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School shootings and mental health outcomes: a scoping review

Objective

Recent data indicate a rising frequency of school shootings over the past two decades. Although these events are relatively rare within the broader context of firearm violence, more than 357 000 students have been exposed to firearm violence in primary and secondary schools since 1999. However, the psychological impacts remain poorly understood. This scoping review synthesises existing evidence and highlights gaps for further research.

Methods

A systematic search was conducted across PubMed, PsycINFO, Web of Science and Criminal Justice Abstracts to identify empirical studies on school shootings and mental health outcomes. Inclusion criteria encompassed all publication dates, study designs and populations affected. Key attributes were extracted and analysed from included studies.

Results

Of 2798 studies identified, 84 met inclusion criteria, with 13% being qualitative. Despite covering 19 unique shootings, 40% of the articles focused on Virginia Tech and Northern Illinois University. Most studies were cross-sectional (42%), and students were the primary population studied (80%). Post-traumatic stress disorder (29%) and depression (11%) were the most commonly studied outcomes. Common predictors included age (13%) and trauma history (12%). Higher exposure levels to school shootings, prior trauma and existing mental health conditions were key predictors of adverse mental health outcomes. Social support from family or peers emerged as protective factors.

Conclusion

While findings of this review suggest that there is a substantial impact of school shootings on survivors’ mental health, additional research is needed to encompass impacted communities beyond students, integrate qualitative methods and incorporate longitudinal studies to track mental health outcomes over time.

Renewing Assault Weapons Ban Could Have Prevented Mass Shootings

Between 1994 and 2004, the federal assault weapons ban prohibited the sale and manufacture of certain military-style semiautomatic weapons and high-capacity magazines in the US. A study in JMIR Public Health and Surveillance now suggests that the ban not only prevented an estimated 5 public mass shootings during those 10 years, but would have averted many more between 2005 and 2022 if it had stayed in place instead of being allowed to expire.

What We Know About Foiled and Failed Mass School Shootings

Tragic gun violence incidents in schools—including Columbine High (1999), Sandy Hook Elementary (2012), Marjory Stoneman Douglas High (2018), and Robb Elementary (2022)—have made mass school shootings one of the greatest social and political concerns of the 21st century. Although these events are rare relative to other forms of school violence and gun violence at large, their negative impact on the emotional well-being of students, teachers, parents, and society cannot be understated. To address this concern, much academic research has been directed at understanding mass school shootings as a subtype of the public mass shooting phenomenon. Public mass shooting research has largely focused on completed incidents involving four or more victim fatalities. Despite these advancements, current research often excludes relevant cases that are characterized by mass shooting intent—resulting in fewer than four fatalities. In other words, research thus far has largely overlooked foiled and failed mass school shootings: incidents that are planned (foiled) or initiated (failed) but never manifest into an attempted or completed shooting (i.e., involving gunshot casualties).

There are a variety of ways that mass school shootings may be foiled or fail. Some mass school shooting plots are foiled before an offender can progress past the planning and preparation stage into actualized attack initiation. For example, in 2019, a 19-year-old student was planning to carry out a mass shooting at his university. He had been studying previous mass shootings for over a year so he could learn how to complete his attack. He purchased two firearms a week before his intended attack; however, his plot was foiled by fellow students who reported him to campus security after seeing the guns. During a search of his dorm room, police found ammunition and detailed plans (including a timeline) for completing his attack in addition to the firearms. In the end, the other students’ recognition of this potential threat and notification to school officials and police lead to the prevention of this mass school shooting attack.

In other situations, initiated mass school shootings may fail due to the rapid response of potential victims and guardians at the scene. For example, in 2018, a 19-year-old student arrived at his high school with a semiautomatic rifle, intending to commit a mass shooting during graduation rehearsal in the gymnasium. At the entrance of the gymnasium, however, the offender ran into a wrestling coach and opened fire, alerting students, faculty, and the school resource officer (SRO), all of whom responded quickly. Students and faculty engaged in lockdown procedures and the SRO pursued the shooter out of the building. Ultimately, the offender’s intentions failed, as he was the only casualty during the attack after being shot and injured by the SRO. This research brief explores what we know about both foiled and failed mass school shootings—referring to plots and incidents that resulted in zero victim casualties. These thwarted mass shootings—whether foiled or failed—are the ideal outcomes of a planned mass shooting. They are particularly useful for determining effective strategies to prevent incidents or intervene before innocent victims are harmed.

Overview of The American School Shooting Study

Although rare events, school shootings remain a pressing public policy issue in America. Importantly, available data show a modest upward trend in multiple-casualty school shootings. Few crimes are as shocking as the recent mass shooting attack at the Robb Elementary School in Uvalde, Texas, on May 24, 2022, in which 19 students and two teachers were murdered. These high-profile events have led to heated debates about gun control, gun rights, mental health, and privacy rights.

Surveys suggest that Americans today tend to view schools as unsafe, and public fear over school violence has deepened. Indeed, the adverse costs of school shootings go well-beyond the terrible loss of life and grief of the families and communities immediately impacted. The effects reverberate throughout the nation. Not only are teachers and schoolchildren directly exposed, but parents, police, first responders, nurses, surgeons, pastors, counselors, and custodians, to name a few, are also vicariously affected. In the wake of traumatic attacks, schools struggle to cope, and surviving students’ school performance may suffer.

Although research on school shootings has increased recently, much of the literature is inconsistent, primarily due to variations in datasets and school shooting definitions. Most studies employ small nonprobability rather than randomly selected samples of US school shooters or prioritize mass shootings and lethal gun violence. By contrast, the limited quantitative studies tend to be more inclusive by studying fatal and nonfatal gun assaults. Even here, there are disparities in inclusion criteria, as some studies examine school-associated violence that transpires both on and off campus property.

While extensive data have documented school crimes more broadly, there is far less information on school shootings. For instance, the Department of Justice’s National Crime Victimization Survey’s (NCVS) School Crime Supplement provides homicide numbers but exclude precise statistics on school shootings. This lack of consistent, national-level data has hindered the development of systematic research, limiting our capacity to create and implement public policy that is directed toward reducing school shootings and is rooted in rigorous social science. Accordingly, we created a national-level database using open-source information to examine school shootings in the United States and provide stakeholders with the information they need to develop meaningful policies.

Schools and Gun Violence: What Do We Know About the Prevalence and Effects?

As the 2021-22 academic year came to a close, the United States was rocked by the news of another school mass shooting, this time at Robb Elementary School in Uvalde, Texas. Nineteen fourth-grade students and two of their teachers were killed when an 18-year-old former student entered the school through an unlocked door, made his way to his former fourth-grade classroom, and opened fire during a 77-minute rampage. Seventeen others were injured in the attack.

The tragedy in Uvalde conjured up memories of the shooting at Sandy Hook Elementary School in Newtown, Connecticut. Nearly 10 years earlier, 20 first-grade students and six of their educators, including the school’s principal, were killed after a 20-year-old shot his way into the building. Two others were injured during the six-minute attack.

In the aftermath of the shooting in Uvalde, administrators and policymakers struggled to implement policies and procedures that would prevent a similar attack in their schools or minimize the loss of life if one did occur. These included, but were not limited to, increases in the numbers and presence of school resource officers, authorization to arm teachers, and even supplying schools with ballistics shields, despite the lack of evidence to suggest these measures would achieve their intended goals in situations like Uvalde.

Amid growing fear and apprehension about another Sandy Hook or Uvalde happening and the proliferation of purported school safety measures, two questions occupy the minds of many: Are schools a safe place for children to be? And what actually works to make them safer?

As policymakers, school administrators, and other vested stakeholders continue to grapple with these questions, it is critical to plan for every instance of firearm violence on school grounds. In doing so, it is important to implement strategies that are based in research where evidence supports their efficacy in achieving prevention and/or harm mitigation. At the same time, it is imperative to consider not only the short-term effects but also longer-term impacts of both gun violence and the associated strategies for prevention and response on students. Researchers will be key in cultivating this evidence and must continue to work closely with policymakers, school administrators, and the public to protect children from the harmful effects of gun violence.

K-12 School Shootings in Context: New Findings from The American School Shooting Study (TASSS)

Although statistically rare, fatal and nonfatal shootings in the United States at elementary, middle, and secondary schools remain important crime problems with significant public policy implications. Indeed, the impact of such violence exceeds the devastating fatalities and immense sorrow that survivors, families, and communities experience. Even one gunshot fired at a school can subject numerous individuals to the traumas of gun violence. Recent polls indicate that school shootings can also sway broader public views on crime, including attitudes toward violence reduction. As a result, school shootings have become a focal point of US politics, sparking crucial debates on the most effective strategies for preventing and responding to gun violence, both inside and outside K-12 schools.

While there has been a recent surge in school firearm violence studies, discrepancies persist in the research due to variations in definitions and datasets. Initially, our comprehension of school shootings originated from narrow studies focused on small samples of highly publicized mass killings where attackers indiscriminately fired upon multiple victims in their schools. By contrast, recent progress in quantitative studies and the establishment of extensive databases have provided alternative perspectives on the characteristics of school shootings more broadly. Within this domain, however, there are disparities in inclusion criteria, as some studies encompass school-related violence occurring both within and outside of school premises, leading to an inconsistent research base.

We created The American School Shooting Study (TASSS) in 2016 to address these incongruencies in the existing research. Previously, we reported findings from TASSS on the patterns and nature of US school-associated gun violence between 1990 and 2016, defined as the firing of a gun anywhere on K-12 school property, resulting in one or more gunshot injuries or fatalities, irrespective of the time of day or season. Our findings suggested critical nuances in school firearm violence regarding the situations they encompass, the characteristics of the perpetrator and victims, and the location of the incident on school grounds. For instance, this violence encompassed various scenarios, including interpersonal assaults, self-harm incidents where the shooter was the only victim, accidental gun discharges, and legally justified shootings. At the same time, mass casualty shootings (defined as four or more fatalities) were exceptionally infrequent, representing around 5 percent of all interpersonal assaults at schools. The other 95 percent of these shootings involved one or two victims, most of which were nonfatal incidents.

Even among the fatal and nonfatal interpersonal assaults involving known perpetrators, we found that gun violence at American schools displayed considerable variability. Although adults were responsible for almost 29 percent of such incidents, a significant majority (71 percent) involved young individuals aged between 6 and 19. Interestingly, many school shootings were carried out by individuals not enrolled in the schools, often occurring outside school buildings and outside school hours. These incidents were largely fueled by nonacademic concerns, such as personal disagreements or gang-related activities. Therefore, contrary to popular belief, multiple-victim attacks by troubled students account for just a minority of total cases. As such, it is beneficial for policymakers to differentiate between incidents of school shootings that take place within the school during school hours and those that occur outside the school buildings when the school is not in operation. Depending on the specific nature of each incident, tailored intervention strategies are essential. Just as responses to premeditated mass shootings differ from spontaneous assaults, there will be important qualitative differences here between cases that affect how officials prepare, prevent, and respond to school shootings.

In this brief, we present new insights from TASSS, diving deeper into the database’s potential to examine the locations, timing, and student involvement of youth-perpetrated gun violence. In the end, our goal is to equip stakeholders with the essential data they need to formulate effective policies that mitigate school violence.