A family hugs outside the Willie de Leon Civic Center where grief counseling will be offered in Uvalde, Texas, on May 24, 2022.
Allison Dinner—AFP/Getty Images
May 27, 2022 3:53 PM EDT

The May 24 mass shooting in a Uvalde, Texas elementary school, in which a gunman killed 19 young children and two teachers, was the third-deadliest school shooting in U.S. history. But it was also just the latest of an increasingly common type of U.S. tragedy—one that experts say is saddling American schoolchildren, even the youngest, with rising levels of anxiety and other mental-health problems.

Even when children aren’t directly involved in school shootings, they are deeply affected by them and often experience anxiety and depression as a result, says Kira Riehm, a postdoctoral fellow at the Columbia University Mailman School of Public Health. “These events are extremely high profile, and they’re portrayed hugely in the media,” says Riehm. They also happen with alarming frequency. In 2022 so far, there have already been 27 school shootings in which someone was injured or killed, according to Education Week’s school shooting tracker.

In a study published in 2021 in JAMA, Riehm and other researchers surveyed more than 2,000 11th and 12th graders in Los Angeles about their fear of shootings and violence at their own or other schools. Researchers followed up with those same students and found that kids who were initially more concerned were more likely to meet the criteria for generalized anxiety disorder and panic disorder six months later—suggesting that kids internalize these fears, which can then manifest as diagnosable mental-health issues, Riehm says. While the researchers didn’t find an overall association between concern about school violence and the development of depression, they did when they looked specifically at Black children.

“The root issue is this concern and fear that this could also happen at your school or another school,” Riehm says. “They are large numbers, and unfortunately, that’s kind of in line with what I would have expected before even looking at the data.”

Children of all ages are at risk for developing these types of symptoms after shootings, but research shows that younger children are even more likely than older ones to develop symptoms like anxiety and PTSD as a result, says Dr. Aradhana Bela Sood, a professor of psychiatry and pediatrics at Virginia Commonwealth University. “Elementary school kids are probably going to have a much rougher time than perhaps older adolescents,” says Sood. Younger kids haven’t developed “those defenses, those capacities to sort things out in the brain,” Sood says. “They just haven’t had life experiences. And they have no idea how to make sense of this.”

Read More: Close-Knit Uvalde Community Grieves After Elementary School Shooting

In a 2021 review published in Current Psychiatry Reports, Sood and her colleagues analyzed research about the effects of mass shootings on the mental health of children and adolescents. They found that young children (ages 2 to 9) who are directly or indirectly exposed to violence have increased rates of PTSD, but, older children (ages 10-19) “need multiple exposures to violence—direct or indirect—for it to lead to PTSD, suggesting that younger children are more sensitive to violence and develop psychological symptoms post exposure to violence at a higher rate,” the study authors write. (In the review, direct exposures were defined broadly as witnessing or surviving a violent event; indirect exposures included seeing images of a shooting.) High social media use and continuous news reporting on mass shootings expose children repeatedly to these disturbing stories, which “can have at least short-term psychological effects on youth living outside of the affected communities such as increased fear and decreased perceived safety,” the authors write.

Gun-related concern has been widespread among U.S. schoolkids for a long time. Shortly after the 1999 Columbine High School shooting in which 13 people were killed, researchers surveyed high school students across the U.S. Their results, published in the American Journal of Preventive Medicine, found that 30% more students said they felt unsafe at school, compared to national survey data collected before the shooting. This is evidence of “vicarious traumatization,” Sood says, which can occur when a child hears about a tragedy or sees images of it—even if they don’t experience it firsthand. Sood says that kind of exposure is much more likely to produce long-term damage in children who already have shown symptoms of anxiety and depression—which describes a growing number of American kids. “There are certain children that I would be very vigilant about,” Sood says.

While young children are deeply affected by traumatic events, the good news is that they are also resilient. “Obviously there’s an impact, but what you want to see over weeks is a gradual reduction in this response, and that’s normative for young kids,” Sood says.

Whether a child is directly or indirectly impacted by a mass shooting, there are specific steps parents and guardians can take to help their young children process the tragedy. “It is important for people around the child to be vigilant and aware of how they can be supportive and allow the evolution of the grief,” Sood says. Giving the child a predictable routine, allowing them to talk about the experience without judgment, and limiting the news that the child takes in about a tragic event all help, Sood says. Parents or guardians should also make sure they are taking care of their own mental health.

The omnipresent threat of gun violence is just one of the many contributors to the worsening mental-health crisis among U.S. adolescents. Riehm says that issues like climate change and COVID-19 are other large concerns. In November 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association jointly declared a national emergency for the mental health of children. “We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, and their communities,” the experts wrote.

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