Prevalence and risk factors of depression in U.S. adults post mass shootings: evidence from population-based surveys of multiple communities.

OBJECTIVES: Mass violence incidents (MVIs) involving firearms, commonly referred to as "mass shootings" have become increasingly frequent in the United States. These shootings often result in immediate casualties and have far-reaching psychological impacts on survivors, witnesses, and the broader community. This study aimed to assess the prevalence and risk factors of depression within affected communities. STUDY DESIGN: Population-based cross-sectional study. METHODS: Data were collected from six communities affected by MVIs involving firearms that occurred between 2015 and 2020. Participants were randomly selected through address-based sampling, and depression was assessed using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic-level major depressive episode (MDE). RESULTS: Overall, the MDE prevalence was 17·2% since the MVI, 15·4% in the past year, and 8·2% in the past month. Significant risk factors for MDE since MVIs include high exposure to the incident (adjusted relative risk [aRR] = 1·32, 95% confidence interval [CI]: 19-1·60), being aged 18-29 years (aRR = 2·52, 95% CI: 1·61-3·95), being a woman (aRR = 1·58, 95% CI: 1·27-1·96), having low social support (aRR = 1·80, 95% CI: 1·46-2·22), and experiencing past sexual or physical trauma (aRR = 2·20, 1·52-3·19). CONCLUSION: Our study reveals a high burden of depression within communities affected by MVIs involving firearm use. Persons with high exposure to the MVIs and certain demographic groups had greater risks for MDE. These findings highlight the long-term mental health burden in communities affected by MVIs and underscore the necessity of providing mental health services in its aftermath.

Mass shootings, firearm injuries, and mental health.

INTRODUCTION: The correlation between mass shootings, firearm injuries, and mental health is an ongoing polarized debate within the U.S., making it essential to develop public policy on mental illness and firearm injuries exacerbated by a significant increase in firearm sales in March 2020. Although many mass shooters are labeled "mentally ill," mental illness is only present in a small minority of cases. Most mentally ill people are never violent but are more likely to be the victims of violence. Easy access to firearms and a triggering event deriving from social and economic inequalities are primary causes of mass shootings and growing online radicalization. Radicalization can easily lead to fatal firearm injuries, particularly for individuals with diagnosed or undiagnosed mental illness. RECOMMENDATIONS: Proposed solutions include permits for firearms purchase, including a 25-year-old age limit, universal background checks, and banning large-capacity magazines. Additionally, a speedy and effective law enforcement response is the sole factor and the most reliable way to stop a mass shooting once it has started. The research identified several other recommendations, including expanding Medicare and mental health care access, expanding school safety and law enforcement training, and promoting public education about mental health and firearm safety.

"This is a political movement, friend": Why "incels" support violence.

How do members of extremist groups think about violence conducted by individual members on the group's behalf? We examine the link between extremism-motivated violence and extremist groups through a case study of misogynist incels, a primarily online community of men who lament their lack of sexual success with women. To learn how misogynist incels talk about mass violence committed by members of their group, we conduct a qualitative content analysis of 3,658 comments relating to the 2018 Toronto van attack, in which self-declared incel Alek Minassian drove a van into pedestrians, killing 10 and injuring 16. We find overwhelming support among self-proclaimed incels for the attack and violence more generally. Incels viewed mass violence as instrumental, serving the following four main purposes: garnering increased attention, exacting revenge, reinforcing masculinity, and generating political change. Our findings indicate the need to examine misogynist incels as a potential terrorist group and male supremacism as a basis for terrorism.

Awareness and use of support services following mass violence incidents.

Mass violence incidents (MVIs) result in significant psychological distress for survivors and the broader community. Support services (mental health services, support groups, religious support) can buffer negative effects of MVIs and facilitate recovery. However, the extent to which community members are aware of and use support services post-MVIs is unknown. A probability sample of 5991 adults (Meanage = 45.6, SD = 17.6), mostly female (53%) and White (71%), were recruited from six communities that had experienced an MVI. Participants answered questions on their awareness and use of support services after the MVI and completed measures assessing predisposing, enabling, and need factors that may influence service use. Approximately 20% of participants reported they were aware of mental health services, 20% reported awareness of support groups, and 16% reported awareness of religious support. Younger participants with higher income (predisposing factors), high social support (enabling factor), and direct MVI exposure and psychological distress (need factors) were more likely to report awareness of support services. Of those aware of services, approximately 21% reported using support services. Those with direct MVI exposure and psychological distress were more likely to use each type of service. Otherwise, use of mental health services, support groups, and religious support varied across predisposing factors (race, age, income). Overall, findings suggest there is limited awareness of support services post-MVI, despite the well-documented mental health burden after these incidents. This suggests the need for improved communication about available services after MVIs.

Gun-free zones and active shootings in the United States: a matched case-control study.

Background: Most Americans believe that gun-free zones make locations more vulnerable to violent crimes, particularly active shootings. However, there is no empirical evidence regarding the impact of gun-free zones on protecting locations from violence. The objective of this study was to estimate the association between gun-free zones and active shootings. Methods: We used a pair-matched case-control study where cases were all US establishments where active shootings occurred between 2014 and 2020, and controls were randomly selected US establishments where active shootings could have but did not occur, pair-matched by establishment type, year, and county. Gun-free status of included establishments was determined via local laws, company policy, news reporting, Google Maps and posted signage, and calling establishments. Findings: Of 150 active shooting cases, 72 (48.0%) were determined to have occurred in a gun-free zone. Of 150 controls where no active shooting occurred, 92 (61.3%) were determined to be gun-free. After accounting for matched pairs, the conditional odds of an active shooting in gun-free establishments were 0.38 times those in non-gun-free establishments, with a 95% confidence interval of 0.19-0.73 (p-value = 0.0038). Several robustness analyses affirmed these findings. Interpretation: It is unlikely that gun-free zones attract active shooters; gun-free zones may be protective against active shootings. This study challenges the proposition of repealing gun-free zones based on safety concerns. Funding: This work was funded in part by the National Collaborative on Gun Violence Research and the Arnold Foundation.

An evaluation of completed and averted school shootings.

Introduction: For over two decades school shootings have become a significant concern, especially in the United States. Following a rampage school shooting, extensive resources are devoted to gathering all of the information surrounding the event. To date, few studies have compared completed to averted, or near-miss, school shootings. This study utilized the largest known sample of cases based in the United States in an effort to identify potential targets for prevention. Method: Data were derived from the Averted School Violence database of incidents occurring between 1999 and 2020. Statistical analyses were conducted to determine how age, co-conspirator involvement, engagement in leakage warning behavior, and motives - in isolation and in combination - varied between groups. Results: In insolation, age, co-conspirator involvement, engagement in leakage warning behaviors, and motives were significantly different between groups. However, when these variables were combined into a logistic regression, co-conspirator involvement, engagement in leakage warning behaviors, and motives involving suicidal intent emerged as statistically significant predictors of group membership. Age no longer differentiated the two types of events. Conclusion: This study demonstrates that regardless of suspect age, threats of school violence must be taken seriously and investigated fully. Further, students reporting their peers' engagement in shooting-related behaviors (e.g., bringing a gun to school, mapping school, etc.) was one of the most significant predictors that a plot will be thwarted. While perpetrators who planned with others had increased odds of their plot being identified, those acting alone still demonstrated leakage behaviors. If individuals in the school environment are educated regarding warning behaviors, lone perpetrators can still be identified and reported to authorities. The perpetrator's emotional distress, in particular depressive or suicidal thoughts were also a significant predictor of a completed school shooting. Future research efforts should focus on the development and evaluation of peer training programs to assist in the detection of school shooting warning behaviors.

Estimating the Global Prevalence of Mass Public Shootings.

Previous studies have yielded widely divergent conclusions about the percentage of all mass public shootings globally that take place in the US, ranging from a low of 3% to a high of 36%. Because of documented underreporting of lower-severity attacks involving fewer than 10 victim fatalities in US cases in these studies, it is reasonable to assume that this underreporting issue also applies to their measurement of mass public shootings outside the US. To estimate the total number of mass public shootings worldwide, we use multiple assumptions and modeling approaches, including a hierarchical Bayesian model. Our estimates show the US accounted for anywhere between 16% and 26% of the world's mass public shootings during the 1976 to 2012 period. These estimates suggest the US share of the total is between four and six times higher than its 4% share of the world's population.

Complicity at a distance: commemorating problematic involvement in perpetration in contemporary Central and Eastern European literatures.

Background: In the twenty-first century, literatures from Central and Eastern Europe are marked by a boom of documentary fiction portraying complicity Nazi perpetration, Soviet terror, or other instances of 20th century mass violence and totalitarianism. Since understanding the past serves requirements of the present, the boom prompts the question: Why the interest in past complicities now? My hypothesis is that the texts address convergences between involvements in past acts of mass violence and current forms of participation in wrongdoings in neoliberalism. While these issues differ profoundly, they are related: structurally, both present the challenge of forming a nuanced notion of participation. Historically, they are related since justifications of past involvements have established the terminology, narratives, and heuristics in which terror, repression, and mass violence are subsequently discussed, thus forming the frame for negotiating current problematic involvements. Method: Critical discourse analysis is used to scrutinize the legal concept of complicity and combined it with close readings of passages from four literary texts to outline how attention to reciprocity in language can enhance our understanding of problematic involvement. Results: Literary portrayals of historical complicity are ambivalent; they can help to find models for comprehending issues of the present in cultural memory, but they can also serve to establish distance between present and past to appease the sense that all is not quite well, even after the demise of Nazi and Soviet terror. The article outlines two modes of distancing: a) spacio-temporal distancing of the commemorating point of view in 'the West' from the portrayed violence in 'the East', and b) moral distancing that casts the audience as superior to complicit characters. Conclusion: By pressing for analytic or consoling distance, both strategies of distancing amount to a complicity with the transmission of discourses that justify, excuse, or deny mass violence and totalitarian terror.

Disaster Behavioral Health Research Involving Military Facilities and Populations after Mass Violence: Insights from the 2013 Washington Navy Yard Shooting.

Research on disaster behavioral health presents significant methodological challenges. Challenges are even more complex for research on mass violence events that involve military members, families, and communities, due to the cultural and logistical considerations of working with this population. The current article aims to inform and educate on this specialized area of research, by presenting a case study on the experience of designing and conducting disaster behavioral health research after a mass violence event in a military setting: the 2013 mass shooting at the Washington Navy Yard, in Washington, D.C. Using the case example, the authors explore methodological challenges and lessons learned from conducting research in this context, and provide guidance for future researchers.

Mass violence planned as ultimate leisure experience? Four diverse cases.

As part of a larger project on contextual factors of mass murder, this paper identifies and discusses four cases that quite clearly suggest, based on the content of perpetrators' personal communications and/or reports from those who knew them, that the perpetrators purposely planned and experienced their attacks as desired leisure experience. Leisure science, while consistent with the multidisciplinary roots of forensic behavioral science, has not yet been applied to better understand cases of mass violence. Together with traditional forensic behavioral science approaches, leisure theory may produce insights in cases of mass violence that are uncoerced, largely intrinsically motivated, and committed for personal enjoyment.

Teaching forensic science under conditions of humanitarian crisis: Toward a critically-informed experiential approach.

This article examines the use of critical pedagogy practices for teaching students the forensic science of migrant death and identification in the US borderland. Critical pedagogy, a philosophy of education that centers issues of social justice and human rights in the classroom, insists that teaching is inherently political, and challenges students to recognize and address power structures which perpetuate an unjust status quo. Drawing examples from qualitative data gathered during two field seasons in South Texas with the University of Indianapolis Forensic Science Team and narrative analysis of students team members' daily reflections about their work within structures designed to address the US border crisis, this article illuminates challenges and possibilities for teaching in learning in a context of mass violence.

A systematic review on the relationship between mental health, radicalization and mass violence.

Radicalization is a process, by which individuals adopt extreme political, social and religious ideation that leads to mass violence acts. It has been hypothesized that mental health characteristics might be associated with a risk of radicalization. However, a qualitative synthesis of studies investigating the relationship between mental health and radicalization has not been performed so far. Therefore, we aimed to perform a systematic review of studies examining the association between mental health characteristics and the risk of radicalization. Two reviewers performed an independent search of online databases from their inception until 8th April 2018 and 12 publications met eligibility criteria. There were several methodological limitations across the majority of eligible publications, including doubtful sample representativeness, use of diagnostic procedures without personal assessment of mental health status or lack of standardized tools for assessment of mental health. Representative cross-sectional studies revealed that depressive symptoms might be associated with radicalization proneness. However, it remains unknown whether depressive symptoms are associated with resilience or vulnerability to radicalization. Another finding from our systematic review is that several personality traits might predispose to develop extreme ideation. Finally, there is some evidence that lone-actors might represent a specific subgroup of subjects with extreme beliefs which can be characterized by high prevalence of psychotic and/or mood disorders. In conclusion, this systematic review indicates that caution should be taken on how the association between 'mental health' and 'radicalization' is being claimed, because of limited evidence so far, and a number of methodological limitations of studies addressing this issue.

Special Considerations for Mass Violence Events in Senior Living Facilities: A Case Report on the Pinelake Health and Rehab Center Shooting.

The 2009 Pinelake Health and Rehab Center shooting in Carthage, North Carolina, presents a unique case study for examining the specific considerations for mass violence events in senior living facilities. A variety of factors, including reduced sensory perception, reduced mobility, and cognitive decline, may increase the vulnerability of the populations of senior living facilities during mass violence events. Management of response aspects such as evacuation, relocation, and reunification also require special consideration in the context of mass violence at senior living facilities. Better awareness of these vulnerabilities and response considerations can assist facility administrators and emergency managers when preparing for potential mass violence events at senior living facilities. (Disaster Med Public Health Preparedness. 2017;11:150-152).