Posttraumatic Stress in the Aftermath of Mass Shootings


Year

Location

Context

Perpetrator

Fatalities

Injuries

Peer-reviewed articles

Samples

1984

Los Angeles, CA

Elementary school

Adult African American male

3

14

2

1

1984

San Ysidro, CA

Fast-food restaurant

Adult white male

21

15

1

1

1987

Russellville, AR

Four local businesses

Adult white male

2

4

1

1

1988

Winnetka, IL

Elementary school

Adult white female

2

5

6

3

1991

Killeen, TX

Cafeteria-style restaurant

Adult white male

24

20

5

2

1992

St. Louis, MO

Courthouse

Adult white male

1

5

1

1

1993

San Francisco, CA

Office building

Adult white male

6

14

1

1

1994

Brooklyn, NY

Brooklyn Bridge

Adult Lebanese-born immigrant male

1

3

1

1

2006

Montreal, Quebec, Canada

University (Dawson College)

Adult Indo-Canadian male

2

17

1

1

2007

Tuusula, Finland

High school (Jokela High School)

Adolescent white male

9

19

2

1

2007

Blacksburg, VA

University (Virginia Polytechnic Institute and State University)

Adult South Korean male

33

25

4

2

2008

DeKalb, IL

University (Northern Illinois University)

Adult white male

6

18

7

1

2008

Conway, AR

University (University of Central Arkansas)

Four adult African American males

2

1

1

1

2008

Kauhajoki, Finland

University (Seinäjoki University of Applied Sciences)

Adult white male

11

1

1

1


Table does not include one study that focused on two different events (Vicary & Fraley, 2010)





Posttraumatic Stress Disorder


Table 6.2 denotes the prevalences of PTSD across the studies, as well as the measures and classification systems used to determine them, if this information was available. The lowest PTSD prevalence reported was 3 % among parents of children exposed to an elementary school shooting 6–14 months post incident, determined using conservative diagnostic and statistical manual (DSM)-III-R criteria with the PTSD Reaction Index (PTSD-RI; Schwarz & Kowalski, 1991a) . The highest prevalence reported was 91 % among children in the same study, using liberal (proposed) DSM-IV criteria and the children’s version of the PTSD-RI (Schwarz & Kowalski, 1991b) .


Table 6.2
Summary of the findings from peer-reviewed studies on the psychological effects of mass shooting incidents

































































































































































































































































Author, year

N

Sample

Timing

PTSD assessment: measure; classification system

Prevalence

Predictors

1984: Elementary school in Los Angeles, CA

 (1a) Pynoos et al. (1987)

159

Elementary school students

1 month

PTSD-RI; DSM-III

60.4 %

PTSS, 1 month: proximity to attack, greater acquaintance with the deceased victim

 (1b) Nader, Pynoos, Fairbanks, and Frederick (1990)

100

a

1 month, 14 months

a


PTSS, 14 months: proximity to attack, greater acquaintance with the deceased victim; grief: greater acquaintance with the deceased

1984: Fast-food restaurant in San Ysidro, CA

 (1) Hough et al. (1990)

303

Middle-aged Mexican-American women from the community, but who were not directly involved in the incident

6–9 months

Scale derived for the study, based on the DIS, DSM-III

Post-incident, 12.6 %; past month, 6.8 %

Severe PTSD (significance of trends not tested): widowed, separated or divorced status, older age, no children at home, lower income, unemployment, having friends/relatives involved in event, fair–poor physical health, higher depression. Mild PTSD (significance of trends not tested): middle age, having three or more children at home, middle income, having friends/relatives involved in the event, fair–poor physical health

1987: Four local businesses in Russellville, AR

 (1) North, Smith, McCool, and Shea (1989)

18

Employees at two of the four local businesses who were either at work during the shooting (n = 15) or absent (n = 11)

4–6 weeks

DIS/disaster supplement; DSM-III

5.6 %


1988: Elementary school in Winnetka, IL

 (1a) Schwarz and Kowalski (1991a)

130

Elementary school students (n = 64) and their parents (n = 66)

6–14 months

PTSD-RI; DSM-III-R, liberal moderate and conservative criteria

Children, DSM-III-R: 50 % (liberal), 41 % (moderate), 8 % (conservative); parents, DSM-III-R, proposed: 39 % (liberal), 24 % (moderate), 3 % (conservative)

PTSD, children (predictors of diagnosis based on liberal, moderate, or conservative criteria): perception that he/she would get shot or was in danger during event, increased physical symptoms, increased visits to school nurse, increased or new fears, guilt. PTSD, parents (predictors of diagnosis based on liberal, moderate, or conservative criteria): felt numb, scared, or fearful that the alleged perpetrator was still on the loose

 (1b) Schwarz and Kowalski (1991b)

130

a

6–14 months

PTSD-RI; DSM-III, DSM-III-R (same prevalences as Schwarz & Kowalski, 1991a), proposed DSM-IV: liberal, moderate, and conservative criteria

PTSD, children, DSM-III, proposed DSM-IV: 91 %, 41 % (liberal), 61 %, 41 % (moderate), 16 %, 9 % (conservative); PTSD, parents, DSM-III, proposed DSM-IV: 52 %, 54 % (liberal), 16 %, 24 % (moderate), 4 %, 6 % (conservative)


 (2a) Schwarz and Kowalski (1992a)

24

School personnel

6 months

PTSD-RI; DSM-III


PTSS: personality traits—guilt and resentment, insecurity, psychasthenia

 (2b) Schwarz and Kowalski (1992b)

24

a; subsample completed two waves (n = 13)

6 months, 18 months

a


PTSS, 6 months: loss to follow-up

 (2c) Schwarz, Kowalski, and McNaly (1993)

24

a; subsample completed two waves (n = 12)

6 months, 18 months

a


PTSS, 6 months: enlargement of recall of emotional experiences (hyperarousal), life-threat experiences (hyperarousal), and sensory experiences (avoidance, hyperarousal, total PTSS), lack of diminishment in recall of emotional experiences (intrusion); PTSS, 18 months: enlargement in recall of sensory experiences (hyperarousal)

 (3) Sloan, Rozensky, Kaplan, and Saunders (1994)

140

Emergency responders

6 months

IES intrusion, and avoidance; unspecified


PTSS: five indicators of job stress during the event—exposure to traumatic stimuli, adverse work environment, time pressure, quantitative workload, qualitative workload (intrusion and avoidance)

1991: Cafeteria-style restaurant in Killeen, TX

 (1a) North, Smith, & Spitznagel (1994)

136

Survivors (e.g., restaurant patrons and employees, emergency responders)

1–2 months

DIS, DSM-III-R

28.6 %

PTSD: female gender, pre-incident Major Depression (MD) (among female participants only), any pre-incident psychiatric diagnosis (among female participants only), post-incident MD, any post-incident psychiatric disorder (among female participants only), seeing a doctor or counselor, taking medication

 (1b) North, Smith, and Spitznagel (1997)

124

a

1–2 months, 1 year

a

At 1 year: 17.7 %

PTSD, either/both 1–2 months and 1 year: female gender, any pre-incident psychiatric diagnosis (among female participants only), any other post-incident psychiatric disorder, any other lifetime psychiatric disorder, pre-incident MD, MD at 1–2 months, lifetime MD

 (1c) North, Spitznagel, and Smith (2001)

136

a

1–2 months, 1 year, 3 years

a


PTSD, 1–2 months: lower active outreach and informed pragmatism coping at 1–2 months; PTSD, 1 year: lower informed pragmatism coping at 1–2 months; PTSD, 3 years: lower informed pragmatism coping at 1–2 months

 (1d) North, McCutcheon, Spitznagel, and Smith ( 2002)

116

a

a

a

At 3 years: 18 %

Non-recovery from PTSD, 3 years: functional interference due to symptoms, having seen a mental health professional at 1–2 months

 (2) Sewell (1996)

92

Persons either directly exposed (e.g., restaurant patrons) or indirectly exposed (e.g., relatives of directly exposed)

1 week, 3 months

Module from the PDI; DSM-IV

At 1 week: 38.7 %

PTSD, 1 week: pre-incident PTSD; PTSD non-recovery, 3 months: lower trauma-related construct elaboration

1992: Courthouse in St. Louis, MO

 (1) Johnson, North, and Smith (2002)

80

Employees at courthouse and offices of involved individuals; subsample completed two waves (n = 77)

6–8 weeks, 1 year, 3 years

DIS/disaster supplement; unspecified

At 6–8 weeks: 5 %; at either 6–8 weeks, 1 year, or 3 years: 10 %

PTSS, 6–8 weeks: younger age, being married, lower education, feeling like the incident had caused them a great deal of harm (total PTSS, reexperiencing), reporting that the incident was very upsetting (avoidance), perceived lack of recovery (avoidance), mental health service utilization (reexperiencing, avoidance, and hyperarousal)

1993: Office building in San Francisco, CA

 (1) Classen, Koopman, Hales, and Spiegel (1998)

36

Office employees; subsample completed two waves (n = 32)

1 week, 7–10 months

IES, DTS; DSM-III-R


PTSD, 7–10 months: ASD symptoms (DTS total, IES-R intrusion, IES-R avoidance)

1994: Brooklyn Bridge in Brooklyn, NY

 (1) Trappler and Friedman (1996)

22

Youth who were in the van that was target of shooting (survivors); 11 students, age-matched and from the same community (comparison)

8 weeks

PTSD symptom scale, IES-R, clinical information; DSM-IV

Among survivors: 36.4 %

PTSS: being a survivor (vs. member of comparison group, intrusion and avoidance)

2006: Dawson College (DC) in Montreal, Quebec

 (1) Séguin et al. (2013)

948

DC students and employees

18 months

Measure adapted from the 2002 Canadian Community Health Survey; unspecified

Post-incident incidence rate: 1.8 %


2007: High school in Jokela, Finland

 (1a) Suomalainen, Haravuarti, Berg, Kiviruusu, and Marttunen (2011)

231

Jokela High School students. Unexposed comparison group of students from a different high school in Finland (n = 526)

4 months

IES; unspecified

Among exposed: 19.2 %

PTSD: female gender, exposed (vs. unexposed), severe or extreme exposure (vs. mild to significant exposure), lower perceived support from family and friends

 (1b) Murtonen, Suomalainen, Haravuori, and Marttunen (2012)


Jokela High School students

a

a


PTSD: not perceiving crisis support as helpful

2007: Virginia Tech (VT) in Blacksburg, VA

 (1a) Littleton, Grills-Taquechel, and Axsom (2009)

293

Female VT students

Pre-incident, 2 months, 6 months

PSS-SR; DSM-IV

At 2 months: 30 %; at 6 months: 23 %

PTSS, 2 months: higher resource loss at 2 months post-incident. PTSS, 6 months: higher resource loss at 2 and 6 months

 (1b) Littleton, Axsom, and Grills-Taquechel (2011a)

368

a

Pre-incident, 2 months, 6 months, 1 year

a

At 1 year: 27 %

PTSS, 6 months: PTSS at 2 months, maladaptive coping at 2 months; PTSS, 1 year: PTSS and maladaptive coping at 6 months

 (1c) Littleton, Grills-Taquechel, Axsom, Bye, and Buck (2012)

215

a

Pre-incident, 2 months, 6 months, 1 year

a


PTSD, 1 year: pre-incident sexual victimization, lower benevolence beliefs at 2 months, lower family support at 2 months

 (2a) Hughes et al., 2011

4639

VT students

3–4 months

TSQ; DSM-IV

15.4 %

PTSD: female gender, higher exposure to first incident of attack, inability to contact close friends during incident, death of a close friend, death of a friend of acquaintance

2008: Northern Illinois University (NIU) in Dekalb, IL

 (1a) Stephenson, Valentiner, Kumpula, and Orcutt (2009)

691

Female NIU students

Pre-incident, 2–4 weeks

DEQ; DSM-IV


PTSS, 2–4 weeks: higher anxiety sensitivity (physical and cognitive concerns), higher exposure

 (1b) Fergus, Rabenhorst, Orcutt, and Valentiner (2011)

58

a; subsample of participants with highest and lowest levels of exposure participated in a laboratory experiment

6 weeks

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Oct 28, 2016 | Posted by in CRITICAL CARE | Comments Off on Posttraumatic Stress in the Aftermath of Mass Shootings
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