Gun violence doesn't just kill and injure people—it also takes a heavy emotional toll, leading to everything from anxiety to PTSD.

By Karen Pallarito
April 09, 2021
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In the aftermath of a mass shooting, we count bodies. Eight in Atlanta's spa massacre; 10 in Boulder's King Soopers rampage. What we don't tally are the nameless victims. These are the multitude of Americans shaken or retraumatized by news of the latest attack, folks in the affected communities left emotionally reeling, family and friends in mourning, and those who survived.

How to Deal With the Emotional Fallout From a Mass Shooting Incident , BOULDER, CO -MARCH 23: From left to right: Nirbisha Shrestha, Sophia Kennedy, and Josie Elowsky, all 19, are emotional as they hug near the fence surrounding the King Soopers on Table Mesa Drive on March 23, 2021 in Boulder, Colorado. The four went to high school in Boulder and spent almost every lunch hour at the King Soopers. Hundreds of people turned out late in the day to pay their respects to those that lost their lives by a gunman who opened fire inside the grocery store. People stayed well into the dark to drop off flowers, light candles, hug one another and to show their respects for the ten victims of the mass shooting. (Photo by Helen H. Richardson/MediaNews Group/The Denver Post via Getty Images)
Credit: Helen H. Richardson/MediaNews Group/The Denver Post via Getty Images

Mass shootings, while still a tiny fraction of all gun violence incidents, make headlines—and they're on the rise. In 2020, there were 611, up from 417 the prior year, according to the independent, nonprofit Gun Violence Archive. The group defines a mass shooting as having four or more victims, not counting the shooter, who were injured or killed by gunfire.

"Gun violence in this country is an epidemic," President Biden declared Thursday as he announced new gun-control measures. But even as Biden unveiled his plans, another mass shooting at a Bryan, Texas, cabinet business left one person dead and five injured. A day earlier, a South Carolina doctor, three of his family members, and a technician working at the doctor's home fell victim to a shooter. Those are the victims we know. How many other relatives, coworkers, and community members were left emotionally broken?

Long after the yellow crime-scene tape drifts away, the mental health repercussions of a mass shooting can linger, mental health professionals say. Here's what they want you to know about the emotional fallout of mass shootings, which touch everyone from survivors on the scene to those watching news images of the carnage from home.

Expect short-term and potentially long-term effects

The mental health impact can be wide-ranging. In the short term, you might feel startled or jumpy or have trouble eating and sleeping or trusting people, Sheela Raja, PhD, clinical psychologist and associate professor at the University of Illinois at Chicago and author of Overcoming Trauma and PTSD, tells Health.

She tries to assure people that these sorts of feelings and experiences are perfectly normal. "Human beings are not robots," she says, "so how could we not have a reaction?"

The fallout can be even more long-lasting and devastating, especially for victims and members of affected communities, research suggests—with some people experiencing clinical depression or post-traumatic stress disorder (PTSD), among other disorders. Sometimes when things become overwhelming, our go-to strategy is avoidance, Raja says. But as a long-term strategy, avoidance doesn't work very well, she says. "That's when we tend to see post-traumatic stress disorder, especially for an individual right in the middle of something traumatic."

A 2015 review of studies looked at the mental health consequences of 15 mass-shooting incidents. The review, published in the journal Trauma, Violence, & Abuse, links mass shootings with a variety of adverse psychological outcomes in survivors and members of affected communities. One of the most consistent predictors of post-trauma mental health consequences is fear for one's own life and safety, study author Sarah Lowe, PhD, now a clinical psychologist and assistant professor in the Department of Social and Behavioral Sciences at Yale School of Public Health, tells Health.

Lowe's research equated greater incident exposure, which includes proximity to an event, with more severe psychological reactions. "So if you are in a position where you are seeing people get injured or hearing gunshots, you are more likely to have the perception that your own life is in danger, versus someone just watching it on TV," she says.

Some people are more vulnerable than others

Anyone can be traumatized by an event, whether the person was at the scene or not, experts say. In general, though, the bigger the "dose" of the exposure, the greater the risk, Karla Vermeulen, PhD, associate professor of psychology and deputy director of the Institute for Disaster Mental Health at SUNY New Paltz, tells Health. "In the Boulder event, it was almost an hour between when the shooting started and when it ended," she observes. "Pulse nightclub, it was multiple hours," during which those who flocked to the Orlando, Florida, nightclub in June 2016 were subjected to an extremely heightened state of flight or flight.

Emotional proximity can be a factor too, Maggie Feinstein, a licensed professional counselor and director of the 10.27 Healing Partnership, which sprung up in the wake of the 2018 mass shooting at the Tree of Life–Or L'Simcha Congregation in Pittsburgh, tells Health. People didn't have to be on the scene or even be a member of the congregation to experience the pain of that day, she notes. Just think all the neighbors who previously attended a bar mitzvah or other event at the synagogue who were shook up.

Even folks far from the epicenter of a shooting can become emotionally fraught. "Certainly after the Sandy Hook school shooting, I think every parent in the universe felt that one very vividly," Vermeulen says.

It's not clear why, but being female is a risk factor for poorer mental health outcomes after a mass shooting. Perhaps it reflects biological differences in women's stress response, Lowe says. But it could also be true that women have greater self-awareness of their own stress levels, that they're more forthcoming about their symptoms, or that they believe they can freely discuss their feelings without fear of being stigmatized, she reasons.

Studies examining mental health after mass violence often focus on PTSD, depression, and anxiety—conditions that tend to be more female-dominated, Lowe points out, while substance abuse, anger, aggression, and violence "might be more common in men."

Finding a path to healing and recovery

Humans persevere through all sorts of tragedy doled out by Mother Nature. (Think fires, floods, COVID-19.) A mass shooting, though, can be more difficult to recover from because it's an intentional act. "Somebody did that on purpose, so there's that element of betrayal," says Vermeulen.

So how do you heal from such a heinous act? Depending on your symptoms, it's always a good idea to speak with a trained mental health professional. But here's what else experts say you should (and shouldn't) do to cope with your emotions, depending on your proximity to the mass shooting.

You were on the scene—or a loved one was involved

Lean on people outside of the mass shooting. You need emotional support, but now may not be the time to seek solace from those who were there or had family members involved. Placing that burden on people close to the event could incite your own feelings of shame or guilt. Instead, seek support from people who have some distance from the shooting. "You might lean on somebody who doesn't live in town," Feinstein suggests.

Don't rehash every detail. Beware of well-meaning friends or providers of care who ask you to share every detail of what you've been through. Based on current evidence, "that can be really harmful for people," Lowe cautions. The reason? There's some evidence that such a debriefing may increase the risk of PTSD, per the Cochrane Database of Systematic Reviews. Lowe explains that recounting all the details about the event could interrupt the person's own coping processes. Raja agrees: "You don't want to retraumatize people by asking them to share too much."

Check out self-help apps. The National Mass Violence and Victimization Resource Center created Transcend, an app designed specifically for survivors, families, and anyone wanting to support those affected by mass violence. Developed with funding from the Justice Department's Office for Victims of Crime, the app provides tools and activities to help users recover from trauma, including managing distressful thoughts. There's also a "Get Help" feature for connecting with crisis hotlines and accessing services.

Limit your media exposure. While it's fine to seek out the facts, you won't be doing your mental health any favors by immersing yourself in round-the-clock coverage of the shooting. "You've got your own news reel in your mind of what you witnessed," Vermeulen says.

Practice self-care. Something terrible just happened to you, but you still need to take good care of your body, mind, and relationships, Raja says. So whether that's exercising, praying, practicing mindfulness, or going to therapy, put yourself on your to-do list.

Establish boundaries. As a researcher, Lowe knows just how difficult it is to study victims of mass shootings. "It's like scratching an open wound," she says. If someone calls to ask you what you heard or saw, "you can absolutely say no or have someone take that call for you."

It happened in your community

Make a contribution. Yes, you can donate to a fundraiser to help victims and families. But your contribution doesn't need to be monetary. After the Tree of Life synagogue shooting, people from other religious communities showed up to stand guard outside of services, Feinstein noted. Their willingness to step up served not only as an endorsement of religious freedom but a selfless act of fellowship.

Take an advocacy role. Mass shooting incidents often serve to rally citizens around issues such as gun reform. While some survivors or family members of those killed in mass shootings have taken the lead in the fight for gun control,"[the] people who are more removed from the event are the ones who can dive into a more activist role," Raja observes.

Provide social support. You're dealing with your own emotions, but your friend who is a victim of the shooting is hurting and needs you now. Bring her groceries. Pick up her kids from soccer practice. Be a good listener.

Consider attending a candlelight vigil. These events exist because "people just want to do something," Vermeulen says. "They want to be able to come together with other people who care." But there are pros and cons, she cautions. Such events expose people to very powerful emotions, and they can get political. On a positive note: "They can be a real source of comfort and solidarity."

You saw it on TV

Write cards. Some people may find comfort and healing in sending love to people who are suffering.

Make a call. The Substance Abuse and Mental Health Services Administration's  Disaster Distress Helpline is a 24/7 hotline available to any US resident experiencing emotional distress related to a natural or human-caused disaster. Trained counselors can provide crisis counseling, information, and referrals for follow-up care and support. Call or text 1-800-985-5990.

Check in. Each new mass shooting can be a painful reminder of a previous incident. If you love someone who's suffered this kind of hurt before, remember to reach out to them, Feinstein says. Show care and kindness when the news dredges up what they've been through. Drop off cookies, text to say you're there to listen, remind them that it's okay to turn off the news—"any sign that shows you care and are thinking of them," she says.

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