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
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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