The health harms from mass shootings are spread across communities

This article was originally published in Stateline, an initiative of The Pew Charitable Trusts.

A grim and familiar pattern followed the procession of mass shootings across America. In its aftermath, the nation’s attention is focused on the immediate victims of the attacks, the dead and injured, and their families, friends, and witnesses.

But a growing body of research reveals that the negative effects of mass shootings extended further than previously understood, harming the health of local populations not directly affected by the violence. Mental health experts say the recognition should prompt authorities to direct more attention and resources towards preventing such events – and helping a wider group of people after the fact.

Erdal Tekin, co-author of the September briefing on expanding research in the journal, said: Health Affairs. “It would be helpful for the public and policymakers to know that the impact of gun violence extends to people who believe they are safe.”

Research shows that mass shootings lead to higher rates of depression and anxiety and higher risk of suicide among young people. They also lead to a general decline in society’s sense of well-being. One study found a higher incidence of babies born prematurely or with a low birth weight in counties where mass shootings occurred.

Some studies show that mass shootings damage the economic prospects in a community, reducing productivity and profits.

There is no consensus about what constitutes a mass shooting. The Health Affairs The brief describes mass shootings as follows: those that involve multiple victims, are unexpected and random, typically occur in a public place and are unrelated to another crime such as gang activity or armed robbery. The FBI definition is one in which at least four people were killed with a handgun.

Researchers say mass shootings occur more often in areas that are not prone to routine gun violence, shattering the sense of safety and well-being that residents once took for granted for themselves and their families.

Aparna Soni, an American University health economist and co-author of the article, said Health Affairs. Anxiety, depression and post-traumatic stress disorder. What we haven’t dealt with very well are the effects on the community, on those who live close by and who have been affected emotionally by something going on in their community. ”

Similarly, said Daniel W. Webster, co-director of the Johns Hopkins University Center for Gun Violence Solutions, the new health research should change the calculus about the societal costs of gun violence.

“When we think about policies to reduce gun violence, whether in communities or schools or whatever, there’s always a cost-benefit analysis that goes on for policymakers,” he said.

The community-wide impact of gun violence is rarely considered in this analysis, Webster said, whether in Baltimore, Chicago and other cities where shootings are common or in areas with mass events that attract national media attention.

“People are really vastly underestimating the social cost of gun violence in all its forms in the United States,” he said.

Inform public debate

Heather Harris, a criminal justice research fellow at the nonprofit research organization the California Public Policy Institute, said that although political parties disagree about what to do about guns, the new research should prompt increased spending on mental health services.

“Building community mental health is not just a way to prevent mass shootings, but a way to help people who are affected when they happen,” she said. “It all has to be more robust, but it takes resources and people who are capable of doing the work.”

The Affordable Care Act increased access to mental health services for millions who previously did not have health insurance. And after years of relatively steady federal funding for community mental health, the federal government recently made huge new investments in the field. Since 2020, federal spending on community mental health has increased by about 75%, to nearly $3 billion in 2022, according to the Federal Administration on Substance Abuse and Mental Health Services.

Most of that additional spending has come through one-time payments included in various COVID-19 relief packages, which mental health advocates have celebrated, even as they worry about what happens when those investments run out.

“We have these huge, massive investments in cash in these COVID packages, but as we run out, it’s more about what happens next,” said Hannah Wisolowski, chief advocacy officer for the National Alliance on Mental Illness. “Will states step up to fill this gap, or will they look to the federal government to continue funding these services?”

Some states have increased mental health spending, spurred in part by mass school shootings. After the 2019 mass shooting at Marjory Stoneman Douglas High School, for example, Florida increased school mental health spending by $100 million annually. In addition, the state increased spending this year on community mental health by $126 million.

Melanie Brown-Waufer, president of the Florida Association for Behavioral Health, said the boosts came after years of steady government spending on mental health. “Our legislature has made great strides in recognizing the need for mental health and substance abuse treatment,” she said. “They have shown a greater willingness not only to discuss it but also to fund it.”

Many jurisdictions have crisis psychological services that intervene after mass shootings, particularly when schools are involved. But experts on gun violence say these services generally don’t last long and don’t extend to the wider community.

Cost also remains a barrier for many residents who need mental health services. Even those with health insurance still often face significant out-of-pocket expenses. But an equally troubling problem is the severe shortage of mental health providers, particularly in rural America.

“Even if you have adequate funding and evidence-based best practices, if we don’t have the workforce to provide this care, we won’t be able to help people and it will take time to build that resource,” Wesolowski said.

According to a 2020 analysis by the Commonwealth Fund, which seeks to improve the health care system in the United States, America has 105 mental health professionals per 100,000 people, half the number of Australia, Canada and Switzerland. The study also found that about a quarter of adults in the United States reported having a mental health diagnosis such as anxiety or depression, one of the highest rates among the 11 high-income countries considered.

Although much of the research on the health effects of mass shootings has to do with mental health, Soni and Tekin also cited a 2019 study that suggested a link between anxiety, resulting stress, and physical problems in newborns.

The study by Bahadir Dursun, formerly a health economist at Princeton University and now at Newcastle University in the UK, examined 81 US counties between 2005 and 2016 in which mass shootings occurred. Dursun found increased rates of women delivering babies prematurely or with low birth weights compared to babies born before the shooting events. It also found higher incidences of congenital anomalies and other abnormalities at birth as well as more stillbirths.

Duerson estimates that the resulting disabilities, reduced economic and income opportunities, and lower life expectancy have cost society an estimated $1 billion in those 81 counties.

Dursun’s work on the population-level health impact of mass shootings is one of the few that demonstrates the specific physical effects of mass shootings on those who were not present (or even born at that time). But it’s not the only study attesting to the health implications at the community level.

A paper published this year by the Global Labor Organization research forum found that adults who lived in US counties where a mass shooting occurred were more likely to rate their physical and mental health negatively than those who lived elsewhere, which the researchers confirmed translated into less. profits.

Another recent study published by the National Academy of Sciences found that the use of antidepressants prescribed to children who lived within five miles of a school shooting increased by 21% in the two years following the incidents.

Using the survey data, Soni and Tekin also published a research paper in National Journal of Economic Research In 2020, it showed that residents who lived in communities where mass shootings had occurred reported significant declines in their sense of emotional well-being as well as their sense of their community as a safe and desirable place to live. They examined 47 mass shootings between 2008 and 2017.

One study in Journal of Gay and Lesbian Mental Health It showed that even people who live outside of a county or state where a mass shooting occurred can be harmed. The study found that the 2016 massacre at Pulse, a gay nightclub in Orlando, Florida, increased severe psychological stress among gay men nationwide.

“Even if it doesn’t happen in my country, the whole country is kind of a crime scene,” said Tekin of AUC.

Mass shooting versus endemic armed violence

The researchers acknowledge that studying the impact of mass shootings is difficult. Although these episodes are becoming more frequent and get a lot of media attention, mass shootings account for less than 1% of all firearm deaths in the United States. This means that the size of the data set is limited, especially for researchers trying to look for which populations are most likely to have severe health reactions.

The researchers also did not compare the impact of mass shootings on society with the effects in areas where gun violence is a regular feature of life. Studies have found that residents who live in areas with frequent gun violence experience higher rates of anxiety and depression.

Routine gun violence affects children more severely than adults, with studies showing high levels of anxiety, insomnia, developmental delay, poor performance in school, development of aggressive behaviors, and an inability to trust.

But the two types of gun violence are different. One is a grim everyday reality. The other is completely unexpected, the kind of event that event residents often say afterwards they could not imagine happening in their community.

“Where there are high rates of gun violence, particularly in marginalized communities with fewer jobs and opportunities, people in those communities have long been concerned about children going to school or playing in parks, something that people in White suburban areas said Dr. Amy Barnhorst, deputy chair of community mental health at the University of California, Davis, department of psychiatry.

“It was easy to ‘different’ yourself because you don’t live in that kind of neighborhood,” she said. “But now we all live in this kind of neighborhood.”


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