Multiple Vantage Points on the Mental Health Effects of Mass Shootings
- 2.5k Downloads
The phenomenon of mass shootings has emerged over the past 50 years. A high proportion of rampage shootings have occurred in the United States, and secondarily, in European nations with otherwise low firearm homicide rates; yet, paradoxically, shooting massacres are not prominent in the Latin American nations with the highest firearm homicide rates in the world. A review of the scientific literature from 2010 to early 2014 reveals that, at the individual level, mental health effects include psychological distress and clinically significant elevations in posttraumatic stress, depression, and anxiety symptoms in relation to the degree of physical exposure and social proximity to the shooting incident. Psychological repercussions extend to the surrounding affected community. In the aftermath of the deadliest mass shooting on record, Norway has been in the vanguard of intervention research focusing on rapid delivery of psychological support and services to survivors of the “Oslo Terror.”
Grounded on a detailed review of the clinical literature on the mental health effects of mass shootings, this paper also incorporates wide-ranging co-author expertise to delineate: 1) the patterning of mass shootings within the international context of firearm homicides, 2) the effects of shooting rampages on children and adolescents, 3) the psychological effects for wounded victims and the emergency healthcare personnel who care for them, 4) the disaster behavioral health considerations for preparedness and response, and 5) the media “framing” of mass shooting incidents in relation to the portrayal of mental health themes.
KeywordsMental health Mental disorders PTSD Stress disorders/post-traumatic Shooting Mass shooting Shooting massacre Rampage shooting Weapons Firearms Guns Gunshot wounds Violence Firearm violence Workplace violence Homicide Gun control Media framing
Compliance with Ethics Guidelines
Conflict of Interest
James M. Shultz, Siri Thoresen, Brian W. Flynn, Glenn W. Muschert, Jon A. Shaw, Zelde Espinel, Joshua B. Gaither, Yanira Garcia-Barcena, Kaitlin O’Keefe, and Alyssa M. Cohen declare that they have no conflict of interest.
Frank G. Walter has financial relationship with and has received paid travel expenses from Heyltex Corp.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Agnich LE. Shooting incidents in educational settings. In: ACIA Archives. The Academy for Critical Incident Analysis at John Jay College. 2010. http://archive.aciajj.org/the-acia-archive/datasets-available-for-analysis/shooting-incidents-in-educational-settings/. Accessed June 2014.
- 4.•Flannery DJ, Modzeleski W, Kretschmar JM. Violence and school shootings. Curr Psychiatry Rep. 2013;15(1):331. Provides an overview of multiple-homicide school shootings in relation to the ecology of schools and communities and emphasizes the need for “threat assessments.” PubMedCrossRefGoogle Scholar
- 5.••Shultz JM, Cohen AM, Muschert GW, Flores de Apodaca R. Fatal school shootings and the epidemiological context of firearm mortality in the United States. Disaster Health. 2013;1(2):84–101. Presents a detailed and well-illustrated analysis of the epidemiologic context of school shootings in the United States, distinguishing random/rampage vs. targeted shootings, and relating school shootings to overarching patterns of firearm homicides.CrossRefGoogle Scholar
- 7.International Monetary Fund. World economic outlook: growth resuming, dangers remain: a survey by the staff of the International Monetary Fund. Washington, DC; 2012, pp. 177–80. http://www.imf.org/external/pubs/ft/weo/2012/01/. Accessed June 2014.
- 8.Sydney School of Public Health, The University of Sydney. GunPolicy.org. http://www.gunpolicy.org/. Accessed October 2013.
- 9.List of countries by firearm-related death rate. In: Wikipedia. http://en.wikipedia.org/wiki/List_of_countries_by_firearm-related_death_rate. Accessed June 2014.
- 12.••Dyb G, Jensen TK, Nygaard E, et al. Post-traumatic stress reactions in survivors of the 2011 massacre on Utøya Island, Norway. Br J Psychiatry. 2013;204(5):361–7. A landmark paper that presents an analysis of mental health effects of high intensity exposures among survivors of the Utøya Island shooting.PubMedCrossRefGoogle Scholar
- 17.••Hughes M, Brymer M, Chiu WT, et al. Posttraumatic stress among students after the shootings at Virginia Tech. Psychol Trauma. 2011;3(4):403–11. Examines rates of PTSD and trauma-related stressors in a large survey sample of Virginia Tech University students with widely varying levels of exposure to a major campus shooting.CrossRefGoogle Scholar
- 19.••Orcutt HK, Bonanno GA, Hannan SM, Miron LR. Prospective trajectories of posttraumatic stress in college women following a campus mass shooting. J Trauma Stress. 2014;27(3):249–56. Examines four distinct trajectories of posttraumatic stress ranging from resilience to chronic dysfunction among college women exposed at various levels to the Northern Illinois University campus shooting.PubMedCrossRefGoogle Scholar
- 21.Turunen T, Haravuori H, Pihlajamäki JJ, et al. Framework of the outreach after a school shooting and the students perceptions of the provided support. Eur J Psychotraumatol. 2014;5:23079.Google Scholar
- 25.••Thoresen S, Jensen TK, Wentzel-Larsen T, Dyb G. Social support barriers and mental health in terrorist attack survivors. J Affect Disord. 2014;156:187–93. Describes a new line of research inquiry focusing on analysis of barriers to receiving social support among survivors of a mass shooting.PubMedCrossRefGoogle Scholar
- 29.••Thoresen S, Aakvaag HF, Wentzel-Larsen T, et al. The day Norway cried: proximity and distress in Norwegian citizens following the 22nd July 2011 terrorist attacks in Oslo and on Utøya Island. Eur J Psychotraumatol. 2012;3:19709. Documents the widespread and impactful mental health effects of the Utøya Island shooting on a representative sample of the Norwegian population.CrossRefGoogle Scholar
- 32.Hawdon J, Räsänen P, Oksanen A, Ryan J. Social solidarity and wellbeing after critical incidents: three cases of mass shootings. J Crit Incid Anal. 2012;3(1):2–25.Google Scholar
- 33.•Dyb G, Jensen T, Glad KA, Nygaard E, Thoresen S. Early outreach to survivors of the shootings in Norway on the 22nd of July 2011. Eur J Psychotraumatology. 2014;5:23523. Describes the early and proactive program of nationwide outreach to survivors of the Utøya Island shooting, demonstrating the value of this approach following high intensity trauma exposure.Google Scholar
- 34.Reifels L, Pietrantoni L, Prati G, et al. Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective. Eur J Psychotramatol. 2013;4:22897.Google Scholar
- 38.•Shaw JA, Espinel Z, Shultz JM. Care of children exposed to the traumatic effects of disaster. Arlington: American Psychiatric Publishing; 2012. This text provides a comprehensive description of children’s experiences when exposed to disasters and extreme events. Google Scholar
- 39.Elklit A, Kurdahl S. The psychological reactions after witnessing a killing in public in a Danish high school. Eur J Psychotraumatol. 2013;4:19826.Google Scholar
- 41.Pfefferbaum B, Sweeton JL, Newman E, et al. Child disaster mental health interventions, part II: timing of implementation, delivery settings and providers, and therapeutic approaches. Disaster Health. 2014;2(1):13–24.Google Scholar
- 51.•Santiago PN, Ursano RJ, Gray CL, et al. A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events. PLoS One. 2013;8(4):e59236. Contrasts the effects of exposure to intentional acts of mass violence (using school shooting examples), in relation to higher observed rates of PTSD.PubMedCentralPubMedCrossRefGoogle Scholar
- 59.Mass shooting in Colorado: practice drills, disaster preparations key to successful emergency response. ED Management: AHC Media. 2012;24(10):109–12.Google Scholar
- 64.••Flynn BW, Speier AH. Disaster behavioral health: Legal and ethical considerations in a rapidly changing field. Curr Psychiatry Rep. 2014;16(8):457. Examines legal and ethical issues in disaster behavioral health – important themes that are underrepresented in the published literature.PubMedCrossRefGoogle Scholar
- 65.Muschert GW. School shootings as mediatized violence. In: Böckler N, Seeger T, Sitzer P, Heitmeyer W, editors. School shootings: international research, case studies, and concepts for prevention. New York: Springer Publishing; 2012. p. 265–82.Google Scholar
- 66.Muschert GW, Ragnedda M. Media and violence control: the framing of school shootings. In: Heitmeyer W, Haupt HG, Malthaner S, Kirschner A, editors. The control of violence in modern society: multidisciplinary perspectives, from school shootings to ethnic violence. New York: Springer Publishing; 2010. p. 345–61.Google Scholar
- 67.Muschert GW, Sumiala J. School shootings: mediatized violence in a global age (Studies in media and communications, volume 7). Emerald Group: Bingley, UK; 2012.Google Scholar
- 69.Suimala J. Media and ritual: death, community, and everyday life. New York: Routledge; 2013.Google Scholar
- 70.Hakala S. The mediatized victim: school shootings as distant suffering. In: Muschert GW, Sumiala J, editors. School shootings: mediatized violence in a global age (Studies in media and communications, volume 7). Bingley, UK: Emerald Group Publishing Limited; 2012. p. 255–78.Google Scholar
- 73.Thoresen S, Jensen TK, Dyb G. Media experiences and mental health in terrorist attack survivors. J Trauma Stress. (in press).Google Scholar
- 75.••Schildkraut J, Muschert GW. The usual suspects: violent media, guns, and mental illness. In: Agger B, Luke TW, editors. Gun violence and public life. Boulder: Paradigm Publishing; 2014. p. 59–78. Juxtaposes the media coverage of guns and mental illness, a polemic that plays large in media accounts of mass shootings.Google Scholar
- 77.••McGinty EE, Webster DW, Jarlenski M, Barry CL. News media framing of serious mental illness and gun violence in the United States, 1997–2012. Am J Public Health. 2014;104(3):406–13. Describes how news media framing of mass shootings is negatively influencing public perceptions of serious mental illness (SMI).PubMedCrossRefGoogle Scholar
- 78.Muschert GW. School shootings. In: Herzog-Evans M, editor. Transnational criminology manual, vol. 2. Nijmegan, Netherlands: Wolf Legal Publishing; 2010. p. 73–89.Google Scholar
- 79.••Schildkraut J, Muschert GW. Media salience and the framing of mass murder in schools: a comparison of the Columbine and Sandy Hook massacres. Homicide Stud. 2014;18(1):23–43. Describes shifts in the media framing of school shootings marked by an increasing focus on gun control and mental health issues.CrossRefGoogle Scholar
- 80.Kellner D. The Sandy Hook slaughter and copy cat killers in a media celebrity society: analysis and plans for action. Logos: A Journal of Modern Society and Culture. 2013;12(1).Google Scholar
- 81.Muschert GW, Henry S, Bracy NL, Peguero AA. Responding to school violence: confronting the Columbine effect. Boulder: Lynne Rienner Publishers; 2014.Google Scholar