health) and Sarah Lowe (assistant professor of public health at Yale University), to discuss 122 separate mass shootings that occurred between Together they authored a 2015 review of 49 studies looking at impacts from 15 separate mass shootings that occurred between 1984 and 2008, 12 of them in the U.S. and nine at K-12 schools or universities. Lowe has begun the process of updating that review to cover another decade of mass shootings with data from a total of about 100 studies.
What are the most common long-term mental health consequences for survivors of a mass shooting event?
Major depression and post-traumatic stress disorder (PTSD), or some PTSD symptoms, were the most common psychiatric conditions seen in studies covered by the 2015 review paper, Galea says. Some studies also included reports of anxiety disorders, panic attacks and substance abuse disorders. Lowe says that it’s difficult to determine the most common mental health issues because we only know what was evaluated .
Some studies examined what Lowe refers to as “nonspecific psychological distress,” which Lowe describes as feelings of fear or unease. Some studies also included physical symptoms like headaches or stomachaches.
How do these violent events specifically affect children who experience them?
” There are very few studies on the mental health effects for children,” Galea says. He and Lowe only reviewed five studies that looked at children in high school or younger who had been involved in a shooting. The prevalence of PTSD or its symptoms ranged from 8 to 91 percent, depending in part on how and when they were assessed.
A more recent study, published in 2020 and co-led by Maya Rossin-Slater, now an associate professor of health policy at Stanford University, found a 21.4 percent increase in antidepressant prescriptions for people under age 20 in the local area where a school shooting had occurred, compared with areas 10 to 15 miles away. The study, which included prescription data from 44 communities affected by school shootings, found an elevated use of antidepressants that persisted two years after the incident.
What makes someone particularly vulnerable to long-term psychological effects? What can you do to protect yourself from long-term psychological effects?
Research reveals that many factors fall into three broad categories, namely before, during, and after the shooting. Lowe states that the first determinant is “what people bring with them into these events, such as demographic characteristics.” For example, people with preexisting mental disorders are more likely to develop depression or other psychological problems after a mass shooting. People without psychosocial resources, such as financial support and family cohesion, are also more vulnerable. Lowe states that it is also known that being a girl or a woman increases the risk of developing mental health problems following these events. “Whether this is due to biological differences in sex, gender roles, women’s greater ease with disclosing mental symptoms or other factors, It’s not clear
The second category refers to the shooting itself. Lowe states that people who live in close proximity to violence, such as seeing someone being shot or seeing dead bodies or people hurt, are at greater risk. A person is more at risk if a friend or family member dies.
After an event, social resources can make all the difference for survivors, Lowe states. She adds that tangible support, such as money and physical assistance, can make a difference. Access to mental health counseling and other services are also important. These types of events can shake your foundation and change your beliefs about yourself and others in the world. For example, the belief that the world’s safest place is safe and that most people are good. Lowe says that these shattered assumptions can increase your risk of PTSD and depression.
What impacts do these tragedies have on the local community? What can the residents of Uvalde, for instance, expect?
Galea says there isn’t a lot of data about the community-level effects of mass shootings. “But we know from other collective trauma, like climate-change-related disasters, that the resources within a community really matter,” says Lowe, who has studied the mental health consequences of such calamities. “Often, there is a flood of support after these events–both from government agencies and informally from other communities or strangers. But that tends to diminish over time. People who live in poorer communities are more at risk if they have high levels of exposure . That’s something that we found after Hurricane Sandy,” which struck the North American East Coast and the Caribbean in 2012.
What do we know about the impact on people watching from afar–you, me and everyone else reading about these horrific events and watching news coverage?
” We know that people can experience symptoms of mental illness by watching television or using social media,” Galea states. Galea emphasizes that “the baseline rate for depression is already quite high” due to the COVID pandemic’s prolonged impact. This is not the time to hold more traumatizing events
Remote impacts are not that well studied: only a few of the papers Galea and Lowe reviewed in 2015 looked at the psychological effects on mass shootings on people at a distance. Lowe notes that those who did found “at most temporary decreases in feelings safety and increases in fear
What kinds of interventions have been shown to help people who are more directly affected?
Galea and Lowe say an approach called “psychological first aid” is recommended after traumatic events. Galea says that psychological first aid begins with education and making people aware of possible mental health symptoms. It then gives them tools and helps them access the care they need. It is a way of sequencing interventions.” A school-specific manual is available from the federally funded National Child Traumatic Stress Network.
For those who show signs of distress, an intervention technique called “skills for psychological recovery” can be helpful, Lowe says. It aims to restore psychological and social resources such as hope and optimism, safety, and social support
Mass shootings are so common now that about 96 percent of U.S. public schools hold “active shooter” and/or “lockdown” drills. Do these drills make children feel safer?
There is little evidence to suggest otherwise. A survey published in the Journal of Adolescent Health in 2020 found that 60 percent of young people polled reported feeling unsafe, scared, helpless or sad as a result of such drills. A quarter of respondents said they didn’t believe drills improve safety because they were concerned that students might panic if confronted by an actual threat and because drills could inform potential gunmen.
A 2021 analysis of social media posts made by students after they engaged in such drills indicated that anxiety, stress and depression increased by 39 percent to 42 percent following the drills.
Lowe may not have studied the responses to these drills, but she claims that her students told her they took them as a joke or felt afraid by them. Lowe believes there are ways to approach them that are more trauma-informed. She suggests giving students the option to opt out.
We’ve seen powerful examples of activism after school shootings from groups such as students who survived the Parkland, Fla., shooting and parents of children killed in the Newton, Conn., incident. Can activism reduce hopelessness and depression?
Lowe states that although this is not something she has done in the context school shootings, she has been involved with research on climate anxiety. She says, “We found that environmental activism, such as high levels of collective action, was a buffer against climate change anxiety and depression.” With activism, she points out, “you get to have support from a group of like-minded people who are all committed to the same cause…, but there is also the risk of burnout and disillusionment.”
Has the amount of research on the mental health impacts of mass shootings greatly expanded since Galea and Lowe’s 2015 review? Are there any new lessons?
Both Galea, Lowe state that there is not enough research on the effects of mass shootings. As Lowe prepared to update the 2015 study–a process that is still underway–she found about 50 relevant new papers. That means the total is about twice the 49 in the original survey. “So in less than 10 years, the number has doubled–but it’s still markedly low,” she says. By contrast, she and Galea found 100 papers in a single year that looked at the prevalence of depression and PTSD in the wake of climate-related disasters. One reason for the paucity of studies may be that a 1996 law known as the Dickey Amendment discouraged federal funding of health research related to gun violence. In 2018 Congress clarified the meaning of that law and permitted research into gun violence as long as it did not promote gun control. In late 2019 Congress finally allocated $25 million for such research, including a much needed national study of strategies to protect schools.