Research Shows Heavy Toll on Survivors of School Shootings

As Uvalde copes with tragedy, studies show that children exposed to violence at school suffer academically and psychologically

A memorial dedicated to the 19 children and two adults killed on May 24th during the mass shooting at Robb Elementary School is seen on June 01, 2022 in Uvalde, Texas
Funerals are being held for the 21 victims killed at Robb Elementary School, but research shows that survivors could suffer lasting emotional and psychological damage. (Brandon Bell/Getty Images)

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Community members in Uvalde are still absorbing the loss of 19 children and two teachers after the killings at Robb Elementary School. But they will soon face a pressing issue: What awaits young people who survived the horror? 

It’s a question that has been asked in Columbine, Newtown, Parkland, and elsewhere. And as the number of tragic episodes has climbed in recent decades, it has increasingly drawn the attention of experts studying the effects of trauma on students’ wellbeing. Spanning a variety of settings and drawing from the insights of diverse academic disciplines, their work points to substantial emotional damage trailing students who live through school shootings. The hopes of these children — measured in academic, professional, and psychological terms — are meaningfully diminished, along with the health of their families.

“A growing body of research finds that the costs of gun violence in American schools extend beyond the death toll,” said Maya Rossin-Slater, a professor of health policy at the Stanford University School of Medicine who has carefully observed the aftermath of previous Texas shootings. “The hundreds of thousands of children and educators who experience and survive these tragedies are likely to carry scars for years and decades to come.”

Rossin-Slater is the co-author of a newly released study looking at the survivors of 33 school shootings in Texas between 1995 and 2016, including those with or without fatalities. Using administrative data from the Texas Education Agency, and measuring the academic participation of individual survivors against students from a control group of demographically similar schools, the research team detected obvious short-term consequences from shootings: Affected students were more likely to be absent and chronically absent, and over 100 percent more likely to repeat a grade (though this probability rose from a relatively low baseline).

The authors next examined college enrollment and workforce records of students at eight Texas high schools that saw shootings between 1998 and 2006, comparing the trends of students enrolled both before and during the shootings against same-age students at control schools. Tenth and eleventh graders who lived through shootings became 3.7 percent less likely to graduate, 9.5 percent less likely to enroll in college, and 15.3 percent less likely to obtain a bachelor’s degree. Freshmen, sophomores, and juniors who experienced shootings were more likely to be unemployed between ages 24 and 26; those working by that age earned, on average, $2,350 less in annual wages than their peers, which implies a $115,000 reduction in lifetime earnings.

Evidence of those long-term ramifications can also be found in other recent studies. A 2021 paper analyzed the impact of violence on a broader sample of individuals who were between the ages of 11 and 17 when a school shooting occurred in their home county. Tracking responses to the CDC’s Behavioral Risk Factors Surveillance System (a nationwide survey querying the health of Americans in their 20s and early 30s) the authors found that girls who lived in the vicinity of school shootings tended to report a host of risky behaviors in adulthood, from increased drinking to driving without a seatbelt.

Boys also demonstrated clear effects — including a substantial uptick in smoking and the number of days they described themselves as receiving insufficient rest — and were generally less likely to say they were in excellent or very good health. Similar to the findings of the Texas paper, the authors found that girls in counties where school shootings occurred were less likely to be employed in early adulthood, while boys later earned less than their peers from other counties. Both boys and girls were less likely to be obese in later life, and more likely to be underweight. 

More evidence emerges from a study of the 2011 terrorist attack at Utøya, Norway, the deadliest mass killing perpretrated by a single individual in modern history. Sixty-nine people were killed at a summer camp, the majority under the age of 20; one poll showed that one in four of the country’s residents knew someone touched by the event.

The study, conducted by a team of mostly Norwegian researchers, used academic and medical records to pair children who lived through the attack with similarly aged peers who attended different schools, then divided their findings according to different age groupings. In all, they found that relatively young survivors (either 14 or 15 years old) scored vastly lower on standardized tests, while older survivors (between the ages of 15 and 18) were 20 percentage points less likely to complete high school. Relative to the average for the control group, exposed children of all ages made 60 percent more medical visits and received psychiatric diagnoses nearly five times more frequently in the period immediately following the killings.

Mourners in Oslo gathered to commemorate the victims of a 2011 terrorist attack that killed 77 people, most of them children. (Paula Bronstein/Getty Images)

Families of the survivors weren’t spared. Siblings also scored lower on state tests by roughly .2 standard deviations (a commonly used measurement illustrating the difference in any population from the statistical mean); a drop of that magnitude is much larger than most effects in education research. Parents were much more likely to visit a doctor, receive a mental health diagnosis, and take sick leave from work (28 percent more likely, in the case of mothers) after the Utøya attack.

Study co-author Prashant Bharadwaj — a professor of economics at the University of California, San Diego — wrote in an email that the “big lesson” to be taken from the study was that direct exposure to mass killings can cause enormous ripples even in a Scandinavian setting, where social policy and access to free health care is more generous than in the United States. 

“Norway is a setting with incredible social safety nets: state-provided medical care, high-quality medical care, generous family leave policies, sickness leave, etc.,” Bharadwaj said. “Even within this context, the fact that we find large impacts on mental health for children and sickness absences from work for mothers suggests that in contexts like the U.S., where access to medical care and quality of social safety nets are weaker, the impacts can be much more severe.” 

The medical toll on American children is on display in another study conducted by Stanford’s Rossin-Slater, who measured the impact of 44 school shootings between January 2008 and April 2013. Using information from the IQVIA Xponent panel, which tracks practitioner-level data on medical prescriptions, Rossin-Slater and her colleagues discovered a startling phenomenon: The monthly number of antidepressant medications prescribed to people aged 20 and under increased by over one-fifth in counties that saw school shootings with at least one fatality. The effect continued even three years after the murders occurred. 

Some variety did exist in the effects, however — the spike in antidepressant use was somewhat smaller in areas with higher concentrations of psychologists and social workers, who can offer behavioral treatment outside pharmacological intervention. Rossin-Slater said that this caveat made a case for providing more mental health resources to communities that lack them.

“As we mourn the horrific losses of children and teachers in Uvalde and in many other towns across America, we must ensure that our society provides lasting support and resources to the many survivors who are likely to continue to suffer. This need is especially critical in rural and lower-income areas, such as Uvalde, Texas, which tend to have limited access to mental health professionals and other supports.”

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