The copycat phenomenon after two Finnish school shootings: an adolescent psychiatric perspective

Psychiatric Characteristics of Students Who Make Threats Toward Others at School

OBJECTIVE

While studies have focused on identifying potential school shooters, little is known about the mental health and other characteristics of students who make threats. This study aimed to describe these students and factors prompting psychiatric interventions and treatment recommendations.

METHOD

Child and adolescent psychiatry threat assessment evaluations of 157 consecutive school-referred youths in grades K-12 between 1998 and 2019 were reviewed for demographics, reasons for referral, nature of threat, psychiatric diagnosis, and psychiatric and educational recommendations. Predictors of recommendations for psychiatric interventions were modeled using multivariable logistic regression as a function of above-mentioned covariates.

RESULTS

Mean (SD) age of referred students was 13.37 (2.79) years; 88.5% were male; 79.7%, White; 11.6%, Hispanic; 10.1%, Black; 2.5%, Asian. Of students, 51.6% were receiving special education services. Verbal threat was made by 80%, and 29.3% brought a weapon to school. History included being bullied in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, and verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were attention-deficit/hyperactivity, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. History of medication treatment was reported in 79 (50.3%) and psychotherapeutic interventions in 57 (36.3%). Recommendations to return the student to their prior schools were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication for 88.5%, and both for 70.1%. Therapeutic school setting or psychiatric hospitalization was more likely recommended (with statistical significance) with a prior threat history (odds ratio [OR] 5.47, 95% CI 1.91-15.70), paranoid symptoms (OR 5.72, 95% CI 1.55-21.14, p = .009), autism spectrum disorders (OR 3.45, 95% CI 1.32-9.00), mood disorder (OR 5.71, 95% CI 1.36-23.96), personality disorder (OR 9.47, 95% CI 1.78-50.55), or with psychotherapy recommendation (OR 4.84, 95% CI 1.08-21.75).

CONCLUSION

Students who make threats have diverse psychiatric profiles and warrant treatments. A trauma and/or abuse history is common. Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems. Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations.

DIVERSITY & INCLUSION STATEMENT

The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

The nature of co-morbid psychopathology in adolescents with gender dysphoria

Gender-referred adolescents (GR) have been reported to present with considerable psychiatric symptomatology compared to their age-peers. There is, however, little research on how they compare to adolescents referred due to mental health problems (MHR). We set out to compare psychopathology in adolescents referred to our specialized gender identity unit (n = 84) and adolescents referred to a general adolescent psychiatric clinic (n = 293) in a university hospital setting in Finland. Of the GR adolescents, 40.9% had not received any psychiatric diagnosis during adolescence. Eating disorders were less common in the GR than in the MHR group, but otherwise the prevalences of disorders did not differ statistically significantly. At the symptom level, the GR adolescents displayed significantly more suicidal ideation and talk and less alcohol abuse and eating disorder symptoms than did the MHR adolescents, but otherwise their symptom profiles were comparable. Additionally, the GR adolescents had significantly fewer total externalizing symptoms than did the MHR adolescents. Adolescents seeking gender affirming treatments present with psychiatric symptoms and disorders comparable to those seen among adolescent psychiatric patients. Medical gender affirming care may not be a sufficient intervention for treating psychiatric comorbidities of adolescents with gender dysphoria.

Selected Texan K-12 Educators' Perceptions of Youth Suicide Prevention Training

K-12 school personnel may be frontline responders for youth contemplating suicide or other harmful behaviors. Therefore, the purpose of this preliminary study was to determine selected K-12 educators' perceptions of youth suicide prevention (YSP) training. A longitudinal trend survey with repeated measures and proportionally stratified random samples of K-12 personnel from nine Texas independent school districts provided data. Participants' perceived knowledge of the YSP content showed significant appreciative gains between pre- and follow-up post-tests. Likewise, their confidence levels for helping students at risk of suicide and approaching other adults to talk about students at risk of suicide rose significantly between pretests and follow-up post-tests. This preliminary study reinforces the value of training educators to acquire content knowledge and confidence boosting opportunities for engagement in difficult dialogue about suicidality. YSP training helped improve educators' confidence to engage with others about students' mental health concerns, calling attention to the importance of identifying early warning signs that may aid in early support and prevention of youth mental health concerns.

"The Need to See and Respond": The Role of the Child and Adolescent Psychiatrist in School Threat Assessment

Child and adolescent psychiatrists are on the front lines of performing challenging school threat assessments. With respect to school climate, clinicians should be aware of the presence of zero tolerance policies and inappropriate profiling. Removing a student from school does not eliminate the risk to the school community. School shootings often present similarly horrific themes and failures to respond properly to warning signs. Threatening communications in social media posts, drawings, and writings are significant clues to potential violence. Fascination with prior mass shooters is a potential high-risk warning sign. Thorough assessment of weapon access is essential. If there are significant concerns about a student's Internet activities, police can access a student's telephone and computer; the Federal Bureau of Investigation can also be contacted. Even if a threat appears to be relatively minor, a comprehensive psychiatric evaluation should still be performed, as important psychiatric concerns may be present. After threat assessment completion, it can be extremely challenging to find appropriate school placements for students with complex psychiatric problems who make serious threats. If indicated, a judge can order a forensic evaluation or remand the student to a hospital or residential programs. Ultimately, it is up to the psychiatrist to decide on the severity of the threat and the proper course of action, in collaboration with a school-based threat assessment team. The child and adolescent psychiatrist who performs a comprehensive threat assessment is likely to be in the best position to make these judgments to ensure the safety of all.

The unique role and special considerations of mental health professionals on threat assessment teams at institutions of higher education

Threat assessment has been used in educational settings to assess and manage the risk of targeted violence for nearly two decades, and mental health professionals commonly serve on threat assessment teams. Despite how prevalent threat assessment has become, the extant literature on the psychological factors relevant to the assessment of targeted violence has infrequently distinguished between the types of institutions in which this form of intervention is employed. Furthermore, the unique considerations for mental health professionals on threat assessment teams have received limited attention. The purpose of this manuscript is the following: (a) to review existing research and knowledge regarding mental health and developmental issues prudent for consideration at institutions of higher education and explore the relevance of these findings to the practice of threat assessment, (b) to review professional practice issues commonly encountered by threat assessment professionals at institutions of higher education and establish best practice guidelines, and (c) to define the proper role of mental health professionals who serve on threat assessment teams at institutions of higher education.

Gender differences in first onset Schizophrenia spectrum psychoses

BACKGROUND

Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals.

AIMS

To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20-29) among adolescents aged 13-17.

METHODS

A retrospective chart review of all (n = 106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20-29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received.

RESULTS

During the study period more adolescent girls (n = 70, 66%) than boys (n = 36, 34%) were diagnosed with schizophrenia spectrum (F20-29) psychoses, most commonly F29. Girls were moreover younger (mean age = 15.46) than boys (mean age = 16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys.

CONCLUSIONS

The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.

[Leaking: Frequency and correlates of announcements and threats of homicidal violence reported by Berlin schools between 1996 and 2007]

Threats and announcements of homicidal violence at schools may have massive consequences like evacuations, police searches, criminal investigations, or loss of the sense of security by students, teachers, and parents. However, there is a lack of systematic studies about that phenomenon. The present article would like to contribute to closing the research gap. It presents results about the frequency and structure of threats and announcements of homicidal violence in schools in Berlin. The study is based on an official dataset from school administration reports of violent acts in Berlin schools which has been studied within the Berlin Leaking-Projekt. The sample consists of 427 threats and announcements of homicidal violence between 1996 and 2007. The study is an exceptional analysis of the phenomenon: it presents crosscutting results about frequency and characteristics of threats and the threatening students as well as results of a longitudinal analysis about the development of threats and announcements. Results show a rate of 0,3 threats and announcements per 1 000 student and year. During the observation time span a steady increase of threats and announcements – year by year, influenced by imitation effects after school shootings – has been observed.

Emile, or on devastation: when virtual boundlessness meets inner emptiness

The author's starting point is a psychoanalysis conducted with Emile, a teenager who was unable to form close relationships and was living in a virtual world, planning a school massacre. For him, virtual reality functioned as a bottomless container in which he was no longer a victim of bullying but rather a god. When the boundlessness of cyberspace encounters a "black hole" in the psyche, any fantasies can be put into virtual realization and actions. By recounting his wickedness, violence, destructiveness, and perversion, Emile could start restoring his self boundaries and create his own autobiographical narrative. Unable to sustain the pain of mourning his envelope of invulnerability and omnipotence, however, he prematurely terminated analysis.

Adolescents expressing school massacre threats online: something to be extremely worried about?

BACKGROUND

Peer groups identified through the Internet have played an important role in facilitating school shootings. The aim of the present study was to determine whether the adolescents who had expressed a school massacre threat online differed from those who had expressed one offline.

METHODS

A nationwide explorative study was conducted on a group of 77 13- to 18-year-old adolescents sent for adolescent psychiatric evaluation between November 2007 and June 2009 by their general practitioners because they had threatened to carry out a school massacre. According to the referrals and medical files, 17 adolescents expressed the threat online and 60 did so offline.

RESULTS

The adolescents who expressed their threats online were more likely to be bullied and depressed, had more often pronounced the threat with clear intention and had more often made preparations to carry out the act. In contrast, the adolescents who expressed their threats offline were more likely to have problems with impulse control and had showed delinquent behavior prior to the massacre threats.

CONCLUSIONS

The Finnish adolescents who expressed their massacre threats online could be considered a riskier group than the group who expressed the threats offline. Further studies with larger sample sizes are needed to elucidate this important topic.