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'A silent reckoning': Stanford research illustrates mental health cost of school shootings for youth survivors

As gun violence increases at schools, scholars call for more research into surviving students

New Stanford University-led research has documented a "silent" cost of gun violence at American schools: a significant increase in antidepressant prescriptions for students who were exposed to fatal campus shootings.

The study, the largest to date on the effects of school shootings on youth mental health, found that the average rate of antidepressant use among students under age 20 increased by 21% in the communities nearby where fatal shootings occurred. The increase persisted three years after the shootings, according to the study.

"There are articles that suggest school shootings are the new norm — they're happening so frequently that we're getting desensitized to them — and that maybe for the people who survive, they just go back to normal life because this is just life in America. But what our study shows is that does not appear to be the case," said Maya Rossin-Slater, a faculty fellow at the Stanford Institute for Economic Policy Research (SIEPR). "There are real consequences on an important marker of mental health."

The study, published this month by the National Bureau of Economic Research, was co-authored by Rossin-Slater, an assistant professor of health policy in the Stanford School of Medicine; Molly Schnell, a former postdoctoral fellow at SIEPR who is now an assistant professor at Northwestern University; Hannes Schwandt, an assistant professor at Northwestern and former visiting fellow at SIEPR; Sam Trejo, a Stanford doctoral candidate in economics and education; and Lindsey Uniat, a former predoctoral research fellow at SIEPR and now a doctoral student at Yale University.

The study analyzed 44 shootings at schools in 10 states across the country between January 2008 and April 2013. Using a database of U.S. retail pharmacy prescriptions and the addresses of medical providers who prescribed each drug, they compared the antidepressant prescription rates of providers practicing within a 5-mile radius of a school shooting to those 10 to 15 miles away, looking at the two years before and two to three years after a shooting.

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Of the 44 shootings, 15 involved at least one death. The researchers found that youth antidepressant use went up only in the fatal shootings, not the non-fatal ones. Adults did not appear to be significantly impacted, the study found. They also found no evidence that mental health conditions that were undiagnosed before the shootings caused the rise in youth antidepressant use.

They also found that the rise in antidepressant prescriptions was smaller in communities with more mental health providers who focused on behavioral rather than pharmacological treatment, such as psychologists and social workers.

The study acknowledges several "shortcomings" in the data analysis, including that the researchers looked only at a number of prescriptions rather than specifics around the medications and that they did not have information on the number of patients seen by each provider.

"While sizable, the increases in antidepressant use that we document are unlikely to capture the full mental health consequences of these events: if school shootings increase the use of non-pharmacological treatment, the use of pharmacological treatment with medications other than antidepressants, or the prevalence of untreated mental illness, then the true effects of school shootings on youth mental health will be even larger," the study reads.

By December 2019, at least 245 primary and secondary schools in the U.S. had experienced a shooting, leaving 146 dead and 310 injured.

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Understanding the full impact of school-based gun violence, not only on the victims and their families but also the survivors, is critical as policymakers and school administrators continue to grapple with school shootings, the researchers wrote. They find themselves among other scholars who have called for more research on a still "understudied" population.

"When we think about the cost of school shootings, they're often quantified in terms of the cost to the individuals who die or are injured, and their families," Rossin-Slater said. "Those costs are unfathomable and undeniable. But the reality is that there are many more students exposed to school shootings who survive. And the broad implication is to think about the cost not just to the direct victims but to those who are indirectly affected."

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'A silent reckoning': Stanford research illustrates mental health cost of school shootings for youth survivors

As gun violence increases at schools, scholars call for more research into surviving students

by Elena Kadvany / Palo Alto Weekly

Uploaded: Thu, Dec 26, 2019, 9:32 am

New Stanford University-led research has documented a "silent" cost of gun violence at American schools: a significant increase in antidepressant prescriptions for students who were exposed to fatal campus shootings.

The study, the largest to date on the effects of school shootings on youth mental health, found that the average rate of antidepressant use among students under age 20 increased by 21% in the communities nearby where fatal shootings occurred. The increase persisted three years after the shootings, according to the study.

"There are articles that suggest school shootings are the new norm — they're happening so frequently that we're getting desensitized to them — and that maybe for the people who survive, they just go back to normal life because this is just life in America. But what our study shows is that does not appear to be the case," said Maya Rossin-Slater, a faculty fellow at the Stanford Institute for Economic Policy Research (SIEPR). "There are real consequences on an important marker of mental health."

The study, published this month by the National Bureau of Economic Research, was co-authored by Rossin-Slater, an assistant professor of health policy in the Stanford School of Medicine; Molly Schnell, a former postdoctoral fellow at SIEPR who is now an assistant professor at Northwestern University; Hannes Schwandt, an assistant professor at Northwestern and former visiting fellow at SIEPR; Sam Trejo, a Stanford doctoral candidate in economics and education; and Lindsey Uniat, a former predoctoral research fellow at SIEPR and now a doctoral student at Yale University.

The study analyzed 44 shootings at schools in 10 states across the country between January 2008 and April 2013. Using a database of U.S. retail pharmacy prescriptions and the addresses of medical providers who prescribed each drug, they compared the antidepressant prescription rates of providers practicing within a 5-mile radius of a school shooting to those 10 to 15 miles away, looking at the two years before and two to three years after a shooting.

Of the 44 shootings, 15 involved at least one death. The researchers found that youth antidepressant use went up only in the fatal shootings, not the non-fatal ones. Adults did not appear to be significantly impacted, the study found. They also found no evidence that mental health conditions that were undiagnosed before the shootings caused the rise in youth antidepressant use.

They also found that the rise in antidepressant prescriptions was smaller in communities with more mental health providers who focused on behavioral rather than pharmacological treatment, such as psychologists and social workers.

The study acknowledges several "shortcomings" in the data analysis, including that the researchers looked only at a number of prescriptions rather than specifics around the medications and that they did not have information on the number of patients seen by each provider.

"While sizable, the increases in antidepressant use that we document are unlikely to capture the full mental health consequences of these events: if school shootings increase the use of non-pharmacological treatment, the use of pharmacological treatment with medications other than antidepressants, or the prevalence of untreated mental illness, then the true effects of school shootings on youth mental health will be even larger," the study reads.

By December 2019, at least 245 primary and secondary schools in the U.S. had experienced a shooting, leaving 146 dead and 310 injured.

Understanding the full impact of school-based gun violence, not only on the victims and their families but also the survivors, is critical as policymakers and school administrators continue to grapple with school shootings, the researchers wrote. They find themselves among other scholars who have called for more research on a still "understudied" population.

"When we think about the cost of school shootings, they're often quantified in terms of the cost to the individuals who die or are injured, and their families," Rossin-Slater said. "Those costs are unfathomable and undeniable. But the reality is that there are many more students exposed to school shootings who survive. And the broad implication is to think about the cost not just to the direct victims but to those who are indirectly affected."

Comments

Independent
Esther Clark Park
on Dec 26, 2019 at 10:27 am
Independent, Esther Clark Park
on Dec 26, 2019 at 10:27 am

Interesting - what about the mental health cost of being sexually assaulted at school and your school administrators not making sure you feel safe at school, or helping you continue to access your education? Wouldn't that be interesting to find out?


Safety First
Another Palo Alto neighborhood
on Dec 26, 2019 at 7:46 pm
Safety First, Another Palo Alto neighborhood
on Dec 26, 2019 at 7:46 pm

Given some of the scares that have happened locally over the years, I think attention to safety of all kinds is important.

It makes me sad when the headline-grabbing things take up everyone's time and resources, when something as straightforward to address as asthma languishes.

Over 4,000 people a year die of asthma in our nation, and while it's actually more deadly in adults than young people, the number of children who die every year is still greater by far than in school shootings. Asthma, serious allergy, and air-quality health issues (for all students) are a significant public health problem nationally, including in wealthy districts like ours.

I'm not suggesting it's an either-or, but rather, that we need leadership with a more proactive stance on safety.


Safety First
Another Palo Alto neighborhood
on Dec 26, 2019 at 7:53 pm
Safety First, Another Palo Alto neighborhood
on Dec 26, 2019 at 7:53 pm

Re the above -- it needs to be said that school environments are a significant reason for asthma development and attacks, despite well-researched, low-cost, evidence-based steps that can reduce them -- which our district overtly ignores.

Illness-related absenteeism is directly related to increased stress and depression in districts like ours, too, and the same air quality factors are known to be causative factors. Again, there are evidence-based steps to substantially reduce such problems -- we have even been promised in our facilities bonds -- that have not been implemented or taken seriously.

It would be nice if we weren't just following the headlines but also looking at safety and health holistically. The state of Minnesota passed a funding bill specifically for health and safety, and this in turn gave local districts a much healthier attitude toward all health and safety improvements. Though our district proves you can have all the funding in the world and it doesn't make a difference if administrators are willfully ignorant about a safety issue.


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