psychological research on gun violence

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Mental Illness, Mass Shootings, and the Future of Psychiatric Research into American Gun Violence

Affiliation.

1 From the Department of Medicine, Health, and Society (Drs. Metzl and McKay), Vanderbilt University; Joint Program in Psychology and Women's and Gender Studies, University of Michigan (Ms. Piemonte).
PMID: 33417376
PMCID: PMC7803479
DOI: 10.1097/HRP.0000000000000280

This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated "lone wolf" individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time-and to prevent serious acts of violence more generally-will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.

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Published: 08 December 2021

Impacts of school shooter drills on the psychological well-being of American K-12 school communities: a social media study

Mai ElSherief 1 na1 ,
Koustuv Saha ORCID: orcid.org/0000-0002-8872-2934 2 na1 ,
Pranshu Gupta 3 ,
Shrija Mishra 3 ,
Jordyn Seybolt 3 ,
Jiajia Xie 3 ,
Megan O’Toole 4 ,
Sarah Burd-Sharps ORCID: orcid.org/0000-0002-9796-8610 4 &
Munmun De Choudhury ORCID: orcid.org/0000-0002-8939-264X 3

Humanities and Social Sciences Communications volume 8 , Article number: 315 ( 2021 ) Cite this article

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Language and linguistics

The toll from gun violence in American K-12 schools has escalated over the past 20 years. School administrators face pressure to prepare for possible active shootings, and often do so through drills, which can range from general lockdowns to simulations, involving masked “shooters” and simulated gunfire, and many variations in between. However, the broad and lasting impact of these drills on the well-being of school communities is poorly understood. To that end, this article applies machine learning and interrupted time series analysis to 54 million social media posts, both pre- and post-drills in 114 schools spanning 33 states. Drill dates and locations were identified via a survey, then posts were captured by geo-location, school social media following, and/or school social media group membership. Results indicate that anxiety, stress, and depression increased by 39–42% following the drills, but this was accompanied by increases in civic engagement (10–106%). This research, paired with the lack of strong evidence that drills save lives, suggests that proactive school safety strategies may be both more effective, and less detrimental to mental health, than drills.

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Introduction.

As firearm fatalities surge as a major public health problem in the United States (Grinshteyn and Hemenway, 2019 ), the country has also been experiencing more shootings in K-12 school premises than nearly all other nations (Grabow and Rose, 2018 ). Although school shootings are still rare compared to daily gun violence (Nekvasil et al., 2015 )—a cause that leads to about 103 daily gun deaths in the U.S. (Ludwig, 2017 ; Resnick et al., 2017 )—current statistics show that school shootings are happening more frequently (Bonanno and Levenson, 2014 ; Everytown, 2019 ). Each of these incidents is alarming to both local communities and the nation as a whole (Rygg, 2015 ), particularly because schools are intended to be safe spaces for children to grow and learn (Williamson, 2019 ).

Likewise, recent years have seen an increase in calls for improved school safety and preparedness, particularly related to active-shooter incidents (Madfis, 2016 ; Schildkraut et al., 2020 ; Terrades and Khan, 2018 ). According to the U.S. Education Department’s National Center for Education Statistics, one of the notable responses to make schools safer has been drill implementation (Diliberti et al., 2017 ). Since the 1999 Columbine shooting, school shooter drills have proliferated in America’s school systems at an exponential rate. By the 2015–16 school year—3 years after the Sandy Hook shooting—95 percent of public schools drilled students on lockdown procedures, with at least 40 states requiring these drills today (Musu-Gillette et al., 2018 ). However, limited guidance exists on what these drills should look like, or their impacts in light of these many variations. One example of this can be seen in the fact that these drills are often referred to as both “lockdown drills,” and “active-shooter drills.” While researchers, school safety and mental health organizations, and drill programs (e.g., A.L.I.C.E.) themselves have made strides to standardize these definitions (i.e., lockdown drills prepare students and teachers for general danger, and active-shooter drills specifically address an armed assailant), the general public and school administrators often conflate and/or use the two terms synonymously (see ALICE, 2021 ; NASP and NASRO, 2017 ; Schildkraut and Nickerson, 2020 ). A New York Times headline in 2019 illustrates this lack of clarity on the distinction between these two terms: “How Do You Feel About Active-Shooter Drills in Schools? Nearly every American public school now conducts lockdown drills. Do they make you feel more safe?” Similarly, state statutes on this type of drill are often vague and leave the nature, content, and identification of who participates up to the interpretation of school administrators. As a result, students are required to participate in drills that vary dramatically across America’s schools. Some of these drills require students and school staff to remain in hiding in a designated area and practice specific emergency procedures, such as staying quiet, locking the door, and turning off lights, but can also feature tactics such as fighting back, distracting the shooter, and evacuating. In some instances, the drills are unannounced and some present “masked gunmen” actors, simulated gunfire, and fake blood (Gubiotti, 2015 ).

At the same time, extant research on school shooter drills is mixed and methodologically limited. Ethical limitations and (fortunately) low base rates of active-shooter incidents in schools make it particularly difficult to study lives saved by implementing drills (Jonson et al., 2020 ). In the absence of this, studies have relied primarily on behavioral observations or surveys to assess drill instruction compliance and/or related perceptions and emotions. Some results suggest that drills improve students’ abilities to perform lockdown instructions (e.g., improvements in turning lights off and locking doors), while others do not (e.g., continued difficulties with hiding and remaining silent) (Dickson and Vargo, 2017 ; Schildkraut and Nickerson, 2020 ). Similarly, some suggest that participants report feeling more prepared and less anxious right after completing drills, while others suggest that they feel less safe, more scared, and more concerned that could-be school shooters—given that most are current or former students—now have insight into emergency response strategies (Peterson et al., 2015 ; Peterson and Densley, 2019 ; Schildkraut and Nickerson, 2020 ; Schildkraut et al., 2020 ; Zhe and Nickerson, 2007 ). Notably, all of these studies are conducted in individual schools/districts, each of which implements its own drill protocols, thus limiting generalizability of the results to the many diverse drills implemented across the country today. Further, only two of the aforementioned drills explicitly referenced active shooters—at least within study protocols—suggesting that some of the emotional harms caused may be even more heightened under different conditions.

Also missing from the extant research is an exploration of the long-term mental health impacts of drills. This is a particularly important inquiry, because while not every student will experience an active-shooter incident—nor is the evidence on their effectiveness in these situations clear-cut—at this point, most will experience a drill. For students, schools constitute formative years of their life, when their brains and coping skills are still developing—thereby making them react to stress in varied ways (King and Bracy, 2019 ). Psychologists and health professionals have argued that these tactics can developmentally uninformed (King and Bracy, 2019 ), and in some cases terrorize already anxious students, increase student fear and anxiety about a shooting occurring, and even risk inducing trauma (Jonson et al., 2020 ). School teachers, counselors, and parents may experience similarly adverse effects, especially as they assume responsibility for students’ well-being and post-drill follow-up, feel pressure to comply with drill guidelines, and experience their own, often unattended, adverse emotional reactions (Goodman-Scott and Eckhoff, 2020 ). Parents especially also report feeling stress and anxiety over navigating how to explain school safety threats to their children (Kubicek et al., 2008 ). However, empirical research has not yet assessed whether these impacts sustain over time, or manifest in behaviors and symptoms beyond self-reports.

As a way to close this gap, this article provides empirical evidence on both the long term and widespread mental health impacts of school shooter drills on affected school communities . It does so by applying rigorous, evidence-based machine learning and interrupted time series analysis of mental health-relevant phrases in social media posts made by local school communities both before and after drills, comparing these results with a control group, and further triangulating them through a final set of focus groups. In particular, the findings are based on data that spans 114 K-12 schools and drills, 54 million social media posts, and focus groups of 34 K-12 students, parents, and teachers .

Data and methods

Our approach builds on a growing body of evidence in three complementary research directions. First, the past decade of computational social science research, which has repeatedly showcased how social media postings can provide rich insights about many real-world happenings, whether political, economic, social, or about health and well-being (Golder and Macy, 2011 ; Lazer et al., 2009 , 2020 ). Specifically, studies in psycholinguistics and crisis informatics have found promising evidence that the content shared on social media can help us to study mental health responses to crises, ranging from understanding how communities cope with protracted wars (Mark et al., 2012 ), community violence (De Choudhury et al., 2014 ; Saha and De Choudhury, 2017 ), terrorism (Hoffman, 2018 ), homicides and mass shootings (Glasgow et al., 2014 ; Jones et al., 2017 ; Lin and Margolin, 2014 ). Second, with the growing adoption of social media among K-12 school communities including students, teachers, school administrators, and parents (Kimmons et al., 2018 ), social media constitutes a promising opportunity to study psychological states unobtrusively and passively. Finally, a growing body of work has been appropriating social media data for observational research, to establish causal relationships between interventions and outcomes, especially in contexts where randomized experimentation may be infeasible or unethical (De Choudhury and Kiciman, 2017 ; Saha et al., 2019b ; Tian and Chunara, 2020 ). Our approach aligns with these efforts where we circumvent the limitations of existing approaches by leveraging self-initiated, voluntary expressions shared by various school stakeholders on social media. Notably, this study is the most comprehensive investigation of the impact of school shooter drills in school communities in the United States thus far. Supplement S 1 gives an extended rationale behind the use of social media data in this research.

Sources of data

This research uses responses from a survey and a variety of public social media data.

Data on school drill events

K-12 schools in the United States conduct lockdown and active-shooter drills at various frequencies and using a variety of techniques and simulations. To date, the majority of research on the impacts of these drills has been narrowly defined to individual school models and short term outcomes, thus limiting our ability to capture the reality that countless variations on these models exist in practice, and may have widespread and lasting impacts. There is no comprehensive resource currently available that includes information on these drills at scale or with precision and completeness, however. In fact, schools rarely maintain historical records of drills, as they are often unannounced, unregulated, and do not follow a precise periodic schedule, making it difficult to systematically archive dates on which they occurred.

In the absence of a national dataset, we first identified a sample of drill dates and locations through a survey (Table S 1 ) completed by student, teacher, and parent volunteers of a grassroots gun violence prevention organization. Notably, while volunteers shared a similar goal of ensuring school safety, their views on the appropriateness of drills varied, as some had survived actual shooter events, others experienced trauma following drills, and others still experienced drills that were mostly discussion-based, etc. Likewise, a strength of this sample came not from a uniformity in stances or experiences with drills, but a heightened attention to gun violence prevention strategies, and a related increase in the likelihood of their writing down or recalling the dates of drills.

The survey was fielded through a variety of electronic channels such as emails, electronic flyers, and postings in online groups, and remained active between November 2019 and February 2020. A total of 153 individuals responded and provided information regarding the dates of the school shooter drills occurring between April 2018 and December 2019, the school grade (elementary, middle, or high school), the school name and location (geographical address, city, state, and zipcode). No personal identifiers or social media usernames were collected through the survey, nor was an active social media profile or participation in online discussions about drills a requirement for participation, as the survey’s purpose was to identify a sample of drill dates and places, not specific individuals or their perceptions of the effectiveness or impact of the drills, to be featured in this study. A summary of the key questions in the survey are included in Table S 1 . Figure S 1 a gives the geographical distribution of the 138 schools and corresponding drills, spanning 37 states, considered in this work, while Fig. S 1 b depicts the temporal distribution of these drills in our dataset. 13% of schools in our sample were geographically located on the west coast, 40% in the central U.S., and 47% on the east coast. Of the 138, 63 were elementary schools, 35 were middle schools, 18 were high schools, while 21 were uncategorized. 130 schools were public, public-charter or pre-K, and 8 were private.

Social media datasets

We then assembled a diverse set of public social media posts associated with survey-identified K-12 schools spanning a 90-day period before (~3 months) and a 90-day period after (~3 months) after each drill identified above. We adopted three procedures to build out this dataset: (1) Identifying Twitter posts by individuals who follow the official Twitter account of one of the schools identified to have had a drill event in the survey; (2) Identifying Twitter posts by individuals whose self-reported geo-location on Twitter lies with the officially defined district of one of the drilled schools; and (3) Identifying Reddit posts shared within communities associated with one of the school names. The first approach uses the homophily principle that structures network ties such as those relating to work, support, and other relationships (McPherson et al., 2001 ). Based on cursory observations, usually, parents, teachers, students, and other members of a school community tend to follow the Twitter account of a school. This can be due to multiple reasons, such as to stay updated with the content posted by the school or engage in discussions with other members of the community. School followers are also more likely to share posts that might be relevant to the school, the events related to the school or the neighborhood. The second approach leveraged the fact that those likely to be directly impacted by the drills will reside within associated school districts’ geographic boundaries. The third and final approach leveraged the observation that K-12 related discussions often happen in a variety of Reddit communities (or “subreddits”), ranging from dedicated school subreddits, to the neighborhood or city in which the schools are located. In all, we analyzed 27.8M social media posts shared between January 2018 and March 2020 by 542.27K unique users for 114 schools (out of the 138 extracted from the survey responses) that were present in one of the three data collection strategies and located in 33 states. Detailed information on this data collection are given in Supplement S 2.1 , S 2.2 , S 2.3 , Table S 2 , and Fig. S 11 . We also gathered an equal size sample of control postings. Specifically, we selected a random sample of about 27M posts from the 1% sample of Twitter’s public stream whose geo-location (or the self-reported location of the post author) lied outside the 114 school districts. These control posts spanned a 90-day period before (~3 months) and a 90-day period after (~3 months) each of the drills identified in the above survey, thus making their timeframe the same as our social media data on the drills, and thus providing us a total of 54 million posts on which the ensuing analyses were conducted.

We note here that we intentionally did not filter the social media posts to only look at those with explicit mentions of the drill events. This is because literature indicates that well-being concerns may manifest in different ways in an individual’s interaction with others, sometimes with explicit references to the underlying causes and sometimes implicitly embedded in other conversations (Kícíman et al., 2018 ). Moreover, psycholinguistic expressions that signal an individual’s underlying psychological state, are associated with non-content words, such as articles and pronouns, which are rarely consciously regulated by the individual and may span a variety of topics directly or indirectly related to a crisis, whether offline (Cohn et al., 2004 ) or online (Saha and De Choudhury, 2017 ). Analyzing all temporally and school-community relevant longitudinal social media data mitigates issues of partial observability of well-being outcomes that may result from focusing on drill-specific postings.

Machine-learning methods

Stress, anxiety, and depression are often fueled by unconscious factors that people are unable to pinpoint. Similarly, they manifest in many aspects of our lives, including our general thought processes (Palen and Anderson, 2016 ; Tausczik and Pennebaker, 2010 ). Language can reflect these affective, cognitive, perceptual, and other psychological processes of individuals, including changes over time around specific events (school shooter drills in our case) (Pennebaker et al., 2003 ). In our case in particular, anyone who experienced a drill could experience these impacts, positive or negative, without being consciously aware of what was driving them. Therefore, our analysis was not limited to just individuals who recalled the date and location of a drill enough to report it in our survey, or people who posted their thoughts or experiences about drills online—rather we analyzed all social media postings of individuals in the school community datasets compiled above, regardless of their stance on the drills or participation in our initial survey. Motivation behind our analytic approach is further borrowed from prior research in crisis informatics (Palen and Anderson, 2016 ; Reuter and Kaufhold, 2018 ), where it has been observed that, from a psycholinguistics perspective, for both positively and negatively affected individuals, the effects of a certain event are likely to spill into their linguistic expressions across a wide range of topics, not just those relating to the event (De Choudhury et al., 2014 ; Mark et al., 2012 ). We also note that similar approaches have been used in prior crisis informatics research: De Choudhury et al. ( 2014 ) analyzed Twitter postings from the entire community to understand the affective responses, both positive and negative, to the Mexican Drug War, and Saha and De Choudhury ( 2017 ) looked at Reddit posts of the entire college community to assess stress levels following incidents of violence on campus.

We adopted a two-dimensional approach to quantify psychological impacts as observed via social media posts: mental health symptoms and psycholinguistic expressions, described below.

Mental health symptomatic expressions

We quantified symptomatic expressions of stress, anxiety, and depression using machine-learning classifiers that were built and validated in prior work (Saha et al., 2019b ). These are essentially n -gram based binary support vector machine (SVM) models trained using transfer learning methodologies (Pan and Yang, 2009 )—transfer learning is a method where a model developed for a task is reused as the starting point for a model on a second task. Therefore, the main idea here is to infer mental health outcomes in an unlabeled data by transferring a classifier trained on a different labeled dataset, as first introduced by Bagroy et al. ( 2017 ). The positive class of the training datasets in this approach come from appropriate Reddit communities ( r/depression for depression, r/anxiety for anxiety, r/stress for stress), and the negative class of training datasets comes from non-mental health-related content on Reddit—a sample of 20M posts, gathered from 20 subreddits (such as r/AskReddit , r/aww , r/movies , and others) that appeared in the landing page of Reddit during the same period as the mental health subreddit posts. These classifiers have been found to yield a high-performance accuracy of approximately 0.90 on average and transfer well on Twitter with an 87% agreement between machine-predicted labels and expert appraisal (Saha et al., 2019b ). Details of the validity of these classifiers are in Supplement S 4 . Given the high likelihood of comorbidity of stress and anxiety in crisis contexts (O’Donnell et al., 2004 ), our analyses combined these expressions for the ease of exposition, that is, any post that expresses either or both of High stress or anxiety (according to our classifiers) are labeled as high symptomatic expression.

Psycholinguistic expressions

People’s affective, cognitive, perceptual, and other psychological processes can be reflected in their language and its changes around specific crisis events (active-shooter drills in our case) (Pennebaker et al., 2003 ). As we seek to understand psycholinguistic expressions, we employed the well-validated psycholinguistic lexicon, Linguistic Inquiry and Word Count (LIWC) (Tausczik and Pennebaker, 2010 ). This tool is known to work well with short text and social media data, as revealed in a large body of social computing and crisis informatics literature (Lin and Margolin, 2014; Mark et al., 2012 ; Saha and De Choudhury, 2017 ). We used the following non-affective psycholinguistic expression categories given in the LIWC dictionary: “cognition and perception”, “interpersonal focus”, “temporal references”, “lexical density and awareness”, and “social and personal concerns.”

Temporal analytic technique

We investigated two types of temporal change in expressions of psychological well-being, drawing on the interrupted time series (ITS) literature (Tian and Chunara, 2020 ): immediate change ( I C ) and a longer-term change ( L C ). ITS is a quasi-experimental study adopted as an alternative to randomized control trial research designs, typically used to measure the causal effect of an intervention, by controlling for confounds, and primarily through its control over regression to the mean. ITS is an analysis of a single time-series data before and after the intervention (Bernal et al., 2017 ; McDowall et al., 2019 ). This method also contains a strong inferential power and has wide applications in epidemiology, medication research, and program evaluations in general (Chandrasekharan et al., 2017; Linden, 2013 ). The immediate change ( I C ) in outcomes is calculated by measuring the difference in z -scores of the daily measures immediately after and before the drill. On the other hand, longer-term change L C measures the relative change, between the After and Before periods, in terms of the average proportion of social media posts that are associated with a certain outcome. First, for all time series corresponding to a mental health or psycholinguistic expression, we calculated the immediate change or I C by performing an ITS analysis (Saha and De Choudhury, 2017 ; Tian and Chunara, 2020 ). We first normalized all of the time series corresponding to each well-being outcome, and spanning the whole time duration under examination (180 days), using the statistical standard score ( z -score). The z -score measure allows comparison of trends across time and data types because of a reliance on proportions, rather than raw frequencies. For this, aggregated across all schools and their respective drills, we fitted a linear function for the 90 days of data (mental health symptomatic or psycholinguistic expression) before the drill ( Before ) and a linear function similarly for the 90 days after the drill ( After ). Hence, I C in each of the outcomes of psychological well-being (e.g., stress/anxiety, depression, etc.) was calculated as the interrupted change at time zero—the day of the drill event—based on the difference in intercepts of the After linear fit with respect to Before —essentially capturing differences in levels surrounding the event. Contrastively, the long-term relative change measure, L C gives how each of the outcomes were manifested over the entire 90-day duration following the drills, in comparison to that preceding them. For all outcomes, to assess whether the I C and L C differences between the Before and After periods were statistically significant, we performed Welch t -test, followed by Benjamini-Krieger-Yekutieli False Discovery Rate (FDR) correction, given multiple comparisons. Further details are given in Supplement S 6 .

Establishing causality

Although interrupted time series analysis is a fairly strong quasi-experimental design (Cousens et al., 2011 ), recent research has shown that it can either fail to identify the effects of external factors on the time series, resulting in a false causal attribution, or conversely, confuse the causal interpretation when a directionally correct change in the time series also occurs prior to the intervention (Linden, 2018 ). To reduce bias and strengthen causal interpretation in interrupted time series analysis studies, the treated unit’s outcomes should be contrasted to those of a “control” group that is comparable on observed characteristics (including, at a minimum, the baseline level and trend of the outcome). For this reason, various robustness checks are often recommended to determine if treatment effects persist under various data and model specifications, and to individuals outside of the sample used for model estimation (Kiciman and Sharma, 2019 ; Linden, 2018 ). Consequently, to determine if the change we see spanning from 90 days before the drill and until 90 days after the drill, is really a causal effect of the active-shooter drill, we employed four methods, as four types of robustness checks. These approaches are motivated from prior work (Saha and De Choudhury, 2017 ; Saha et al., 2018 ), and they essentially minimize confounding effects of social media expressions such as changes due to seasonal, local, and other coincidental factors on our outcomes of interest.

Temporal alignment based on offsets from drills dates and isolating impacts of other events

In the first method , while examining the changes for the various psychological well-being outcomes, we aggregated all the posts associated with all of the schools in our dataset spanning the Before and After periods. That is, we temporally aligned the Before and After datasets for all schools across their respective drill dates by using the date offset of each social media post with respect to the associated school’s drill date (day zero). As the drills happened at various different times of the year (ref. Fig. S 1 b), this alignment of the Before and After periods would minimize the confounding effects of other stressors that are seasonal or subject to school-specific events.

In addition, we examined the impact of other events that might confound the changes in well-being outcomes. In particular, since gun violence incidents may also trigger similar patterns of responses, we isolated temporally and spatially those schools impacted by such an event during our study period. Should the patterns of changes in well-being outcomes hold with the temporal and spatial exclusion of these events, it would be logical to ascribe the changes to the drills.

While there is no broad consensus on what constitutes a gun violence incident on a school campus, we ground our definition with that of mass shooting incidents derived from the Congressional Research Service and the Gun Violence Archive; this definition considers an incident to be a mass shooting if four or more people shot (injured or killed) (Bagalman et al., 2013 ; Gun Violence Archive, 2020 ). We implemented two different settings: (1) Temporal overlap mitigation : removing all schools that had drill dates that coincide within the same month as when a gunfire mass shooting occurred. For this analysis, we considered the following six mass shooting events occurring in Santa Fe, TX, Charlotte, NC, Highlands Ranch, CO, Atlanta, GA, Santa Clarita, CA and Edgard, LA in May 2018, April, May, August, November and December 2019, respectively. (2) Spatial overlap mitigation : removing all schools whose locations were in the same state where a gunfire mass shooting events occurred. For this analysis, we considered the entire duration of our analysis (90 days before the earliest drill date and 90 days after the latest drill date) to pinpoint these gunfire events. This led to the identification of eight mass shooting events in nine states including the six incidents from the temporal analysis in addition to two mass shooting events in Benton, KY and Parkland, FL. These states were Kentucky, Florida, Texas, North Carolina, Colorado, Georgia, California, and Louisiana.

Comparison with the counterfactual

Per the ITS framework, one way to infer causality is to estimate what the outcome variable could look like, if there were no intervention (Cousens et al., 2011 ); in our case, this would translate to inferring the future well-being outcomes based on the past outcomes, assuming that the drill (an intervention) has not occurred. To do this, we train an an autoregressive integrated moving average (ARIMA) model (a statistical model for analyzing and forecasting time series (Hyndman and Athanasopoulos, 2015 )) on the 3-month period prior to the drill events for stress/anxiety and depression ( Before period). We then use this trained model to forecast the future values of the two well-being outcomes in the aftermath of the events (the 3-month long After period). Our goal here is to understand what the time series would look like without the drill occurring. If significant differences were to be found between the predicted time series and the actual time series in the After period, with the predicted time series showing lower values for the well-being outcomes, we can conclude that the increase in stress/anxiety and depression during the After period is due to the occurrence of the drills (the intervention).

Comparison with a synthetic control

The third method tested for the validity and robustness of our causal claims—that the active-shooter drills impacted mental health and community outcomes—by using permutation tests conducted on the (treatment) time series data on our mental health symptomatic expressions of anxiety/stress, depression, and the six LIWC-based psycholinguistic categories associated with community outcomes. This examination aimed to rule out the possibility of observing the temporal changes by chance (Anagnostopoulos et al., 2008 ), and serves as a comparison of the actual (treatment) time series changes with a “synthetic time series”. Essentially, for each outcome measure, we generated 1000 synthetic time series, which followed similar non-parametric data distribution as the treatment (actual) time series data. Then, we compared the relative change in each outcome around a placebo drill date in control (mid-point of the time series) against the actual drill date in our treatment data. That is, for each synthetic time series, we measured the L C (synthetic L C ) and record if it is larger than the actual L C . We measured the probability ( p -value) that the synthetic L C is greater than actual L C , which helps to quantify the statistical significance of our observations against chance or random observations. This method emulates permutation test frameworks applied in the prior work (Das et al., 2020 ; Saha, 2019a ), and tests for the null hypothesis that outcome change around a randomly generated drill date is comparable to outcome change around actual drill date. If this p -value is found to be zero or significantly low (e.g., p < 0.05), then we can deduce that the treatment L C is indeed attributed to the effects of the active-shooter drill.

Comparison with an actual control

The fourth method involved comparing our temporal trends (treatment), specific to the schools and their respective drill dates, with a suitably chosen control time series in the same timeframe (De Choudhury and Kiciman, 2017 ). Specifically, as described above, we use the random sample of 27 M posts from the 1% sample of Twitter’s public stream (control) that covered the Before and After timeframes for our school dataset, and whose geo-location lied outside of the school (districts) under considerations. We then proceeded to calculate the date offsets of each post in the control data, from the school drills, and measured the various psychological well-being outcomes of interest: mental health symptoms like anxiety/stress and depression, and the six LIWC-based psycholinguistic expressions for each Twitter post. By aggregating the results for each offset, we were able to construct a control time series and compute the temporal trends for each outcome for our control dataset.

Focus group triangulation

Finally, the research team conducted semi-structured interviews in the form of focus groups with students, parents, and K-12 school teacher volunteers at a grassroots gun violence prevention organization, to provide a school community-centered contextualization, to triangulate our results, and to ensure that our findings mimicked and were informed by lived experiences. As referenced above, volunteers shared a common commitment to ensuring school safety, but different stances on, and experiences with, both drills and actual active-shooter incidents, rendering them a relatively diverse set of focus group participants.

This supplemental triangulation methodology was guided by (Boyd and Crawford, 2012 )’s provocation, “in this computational turn, it is increasingly important to recognize the value of ‘small data”’—a mixed methods approach enables us to represent the voices of those directly impacted by drills in two different ways in our investigation. First it allows for a large-scale, generalizable analysis of the students, parents, and teachers naturalistically shared social media data and juxtaposes it with a sample of their retrospective interpretation of those incidents. These interpretations may not be apparent in an individual’s online content, but stem from offline factors that serve as motivations and intentions behind online behaviors. Essentially, our approach allows us to more accurately uncover the social meanings and offline implications of online articulations of the psychological impacts of the drills. Second, in the absence of any prevailing knowledge or “ground-truth” about the psychological impacts of drills, our approach enables aligning machine-learning inferences and estimations of well-being outcomes of the drills, with the self-reported lived experiences of the stakeholders to gain concurrent validity in the quantitative findings. Likewise, other recent research has used qualitative data, such as that from field work and domain experts, to enhance the validity or ground truth of computational linguistic analyses (Stuart et al., 2020 ). Like Fine ( 2006 ), we adopt this term, which had first appeared in meteorological research to denote the practice of checking weather forecast models against direct observations of weather conditions occurring “in the real-world” (e.g., verifying that a tornado has in fact touched down at the geographic coordinates indicated by remote sensing). Here, ground truth refers specifically to the correspondence between social media signals of the well-being impacts of the school shooter training programs and the trauma that school communities experience when they undergo these drills. Summarily, contextualization and validity via adequate representation of the voices of school community members, as supported by our chosen methodology, are key to ensure that the outcomes of this project accurately depict reality and are not misconstrued as provisions for school safety are evaluated and implemented in K-12 schools.

Nevertheless, it is important to note from McDonald et al. ( 2019 ) that, qualitative interviews cannot be expected to provide the same type of quantitative validity as large-scale data would, because the qualitative and quantitative approaches fundamentally differ epistemologically and ontologically (Hunt, 1991 ). Qualitative data can be useful to unpack the stories behind quantitative observations through triangulation, with the intention to increase or deepen understanding of the study phenomenon (Hussein, 2009 ). In this work, our focus is on social and interpreted, rather than quantifiable, phenomena and we aimed to discover and describe rather than to test and evaluate. Therefore, we deemed the latter to be appropriate for this study, which served as rationale behind our focus group study design, described next.

Focus group study design

Our focus group based validation approach interviewed 34 stakeholders through 6 focus groups. Before recruiting and engaging with participants. Individuals 15 years or older were invited to participate in 1-h interviews. Participants were eligible if they engaged (teachers and students) in at least one school shooter drill in a U.S. based school in 2018–2019 or if they had a child who participated in at least one school shooter drill in a U.S. based school in 2018–2019.

We conducted 6 1-h long focus group interviews with 21 parents, 11 teachers, and 2 students. All except one participant were female. All focus groups were conducted by three coauthors over the teleconferencing software Zoom; an in-person format for these discussions was not possible at the time due to the geographical spread of the participants as well as social distancing/travel restrictions imposed by the Coronavirus Disease 2019 (COVID-19) pandemic (Organization et al., 2020 ). Discussions were audio-recorded with permission. Participants were asked to freely share their experiences with and stances on drills—their efficacy, benefits, harms, and engage in semi-structured group discussions based on several key results from the social media data-driven results of this study particularly around the observed psychological well-being impacts in the school communities. Guiding questions are included in Table S 4 .

We then transcribed the audio recordings, along with removal of any personally identifiable information, and stored them in secure, two-factor authenticated, encrypted servers. Transcribed data was analyzed using an inductive and iterative semi-open coding approach (Mayring, 2004 ). Open coding is common in the analysis of qualitative research and is an established approach in Grounded Theory (Charmaz, 2014 ). With open coding, a first step is breaking up the data into discrete parts and creating—codes— by hand to label them. The purpose of breaking up the data and labeling them with codes is to enable the researcher to continuously compare and contrast similar events in the data. This is done by collating all pieces of data (such as quotes) that were labeled with a particular code. In this work we have focused on social and interpreted, rather than quantifiable, phenomena and aimed to discover, interpret, and describe rather than to test and evaluate; therefore this analytic approach was deemed appropriate (McDonald et al., 2019 ). We used a primary coder with a background in Psychology and a secondary coder with a background in Computing for the tasks; both coders are authors of this paper. Through mutual and iterative discussion, the coders relied on our quantitative methodology and well-being outcomes of interest (Cohen and Wills, 1985 ; Sullivan, 1996 ). Our final list consisted of 15 codes (Fig. S 5 ). Finally, the researchers used this codebook to code all of the transcripts and identify interpretive broader themes that aligned with lived experiences of the school stakeholders around the drills. Paraphrased quotes from the participants are inter-dispersed among the discussion of results when appropriate throughout the main manuscript, along with attributions of specific quotes to specific participants—the 21 parents are referred to as P1-P21, the 11 teachers as T-T11, and the 2 students as S1 and S2.

Impacts on mental health

We first discuss the aggregated temporal patterns of mental health symptomatic expressions before and after the school-specific drill events. Based on Fig. 1 a, we observe a notable increase in stress or anxiety and depression markers. To quantify the extent of change, we first measure the mean proportion of posts that are indicative of high stress or anxiety and depression for Before and After -drill periods (the measure L C ). We find that the mean proportion of posts indicative of stress or anxiety to be 0.281 for the Before period and 0.399 for the After period; an L C of 42.1% increase ( t = 19.1, p < 10 −15 ). As for depression, we find that the mean proportion of posts indicative of depression is 0.125 and 0.173 for the Before and After -drill periods, respectively. This change in depression constitutes an L C of 38.7% ( t = 10.13, p < 10 −15 ). While we not only observe a statistically significant increase in the levels of stress/anxiety and depression in terms of L C , when we calculate the trends for the Before and After time series, as shown in Fig. 1 b, c using a linear fit (see Supplement S 6 ), we observe immediate changes ( I C ) as well. The After trends seem to be sustained (in the case of anxiety or stress, the slope is 0.00144) or show an increase (in the case of depression, the slope is 0.0053). We additionally measure the I C for stress/anxiety and depression for the z -score distribution and find them to be 0.936 and 0.545, respectively. Examples of anxiety/stress and depression-indicative posts shared by different school communities in the aftermath of the drills are given in Table S 6 .

a Aggregated temporal variation of mental health symptomatic expressions. Also shown are trends corresponding to ( b ) anxiety/stress and ( c ) depression in a 90-day period before and after school shooter drills. Solid lines in ( b ) and ( c ) denote a 2-week moving average of the normalized volume of posts.

To give richer context to our analyses, we next examine the linguistic markers ( n = 1-grams) present in posts classified as indicative of High stress/anxiety or depression using a commonly used lexical analytic generative model known as SAGE (Eisenstein et al., 2011 ) (see Supplement S 5 for a description of the technique). Table 1 has two parts corresponding to the anxiety/stress and depression expressions: on the left, it shows the top salient words that uniquely characterize the Before time period but not the After time period and vice versa. Based on Table 1 , positive words like proud , grateful , best and great exhibit saliency in the Before period and a decreased usage after the drills among the High stress or anxiety posts. In contrast, home , school , kids , community , and help show increased use in the High stress/anxiety posts after the drills. This is indicative of people sharing concerns about kids, classrooms, and schools in the aftermath of the school drills. The same trends are sustained for High depression posts. We notice positive emotions and thoughts such as excited , beautiful , care , best , and amazing to be salient before the drills and calls for support and help afterward ( hope , love , help , support , need , young , thank , family ).

Based on the above, our results indicate that school shooter drills can negatively impact the well-being of school communities over prolonged periods of time . The focus groups provide further support and convergent validity to these observations. For instance, parents and teachers noted that drills can be triggering. Many students were “texting their parents, praying, crying” (teacher participant #2 or T2) because they thought “they were going to die,” (T1) and this caused many of them to remain nervous long after the drill was over, even prompting extreme reactions such as panic attacks and “downright fear” (P1) in response to other unrelated, innocuous situations such as “a fire alarm going off” (P2). The drills caused even seasoned teachers to “break down at recess” (teacher participant #7 or T7) on the day of the drills. Other reactions included avoiding talking about the school drill experience as a result of being desensitized; “It was like nothing happened. It was the same thing as breaking a pencil (P3)” and “It’s just kind of part of their norm. She’s been doing it ever since she was in preschool (P9)”.

Community outcomes

Next, we explore the psycholinguistic aspects related to community outcomes, such as the LIWC categories of perception , article , second person pronouns , first-person plural pronouns , friends , and work , as given in Fig. 2 . These categories have been noted to be the most salient to understand social media dynamics around crisis events (Lin and Margolin, 2014 ; Saha and De Choudhury, 2017 ). Results pertaining to the rest of the non-affective psycholinguistic expressions can be found in Table S 7 . Based on Fig. 2 a, we find that words that invoke perceptual processes (e.g., see , hear , and feel ), summarized in the LIWC category of perception as well as those in the lexical density and awareness LIWC category article (e.g., a , an , the ) show an increase in terms of L C ; 10.78% ( t = 3.6, p < 10 −4 ) and 16.3% increase ( t = 9.5, p < 10 −15 ), respectively. In terms of I C (difference in intercepts of the linear fits between the After and Before periods), we observe that both of these LIWC categories show a positive change: 0.084 and 0.353, respectively. These increases, which are often associated with first-person accounts of unanticipated incidents as well as greater awareness of and attention to one’s surroundings (Tausczik and Pennebaker, 2010 ), together indicate that, to the students, parents, and teachers, the drills impacted their cognitive mechanisms in a way that traumatizing crises would, instilling fear and confusion. They also show that, in the 90 days following drills, social media conversations featured significantly more words that show attributions, attempts to make sense of why something occurred, and reflections on the experience itself and what feelings it evoked. The focus group interviews provided more context and credence to these observed cognitive changes. A teacher (T10) said that she could not “really shake the feeling of [being faced with an active shooter]” although she knew “who was rattling the door” and “what was going on.” To a student (S2) participating in the focus groups, a similar acute response accompanied the drills—he felt “convinced there was a shooter on campus” whereas a parent (parent participant #3 or P3) said that their child reported “[hearing] someone going and jiggling the doorknobs in the classrooms” well after the drills were over.

The figures show trends in the form of LIWC categories perception , article , 1st person plural pronouns , second person pronouns , friends , and work , in a 90-day period before and after school shooter drills. Solid lines in a – c denote a 2-week moving average of the daily values. d – i represent the z -score trends computed on the time series in a – c . d – i also include linear fits in the form of dotted lines, corresponding equations indicating the nature of the fit.

In terms of the L C of interpersonal focus (Fig. 2 b), our analysis shows a 47.79% increase ( t = 8.1, p < 10 −15 ) and a 10.21% increase ( t = 3.1, p < 0.01) in the usage of first-person plural pronouns and second person pronouns, respectively, for the After period compared to Before . For outcomes related to personal and social concerns such as friends and work , per Fig. 2 c, we observe a 33.7% ( t = 3.5, p < 10 −4 ) and a 106.18% ( t = 18.3, p < 10 −15 ) increase, respectively, in the After period. For all these categories (Fig. 2 d–i), the I C is also positive (0.423–1.175), indicating that overall, the levels of psycholinguistic expressions became more prominent or heightened right after the drills. These results summarily indicate an increased sense of solidarity and engagement among members of school communities, despite the mental health impacts noted above.

This is echoed by teachers in our focus groups, where one teacher (T3) mentioned that she “felt more comfortable bringing this up with like-minded people who are concerned..or if we know somebody understands that that was like a stressful event” in a mom’s meeting or other kinds of gatherings. A parent (P8) similarly said that, after the events happened in her child’s school, she felt the need to “bring [the issues around school shooter drills] up” in her conversations with other moms, who she noted felt overwhelmed, but did not “necessarily [have] the time to process it, think it through, [or] follow up with their kids.” A student (S1) confirmed that the drills spark conversations in her school about [preparation for an active shooter should it happen...a lot of the teachers would ask like do you think that was helpful in preparing you for this event?]. The student elaborates that the main response is that [it stresses students out and that it can cause sort of a collective worry among my classmates]. Together, these results suggest that school shooter drills in schools may fuel collective action and community advocacy .

Additional analyses to examine causality

To what extent can we causally attribute the changes observed in the trends of various psychological well-being outcomes, such as anxiety/stress, depression, and the psycholinguistic categories, to the drill events? To answer this, we adopted a multi-prong causal analysis approach outlined in above in the Data and Methods section.

Isolating impacts due to other events

Recall that, beyond drills, mass shootings themselves can lead to an increase in stress and anxiety-inducing online conversations; thus potentially affecting overall measurements of psychological well-being in online discourse. To account for these incidents and their potential impact on the well-being of the school communities, we report on how well-being outcomes changed from our analyses, when drills that overlapped with these events were excluded spatially or temporally. First, the temporal overlap mitigation led to the exclusion of 31 drill events corresponding to approximately 1.5M data points/posts from our analysis. Figure S 6 a–S 6 c show the results for this analysis. We note that this resulted in an ( L C ) of 43.12% increase in stress/anxiety ( p < 0.001) and a 39.58% increase in depression ( p < 0.001). Next, the spatial overlap mitigation led to the exclusion of 41 drill events corresponding to approximately 10.7M data points/posts from our analysis. Figure S 6 d–S 6 f show the results for this second analysis. We observe the following results: an L C of 30% increase in stress/anxiety ( p < 0.001) and a 29.6% increase in depression ( p < 0.001). Together, these results show that even when accounting for large-scale mass shooting events ( L C range [29.6-43.12%] with changes in the range [ − 12.1 − 1%] in comparison to the original results), the changes in well-being outcomes still persist and could be attributed to the actual real-world intervention of conducting a drill.

Based on the approach described in “Data and Methods", we fitted two ARIMA models for stress/anxiety and depression, respectively, based on Akaike’s Information Criterion (AIC) score, and using data from the 90-day Before period. The best performing models were ARIMA models with an order of (0, 0, 0) and (1, 0, 0) for stress/anxiety and depression, respectively. Upon using these fitted ARIMA models to forecast values in the 90-day After period, we found the Root Mean Square Error (RMSE) between the forecasted values and the actual time series to be 0.14 and 0.09 for stress/anxiety and depression, respectively. Figure S 7 a and S 7 b show the predicted time series based on the ARIMA models (predicted) versus the actual time series based on our well-being measurements during the After period. On average, we find that the predicted time series exhibits lower levels (26.3% and 50% lower than the actual levels) of stress/anxiety and depression for the After prediction ( p < 0.001). This shows that the two time series (actual versus predicted) are significantly distinct, indicating that the interventions (drill events) likely caused a notable change in the expressions of depression and anxiety/stress, as demonstrated in the social media posts of the respective school communities.

Comparison with an synthetic control

In addition, we conducted the robustness test of causality using permutation tests, and across 1000 permutations of synthetic time series for each outcome; Figure S 8 shows our results. In all the cases, the relative change in the After period compared to Before in the synthetic time series, around placebo drills, was significantly smaller than that in the treatment (actual) data. For the various synthetic time series, we find that the probability ( p -value) that a placebo drill leads to a greater relative change than actual drill is extremely low for all the measures: p = 0 for stress/anxiety, depression, article, first-person plural, second person , and work , and p = 0.021 for perception , p = 0.035 for second person ), and p = 0.013 for friends . This indicates statistical significance in all our observations at the p < 0.05 level, suggesting that changes observed in our study can indeed be attributed to the actual (treatment) school shooter drills, and are not by chance.

Finally, we compared the time series of normalized posts associated with all of the outcomes: anxiety/stress, depression, and the LIWC categories, with an equal duration control time series capturing these same outcomes in the same timeframe of the drills, in non-school-specific Twitter data. As per Fig. 3 and Table S 5 , the control time series show a change ( L C ) of only − 0.375–2.5% (and corresponding 0-lag cross correlation of 0.593–0.988) across all outcomes in their second 90-day period, compared to their first, assuming the mid-point of the control time series as the placebo drill. This change is statistically significantly lower than the change ( L C ) of 10.2–106.18% for the treatment (actual) time series whose 0-lag cross correlation between Before and After periods is much lower (−0.009 to 0.043), allowing us to associate the changes in the treatment to the drill events. Additionally, many of the changes we observe for the control time series were found to be statistically insignificant (0.36 ≤ p ≤ 0.77) for all outcomes with the exception of stress/anxiety ( L C = 0.3%, p < 0.05), work ( L C = 2.5%, p < 0.05), and perception ( L C = 0.43%, p < 0.05).

Causality analysis comparing treatment and control trends for ( a ) Stress/Anxiety, ( b ) Depression, and the LIWC categories ( c ) Percept, ( d ) Article, ( e ) 1st person plural pronoun, ( f ) 2nd person plural pronoun, ( g ) Friends, and ( h ) Work. Figures show comparison between (1) normalized levels of mental health and psycholinguistic expressions around a 90-day period before and after school shooter drills (treatment); and (2) an equal duration control time series for the same mental health outcomes and psycholinguistic expressions, non-specific to the school districts and communities with the drills. Individual heatmap values are scaled between 0 and 1 for visual comparability purposes.

Subgroup analyses

We additionally investigate changes in the outcomes broken down by three different community groups who are likely to be directly experiencing school drills—teachers, students, and parents, as well as school grade types— elementary, middle, and high. These results are outlined in Supplement S 7 and S 8 . We find the general patterns observed for the aggregate to hold true in these subgroups, with high school communities and teachers showing the largest changes in terms of worsened mental health ( ↑ 24.3–55.1%; p < 0.001 for anxiety/stress and depression) and heightened community outcomes ( ↑ 5.9–27.2%; p < 0.001 for the LIWC categories).

Interpreting the results

The crisis literature posits that external reality, for example, traumatic events, can have profound effects on an individual’s psyche, and can be considered to be the cause of emotional upheaval and stress (Vernberg et al., 2008 ). For example, persons exposed to mass shootings frequently report sleep disruption, due to feelings of grief over loss and anxiety about disaster re-occurrence and ongoing threats or due to symptoms of depression or post-traumatic stress. Notably, when children experience trauma leading to chronic stress or fear in the early childhood years, they are more vulnerable to behaviors associated with anxiety, which can also inhibit their ability to engage in higher-level thinking (Mulvihill, 2005 ). While the school shooter drills are not designed to be crises or to cause trauma—on the contrary, they are intended to better prepare students, staff, and teachers to face a traumatizing event involving an actual shooter on campus—this research empirically reveals, for the first time in such a large and diverse sample the negative psychological impacts of currently unregulated drills on school communities.

Our results on mental health symptoms expressed in social media indicate in terms of broader longitudinal trends, that trauma and collective worry experienced by school stakeholders, increased by 42% for anxiety/stress, and 39% for depression, following drills. This trend sustains at least 90 days following drills and spans across diverse school districts, drill tactics, and the times of the year when the drills were conducted. In addition, the absence of such a change in the control data, that spanned the same time period in non-school-specific communities, further indicates a causal relationship between the drills and the well-being outcomes; in other words, the observed changes in the treatment data are not a consequence of seasonal or concurrent events. The focus groups further contextualized the computational insights, with some students asking their teachers and parents if they could be exempt from participating in these programs in the future, and others internalizing the reality of drills. Furthermore, the lexical analyses of the social media posts associated with high anxiety/stress and depression as well as the psycholinguistic outcomes reveal shifts in cognitive capacity and vocabulary changes, as well as people’s perception and thinking in the aftermath of the drills. Overall, this study echoes and adds rigorous and scalable statistical support to the lived experiences of many American students, parents, and teachers who have expressed reservations with the inconsistent, unregulated, and at times traumatizing nature of K-12 school drills (Hamblin, 2018 ). Notwithstanding these negative impacts, the finding around increased collective action and advocacy resonates with the trend whereby school shooting incidents and the fear surrounding them propels many to join the broader movement of gun violence prevention (Everytown, 2019 ).

Methodological and practical implications

Our work bears important methodological implications. As noted above, existing research on school shooter drills is limited and fraught with methodological challenges. Given the nature of active-shooter incidents, it is nearly impossible to study the direct impacts of drills on safety during these events. Therefore, most researchers in the past have opted to observe compliance with emergency procedures during drills and self-reported perceptions of safety and anxiety immediately following them (Dickson and Vargo, 2017 ). Moreover, due to a lack of well documented information on such training programs in various campuses and to circumvent potential for harm in gathering direct self-reports, some scholars have used lab-based experimental study to expose students to recordings of a simulated incident on campus, and then measure change in their psychological response (Peterson et al., 2015 ). However, these approaches lack ecological validity and suffer from the problem of small, non-representative sample. Together, this has hampered the development of scientific consensus as findings often conflict, as described above. To this end, our observational study approach contributes rigorous, scalable, and comprehensive scientific evidence to this debate. In other words, in this work, we observed how various school communities responded to the drill events based on their social media feeds, without us controlling who undergoes or experiences a drill at a school. We leveraged social media data as a natural experiment to provide a temporal pre- and post- (drill) event comparison with respect to a community’s psychological health. Since we focused on an intra-community comparison (the changes in well-being outcomes noted in the paper are actually the changes in the same set of individuals in the three months preceding and succeeding the drills) and a sizable pre-post drill comparison period (~3 months before the drills, representing pre-drill baseline levels of the well-being measures), our approach inherently accounts for implementation, socio-cultural-political, and geographic differences across schools. Moreover, since the drills considered in the 114 schools were distributed through the school year, albeit not uniformly, our approach allows us to rule out the effects of local, national, or global events, seasonal trends, that might impact people’s mental health or psycholinguistic expressions on social media (see Fig. S 6 for additional analyses that repeated our analysis of the trends of stress/anxiety and depression excluding schools who experienced a gun violence incident as well as excluding time periods when such an incident was reported at one of the 114 schools under consideration). Our work thus advances existing approaches used to study the potentially causal impacts of school shooter drills.

Altogether, our findings raise important questions regarding the unseen costs of these school safety strategies that so far have not been evidence-based. In our focus groups, while parents and teachers noted that school shootings are “not an if, but when” (P19) and many were “just waiting for the next one to happen,” (T11) at the same time, they argued that a trade-off must be navigated between preparedness and the psychological ramifications of these programs. In view of the lasting impact on psychological well-being we observed in our data, alternative, proactive school safety measures should be considered. These alternatives reduce the risk of harmful impacts and are supported by stronger evidence on their effectiveness. These include placing priority on school climate—creating a trusting school environment where all students are treated equally and bullying is not tolerated at any level. Research has shown that school climate is a strong predictor of school violence (Hurford et al., 2010 ). A second important proactive measure is student access to quality mental health resources, particularly for students in crisis or who are encountering social or emotional difficulties (NASP, 2021 ). Finally, school safety experts strongly support the use of threat assessment programs, multidisciplinary teams that intervene early when threats of violence come to light in a school. In 2018, the US Department of Homeland Security concluded that addressing these threats and behavioral issues are more effective than physical plant improvements for school safety (US Department of Homeland Security, 2018 ).

Schools that do choose to implement shooter drills as their evidence-base continues to be assessed should prioritize trauma-informed trainings and excluding students, given their unique developmental stage. A 2020 report by Everytown for Gun Safety, American Federation of Teachers, and the National Education Association outlines several recommendations for drills, should they be implemented, which may help to ensure that they are trauma-informed and less detrimental to mental health (Everytown for Gun Safety, 2020 ). These include strategies like notifying school communities in advance; avoiding realistic simulations; ensuring developmental appropriateness; consulting with mental health professionals; and tracking data on their efficacy and effects.

Limitations, future research, and conclusion

Our study has limitations some which also open up opportunities for future directions. Although our classifiers of mental health symptomatic outcomes were built with expert appraisal and clinically validated instruments, we caution against making clinical inferences. As with other observational studies, we recognize that we cannot infer true causality (Watts, 2014 ). However, our work includes statistical rigor in minimizing various confounds, including additional triangulation from interviewing focus group participants; therefore the work provides insights beyond correlational analyses. Further, albeit longitudinal, our work only looks at the effects at a limited period of time (3 months). Future studies that include multiple follow-ups would allow for an enhanced understanding of the processes that lead to the observed trends and potential for the symptoms to turn chronic over time. In addition, to the best of our knowledge, the majority of school shooter drills are conducted on a quarterly to annual basis (Education Commission of the States, 2019 ). Therefore, drills occurring at least 90 days apart—not the whole 6 months—did not overlap with the pre- or post-periods and thus were unlikely to impact results. Since also we offset every day in comparison to the drill date (that is, the drill dates were spread across various times of the year), the probability of having multiple drills happen at the same school more than once in the period under investigation is low, allowing us to further isolate the effect of a single drill. That said, future work can explore additional causal inference techniques, such as that involving alternate hypothesis testing, to tease out situations where multiple drills may happen in quick succession.

We also acknowledge that our quantitative analyses may suffer from self-selection bias, as it is restricted to only those who are on social media and choose to post on it (Olteanu et al., 2019 ). Such data likely leaves out particularly young students at the schools where these drills were conducted, because Twitter’s Terms of Service prevents individuals under the age of 13 to have accounts on the platform. Students’ perspectives were somewhat supplemented with the focus groups as well as limited Twitter data from older students; however deeper analysis, with careful ethical considerations (Anderson, 2005 ; Farrell, 2005 ) can involve younger children more actively. On a related note, recall that our study focused on all individuals on social media potentially connected to the 114 school communities that experienced a drill during the study period, not just the direct victims. Parents were intentionally included in this sample, as research and anecdotal evidence suggests that they feel pressured to allow their children to participate in drills, are often the adults that must help them cope with any emotions in the aftermath, and have their own fears and anxieties around how to teach their children about gun threats at school (Kubicek et al., 2008 ). Moreover, the broader sample we focused on is likely to involve other family members and caregivers of students, teachers, and staff, or bystanders of school communities who may be indirectly impacted by the drills or have an interest in the topic. Crisis psychology literature advocates considering both the direct and indirect victims of crisis events, to comprehensively understand the impacts in the aftermath (Beaton and Murphy, 1995 ; Harvey, 1998 ). Future research may expand on the diversity of psychological impacts in people who experience the drills directly as well as indirectly. Finally, our survey did not collect information about the type nor implementation of the school shooter drill. Future research can assess the differential impact of various protocols and their differing implementations to understand which, if any, pose fewer mental health risks.

In conclusion, by analyzing social media data in this study, we were able to quantify hard-to-observe impacts of school shooter drills; assess whether they are sustained over time and in comparison to suitable controls; and draw conclusions that uphold across different schools, drills, geography, communities, and time of the year. We provide the first empirical evidence that school shooter drills—in their current, unregulated state-negatively impact the psychological well-being of entire school communities, indicating that those who are affected are in need of continued support to process their aftermath, and that school systems need to rethink the design and utility of these approaches, against alternative gun violence prevention measures.

Data availability

We used public online data (Twitter, Reddit), whose sharing in the raw form is restricted by the official API policies of the respective platforms. In addition, the paper also uses information on active-shooter drills gathered through a survey and focus group insights from school stakeholders. Deidentified version of this data can be requested by interested parties through appropriate data use agreements.

Code availability

Custom code that supports the findings of this study is available from the corresponding author upon reasonable request.

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Acknowledgements

This research was supported through a grant from Everytown for Gun Safety to Georgia Institute of Technology; PI: Munmun De Choudhury.

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University of California, San Diego, CA, USA

Mai ElSherief

Microsoft Research, Montreal, QC, Canada

Koustuv Saha

Georgia Institute of Technology, Atlanta, GA, USA

Pranshu Gupta, Shrija Mishra, Jordyn Seybolt, Jiajia Xie & Munmun De Choudhury

Everytown for Gun Safety, New York, NY, USA

Megan O’Toole & Sarah Burd-Sharps

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MOT, SBS, and MDC designed the research; ME, KS, and MDC conceptualized and developed the analytic techniques; ME, KS, PG, SM, JX, MOT, SBS, and JS gathered and analyzed the data; ME and MDC interpreted the results; ME, KS, and MDC drafted the paper; and MOT and SBS read, edited, and provided feedback on the paper.

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Correspondence to Munmun De Choudhury .

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This focus group study was approved by the Institutional Review Board at the lead authors’ institution, Georgia Tech. As noted in the manuscript, the focus group interview study constituted human subjects research, for which IRB approval was obtained at the lead author’s institution, Georgia Tech, and participants were recruited following informed consent. Since historical, publicly accessible social media data from Twitter and Reddit were used for the computational aspects of this research and it involved no interaction with the authors of the social media postings, this part did not constitute human subjects research and therefore ethics approval was not required

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ElSherief, M., Saha, K., Gupta, P. et al. Impacts of school shooter drills on the psychological well-being of American K-12 school communities: a social media study. Humanit Soc Sci Commun 8 , 315 (2021). https://doi.org/10.1057/s41599-021-00993-6

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The Intersection of Mental Illness and Gun Violence: Examining the Evidence to Guide Sound Public Policy

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In Brief ■ The pervasive narrative linking mental illness to gun violence is harmful to individuals, families, and communities. ■ The widespread belief that mental illness drives mass shootings and interpersonal gun violence more broadly has shaped 50 years of gun control policy. ■ Family health professionals must actively engage in research, education, and outreach to shape effective policies around gun violence and mental health.

Gun Violence and the Perceived Link to Mental Illness

Gun ownership, gun control, and gun violence have long been contentious topics in national policy discourse. In its most recent report, the Small Arms Survey estimates that individuals in the United States own more than 393 million guns, representing nearly half of the world’s privately owned guns (Karp, 2018). In other words, there are more guns in the United States than there are residents, who numbered 325.7 million in 2017. The public health impact of resulting gun violence is staggering. The Centers for Disease Control and Prevention (CDC, 2017) reported that there were nearly 39,000 firearm-related fatalities in this country in 2016. Approximately 59% of those fatalities were due to suicide, and 37% to homicide. Each day in the United States, an average of 96 people are killed and more than 200 injured by guns (CDC, 2017).

Mass shootings account for approximately 1% of all firearm-related deaths in the United States—far fewer than suicide, intimate partner violence (IPV), and other gun-related violent crime—but they garner far more news coverage (Rozel & Mulvey, 2017). An increasingly common narrative emerging from these widely publicized tragedies is that individuals with mental illness are violent and that mass shootings and other acts of gun violence are the result of mental illness (Rozel & Mulvey, 2017). Much of the public has embraced this narrative. According to 2013 polling data collected in the aftermath of the 2012 Sandy Hook Elementary School shooting, people were more likely to blame the mental health system than easy access to guns for mass shootings; moreover, the majority of people surveyed supported increased spending on mental health screening and treatment as a gun violence prevention strategy (Swanson, McGinty, Fazel, & Mays, 2015). Public perception of a link between mental illness and gun violence is problematic for numerous reasons. It reinforces stigma around mental illness and potentially deters people from seeking treatment (Chappell, 2014; Swanson et al., 2015). Furthermore, this narrative distracts policymakers and the general public from responding in an empirically grounded way to the complex—and distinct—public health problems of gun violence and mental illness.

The Evidence

A wealth of evidence reveals that the vast majority of people with serious mental illness will never behave violently toward others (Swanson et al., 2015). When a person with mental illness does commit an act of violence, it can often be explained by the same risk factors that predict violence by people without mental illness. Among the most significant risk factors for interpersonal gun violence are socioeconomic disadvantage, abuse of illicit drugs or alcohol, and a history of trauma and/or violent victimization (Swanson et al., 2015).

Whereas mental illness only weakly predicts violence toward others, numerous studies have demonstrated a substantially higher risk of suicide among individuals with mental illness (Swanson et al., 2015). Notably, studies also show that access to firearms strongly contributes to suicide risk (Baumann & Teasdale, 2017): Individuals who commit suicide are more likely to have had access to guns in the home. Still, the narrative linking mental illness and gun violence remains narrowly focused on mass shootings while paying insufficient attention to gun-involved suicide.

Gun violence in any form affects families in a multitude of ways, each important to address. From our perspective as family health professionals, we must also consider the impact on families of the pervasive narrative linking mental illness to gun violence. For example, families convinced of the narrative may believe that it is unnecessary to practice safe firearm storage in the absence of a known mental illness in their family. As the narrative perpetuates untrue stereotypes against persons with mental illness, families in which mental illness is present may experience increased stigma and may avoid treatment out of fear that their rights and privacy will be violated. Given the evidence that serious mental illness in and of itself is not a predictor of future interpersonal violence (Price & Norris, 2010), family health professionals must advocate for policies that promote the safety and well-being of families and communities without reinforcing or exacerbating stigma related to mental health problems (Swanson et al., 2015).

Current Policy Landscape

Despite the lack of evidence, the widespread belief that mental illness drives mass shootings and interpersonal gun violence more broadly has shaped 50 years of gun control policy in the United States (Swanson et al., 2015). Since the 1968 passage of the Gun Control Act, a key component of federal policy has been to identify categories of individuals prohibited from purchasing guns. One such category is individuals with severe mental illness, generally defined in federal regulations as people who have been either involuntarily committed to the hospital or legally declared incompetent to stand trial or manage their affairs as a result of mental illness (Rozel & Mulvey, 2017). The 1993 Brady Handgun Violence Prevention Act and subsequent policies in the 2000s led to the creation and expansion of a national electronic registry, which relies on states to report their criminal justice and mental health records.

Various states have implemented additional policies addressing gun violence by persons with mental illness. For example, California and Florida have expanded gun ownership prohibitions against individuals who have been admitted to psychiatric hospitals (Swanson et al., 2015). New York went a step further when it passed the Secure Ammunition and Firearms Enforcement (SAFE) Act of 2013, which mandated that mental health professionals report to police the names of patients posing a “substantial risk” of violence. Police could then crossreference names with those in the state’s handgun permit registry and remove handguns from reported patients (Swanson et al., 2015).

Although state-level policies such as SAFE have not yet been adequately studied, there is scant evidence that placing mental health restrictions on guns effectively identifies individuals with mental illness who pose a significant risk of gun violence or deters those individuals from accessing guns (Swanson et al., 2015). A plausible reason for this is that most people who are at risk of violence have no record in the judicial or mental health systems that would disqualify them from owning a gun (Swanson et al., 2015). Even among those with legal disqualifications, there are avenues by which they may access guns (e.g., purchasing a gun online or at a gun show). Moreover, a large proportion of individuals in the United States live in households with guns, making it possible for them to engage in gun violence without having to purchase their own firearms (Rozel & Mulvey, 2017).

Policy Recommendations

To address the intersection of mental health and gun violence, policymakers must develop policies that are evidence based rather than crisis driven. We agree with the numerous researchers, practitioners, and advocates who have called for robust research funding on gun violence causes, consequences, and prevention (e.g., Consortium for Risk-Based Firearm Policy, 2013; National Physicians Alliance and Law Center to Prevent Gun Violence, 2013).

On the basis of available evidence, we also support the adoption of state- and federallevel policies that restrict the purchase or possession of guns by individuals whose behaviors represent identifiable risk factors for violence (Consortium for Risk-Based Firearm Policy, 2013). For example, people subject to a restraining order for domestic violence, those with more than one conviction for driving under the influence of drugs or alcohol, or those convicted of a violent misdemeanor are more likely than others to pose a danger to themselves or others. Focusing on risk factors like IPV and substance abuse would enable policymakers and law enforcement to develop more effective criteria and processes for restricting access to or removing firearms from at-risk individuals. Furthermore, states should consider and evaluate gun violence restraining order laws, which allow family members and intimate partners to petition the court to temporarily remove guns from an individual with significant risk factors for causing harm to self or others (Frattaroli, McGinty, Barnhorst, & Greenberg, 2015).

Implications for Family Professionals

Family health professionals must actively engage in shaping policies and practices that acknowledge the complex realities and risks of firearm access and ownership in the United States (Rozel & Mulvey, 2017). Although evidence from other countries suggests that broadly restricting access to guns effectively reduces all forms of gun violence, such policy options are constrained in this nation by the constitutionally protected individual right to own firearms (Swanson et al., 2015). Thus, it is vital that we consider strategies for reducing the negative consequences of high rates of gun ownership. One strategy would be to develop and test trainings and resources for health professionals that are related to gun safety counseling, risk assessment, and violence management (Rozel & Mulvey, 2017). Family health professionals are well positioned to inform and implement evidence-based standards of care related to assessing families’ risk factors and promoting safer gun practices. It is incumbent upon us to educate families, communities, and policymakers that gun violence and mental illness are complex problems, each requiring a range of thoughtful responses. They are distinct problems that “intersect at their edges” (Swanson et al., 2015, p. 374). Policies based on a narrative that conflates the two will almost certainly fail to meaningfully reduce gun violence.

Complete References

Baumann, M. L., & Teasdale, B. (2017). Severe mental illness and firearm access: Is violence really the danger? International Journal of Law and Psychiatry, 56 , 44–49 .

Brady Handgun Violence Prevention Act of 1994. Pub. L. No. 103-159, 18 U.S.C. § 921–922 (1994).

Centers for Disease Control and Prevention. (2017). Fatal injury reports, injury prevention & control: Data & statistics. Retrieved from https://webappa.cdc.gov/sasweb/ncipc/mortrate.html

Chappell, D. (2014). Firearms regulation, violence and the mentally ill: A contemporary Antipodean appraisal. International Journal of Law and Psychiatry, 37 , 399–408.

Consortium for Risk-Based Firearm Policy . (2013). Guns, public health, and mental illness: An evidence-based approach for federal policy. Retrieved from www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/GPHMI-Federal.pdf

Frattaroli, S., McGinty, E. E., Barnhorst, A., & Greenberg, S. (2015). Gun violence restraining orders: Alternative or adjunct to mental health-based restrictions on firearms? Behavioral Sciences and the Law, 33 (2–3), 290–307.

Gun Control Act of 1968. Pub. L. No. 90-618, 18 U.S.C. ch. 44 § 921 (1968).

Karp, A. (2018). Estimating global civilian-held firearms numbers: Small Arms Survey. Retrieved from www.smallarmssurvey.org/fileadmin/docs/T-Briefing-Papers/SAS-BP-Civilian-Firearms-Numbers.pdf

National Physicians Alliance and Law Center to Prevent Gun Violence. (2013). Gun safety & public health: Policy recommendations for a more secure America. Retrieved from http://lawcenter.giffords.org/wp-content/uploads/2013/09/gunsafety-and-publichealth.pdf

New York Secure Ammunition and Firearms Enforcement Act of 2013. New York Senate Bill 2230 (2013).

Price, M., & Norris, D. (2010). Firearms laws: A primer for psychiatrists. Harvard Review of Psychiatry, 18 (4), 326–335.

Rozel, J. S., & Mulvey, E. P. (2017). The link between mental illness and firearm violence: Implications for social policy and clinical practice. Annual Review of Clinical Psychology , 13 , 445–469.

Swanson, J. W., McGinty, E. E., Fazel, S., & Mays, V. M. (2015). Mental illness and reduction of gun violence and suicide: Bringing epidemiologic research to policy. Annals of Epidemiology , 25 (5), 366–376.

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The Crisis of Gun Violence

Addressing gun violence requires taking into account multiple perspectives..

Posted April 13, 2021 | Reviewed by Abigail Fagan

The topic of guns and gun violence has again become front-page news as it does with each mass shooting. I’ve written about gun violence and what it will ultimately take to address it in articles through the years. It is a concern about which opinion today becomes immediately polarized.

In my work as a cultural psychiatrist, I attempt to bring a big picture, “culturally mature,” systemic perspective to essential issues. First, such a perspective commonly requires that we take into account multiple, interwoven causal factors. Second, it alerts us to the fact that effectively addressing many of those factors necessarily involves thinking and acting in ways that before now would not have made sense to us. In my most recent book, Creative Systems Theory: A Comprehensive Theory of Purpose, Change, Interrelationship in Human Systems , I attempt to bring such perspective to current critical issues, including gun violence.

Most efforts to address today’s crisis of gun violence in the United States reduce to a simple answer, single-cause/single-cure ideological debate. Liberals argue that gun control measures will make us safer. Conservatives argue that such measures will make us less safe, often shifting the focus to mental health concerns. Pieces of the truth lie in each claim, but each position is limited by simplistic assumptions. And other essential aspects of the gun violence question—arguably those of greatest significance—are rarely part of the conversation.

Given this complexity, a brief listing of factors can provide only a start, but here is my list, with emphasis given to needed interventions. Only the first two factors below are directly addressable through policies. At the same time, all must play a role if we wish to bring mature, systemic understanding to this essential issue. With all of them, it is important to appreciate that the great preponderance of gun violence incidences involve not mass shootings but homicides and suicides.

Limiting access to guns certainly has a place in curbing gun violence. Statistics show that gun violence is less common in countries where guns are less readily available. But limiting access to guns alone is less of a solution than people like to think. Gun advocates are correct in their assertion that people who are determined to get guns will find ways to do so.

As a psychiatrist, I agree that increased availability of mental health services can make a significant difference—both better treatment for those whose mental states might lead them to commit violent acts and better systems for identifying such individuals. But many people who perpetrate gun violence do not have obvious psychiatric diagnoses. And while those who resist gun control measures can be quick to shift attention to the mental health of perpetrators, often these same people are the first to resist increased spending for mental health services.

The remaining factors all in some way concern the degree to which people experience meaning and possibility in their lives. When people do not, they become more vulnerable to perpetrating violent acts. As a start, poverty, bigotry, cultural background, or simply temperament can deprive people of meaningful options. In the long term, improving economic opportunity, addressing discrimination , and increased appreciation of diversity should all have important roles in lessening gun violence.

The role of violence in media and popular culture is sometimes acknowledged, but rarely does it get the emphasis it deserves, and the mechanisms of its effects tend not to be fully appreciated. Certainly violence is dramatically more pervasive in the media than it is in daily life. “If it bleeds it leads” too often determines what is on the evening news, and it is rare to see television programming intended for adults that doesn’t include at least one shooting (and often many).

And violence is central to the attraction of video games. Research supports that this constant barrage of violent imagery by itself contributes to the problem. But there is also a more troubling mechanism at work beyond just familiarity. At a deep neurological level, people may come to associate the jolt of excitement that accompanies witnessing violent acts with significance. Given violent imagery’s defining importance in the media today, we should not be surprised when someone who feels a lack of purpose in his or her life responds violently. I think this factor—both its pervasiveness and the fact that we so often fail to acknowledge it—is one of the greatest contributors to what we see today.

The last factor is likely the most ultimately important, but it also most specifically requires an understanding of the broader cultural change processes that the Creative Systems Theory concept of Cultural Maturity describes. Again it concerns people’s experience of significance, but here at the most encompassing of scales. The concept of cultural maturity proposes that underlying all more specific crises in our time is a more basic crisis of purpose. As culture functions less as a symbolic parent, traditions and cultural dictates stop providing the same ready sense of meaning.

In my writings, I describe how we reside today in an awkward “in-between-stories” place in these changes and often feel adrift. Indeed we often find regression with regard to needed steps forward. Ultimately, the most important factor in reducing gun violence may be the recognition of a new, more mature cultural narrative able to provide a renewed sense of individual meaning and shared purpose.

Given the complexity of this picture, a person attempting to make sense of gun violence could easily feel overwhelmed, or even dispirited. But we have to accept that the challenge confronts us this deeply if we are to make real progress in addressing it. Like it or not, seemingly easy solutions of any sort are going to leave us short.

The “good news” about applying a culturally mature perspective to public policy is that it helps us understand the systemic sophistication needed to act wisely. The “bad news” is that it doesn’t let us off easily. It alerts us to how our conclusions most often have their roots in simple answer, ideological thinking. And it makes clear that with most policy questions, multiple, evolving, interrelated causal variables come into play. It also confronts us with the recognition that effectively addressing key variables may require that we think in new—more mature and systemic—ways. The result asks more of us, but it offers the possibility of getting us where we need to go.

Charles M. Johnston, MD , is a psychiatrist, writer, and futurist. He is the author of numerous books and articles on the future and how we can best prepare to meet it.

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APS Spotlight

How owning a gun raises anxiety, aps webinar showcases psychological research on firearms in america.

As the COVID-19 pandemic raged in 2020, gun sales in the United States soared to their highest levels in at least a decade. But purchasers weren’t looking to spend the nationwide lockdown hunting or adding to their gun collections. The primary reason driving one in five American households to buy a gun was security.

Although people in most developed countries view guns as dangerous, Americans largely view guns as a tool to protect themselves in a world they perceive as dangerous, research shows. But ironically, having access to a gun may leave owners feeling more anxious, according to research by social psychologist Nick Buttrick of the University of Wisconsin–Madison.

Buttrick was among four panelists in a Sept. 20 APS webinar, Science for Society: Gun Violence and Anxiety in the United States . The webinar covered a variety of research and insights on gun ownership and attitudes.

If you were unable to attend or wish to watch again, you can now view a recording of the program .

Guns and identity

In a recent Pew Research Center survey , only a third of gun owners cited hunting or sports shooting as a driving reason for possessing a firearm. Nearly 75% of those respondents cited protection as their main reason for owning a gun, compared with just 67% who cited that reason in a similar 2017 survey. More than 80% said they feel safer with a gun in the home than without one.

Statistics show that firearms in the home are actually a danger, not a safeguard. A gun in the household doubles the chance of a murder and triples the likelihood of a suicide, Buttrick said. Yet gun owners appear to embrace their weapons “as a coping mechanism, helping to deal with the anxieties that come from fundamentally believing the world is dangerous and society doesn’t care about you.”

Buttrick shared some yet-to-be-published research showing the psychological drawbacks of this coping mechanism. In an experiment during the pandemic shutdowns, his lab sent a series of text messages to gun owners, asking them how much meaning and control they felt over their lives. When the texts prompted gun owners to think about their guns, the recipients reported finding more meaning in their lives. But they also showed more hypervigilance and anxiety when their guns were accessible versus when they were not (Buttrick et al., under review).

“Actually having [the gun] seems to be associated with appraisals of the situation as being more dangerous,” he said. “So if we’re not taking this psychology into account—the ways in which people are using guns to deal with stresses, with their psychological fundamental needs—we may be missing really important barriers to help people think about what guns can and can’t do in their everyday lives.”

Read all of the articles from the November/December Observer .

Guns and youth

Amanda B. Nickerson, a school psychology professor at the University at Buffalo, The State University of New York, shared her research on the developmental pathways toward gun violence. She and her colleagues found that prenatal exposure to drugs and alcohol predicted aggression in kindergarten, which then predicted the gun-violence attitude of aggressive response to shame. Both victimization and perception of bullying also predicted these gun-violence attitudes among adolescents.

In a policy brief for the Rockefeller Institute of Government, Nickerson and Columbia University associate professor of health and behavior studies Sonali Rajan found that the burden of firearm violence falls disproportionally on people of color, particularly Black men between ages 15 and 24 in urban settings. Black children between ages 5 and 17 were exposed to violence in their neighborhoods 4.44 times more frequently than white children prior to the COVID-19 pandemic, and these stark disparities have become even more pronounced since (Nickerson & Rajan, 2022).

Nickerson also shared several factors that can buffer youth from engaging in gun violence, including family, school, and peer support; concern for others; and future aspirations.

Preventing deaths

Nickerson has also studied the psychological effects of school lockdown drills, which are becoming common amid a string of infamous mass shootings over the last decade. Critics of those exercises warn that they can traumatize students. But research shows that those drills—locking doors, turning out lights, staying silent and out of view—do not appear to raise anxiety levels for children and indeed save lives (Shildkraut & Nickerson, 2022).

“In one study , we found that there was even lower anxiety after students participated in the drill,” Nickerson said.

Chris Knoepke, a University of Colorado scholar and clinical social worker, noted that more than 60% of gun deaths in the United States are suicides. When conducting suicide-risk assessments, doctors tend to ask patients if they have thoughts of death but often don’t mention firearms specifically, he explained. However, he cited several promising programs, including one he helped create, that limit individuals’ ability to harm themselves when they are in crisis. Clinicians can help clients develop a plan to limit their access to firearms or other lethal weapons, such as storing them in a lockbox or giving them to a trusted family member, he said (Betz et al., 2019).

Tracey Scherr, a Wisconsin-based school psychologist and violence-prevention advocate, discussed her use of research data in her efforts to generate more public safety measures that prevent gun-related deaths and injuries. She noted that there’s a tendency among the public to blame mental illness as the cause of gun violence.

“We know that mental illness is actually more connected to being victimized by gun violence than it is to perpetrating gun violence,” Scherr said.

The Bad-Behavior Blend

“The one gene, one disease idea is a thing of the past.” Scientists aren’t simply trying to identify people who are innately predisposed to incivility, immorality, or lawlessness. They’re examining how parenting, education, and other life experiences trigger those biological leanings.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Read the Full Text (PDF, HTML) Mental illness has wide-reaching effects on people’s education, employment, physical health, and relationships. Although many effective mental health interventions are available, people often do not seek out the care

Myth: People With Mental Illness Are More Prone to Violence

Instructors should be prepared to listen for —and challenge — belief perseverance, and can use this myth to highlight how automatic and difficult belief perseverance can be to overcome.

Feedback on this article? Email [email protected] or login to comment. Interested in writing for us? Read our contributor guidelines .

References

Betz, M. E., Knoepke, C. E., Siry, B., Clement, A., Azrael, D., Ernestus, S., & Matlock, D. D. (2019). “Lock to Live”: Development of a firearm storage decision aid to enhance lethal means counseling and prevent suicide. Injury Prevention , 25 , i18–i24. https://doi.org/ 10.1136/injuryprev-2018-042944

Buttrick, N. R., Heintzelman, S. J., Medina-Devilliers, S., & Wang, X. (under review). The world through gun sights: Salient weapons may incompletely help owners deal with psychological threat.

Nickerson, A. B., & Rajan, S. (2022). The effects of firearms violence on children: Implications for its prevention in schools and our communities. [Policy brief]. Rockefeller Institute of Government. https://rockinst.org/issue-area/the-effects-of-firearm-violence-on-children

Nickerson, A. B., Shisler, S. M., Eiden, R. D., Ostrov, J. M., Schuetze, P., Godleski, S. A., & Delmerico, A. M. (2020). A longitudinal study of gun violence attitudes: Role of childhood aggression and exposure to violence, and early adolescent bullying perpetration and victimization. Journal of School Violence , 19 , 62–76. https://doi.org/ 10.1080/15388220.2019.1703716

Schildkraut, J. & Nickerson, A. B. (2022). Lockdown drills: Connecting research and best practices for school administrators, teachers, and parents. MIT Press.

Is there evidence of a *causal* connection between gun ownership and anxiety? Is it possible that anxiety causes gun ownership and accessibility? Please do better here. Better science. Better reporting.

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AI’s Limits, Potential for Psychological Research and Practice

In the latest Science for Society webinar, psychologists came together to discuss the past and current applications of artificial intelligence from a scientific perspective. A recording of the webinar is also available for registrants and APS members.

Professional Development Workshop: The Keys to a Successful Mentoring Relationship

What’s the best way to establish a productive mentoring bond? An APS Professional Development Webinar offers some answers.

Science for Society: How Research Can Foster Social Equity

To create lasting social change, psychological scientists are not just studying marginalized communities, but partnering with them.

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West J Emerg Med
v.19(6); 2018 Nov

Gun Violence: A Biopsychosocial Disease

Stephen w. hargarten.

* Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin

¶ Medical College of Wisconsin, Comprehensive Injury Center, Milwaukee, Wisconsin

E. Brooke Lerner

Marc gorelick.

† Children’s Hospital and Clinics of Minnesota, Minneapolis, Minnesota

Karen Brasel

‡ Oregon Health and Science University, Department of Surgery, Portland, Oregon

Terri deRoon-Cassini

§ Medical College of Wisconsin, Department of Surgery, Milwaukee, Wisconsin

Sara Kohlbeck

Gun violence is a complex biopsychosocial disease and as such, requires a multidisciplinary approach to understanding and treatment. Framing gun violence as a disease places it firmly within medical and public health practice. By applying the disease model to gun violence, it is possible to explore the host, agent, and environment in which gun violence occurs, and to identify risk factors to target for prevention. This approach also provides an opportunity to address scientifically inaccurate assumptions about gun violence. In addition, there are many opportunities for medical communities to treat gun violence as a disease by considering and treating the biologic, behavioral, and social aspects of this disease. The medical community must answer recent calls to engage in gun violence prevention, and employing this model of gun violence as a biopsychosocial disease provides a framework for engagement.

Gun violence is a pervasive public health burden in the United States. Annually, over 36,000 Americans die from firearm-related events; tens of thousands are injured. 1 The medical community has periodically called for framing gun violence as a public health/medical issue. 2 – 9 Given the impact of gun violence on health and longevity, 10 others have suggested that physicians have a moral obligation to address gun violence. 11 , 12 More recently, others have called upon physicians to integrate firearm-related education about safety with their patients. 13

Calls for engagement have increased with multiple physician organizations calling for action. 2 , 14 In much the same way that human immunodeficiency virus (HIV) rates grew unchecked until we began to acknowledge that it was a biopsychosocial disease that could be prevented and controlled, and scientifically we moved past the social stigmas of a disease first recognized as largely affecting homosexual men, gun violence will continue unchecked until we invest in research to discover effective means to reduce it. To fully engage physicians and other sectors of the healthcare community, we need to frame gun violence as a biopsychosocial disease. 12 We know that gun violence follows predictable patterns just like infectious diseases and other illnesses. 15 For example, young African-American males are at increased risk of firearm-related homicide, while older White males are at increased risk for firearm-related suicide. Through an understanding of the risk factors for a disease, we can identify means of control and prevention.

The disease model approach was first advanced in the 19th century and continues today. With a science driven understanding of disease etiology, physicians and other civic leaders were positioned to discover vaccines, thus changing the environments that breed the vectors of illnesses, while identifying high-risk groups for preventative interventions– all driven by the science of discovery. We are seeing this unfold today with the Zika virus, 16 and the prevention strategies of other communicable diseases such as tuberculosis and HIV that continue to benefit from the rigorous application of the disease model. By identifying and understanding the disease agent, its vector of transmission, and the high-risk hosts and environments, all sectors of civil society – healthcare, public health, businesses, schools, fire and police agencies– can work in concert to institute interventions that reduce morbidity and mortality. These interventions may prevent exposure to the agent that causes disease, reduce the chance of becoming ill if exposed, or limit the damage after the disease is contracted.

Scientific investigations have advanced the disease model to include other causes of cellular/organ damage from a variety of etiologic agents. 17 For decades, clinicians and public health professionals have been trained to understand the definition of disease as having four components: etiology, pathogenesis, morphologic changes, and clinical significance. 17 We have learned that the etiologic agents of diseases are categorized into biologic and physical agents that interact with cells and organs, resulting in disruptions of cell walls and the release of substances that cause additional destruction. 18 For example, with the Ebola virus disease, the pathogenesis occurs over days and can manifest up to 21 days after exposure. The virus begins to replicate and results in morphologic changes in cells/organs that manifest as a constellation of symptoms, resulting in nausea, vomiting, and diarrhea, leading to dehydration, organ failure and death.

Analogously, the kinetic energy from a bullet is the physical agent of gun violence. The kinetic energy imparted by the speeding mass of the bullet results in the tearing of cellular membranes, leading to edema, fractures, and bleeding, resulting in organ failure, shock, and death. The energy (KE=1/2MV 2 ), is transmitted to the host/patient from the bullet – penetrating the skin, entering the body, and transmitting the energy, leading to temporary and permanent cavity formation, and a sterile injury to the patient. 18 , 19 The pathophysiology of this disease has received limited examination because the agent (kinetic energy) causes destruction so quickly (less than 0.1 sec). 20 The high-speed video camera is the “microscope” for this rapidly occurring disease. It is through this “lens” that we can document the temporary and permanent cavity formation that is the hallmark of the biology of this disease. 19 – 21 This dramatically brief pathophysiology limits acute interventions during the release of kinetic energy and is distinctive since diseases from other agents, such as viruses and bacteria, clinically develop over days or weeks.

By framing gun violence as a biopsychosocial disease, 22 it engages the healthcare community of physicians and nurses, complements the necessary multidisciplinary approach to advance our scientific understanding, and informs host, agent/vector, and environmentally-focused interventions beyond the immediate biology of fractures, bleeding, and edema. This is critically important since preventing and controlling gun violence will not occur to any significant degree until we begin to approach it in a manner similar to controlling other biopsychosocial diseases such as HIV. One immediate benefit of framing gun violence as a disease is the opportunity to address misleading/limiting statements as scientifically inaccurate, yet repeated over and over again. One of the most common of these is: “Guns don’t kill people, people kill people.”

The disease model provides us with accuracy: the bullet and its kinetic energy shreds, tears and destroys cells, and damages organs, leading to death and disability. While the behavioral health issues that result in a person pulling a trigger and releasing the energy need to be better understood, first and foremost we need scientifically accurate statements that advance the necessary, challenging discussions. By recognizing that bullets kill people, the gun, which carries the bullets, becomes a necessary focus of intervention. One such strategy would be to limit the rate of the release of bullets by, for example, banning bump stocks or automatic weapons, or by reducing the amount of potential energy the gun can carry (magazine capacity). Without this framing we will be limited to education of our patients 13 or continue to be stuck, mired in debates that do not advance scientific understanding, but only entrench positions. We limit progress related to gun violence by not addressing the environment and the social context and psychological antecedents and outcomes of this disease that affect patients, families and communities. 23 , 24

In addition to the injury caused by a bullet, the body’s own biologic stress response is activated and involves a cascade of bodily systems, including stress hormones. While this biological response is adaptive, sustained activation of the acute stress response degrades healthy adaptation following a life-threatening situation. This is even further exacerbated when an individual experiences psychological stress after trauma, particularly post-traumatic stress disorder (PTSD). The social context of gunshot-wound patients is paramount, including the community/neighborhood the survivor is coming from, the location of the wounding event, and the environment to which they have no choice but to return. Unfortunately, issues such as familial retaliation and the maintenance of perceived strength within communities with high levels of violence can perpetuate the cycle of gun violence, “spreading” the risk of the disease. Social, environmental, physical, and psychological pre-, peri-, and post-injury factors influence the course of gun violence as a disease and therefore should be treated from this biopsychosocial perspective.

There are many opportunities for medical communities to treat gun violence as a biopsychosocial disease. Increasingly, trauma centers 25 are recruiting clinical psychologists to provide behavioral health interventions that complement the surgical team’s emphasis on the biology. While the integration of behavioral health specialists is occurring within centers where the disease is most likely to be treated, the majority of centers are not yet advancing care with this integrated approach. Behavioral/social interventions include hospital-based, violence-prevention programs, where the focus is to address the social and behavioral issues of gun violence and to prevent recidivism. In some instances, primary care physicians are 26 trained in assessing exposure to trauma to understand the social context of the patient’s health. They can provide recommendations for psychological care if distress is evident. While these examples exist within healthcare, unfortunately they are not the norm. To move disease prevention forward, significant development of integrated multidisciplinary programs is needed. Additionally, more research is needed in the inpatient setting of trauma centers to better understand the psychosocial elements of this disease to maximize outcomes and reduce recidivism.

The importance of this framing distinction can be more easily seen when we consider prior and ongoing work to reduce the burden of acute injury from car crashes. We have achieved considerable success in the application of the disease model, which has resulted in significant reductions in death and disability over the past 50 years.

Evidence-based policies such as seatbelt laws and significantly improved car and road designs that attenuate and control the energy exchange with passengers and drivers – all components of the disease model – have been systematically investigated and advanced. 29

In the first 10 years of the 21st century there were substantial declines in morbidity and mortality from other public health burdens such as vaccine-preventable diseases, childhood lead poisoning, cardiovascular disease, workplace-associated injuries, and cancer, while improvements were made in areas such as maternal and fetal health. 27 However, similar improvements have not been made in firearm deaths during this time; in fact, deaths from firearms continue to rise. This may be attributed, at least in part, to the relative paucity of funding for firearm-violence research, due in part to the 1996 Dickey amendment, which states that, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” 28

As a society, we have achieved success in controlling infectious diseases with a focused, disease-model approach, and we have successfully expanded the use of the disease model to prevent and control non-communicable diseases such as cancer and heart disease. We have used this approach for other challenging biopsychosocial disease burdens such as smoking and alcohol abuse. 30 Further, it was only once we blunted the political stigma stunting our progress in combating HIV that the most significant discoveries took place and lives were saved. Yet we have not taken the next step in using the disease model to prevent and control gun violence, in part due to the relative lack of funding, and therefore the relative lack of investigation. Framing gun violence as a disease places it firmly within medical and public health practice. Interventions across multiple sectors, informed by comprehensive, linked data and rigorous, adequately-funded research, can be used to prevent injuries, improve acute care and rehabilitation, and inform and evaluate program and policy interventions. These can ultimately reduce morbidity and mortality.

This framing opens up important areas of research and prevention strategies that can and must be organized to address all aspects of the disease: high-risk youth; adults and elderly; the gun and the bullets; and the environment. 30 Specific examination of the gun and its design/safety characteristics open up areas of potential interventions. Much like reducing a child’s access to the energy contained in a medicine container resulted in decreases in unintentional chemical injury from aspirin and Tylenol, 31 banning bump stocks would reduce the rate of energy release that was so tragically seen in the Las Vegas shooting of October 2017. Designing a “smart” gun, which leverages new technologies to identify a gun’s owner and prevent its use by others, could also have the potential to reduce the number of accidental (unintentional) deaths and suicides. 33 , 34 In this environment, requiring background checks on all gun sales has the potential to further reduce unauthorized access. 35

Recent calls to engage the physician and public health communities in addressing gun violence 6 , 11 ,36 must be answered by the medical community. Kaiser Permanente, one of largest health systems in the U.S., has recently approved a $2 million expenditure to study gun violence prevention. 37 By framing gun violence as a biopsychosocial disease we can move beyond acrimony and fear, use the tools that have been honed over centuries to advance science, and prevent and control this disease burden that adversely impacts our patients, families, and communities across the U.S. and the world.

ACKNOWLEDGMENTS

The authors wish to express their gratitude for manuscript preparation to Dawn Lyons.

Section Editor: Jeremy Hess, MD, MPH

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Speaking of Psychology: What do we know about preventing gun violence? With Susan Sorenson, PhD

Episode 145.

Guns killed nearly 44,000 Americans in 2020, a higher number than in any other year in the past two decades. Meanwhile, a spate of mass shootings in the spring brought gun violence to the forefront of the national conversation again. Susan Sorenson, PhD, director of the Ortner Center on Violence and Abuse at the University of Pennsylvania, discusses what we know about the causes and consequences of gun violence in the United States and whether research can offer any insight into how to prevent it.

About the expert: Susan Sorenson, PhD

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Kim Mills: For much of the past year, the coronavirus pandemic overshadowed another public health challenge in the United States, that of gun violence. But gun violence did not go away. The nonprofit Gun Violence Archive, which tracks gun deaths and injuries, estimated that guns killed nearly 44,000 Americans in 2020, 24,000 of them by suicide. That’s the highest number of annual gun deaths in the past two decades. And in March and April mass shootings in Atlanta, Boulder, Colorado, and Indianapolis catapulted gun violence to the forefront of the national conversation yet again.

What do we know about the causes of gun violence in the United States? Why is it rising now? Who is most at risk of committing gun violence or of being a target? And on this politically polarized issue, can research offer any insight into effective prevention strategies and hope for solutions?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I’m Kim Mills. Our guest today is Dr. Susan Sorenson, a professor of social policy, and health and societies, at the University of Pennsylvania, where she directs the Ortner Center on Violence and Abuse. She holds a PhD in clinical psychology and has an interdisciplinary background in epidemiology, sociology, and psychology. Her research focuses on the epidemiology of the prevention of violence, including gun violence. She has a particular interest in the role guns play in violence against women and in guns as a consumer product. She also served on a panel that developed APA’s 2013 report on gun violence prediction, prevention, and policy.

Thank you for joining us today, Dr. Sorenson.

Susan Sorenson, PhD: Thank you. I appreciate your interest in this issue and appreciate your invitation to be joining you today.

Mills: Great. Well, let’s start by talking about mass shootings that have been in the news quite a bit in the past couple of months, but they’re responsible for only a small percentage of gun deaths in this country. What are the main drivers of gun deaths in the United States?

Sorenson: The most common type of gun deaths in the United States is a suicide. As you noted, there are about two suicides for every homicide, but we tend to focus on the criminal uses of guns. And when somebody thinks about gun violence, they tend to think of homicides. In 2019, the most recent year for which we have national data, there are about 14,000 homicides. The next most common type of gun death were shootings by police. And there were 520 that were marked as that. And then the accidents or what public health people call “unintentionals,” there are about 486, and those that they couldn’t really determine what the nature of the death was or what the intent was were about 346. So overwhelmingly it’s an issue of suicide.

Mills: Well, let’s move to gun violence as a public health issue. What exactly does that mean? And why is it important for how we think about prevention?

Sorenson: Looking at guns as a public health issue is really important for a couple of reasons. One is it takes a consumer product approach. How do we prevent this? Let’s look at the gun itself. Let’s look at its design. Let’s look at its manufacturer. Let’s look how it’s advertised. Let’s look at how it’s distributed, how it’s sold. And then finally let’s look at the purchaser and the user. And almost all of our policies focus on that user component. We’d spend very little effort and energy looking at what we would call more upstream sorts of issues. And that’s in no small part because guns were specifically exempted from the Consumer Product Safety Commission Act of 1976. They were the only consumer product that was treated like that. So we don’t have any safety regulations on guns. To continue this just a bit more, when we talk about a public health approach, we’re talking about population, we’re talking about policy and we’re also talking about prevention as opposed to a more criminal justice or after-the-fact approach that focuses on the individuals and on how to treat and intervene after the fact.

Mills: Do you think that the increasing visibility of mass shootings has changed the way people fear gun violence in their everyday life?

Sorenson: Yes, definitely. Going about our basic activities it’s really important to feel safe. And we’ve had mass shootings at schools, movie theaters, concerts, supermarkets, work, nightclubs, places of worship. These are things that we do every day, just as a regular routine and as a regular matter. And yes, that fear of we’re not safe just doing our lives, has crept in. And I think it does change people’s behavior. We don’t have lots of solid research on it, but this is even cocktail party conversation of what it does. People in the past, I think, would try to avoid certain neighborhoods that they thought were risky or certain circumstances that they would think are risky, but this feels different. The mass shootings make it feel random or that it could happen to anyone. So that lack of control or that lack of ability to protect oneself makes people very, very uneasy.

Mills: So even though the likelihood of becoming a target of a mass shooting is small, it’s the fact that it’s so mundane now, it happens anywhere.

Sorenson: Yes. Yes. That’s well-put.

Mills: So gun sales are at a record high for the second year in a row and include many first-time gun buyers, according to recent news reports. What drives gun sales among both first-time owners and those who already own guns? And do you think this is a temporary spike or might this be a continuing upward trend?

Sorenson: Who will be able to know if it’s an upward trend? Only after we have a trend and after we have time. I too wish I had a crystal ball and could figure that out. But you make a really important point that people have bought a lot of guns. At the beginning of the pandemic people bought a lot of toilet paper. They also bought a lot of guns, and that has continued. It’s really remarkable that our gun sales used to peak right after mass shootings. And now 9 of the 10 highest weeks for background checks in the United States are since the pandemic began.

And within those 10 weeks, Americans—there have been background checks on nearly as many guns as are sold in an entire year for the highest years that we’ve ever had guns. So there has been just a surge in gun purchasing and it’s come around mass shootings, such as the Atlanta spa shooting and then the Colorado supermarket shooting. Sandy Hook is still in there in the top 10. But aside from that, it’s been when COVID first hit and there was a stay at home order, the week of the insurrection in January, around the elections, around political unrest, around the federal election last fall. So it’s an indication that there’s a lot of unrest and fear that people are trying to manage.

Mills: What’s interesting though, since we’re all kind of been locked down for a year, that people feel that they need guns to protect themselves when they’re not even going out to potentially dangerous places. It’s just puzzling.

Sorenson: But I think that’s what’s going on here and that’s what’s been posited as driving gun sales for quite a long time. It’s a fear, because even while gun deaths from crime were at low, low rates, lowest they had been for 40 years, people were buying more and more guns. I think that fear is driven in no small part by a lack of confidence in the government and the lack of trust in information sources and the lack of trust of one another. We don’t have research on that because it’s a really hard stuff to research, but that sense of, “I don’t know what’s going to happen. I’m fearful. I need to protect myself. I need to protect my family.” And this is a step that people take to try and buttress up that feeling.

Mills: So you talked about the lack of research, and I know for many years the Centers for Disease Control and Prevention didn’t fund gun violence research, but that is now beginning to change. How has the lack of research affected the field and do you think the recent changes will make a difference anytime soon?

Sorenson: There’s so many important issues that we don’t have answers to. The researchers in the field of gun violence had been sort of caught in this catch-22, because, “Well, what’s the answer to that?” “Oh, you don’t have the answer. We can’t do policy without the answer, but we’re not going to fund the research.” But I think the most devastating thing has been that we have missed the opportunity to train the next generation of researchers. We have missed an entire cohort, an entire generation of researchers who can carry this field forward, again, focusing on the firearm, not on the user, not on the criminal justice system and the processing, but actually to take that approach that might prevent and reduce gun deaths.

Mills: In 2013, as I mentioned in my intro, you were part of an APA task force that wrote a report on gun violence prediction, prevention, and policy. You wrote about policies to counteract gun violence at every level of the lifespan, the gun lifespan, from design, to manufacture, to sales, to use. What are some of the policies that have been effective and what are others that have not been as effective as we might’ve hoped?

Sorenson: I have to preface my response with the reality of, it’s extremely difficult to do research in this area—in no small part because we can’t do experiments, generally, which is the gold standard in research. You can’t randomly assign people to have a gun or not have a gun and then just wait to see what happens. That just would be completely unethical. And also we lack access to very basic information. And that has been precluded in some cases by federal law, by policies that agencies put in place and sometimes by state law. So we can’t get information on the number of purchasers, on any sort of ongoing basis. We have a really hard time getting access to data. And like I said, it’s sometimes precluded by laws. So the information that we want can be had in some of those data sources. So I think that’s what needs to be done and to have more access to the data, as well as the financial resources to actually study it.

But you asked about specific policies and I’ll just offer a couple of ideas. One is a general statement, and that is that the U.S. population is in substantial agreement around a lot of gun policies, but Congress fails to act. And if our representative democracy were working better, I think a lot of the gun policies such as universal background checks, keeping guns out of the hands of people who shouldn’t have them, would be more in place. One thing I would like to point out as something that appears to be working is keeping guns out of the hands of abusers. And we have some evidence that some of those laws are effective in reducing the homicides that are due to domestic violence.

Mills: So this is the red flag law concept where people will be tagged as having had a history of violence and therefore cannot just walk into Walmart and buy an automatic rifle.

Sorenson: Yeah, and the red flag laws are just in the process of being evaluated because they haven’t been in place very long. And just so you know, nobody can go in and buy an automatic rifle, semiauto, yes, but we haven’t allowed automatic weapons for quite a while. And maybe that’s worth mentioning too. The Valentine’s day massacre in 1929, there were seven men shot during that, and they were using machine guns. And shortly after that, we passed a federal law saying, “We’re not going to allow civilians to have machine guns.” And since then, just in the past few years, we’ve had the Harvest shooting in Las Vegas, we’ve had the Pulse nightclub shooting, we’ve had the Charleston Church shooting, we’ve had all of these others and with many, many deaths and Congress has failed to act. They’ve failed to act. When they acted very quickly after the 1929 Valentine’s day massacre.

Back to the issue of the red flag laws. They have been relatively recently implemented in several states and they’re in the process of being evaluated. And we do know that some of the other laws that are related to violence against women, and that were part of the Violence Against Women Act and the subsequent Lautenberg Amendment, have to do with keeping guns out of the hands of those who have been convicted of a misdemeanor of domestic violence and those who are subject to a protection from abuse order. It’s a civil remedy that’s available in all 50 states, called a restraining order in some places, and they go by different names, but those appear to be having some effect.

Mills: In 1994, Congress did enact a 10-year ban on the sale of assault weapons to civilians. And what I’ve been seeing lately is reports that the ban didn’t really have an effect on the rate of gun homicide. Is that correct?

Sorenson: That’s correct. Because the assault weapons are the kinds of guns that are used more in public mass shootings. The more private mass shootings, if you will, such as those that occur in the home when a man, typically a man kills his wife and children or other family members, and then sometimes kills himself, those are most often carried out with handguns. Most of our homicides and most of our suicides are with handguns. So banning a certain type of weapon such as those that are called assault weapons or assault rifles might affect one type of gun violence such as the public mass shootings, but not necessarily all of the others.

Mills: So much of your research has focused on how guns factor into intimate partner violence, not only increasing the risk of death by an intimate partner, but as a tool of coercion, even when they’re not fired. Can you talk about that research?

Sorenson: I’d be happy to. In some of the research that we did here in Philadelphia, working with the police department, and we got all 911 calls for domestic violence for the city in an entire year. And about 35,000 of those were what we called intimate partner violence. Guns weren’t used very often, but if there was an external weapon used, by that I mean a bat, a knife, a brick, a gun, not hands, fist and feet, but an external weapon, about a third of the time, it was a gun, a gun was involved. And when a gun is used in an intimate partner violence incident, it’s most often a man using it against a woman.

About 85% of the time it’s male on female. The other 15% are female on male, male on male, female on female. So I am going to use gendered pronouns here because that’s what the research indicates. And when the man uses a gun against a woman in an intimate partner violence situation to which police have been called most often it’s to threaten her, to instill fear, it’s not to shoot her, shoot at her or pistol whip her. And that’s important for several reasons.

One is that in state law in Pennsylvania, as it is in many laws, police use visible injury as the indicator as to whether or not an arrest is merited. So when they go and there’s no visible injury to her, they’re less likely to make an arrest. So the abuser has been able to use a gun to harm someone, to frighten someone, to terrorize someone, but without any particular consequence. Also, those who had used a gun in an incident were more likely to be gone by the time police arrived. So they were more likely to flee the scene. So they were harder to bring into the criminal justice system in the first place. And women who had had a gun used against them in this way had astronomically high levels of fear, much higher than those who had been beaten, or had a knife used against them or anything like that. So using a gun against an intimate partner changes the nature of that relationship. And it changes the nature of the climate and the atmosphere in the home. Oftentimes children are witness to this.

So one makes an assessment, just like we would if we were in the street and someone approaches with a gun and said, “Give me your money.” We might acquiesce. We might back down and say, “Is there some other way we can handle this?” We would give them their money. We’d give them whatever they asked for. Whereas if somebody came up with a clenched fist, we might run away, we might try to resist, we might try to escape in some way. But a gun just changes the nature of the situation. So we make an assessment that there’s a credible threat, that it’s realistic and then we change our behavior accordingly. And that’s what happens in the home. That’s what happens in the home. And my concern in addition to that experience is that the coercive use of a firearm sets up a context for ongoing abuse and for chronic abuse, because she’s going to be fearful of leaving because he has a gun. And when we know that when a woman leaves the relationship, that’s when she’s at highest risk of being murdered by her partner.

Mills: Are there potential remedies to this situation?

Sorenson: We have some good laws in place on the federal level. And many states have what’s called enabling legislation that basically mirrors that such that those who have been convicted of a misdemeanor domestic violence, or have a domestic violence restraining order against them, are not allowed to purchase or to possess either a firearm or ammunition. So we’re pretty good at the purchase part because if that information, that locality entered into their state database and that is reported up to the Feds, because the FBI does background checks for most of the states, not all, but most, then you can catch those people who have those misdemeanor convictions for domestic violence or a domestic violence restraining order.

We’re not so good though about the possession part, because it requires the abuser to relinquish any firearms that they have in their possession. And mostly what we have to do is go on that person’s word, because we don’t have a registry of guns. We don’t know if that person has guns. So we’re put in the sometimes untenable position of simply taking the abuser’s word that they don’t have guns.

Mills: I’m going to ask you a political question, just to prep you for this one, one large factor in Congress’s inability or unwillingness to enact restrictions on the sale of firearms and ammunition has been the power of the National Rifle Association. And there’s been a lot of publicity lately regarding problems within the NRA, from financial issues to a lawsuit in New York, to the alleged misspending of funds by NRA’s Wayne LaPierre. In your view, are these problems weakening the NRA and might that make it more likely that we will see some real policy changes regarding guns and ammunition in the near future?

Sorenson: These issues I do believe have weakened the NRA. I do not believe it has weakened the people who are members of the NRA, or who believe very strongly in what the NRA has purported for several decades. The NRA used to be, and many people don’t know this, but they used to be really a sport shooting organization. And in the 1980s, they sort of did a pivot and really got into beating the drum for gun rights and the idea that the government was going to take over your guns and take your guns. So they’ve created a narrative that I’ve never found to have much basis in reality, because we have more guns than we have people in the United States.

And let’s say that that’s true that the government does want to come and get your guns, they’re going to take them away. How could they even do that? I don’t even know who has guns. We don’t have gun registries. We don’t have a magnet that will suddenly pull up specific pieces of metal and pull them out. It’s not feasible. It’s not doable. So as an organizing principle, because you have to remember that the NRA is an advocacy organization and they’ve needed to keep money coming in, like all advocacy organizations do. And if they kept beating that drum, they’re going to come and get it, they’re going to come and get it. It heightens that fear, it heightens that sense of being under siege. But when we literally look at it, I don’t even know how that could happen.

Mills: What are the big questions regarding gun violence that we don’t have answers to?

Sorenson: Having spent my career studying gun violence I will take a different tack to answering this question. And that is to simply say, we know so little. I wish I could be more optimistic. I wish I could be. I am optimistic I should say that particularly with the influx of funding that we’re going to be seeing, and if we can get the access to data, then I’m far more optimistic, but I have to be I think appropriately modest and cautious in interpreting what we know right now. It’s relatively limited.

Mills: Given that we don’t have the research, I think you mentioned before that the legislators will ask, “where’s the data?” and you just come up empty handed, but based on what we do know, what are some of the policy changes that researchers like you believe could actually lower the rate of gun violence in this country?

Sorenson: To lower gun violence in the United States I think we need a multifaceted approach. I think we focused so much on looking for the one law or the two or three laws that are going to solve it. And it’s far more complicated than that. It connects into so much of not just a regular consumer product, but also so much of how people see themselves in the world and how they see America. It’s like when we had motor vehicle crashes. In public health, we started to look at how to reduce those. Well, we didn’t say, “okay, if we can reduce the speed limit, then that’s going to solve everything.”

We also had design issues. So we sit in cars, now they’re designed very, very differently than the ones that a generation or two of people grew up in. We have all sorts of laws and particular interventions around specific things. For example, the graduated driver’s license has substantially reduced motor vehicle crashes and deaths among young people. And we used to think driver’s ed is going to be very effective. We have a strong belief in education. If we just educate people, then they’ll do the right thing. And we found instead, driver’s ed had little to no effect and sometimes the opposite effect of what we wanted, because it was getting younger people behind the wheel sooner with less experience, but more confidence because, heck, they had had driver’s ed. We can pass laws around gun training. We can pass laws around registration of firearms.

We can pass laws that have to do with keeping guns out of the hands of people who we all agree should not have them. We could pass laws around assault weapons, which it’s a value statement as a society that we don’t think this type of firearm belongs in the hands of civilians, but it’s that panoply, it’s that multifaceted approach which gives us a chance of doing something, which gives us a chance of accomplishing something. But looking at one thing or even a handful of things, won’t do it. We have to have a comprehensive approach.

Mills: Well, thank you for joining us today, Dr. Sorenson. This has been very interesting and educational. I do hope that we get the data that you need in order to propose the solutions that will perhaps make us a little bit less lethal as a society. Thank you.

Sorenson: You’re most welcome. And I am optimistic because there are so many people who are coming into this field right now, because they do realize that it is a very, very pressing problem. We will have changes. Data do have a place at the policy-making table. Thank you.

Mills: You can read more about new funding for research on gun violence prevention in the April–May issue of APA’s magazine Monitor on Psychology . Just go to www.apa.org/monitor . And you can find previous episodes of Speaking of Psychology at speakingofpsychology.org or on Apple, Stitcher, or wherever you get your podcasts. And please, if it’s available, leave us a review. If you have comments or ideas for future podcasts, you can email us at [email protected] . That’s speaking of psychology, all one word @apa.org. Speaking of Psychology is produced by Lea Winerman, our sound editor is Chris Condayan.

Thank you for listening. For the American Psychological Association, I’m Kim Mills.

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Episode 145: What do we know about preventing gun violence? with Susan Sorenson, PhD

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A thaw in the freeze on federal funding for gun violence and injury prevention research ( Monitor on Psychology , April 2021)
Gun Violence: Prediction, Prevention, and Policy (APA, 2013)

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Kim I. Mills is senior director of strategic external communications and public affairs for the American Psychological Association, where she has worked since 2007. Mills led APA’s foray into social media and envisioned and launched APA’s award-winning podcast series Speaking of Psychology in 2013. A former reporter and editor for The Associated Press, Mills has also written for publications including The Washington Post , Fast Company , American Journalism Review , Dallas Morning News , MSNBC.com and Harvard Business Review .

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COMMENTS

Understanding gun violence: Factors associated with beliefs regarding
Objective: Gun violence is a pressing public health concern, particularly in the United States. In the midst of the COVID-19 pandemic, 2020 was a record-breaking year with 43,551 deaths attributed to gun violence in the U.S., with almost 20,000 classified as murder/unintentional death and more than 24,000 classified as suicide (Gun Violence Archive, 2021). Black men are 10 times more likely to ...
The psychology of guns: risk, fear, and motivated reasoning
A psychological model of the polarized gun debate in America would ideally compare those for or against gun control legislation. However, research to date has instead focused mainly on differences ...
Gun Violence: Prediction, Prevention, and Policy
Gun violence is an urgent, complex, and multifaceted problem. It requires evidence-based, multifaceted solutions. Psychology can make important contributions to policies that prevent gun violence. Toward this end, in February 2013 the American Psychological Association commissioned this report by a panel of experts to convey research-based ...
The War-Zone Mentality
But from this perspective, consideration of gun violence's effects on the mental health of young people highlights two issues among the many facing U.S. society: traumatic responses in children ...
PDF Understanding Gun Violence: Factors Associated With Beliefs Regarding
purpose of this Special Issue of the Psychology of Violence devoted to Gun Violence was to highlight and spur additional, psychologically oriented research regarding ﬁrearm violence. Method: This Special Issue ... Research, 2021). Gun violence is an umbrella term that includes different types of violence that involve a ﬁrearm, including ...
Mental Illness, Mass Shootings, and the Future of Psychiatric Research
Psychiatry stands to be an agent of change in promoting interventions and solutions for improving the health of a community, rather than narrowly addressing the most sensationalized manifestations of gun violence. This body of research becomes more salient as gun ownership emerges as an important theme in narratives surrounding America's ...
PDF Psychology of Violence
When Mass Shootings Fail to Change Minds About the Causes of Violence: How Gun Beliefs Shape Causal Attributions Wolfgang Stroebe1, Maximilian Agostini1, Jannis Kreienkamp1, and N. Pontus Leander1, 2 1 Department of Social and Organizational Psychology, University of Groningen 2 Department of Psychology, Wayne State University Objective: We developed and tested a gun-blame attribution model to ...
Gun Violence
Special issue of APA's Psychology of Violence, Vol. 11, No. 4, July 2021. This special issue is intended to spark greater interest in working to mitigate firearm violence and encourage researchers across scientific disciplines to collaboratively apply their theoretical perspectives and methodologies to reduce the devastating, but understudied, U.S. gun violence epidemic.
Mental Illness, Mass Shootings, and the Future of Psychiatric Research
Abstract. This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in ...
Raising our voices on gun violence
One of the critical strides forward on gun violence prevention has taken place on the research front. Since 1996, research on gun violence had been forestalled under the Dickey Amendment, a rider to that year's appropriations bill that disallowed the funding of any CDC-sponsored research related to gun violence that could be used for advocacy ...
Is Mental Illness a Risk Factor for Gun Violence?
Mental Illness and Firearm Interpersonal Violence. In 2018, 18,830 people died by homicide in the United States, 13,958 (74 percent) of whom died by firearm (Centers for Disease Control and Prevention, 2020). A review by Skeem and Mulvey (2020) examined the evidence base on mental illness and interpersonal violence, including gun violence and ...
Childhood Trauma Exposure and Gun Violence Risk Factors among Victims
The importance of gun violence as a research priority was emphasized at the presidential level under President Barack Obama's "Now is the Time" plan ... Despite the lack of a significant link between SMI and gun violence, psychological factors almost certainly play an important role in gun violence risk, as factors such as aggressive ...
Impacts of school shooter drills on the psychological well-being of
Finally, the research team conducted semi-structured interviews in the form of focus groups with students, parents, and K-12 school teacher volunteers at a grassroots gun violence prevention ...
The Link Between Mental Illness and Firearm Violence: Implications for
Gun violence restraining orders (GVROs) are an alternate pathway to removal established recently in several states. ... Expanded funding streams for well-designed objective research on firearm violence and violence prevention . ... Translating psychological science: highlighting the media's contribution to contagion in mass shootings: comment ...
Understanding gun violence: Factors associated with beliefs regarding
Objective: Gun violence is a pressing public health concern, particularly in the United States. In the midst of the COVID-19 pandemic, 2020 was a record-breaking year with 43,551 deaths attributed to gun violence in the U.S., with almost 20,000 classified as murder/unintentional death and more than 24,000 classified as suicide (Gun Violence Archive, 2021). Black men are 10 times more likely to ...
Gun Violence: Separating Myths From Reality
Myth 1: Mass shootings are a major driver of American gun violence. The sad truth is that preventing all mass shootings would still leave us with about 99.5% of firearm fatalities (Metzl et al ...
The Intersection of Mental Illness and Gun Violence: Examining the
We agree with the numerous researchers, practitioners, and advocates who have called for robust research funding on gun violence causes, consequences, and prevention (e.g., Consortium for Risk-Based Firearm Policy, 2013; National Physicians Alliance and Law Center to Prevent Gun Violence, 2013).
Stress of mass shootings causing cascade of collective traumas
At the policy level, a majority of Americans support stricter gun laws, but progress in that domain may be incremental (Jose, R., et al., Psychology of Violence, Vol. 11, No. 4, 2021). Slovic said it's important to stay engaged and not to let a false sense of inefficacy prevent us from taking steps in the right direction.
The Crisis of Gun Violence
Ultimately, the most important factor in reducing gun violence may be the recognition of a new, more mature cultural narrative able to provide a renewed sense of individual meaning and shared ...
How Owning a Gun Raises Anxiety
But ironically, having access to a gun may leave owners feeling more anxious, according to research by social psychologist Nick Buttrick of the University of Wisconsin-Madison. Buttrick was among four panelists in a Sept. 20 APS webinar, Science for Society: Gun Violence and Anxiety in the United States. The webinar covered a variety of ...
Gun violence and crime
Gun violence and crime. Gun violence affects society in many ways, including higher medical costs, reductions in quality of life because of fear of gun violence, and stresses on the criminal justice system. The United States has the highest rate of gun-related injuries among developed countries, as well as the highest rate of gun ownership.
Gun Violence: A Biopsychosocial Disease
Gun violence is a pervasive public health burden in the United States. Annually, over 36,000 Americans die from firearm-related events; tens of thousands are injured. 1 The medical community has periodically called for framing gun violence as a public health/medical issue. 2 - 9 Given the impact of gun violence on health and longevity, 10 others have suggested that physicians have a moral ...
Political violence, racial violence, and new gun ownership: results
Background U.S. firearm sales surged during the COVID-19 pandemic, with many purchases by first-time firearm owners. The 2023 National Survey of Gun Policy sought to understand the public health implications of this surge by comparing the purchasing motivations and firearm policy views of pandemic-era first-time purchasers to prior gun owners. Methods We fielded a nationally representative ...
Speaking of Psychology: What do we know about preventing gun violence
Susan Sorenson, PhD, is a professor of social policy, and health and societies, at the University of Pennsylvania, where she directs the Ortner Center on Violence and Abuse. She holds a PhD in clinical psychology and has an interdisciplinary background in epidemiology, sociology, and psychology. Her research focuses on the epidemiology of the ...