A controlled follow-up study of adolescents exposed to a school shooting--psychological consequences after four months

Posttraumatic Stress Disorder Among Adults in Communities With Mass Violence Incidents

Importance

Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown.

Objective

To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI.

Design, Setting, and Participants

This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023.

Main Outcomes and Measures

The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria.

Results

A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD.

Conclusions and Relevance

In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.

The Effects of Mindfulness-Based Stress Reduction on Trauma in Victims of Gun Violence: a Pilot Study

Objectives

Gun violence is a significant problem in the United States of America. Gun violence produces lifelong psychological adversity, trauma, and grief. In the face of this epidemic, efficacious therapies that assuage gun violence-based trauma and negative health are lacking.

Methods

The proposed, longitudinal pilot experiment examined the effects of an 8-week mindfulness-based stress reduction (MBSR) program on traumatized individuals as a direct consequence of gun violence. Twenty-four victims of gun violence (median age = 53 years; 21 female) completed measures of the primary outcome: trauma. Secondary outcomes were characterized as grief, depression, sleep quality, life satisfaction, and mindfulness. All assessments were administered before, after 5, and 8 weeks of MBSR training. It was hypothesized that trauma and other comorbidities would improve following MBSR. It was also predicted that outcomes would be significantly stronger from baseline to 5 weeks of MBSR training than from 5 to 8 weeks of training.

Results

Before MBSR, volunteers exhibited high levels of trauma, depression, sleep difficulty, and grief. Participation in MBSR was associated with improved trauma, depression, sleep difficulty, and life satisfaction. The most pronounced improvements in psychological disposition were exhibited within the first 5 weeks of MBSR. However, these benefits were largely preserved after completion of the course. Importantly, increases in dispositional mindfulness predicted lower trauma, complicated grief, and sleep difficulties.

Conclusions

The present findings should be interpreted with caution because they were derived from an uncontrolled, non-randomized trial. However, said findings suggest that MBSR may reduce trauma and improve overall well-being in gun violence victims.

The influence of social support on posttraumatic stress symptoms among children and adolescents: a scoping review and meta-analysis

BACKGROUND

Several risk and protective factors play a role in the development of posttraumatic stress symptoms (PTSS) in children and youth. The evidence for social support (SS) as a protective factor is rising; however, a review of the evidence is lacking.

OBJECTIVE

This scoping review and meta-analysis aims to map out and synthesize the present research on the influence of social support on PTSS in children and adolescents.

METHOD

The literature searched through PubMed, MEDLINE, Embase, PsycInfo, and CINAHL identified 3629 abstracts. Ninety articles published from 1999 to 2020 were selected, including a total of 77,439 participants.

RESULTS

Most papers focused on social and emotional support from family members (36/88) and peers (26/88); other types of support (e.g., informational support and support from professionals) were not widely reported. The cross-sectional studies illustrated an overall significant, but weak, negative correlation between global social support and PTSS. A similar weak negative association was found between family support and PTSS. The association between peer support and PTSS was not significant. For longitudinal studies, 4 of 5 indicated that SS was a significant negative predictor of PTSS.

CONCLUSIONS

There was conceptual, methodological, and statistical heterogeneity of the identified studies. This review suggests a weak negative relationship between global SS and PTSS in children and adolescents. Higher global SS was related to less PTSS. The evidence regarding family support revealed a more stable negative relationship with PTSS than that for peer support. Investigating social support without specifying the form of support confounds the effect. Studies on informational, teacher, or professional support seem to be lacking. More studies are needed on the longitudinal effects of SS on PTSS.

Effects of Mass Shootings on the Mental Health of Children and Adolescents

PURPOSE OF REVIEW

To examine mass shootings in youth including mass shooting trends, risk and protective factors for emotional sequelae, mental health, prevention of mass shootings, and the assessment and treatment of survivors.

RECENT FINDINGS

Many youth are exposed to gun violence, with a smaller subset exposed to mass shootings. While youth have varying responses to mass shootings, possibly due to risk and protective factors as well as level of exposure, the mental health outcomes are significant and include posttraumatic stress, suicide, depression, substance abuse, and anxiety. Efforts at developing effective prevention and treatment programs are still underway but generally take a tiered public health approach. Mass shootings have significant mental health outcomes for youth survivors, particularly those with direct exposure or risk factors. Continued efforts are needed to better understand the effects of mass shootings and how to prevent them from occurring as well as how to best address the needs of survivors.

Supporting Children After School Shootings

Anticipatory guidance should be provided to families on identifying and addressing common adjustment reactions after a school shooting. Although adjustment difficulties may be related to post-traumatic and grief reactions, many will not be directly attributable to the school shooting. Understanding how to cope with associated worries and reactions can help children better adjust. Pediatricians can assist with guidance about the development of a reasonable timeline for emotional and academic recovery, traumatic stress/loss, coping strategies, support for students with special needs, identification of students most in need of support, identification of staff who are most likely impacted, and appropriate preparedness activities.

What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review

The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.

Prevention of Firearm Injuries Among Children and Adolescents: Consensus-Driven Research Agenda from the Firearm Safety Among Children and Teens (FACTS) Consortium

IMPORTANCE

Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality.

OBJECTIVE

The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic.

EVIDENCE REVIEW

A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (≥70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium.

FINDINGS

Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement.

CONCLUSIONS AND RELEVANCE

These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.

Compassionate Goals Predict Social Support and PTSD Symptoms Following a University Shooting: A Moderated Mediation Analysis

Introduction: Social support is known to buffer posttraumatic stress disorder (PTSD) symptoms, but the stress-buffering properties of striving to help and support others (compassionate goals) have received less attention. Recent research suggests that compassionate goals shape social support processes and dampen stress responses following social threat, but their relevance to trauma have not been examined. The present study tested whether, in the aftermath of a university mass shooting, compassionate goals concurrently and prospectively predicted lower PTSD symptoms indirectly via higher social support, and whether this mediation would be stronger with higher proximity to the trauma.

Method: Participants (N = 369) completed measures four months post-shooting (Time 1), and a subset (n = 85) repeated outcome variables at eight months (Time 2).

Results: As hypothesized, there was a significant moderated mediation, with trauma proximity moderating the indirect effect of compassionate goals on PTSD symptoms at Time 1 (B = −0.88, SE = 0.28, 95% CI [−1.47, −0.37]) and prospectively at Time 2 (B = −1.12, SE = 0.77, 95% CI [−3.16, −0.03]), although not when controlling for Time 1 symptoms. The indirect effects were greatest for those with higher trauma proximity, suggesting particular relevance for individuals most at risk for trauma-related difficulties.

Discussion: These findings suggest the need for further research into compassionate goals and strategies for fostering them, particularly in the context of social or community traumas.

The performance of the IES-R for Latinos and non-Latinos: Assessing measurement invariance

Violent acts on university campuses are becoming more frequent. Enrollment rates of Latinos at universities is increasing. Research has indicated that youths are more susceptible to trauma, particularly Latinos. Thus, it is imperative to evaluate the validity of commonly used posttraumatic stress measures among Latino college students. The Impact of Event Scale-Revised (IES-R) is one of the most commonly used metrics of posttraumatic stress disorder symptomatology. However, it is largely unknown if the IES-R is measuring the same construct across different sub-samples (e.g. Latino versus non-Latino). The current study aimed to assess measurement invariance for the IES-R between Latino and non-Latino participants. A total of 545 participants completed the IES-R. One- and three-factor scoring solutions were compared using confirmatory factor analyses. Measurement invariance was then evaluated by estimating several multiple-group confirmatory factor analytic models. Four models with an increasing degree of invariance across groups were compared. A significant χ2 difference test was used to indicate a significant change in model fit between nested models within the measurement invariance testing process. The three-factor scoring solution could not be used for the measurement invariance process because the subscale correlations were too high for estimation (rs 0.92-1.00). Therefore, the one-factor model was used for the invariance testing process. Invariance was met for each level of invariance: configural, metric, scalar, and strict. All measurement invariance testing results indicated that the one-factor solution for the IES-R was equivalent for the Latino and non-Latino participants.

Healthcare to parents of young terrorism survivors: a registry-based study in Norway

OBJECTIVES

To assess changes in parents' short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children.

DESIGN

Registry-based study comparing parental healthcare service consumption in the 3 years before and the 3 years after a terrorist attack.

SETTING

The aftermath of the Utøya terrorist attack. The regular, publicly funded, universal healthcare system in Norway.

INTERVENTION

Parents learning of a terrorist attack on their adolescent and young adult children.

PARTICIPANTS

Mothers (n=226) and fathers (n=141) of a total of 263 survivors of the Utøya terrorist attack (54.6% of all survivors 13-33 years, n=482).

MAIN OUTCOME MEASURES

We report primary and specialised somatic and mental healthcare service consumption in the early (0-6 months) and delayed (>6-36 months) aftermath of the attack, both in terms of frequency of services consumed (assessed by age-adjusted negative binomial hurdle regression) and proportions of mothers and fathers provided for (mean semiannual values). The predisaster and postdisaster rates were compared by rate ratios (RRs), and 95% CI were generated through bootstrap replications.

RESULTS

Frequency of primary healthcare service consumption increased significantly in both mothers and fathers in the early aftermath of the attack (mothers: RR=1.97, 95% CI 1.76 to 2.23; fathers: RR=1.73, 95% CI 1.36 to 2.29) and remained significantly elevated throughout the delayed aftermath. In the specialised mental healthcare services, a significant increase in the frequency of service consumption was observed in mothers only (early: RR=7.00, 95% CI 3.86 to 19.02; delayed: RR=3.20, 95% CI 1.49 to 9.49). In specialised somatic healthcare, no significant change was found.

CONCLUSION

Following terrorist attacks, healthcare providers must prepare for increased healthcare needs in survivors and their close family members, such as parents. Needs may present shortly after the attack and require long-term follow-up.

Predicting Grief Reactions One Year Following a Mass University Shooting: Evaluating Dose-Response and Contextual Predictors

This study identifies risk factors for grief following a mass school shooting. Participants (N = 1,013) completed online questionnaires 3-4 months (Time 1) and 1 year (Time 2) post-shootings. We tested models predicting Time 2 grief reactions, exploring direct and indirect predictive effects of exposure variables (physical and social proximity) through hypothesized peritraumatic mediators (peritraumatic perceived threat to self or others) while controlling for Time 1 grief and posttraumatic stress (PTS) reactions, pretrauma vulnerabilities. Findings demonstrate that closer social proximity predicted higher levels of Time 2 grief, directly and indirectly through increasing peritraumatic perceived threat to others' safety. Physical proximity and peritraumatic threat to self did not predict Time 2 grief reactions. Implications for grief screening instruments and theory building research through identifying risk factors and causal mechanisms are discussed.

The Mental Health Consequences of Mass Shootings

Mass shooting episodes have increased over recent decades and received substantial media coverage. Despite the potentially widespread and increasing mental health impact of mass shootings, no efforts to our knowledge have been made to review the empirical literature on this topic. We identified 49 peer-reviewed articles, comprised of 27 independent samples in the aftermath of 15 mass shooting incidents. Based on our review, we concluded that mass shootings are associated with a variety of adverse psychological outcomes in survivors and members of affected communities. Less is known about the psychological effects of mass shootings on indirectly exposed populations; however, there is evidence that such events lead to at least short-term increases in fears and declines in perceived safety. A variety of risk factors for adverse psychological outcomes have been identified, including demographic and pre-incident characteristics (e.g., female gender and pre-incident psychological symptoms), event exposure (e.g., greater proximity to the attack and acquaintance with the deceased), and fewer psychosocial resources (e.g., emotion regulation difficulties and lower social support). Further research that draws on pre-incident and longitudinal data will yield important insights into the processes that exacerbate or sustain post-incident psychological symptoms over time and provide important information for crisis preparedness and post-incident mental health interventions.

An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV

BACKGROUND

The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored.

METHODS

Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems.

RESULTS

Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4%) PTSD cases, the two-factor ICD-11 identified 56 (24.6%) cases and the DSM-IV identified 43 (18.9%) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3%) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure.

CONCLUSIONS

The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.

School performance after experiencing trauma: a longitudinal study of school functioning in survivors of the Utøya shootings in 2011

BACKGROUND

The psychological impact on survivors of terrorism has been well documented. However, studies on adolescent survivors and the academic performance of high school students following a terrorist attack are lacking.

OBJECTIVE

This study investigated academic performance, absenteeism, and school support amongst survivors of a terrorist attack in Norway.

METHOD

Data from a longitudinal interview study were linked to officially registered grades of students (N=64) who successfully completed their 3-year senior high school program. Statistical tests of mean differences and linear regression were used to compare the survivors' registered grades with the national grade point average, before and after the event, as well as to assess absenteeism, self-reported grades and to test the association with school support.

RESULTS

The students' grades were lower the year after the event than they had been the year before, and they were also lower than the national grade point average (p<0.001). However, their grades improved in the last year of high school, indicating possible recovery. Absence from school increased after the event, compared to the previous year. However, students reported high satisfaction with school support.

CONCLUSION

The results indicate that academic functioning was reduced in the year after the traumatic event, but for students who successfully completed high school, the school situation improved 2 years after the event. The findings underscore the importance of keeping trauma-exposed students in school and providing support over time. A more defined educational approach to maintaining school attendance and educational measures which compensate for learning loss are needed in trauma-sensitive teaching.

Early postdisaster health outreach to modern families: a cross-sectional study

OBJECTIVES

This study investigated whether the early outreach programme following the Utøya massacre reached out to the parents of the young survivors. Additionally, we explored whether specialised mental healthcare services were provided to parents presenting elevated levels of PTSD and depression reactions.

DESIGN

Cross-sectional survey, face-to-face interviews and questionnaires.

SETTING

Norway, aftermath of the Utøya massacre, 4-7 months postdisaster.

BACKGROUND

Following the Utøya massacre, proactive early outreach programmes were launched in all municipalities that were affected, facilitating access to appropriate healthcare services.

PARTICIPANTS

A total of 453 parents of the Utøya survivors aged 13-33 years took part. Overall, 59.8% of the survivors were represented by one or more parent in our study.

MAIN OUTCOME MEASURES

Engagement with the proactive early outreach programme (psychosocial crisis teams and contact persons in the municipalities), utilisation of healthcare services (general practitioner and specialised mental healthcare services) and mental distress (UCLA PTSD-RI and HSCL-8).

RESULTS

A majority of the participants reported contact with the proactive early outreach programme (crisis team, 73.9%; and contact person, 73.0%). Failure of outreach to parents was significantly associated with non-intact family structure (crisis team: OR 1.69, 95% CI 1.05 to 2.72, p=0.032) and non-Norwegian origin (crisis team: OR 2.39, 95% CI 1.14 to 4.98, p=0.021). Gender of the parent was not significantly associated with failure of the outreach programme (p ≥ 0.075). Provision of specialised mental healthcare services was significantly associated with higher levels of PTSD (OR 2.08, 95% CI 1.55 to 2.79, p<0.001) and depression (OR 2.42, 95% CI 1.71 to 3.43, p<0.001) and not with the sociodemography (p ≥ 0.122).

CONCLUSIONS

Proactive early outreach strategies may be helpful in identifying healthcare needs and facilitating access to the required services in a population struck by disaster. Our findings prompt increased attention to the complexity of family structures in reaching out universally to modern families following a disaster.

Post-traumatic stress reactions in survivors of the 2011 massacre on Utøya Island, Norway

BACKGROUND

Although youths in many countries have been exposed to terrorism, few studies have examined early risk and protective factors for the subsequent development of mental health problems.

AIMS

To investigate the levels of post-traumatic stress in survivors of the 2011 massacre on Utøya Island compared with the general population in Norway, and to identify predictive factors.

METHOD

Four hundred and ninety survivors were invited to participate. Structured face-to-face interviews were performed 4-5 months after the attack.

RESULTS

There were 325 study participants (response rate 66%). Survivors had been highly exposed to danger and loss. Post-traumatic stress levels were more than six times higher in survivors than in the general population. Predictors were female gender, minority ethnic status, high level of trauma exposure, pain, the loss of someone close and social support.

CONCLUSIONS

Survivor characteristics that can be assessed in the early aftermath of a terrorist attack strongly predict the subsequent mental health problems of exposed youths. The highly elevated symptoms observed were largely attributable to the traumatic experience and reflect the mental health costs of the terrorist attack.

Brief report: Examining children's disruptive behavior in the wake of trauma - A two-piece growth curve model before and after a school shooting

School shootings may have serious negative impacts on children years after the event. Previous research suggests that children exposed to traumatic events experience heightened fear, anxiety, and feelings of vulnerability, but little research has examined potential aggressive and disruptive behavioral reactions. Utilizing a longitudinal dataset in which a local school shooting occurred during the course of data collection, this study sought to investigate whether the trajectory of disruptive behaviors was affected by the shooting. A two-piece growth curve model was used to examine the trajectory of disruptive behaviors during the pre-shooting years (i.e., piece one) and post-shooting years (i.e., piece two). Results indicated that the two-piece growth curve model fit the data better than the one-piece model and that the school shooting precipitated a faster decline in aggressive behaviors. This study demonstrated a novel approach to examining effects of an unexpected traumatic event on behavioral trajectories using an existing longitudinal data set.

Mass shootings: a meta-analysis of the dose-response relationship

A meta-analysis was conducted to examine the dose-response theory as it relates to posttraumatic stress symptoms (PTSSs) following mass shootings. It was hypothesized that greater exposure to a mass shooting would be associated with greater PTSSs. Trauma exposure in the current study was broadly defined as the extent to which a person experienced or learned about a mass shooting. The meta-analysis identified 11 qualifying studies that included 13 independent effect sizes from a total of 8,047 participants. The overall weighted mean effect size, based on a random effects model, was r = .19, p < .001, 95% CI [.13, .25]. Maximum likelihood meta-regressions revealed no significant linear effects of participant gender, participant age, or time elapsed since the shooting on the relationship between exposure and PTSSs. Because so few studies satisfied the inclusion criteria, the present study also documents that this area of the literature is underresearched.

Multiple vantage points on the mental health effects of mass shootings

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.

Framework of the outreach after a school shooting and the students perceptions of the provided support

BACKGROUND

A large number of bereaved family members, surviving students, and their relatives as well as school staff and the wider community were in need of psychosocial support as a result of a school shooting in Kauhajoki, Finland, 2008. A multilevel outreach project provided psychosocial care to the trauma-affected families, students, schools staff, and wider community for 2 years and 4 months.

OBJECTIVE

This article is twofold. First, it presents the theoretical rationale behind the psychosocial support and describes the multimodal elements of the services. Second, it analyzes the trauma-exposed students' help-seeking behavior and perceptions of the usefulness of the support they were offered in different phases of recovery.

METHOD

Information of students' help-seeking and perceptions of support is based on a follow-up data from 4 months (T1, N=236), 16 months (T2, N=180), and 28 months (T3, N=137) after the shootings. Mean age of students was 24.9 (SD=10.2; 95% women). Their perceptions of the offered psychosocial support were collected with structured and open questions constructed for the study.

RESULTS

The results confirmed the importance of enhancing the natural networks after a major trauma and offering additional professional support for those in greatest need. The students' perceptions of the provided care confirmed that the model of the acute and long-term outreach can be used after major tragedies in diverse situations and in other countries as well.

The role of attachment in recovery after a school-shooting trauma

BACKGROUND

Survivors of life-endangering trauma use varying resources that help them to recover. Attachment system activates in the times of distress, and is expected to associate with stress responses, arousal regulation, and mental health.

OBJECTIVE

We examined the associations of attachment style with posttraumatic stress disorders (PTSD) symptoms and dissociative symptoms, and posttraumatic growth (PTG) among students exposed to a school shooting in Finland in a three-wave follow-up setting.

METHOD

Participants were students (M age=24.9 years; 95% female) who were followed 4 (T1, N=236), 16 (T2, N=180), and 28 months (T3, N=137) after the shooting. The assessments included the Attachment Style Questionnaire, the Impact of Event Scale, part of the Adolescent Dissociative Experiences Scale and the Posttraumatic Growth Inventory.

RESULTS

Securely attached survivors had lower levels of posttraumatic stress and dissociative symptoms than preoccupied at T1 and T2 as hypothesized. At T3 survivors with avoidant attachment style had higher levels of intrusive and hyperarousal symptoms than those with secure style. Concerning PTG, survivors with avoidant attachment style scored lower in PTG at T3 than survivors with both secure and preoccupied style.

CONCLUSION

Secure attachment style was beneficial in trauma recovery. A challenge to the health care systems is to acknowledge that survivors with preoccupied and avoidant attachment styles react uniquely to trauma, and thus need help in different doses, modalities, and timings.