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."