title: Multiple vantage points on the mental health effects of mass shootings.
abstract: The phenomenon of mass shootings has emerged over the past 50 years. A high proportion of rampage shootings have occurred in the United States, and secondarily, in European nations with otherwise low firearm homicide rates; yet, paradoxically, shooting massacres are not prominent in the Latin American nations with the highest firearm homicide rates in the world. A review of the scientific literature from 2010 to early 2014 reveals that, at the individual level, mental health effects include psychological distress and clinically significant elevations in posttraumatic stress, depression, and anxiety symptoms in relation to the degree of physical exposure and social proximity to the shooting incident. Psychological repercussions extend to the surrounding affected community. In the aftermath of the deadliest mass shooting on record, Norway has been in the vanguard of intervention research focusing on rapid delivery of psychological support and services to survivors of the "Oslo Terror." Grounded on a detailed review of the clinical literature on the mental health effects of mass shootings, this paper also incorporates wide-ranging co-author expertise to delineate: 1) the patterning of mass shootings within the international context of firearm homicides, 2) the effects of shooting rampages on children and adolescents, 3) the psychological effects for wounded victims and the emergency healthcare personnel who care for them, 4) the disaster behavioral health considerations for preparedness and response, and 5) the media "framing" of mass shooting incidents in relation to the portrayal of mental health themes.
authors.affiliation: Center for Disaster & Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, FL, 33136, USA, jamesmichaelshultz@gmail.com.
authors.forename: James M
authors.initials: JM
authors.lastname: Shultz
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
authors.forename: Brian W
authors.initials: BW
authors.lastname: Flynn
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Muschert
authors.forename: Jon A
authors.initials: JA
authors.lastname: Shaw
authors.forename: Zelde
authors.initials: Z
authors.lastname: Espinel
authors.forename: Frank G
authors.initials: FG
authors.lastname: Walter
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Gaither
authors.forename: Yanira
authors.initials: Y
authors.lastname: Garcia-Barcena
authors.forename: Kaitlin
authors.initials: K
authors.lastname: O'Keefe
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Cohen
mesh_terms: D019548:Crime Victims / Q000523:psychology*; D004632:Emergency Medical Services / Q000458:organization & administration; D060731:Emergency Responders / Q000523:psychology; D005389:Firearms; D006801:Humans; D054527:Mass Casualty Incidents / Q000523:psychology*; D008402:Mass Media; D001523:Mental Disorders / Q000209:etiology* / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration; D012307:Risk Factors; D014948:Wounds, Gunshot / Q000523:psychology*
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