Heather Martin was a senior at Columbine High School in 1999 when two gunmen, also teenagers, killed 13 people and wounded 21 more before taking their own lives. She ended up barricaded in a room for three hours. And although she wasn’t physically injured, she witnessed the aftermath of the shooting, which she described as “horrifying.”
Despite having survived such a traumatic event, she did not consider how deeply her mental health might have been affected. “I minimized my own experience and always thought, Someone has it worse. I should just be fine or be better,” she said.
But she wasn’t fine. Ms. Martin had recurring nightmares for years and eventually dropped out of college after developing an eating disorder and taking recreational drugs.
It wasn’t until the 10th anniversary of the shooting that she finally found the support she needed and reconnected with some of her classmates “who got it, who were also struggling, who didn’t judge me,” she said.
Mass shootings have become more common during the pandemic, and so, too, have other types of gun violence. So far this year there have been more than 200 mass shootings in the United States, including the one that caused the deaths of 19 children and two teachers in Uvalde, Texas, on Tuesday. But beyond the statistics is a number that is harder to quantify: The large swath of people grappling with the psychological effects that stem from the violence.
The mental health toll doesn’t just affect those closest to gun violence. It also ripples through a community and the nation, said Erika Felix, an associate professor of clinical psychology at the University of California, Santa Barbara, who has studied survivors of shootings.
“It’s felt everywhere,” she said. “We really have to look at this as a public mental health crisis.”
Understand Post-Traumatic Stress Disorder
The invasive symptoms of PTSD can affect combat veterans and civilians alike. Early intervention is critical for managing the condition.
Removing the Stigma: Misconceptions about how PTSD develops and its symptoms, can prevent people from seeking treatment.Psychedelic Drugs: As studies explore the therapeutic value of substances like MDMA, veterans are becoming unlikely advocates for their decriminalization.Seeking Peace: Mission Within is a Mexican retreat that uses hallucinogens to treat PTSD. Some female U.S. veterans and veteran spouses have turned to it to heal from trauma.Virtual Reality: A treatment using new technology to immerse patients in a simulation of a memory could help them overcome trauma.
For survivors, victims’ families and those who live near the location of a shooting, the psychological effects can be intense and prolonged. They may include post-traumatic stress disorder, substance abuse, self-harm and major depressive disorders.
But even among those who do not frequently experience gun violence or who have never been directly affected by a mass shooting, feelings of fear, anger or helplessness can arise. And studies have found that continually consuming news media after a tragedy can lead to acute stress.
“It affects our perceptions of vulnerability and risk,” Dr. Felix said.
Could have happened to any of us
In a 2018 survey conducted by the Harris Poll for the American Psychological Association, 75 percent of young people between 15 and 21 said that mass shootings were significant sources of stress for them. Most adults ranging in age from 22 to 72 said the same.
The fact that the shooting in Uvalde could have happened to any of us “is deeply unsettling,” said Dr. Sara Johnson, a professor of pediatrics at Johns Hopkins University School of Medicine who has studied how chronic stress affects child development and behavior.
Some people may develop a sense that the world is not a safe place, that others cannot be trusted “or that they are powerless to change the circumstances in which they’re living,” Dr. Johnson said. “These kinds of mass shootings really tear at the fabric of society.”
But despite the potential for far-reaching psychological effects, there is limited data on what firearm injury does to our collective mental health.
This is in part because agencies like the Centers for Disease Control and Prevention did not fund gun violence research for more than two decades after a provision called the Dickey Amendment prohibited the use of federal money to “advocate or promote gun control.”
What experts have found is that directly after mass violence, most survivors and responders will have stress reactions that gradually decrease over time, according to the National Center for PTSD. But some people — and especially those with specific risk factors — may experience lasting consequences, including PTSD.
PTSD symptoms can be similar in adults and children, said Nicole R. Nugent, an associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University and an expert in PTSD identification and treatment.
Those with PTSD often have trouble sleeping and may become emotionally numb, continuously on edge or easily startled, she said. The world will often feel unsafe to them, and upsetting memories may intrude on their daily thoughts. Some people may try to avoid things that remind them of their trauma. Teens and adults might turn to substance abuse.
Younger children may experience stomachaches or headaches, and lower-grade anxiety that causes them to misbehave or have trouble concentrating. They may also engage in “traumatic play,” acting out the trauma they experienced, Dr. Nugent added. If the behavior persists, she said, “then we start to worry that it could be signaling something significant like PTSD.”
Proximity to violence
Much like those who experience gun violence, those who live near it may also suffer.
Dr. Aditi Vasan, a general pediatrician at Children’s Hospital of Philadelphia, decided to investigate how children in her community were psychologically affected by nearby shootings after speaking with patients who had anxiety, depression or difficulty sleeping.
“When I asked them when these symptoms started, they told me it was after a classmate or a friend or a neighbor was shot,” she said.
The resulting study, published in JAMA Pediatrics in 2021, examined emergency department admissions between 2014 and 2018 and found that children and teenagers in west and southwest Philadelphia who lived within about four to six blocks of where a shooting had occurred were more likely than other children to use an emergency room for mental health reasons during the two months after the shooting. The odds rose among children who were exposed to multiple shootings and among those who lived closest to a shooting’s location, within two or three blocks. Their symptoms included anxiety, panic attacks, suicidal ideation and self-harm behavior, Dr. Vasan said.
Another study, in California, looked at the effects of police killings on several communities in Los Angeles. It showed decreases in high school students’ academic performance, learning deficiencies related to PTSD and higher levels of depression and school dropouts that correlated to how close students lived to where the shootings occurred. These problems were most pronounced among Black and Latino students who lived near the locations of police shootings of Black and Latino people.
“The fear overcomes the need to connect with other people, and that’s the real tragedy of what violence does to communities,” said Dr. Joel Fein, an emergency medicine physician at Children’s Hospital Philadelphia, where he co-directs the Center for Violence Prevention.
Addressing the psychological effects of gun violence
For younger children affected by violence, Dr. Nugent recommended keeping as much structure in place as possible, like regular bedtimes and mealtimes.
“They are looking to us for those subtle signals that things are OK and things are safe,” she said.
It’s also important to allow ourselves to feel grief, rather than to bottle it up, and to allow our children to acknowledge it, too, said Dr. Megan L. Ranney, an emergency physician and the academic dean of the School of Public Health at Brown University.
Finding the things that give us a sense of control can help us cope as well. Plan on disconnecting from the news media from time to time, Dr. Ranney added, so as not to “re-traumatize yourself over and over.” And consider making a positive contribution to your neighborhood, like getting involved in organizations such the Boys & Girls Clubs of America or planting a community garden.
Shortly after the shooting in a movie theater in Aurora, Colo., in 2012, Ms. Martin and one of her high school friends co-founded the Rebels Project, a nonprofit, nonpartisan peer support group for those directly affected by mass violence. With about 1,700 members, it is one of the largest organizations of its kind, she said.
People will “push down their trauma and their experiences, and it can lead to some really dangerous places,” said Ms. Martin, now 41 and a high school English teacher in Aurora. “It’s really about acknowledging that you are impacted.”