School shootings and mental health outcomes: a scoping review

Recent data indicate a rising frequency of school shootings over the past two decades. Although these events are relatively rare within the broader context of firearm violence, more than 357 000 students have been exposed to firearm violence in primary and secondary schools since 1999. However, the psychological impacts remain poorly understood. This scoping review synthesises existing evidence and highlights gaps for further research.

A systematic search was conducted across PubMed, PsycINFO, Web of Science and Criminal Justice Abstracts to identify empirical studies on school shootings and mental health outcomes. Inclusion criteria encompassed all publication dates, study designs and populations affected. Key attributes were extracted and analysed from included studies.

Of 2798 studies identified, 84 met inclusion criteria, with 13% being qualitative. Despite covering 19 unique shootings, 40% of the articles focused on Virginia Tech and Northern Illinois University. Most studies were cross-sectional (42%), and students were the primary population studied (80%). Post-traumatic stress disorder (29%) and depression (11%) were the most commonly studied outcomes. Common predictors included age (13%) and trauma history (12%). Higher exposure levels to school shootings, prior trauma and existing mental health conditions were key predictors of adverse mental health outcomes. Social support from family or peers emerged as protective factors.

While findings of this review suggest that there is a substantial impact of school shootings on survivors' mental health, additional research is needed to encompass impacted communities beyond students, integrate qualitative methods and incorporate longitudinal studies to track mental health outcomes over time.