A grim and familiar pattern has followed the parade of mass shootings across America. In their aftermath, the nation’s attention focuses on the direct victims of the attacks, the dead and injured, their families and friends, and the witnesses.
But a growing body of research reveals that the negative effects of mass shootings spread much farther than previously understood, harming the health of local residents who were not touched directly by the violence. Mental health experts say the recognition should prompt authorities to direct more attention and resources toward preventing such events — and helping a broader group of people after they occur.
“It changes the entire picture on how much public resources we should use to attack gun violence,” said Erdal Tekin, co-author of a September brief on the expanding research in the journal Health Affairs. “It would be informative for the public and policymakers to know that the impact of gun violence extends to people who think they are safe.”
Research shows that mass shootings lead to higher rates of depression and anxiety and higher risks for suicide among young people. They also lead to an overall decline in a community’s sense of well-being. One study found a higher incidence of infants born prematurely or with low birth weight in counties where a mass shooting had occurred.
Some studies suggest that mass shootings damage economic prospects in a community, diminishing productivity and earnings.
There isn’t a consensus about what constitutes a mass shooting. The Health Affairs brief describes mass shootings as: those with multiple victims, that are unexpected and random, typically occurring in a public place and unrelated to another crime such as gang activity or armed robbery. The FBI’s definition is one in which at least four people are killed with a gun.
Often, researchers say, the mass shootings occur in areas not prone to routine gun violence, shattering the sense of safety and well-being that residents previously took for granted for themselves and their families.
“We’ve known for years, decades in fact, thanks to the work of neuroscientists and others, about the traumatic effects on actual witnesses to mass shootings,” said Aparna Soni, a health economist at American University who co-authored the piece in Health Affairs. “Anxiety, depression, PTSD. What we didn’t have a good handle on are the effects on the community, on those who live nearby who have been emotionally affected by something happening in their own community.”
Daniel W. Webster, co-director of Johns Hopkins University’s Center for Gun Violence Solutions, likewise said the new health research should change the calculus about societal costs of gun violence.
“When we’re thinking about policies to lower gun violence, whether in communities or schools or whatever, there is always this cost-benefit analysis that goes on for policymakers,” he said.
The community-wide impact of gun violence is rarely considered in that analysis, Webster said, whether in Baltimore, Chicago and other cities where shootings are common or in areas with mass events that draw national media attention.
“People really grossly underestimate the social cost of gun violence in all forms in the United States,” he said.
Informing Public Debate
Even though the political parties differ on what to do about guns, the new research should prompt greater spending on mental health services, said Heather Harris, a research fellow in criminal justice at the nonprofit research organization Public Policy Institute of California.
“Building up community mental health isn’t just a way to prevent mass shootings, but a way to help people who are affected when it happens,” she said. “All that should be much more robust, but it takes resources and people capable of doing that work.”
The Affordable Care Act increased access to mental health services for millions who previously didn’t have health insurance. And after years of relatively flat federal funding for community mental health, the federal government recently made mammoth new investments in that area. Since 2020, federal spending on community mental health has climbed by about 75%, to nearly $3 billion in 2022, according to the federal Substance Abuse and Mental Health Services Administration.
Most of that additional spending came via one-time infusions 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, huge investments in cash in these COVID packages, but as they run out, it’s a question of what happens then,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness. “Are states going to step up to fill that gap, or are they going to look to the federal government to keep funding those services?”
Some states have increased mental health spending, spurred in part by mass shootings in schools. After the 2019 mass shooting at the Marjory Stoneman Douglas High School, for example, Florida increased spending on school mental health by $100 million a year. In addition, the state increased spending this year for community mental health by $126 million.
The boosts came after years of essentially flat state spending on mental health, said Melanie Brown-Woofter, president of the Florida Behavioral Health Association. “Our legislature has made great strides in recognizing the need for mental health and substance use treatment,” she said. “They’ve shown more willingness not only to discuss it but fund it.”
Many jurisdictions have crisis psychological services that intervene after mass shootings, particularly when schools are involved. But experts on gun violence say those services generally don’t last long and aren’t extended 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 substantial out-of-pocket expenses. But an equally nettlesome problem is a severe lack of mental health providers, particularly in rural America.
“Even if you have enough funding and the best evidence-based practices, if we don’t have the workforce to provide that care, we aren’t going to be able to help people and it takes time to build up that resource,” said Wesolowski.
According to a 2020 analysis by the Commonwealth Fund, which seeks to improve the U.S. health care system, America has 105 mental health professionals per 100,000 people, half as many as Australia, Canada and Switzerland. The study also found that about a quarter of U.S. adults 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 concerns mental health, Soni and Tekin also cited a 2019 study that suggests a link between the resulting anxiety and stress and physical problems in newborns.
The study by Bahadir Dursun, a health economist formerly at Princeton and now at Newcastle University in the United Kingdom, examined 81 U.S. counties between 2005 and 2016 in which a mass shooting had occurred. Dursun found increased rates of women delivering babies prematurely or with low birth weights compared with infants born before those shooting events. He also found higher incidents of congenital abnormalities and other anomalies at birth as well as more stillbirths.
The resulting disabilities, reductions in economic opportunities and income, and reduced life expectancy cost society an estimated $1 billion in those 81 counties, Dursun estimated.
Dursun’s work on the population-wide health impact of mass shootings is one of the few to demonstrate specific physical impacts of mass shootings on those not present (or even born at the time). But it’s far from the only study attesting to community-wide health repercussions.
A paper published this year by the research forum Global Labor Organization found that adults who lived in U.S. counties where a mass shooting occurred were more likely to assess their physical and mental well-being negatively than those living elsewhere, which the researchers contend translated to lower earnings.
Another recent study published by the National Academy of Sciences found that use of antidepressants prescribed to kids who lived within five miles of a school shooting increased by 21% in the two years after the incidents.
Using survey data, Soni and Tekin also published a paper in the National Journal of Economic Research in 2020 showing that residents who lived in communities where a mass shooting had occurred reported a significant downturn in their sense of their emotional well-being as well as their sense of their community as a safe and a desirable place to live. They examined 47 mass shootings between 2008 and 2017.
One study in the Journal of Gay and Lesbian Mental Health demonstrated that even people living outside a county or state where a mass shooting occurred can be harmed by it. The study found that the 2016 massacre at Pulse, a gay nightclub in Orlando, Florida, increased severe psychological distress among gay men nationally.
“Even if it’s not happening in my county, the whole country is sort of a crime scene,” said American University’s Tekin.
Mass Shootings vs. Endemic Gun Violence
Researchers acknowledge that studying the impact of mass shootings is tricky. Although these episodes have become more frequent and command much media attention, mass shootings account for less than 1% of all gun deaths in the United States. That means the data set is limited in size, particularly for researchers trying to drill down on which population groups are most susceptible to severe health reactions.
Researchers also have not compared the community impact of mass shootings 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 high rates of anxiety and depression.
Routine gun violence affects kids even more severely than adults, with studies showing high anxiety levels, sleeplessness, developmental delays, poor performance at school, development of aggressive behaviors and inability to trust.
But the two kinds of gun violence are different. One is a grim, everyday reality; the other utterly unexpected, the sort of event residents often say afterward they had never envisioned happening in their community.
“Where there are high rates of gun violence, particularly in marginalized communities with less employment or opportunity, people in those communities have long felt anxiety about kids walking to school or playing in parks, the kind of thing people in White suburban areas didn’t really worry about,” said Dr. Amy Barnhorst, vice chair for community mental health in the University of California, Davis, Department of Psychiatry.
“It was easy to ‘other’ yourself because you didn’t live in that kind of neighborhood,” she said. “But now we all live in that kind of neighborhood.”
–Michael Ollove, Stateline
At least we need the ban of assault weapons as Biden proposes. Lets stop the carnage.
Michael Cocchiola says
It’s a start but nowhere enough. We need compulsory registration and a national database. We need detailed background checks and a suitable waiting period to run through the database before issuing a license. We need to require gun sellers, including private and commercial – including gun shows – to comply with the requirements of registration and waiting period with severe (felony?) penalties for non-compliance. And we need to apply severe penalties to those who are caught with an unlicenced firearm. Lastly, we need to code bullets so they can be tracked back to the shooter or at least the last registered gun owner.
Gun ownership should not be a right, but a privilege accorded to those who qualify.
Please define what and assault rifle is. Is it just a scary looking rifle? Fewer than 500 people are killed every year by ANY type of rifles in the US. If you really care about people lives and not just go with the political flow put your efforts into something that will really save lives. Put your efforts in fighting obesity (biggest cause of covid deaths), or how about requiring gun safety training prior to being purchased. Getting a CCW is way to easy and yes I have one.
The left puts way to much effort into things that really will have no effect in the big scheme of things.
Michael Cocchiola says
Obesity does contribute to collateral illnesses that cause death. Our society treats obesity with a plethora of medications, counseling, dietary supplements, and surgery among the most prevalent. What do we do to prevent mass shootings with assault-style weapons? Thoughts ‘n prayers.
BTW, like pornography, I can’t define an assault weapon but I know one when I see one. If you have an ArmaLite AR-15, an AK-47, an AAC Honey Badger, or an AAC-ACR, you have an assault-style weapon.
Chill Out says
5 or 20 plus years ago in the not so distant past we didn’t have the mass casualties we hear about these days and the rate in which they are occurring. As a result of frequent gun related tragedies mental health is now the raging hot topic and the new cash cow. Politicians run campaigns on this and use it to court votes by way of promising more mental health initiatives rather than taking on the gun lobby and risk sinking their campaigns. I’m all for funding mental health when it’s allocated properly but a ton of money is now available for unchecked contractors who are hired to “prevent” threats or “neutralize” them before violent crimes occur. It’s all in line with the initiatives of the DHS, post knee jerk reaction to 9/11. They’ve allowed a very competitive field to evolve. Whoever can prove they have the next crystal ball and are benefiting society by magically peering into the future and preventing crimes before they happen are the businesses that look good on paper and get the job. Imagine your business was a security contractor and your ability to put food on the table for your family and buy that big boat depended on coming up with creative ways to detect the next active shooter in order to remain competitive in your chosen profession. In order to justify the contracts they simply have to create lists of potential bad guys and show progress. To create a list, they either have names of individuals who have previously exhibited violent threats or proactively go out and find people in the name of “security analysis” and look for “triggers” of anger. How do they find what “triggers” people? By finding law abiding citizens and using various tactics that would trigger even the most mild mannered individuals. That could mean you, your grumpy uncle or maybe a loved one who simply was in a bad mood. Many of the seemingly endless security contractor websites are made up of teams of mostly retired military, government and Law Enforcement. This is no secret considering it seems to be a required selling point. Some websites even display images of staff dressed in tactical gear eluding to the promise of neutralizing the next active shooter. But what happens when the business dries up or statistically there just aren’t enough active shooters to go around? Or what happens when these private security teams made up of “heroes” are slanted in their individual beliefs and harboring extremist ideologies themselves? Who would they seek out and place on potential bad guy lists at that point? You get the idea.
How many mass shooters these days are leaving notes claiming they are being followed? From what I read in the news, quite a few. Obviously anyone who commits a mass shooting is a heartless individual with no regard for human life but what drove them to that point and why is there so many more active shooters now as opposed to the near distant past? It’s the million dollar question or the elephant in the room that shouldn’t be ignored and looking at it solely as an individual mental heath issue is not doing the better good of humanity any favors. There is no justification for violence beyond self defense but with that said, imagine the horror of leaving your home and being watched by a team of individuals in plain clothes and not understanding what is going on or being a kid at school being watched more than his or her peers because a “threat assessment team” labeled them a potential problem child. Sorry, but there is no way off that list especially in small towns where people talk and information is spread. Reputations are created and a negative perception under the weight of today’s “mental wellness” craze can last a lifetime without a chance of being able to prove oneself is just another human being. Even with modern (flawed) predictive analysis and intentional stressors that are in practice today, most people subjected to that wouldn’t be triggered into a full blow tragedy yet the stress from living under a microscope could negatively effect their lives in other ways that would run contrary to the entire point of crime prevention or mental wellness in the first place. Maybe they instead render an individual less likely to be successful or a productive member of society as a result of turning a human being with god given human emotions into the equivalent of a stressed out lab rat. Regardless of how the resulting stress of being surveilled or “triggered” might manifest in a persons life, it’s apparently the price some of these security contractors are taking in order to produce a human commodity for their business model. Additionally, I would not be surprised if it occurs beyond the private sector.
Currently I don’t see or read about anyone in the business of private security, government, or healthcare accepting the harsh reality that they may have played a part in the “sensitization” of another human being. My guess is it’s simply unimaginable to look in the mirror and admit some responsibility. The over-policing and for-profit practices should be scrutinized and militant security contractors, religious groups and anyone without a degree in the mental health field should have zero involvement in assessing mental health conditions or weaponizing magic crystal balls. Let people fart in public, let little Johny play in a punk band without judgement, let Uncle Jimmy flip someone the bird if he wants to without the fear of a “predictive” threat assessment job. The freedom and the ability to express oneself is a healthy part of being human as long as it’s in the framework of the law. The differences in attitudes and lifestyles are what makes us not only unique as human beings but American.