Relative to their unexposed peers, survivors of school shootings in the U.S. experience significant declines in health and well-being, are more likely to engage in risky behavior and have worse education and labor market outcomes in early adulthood, according to new research. 

In a working paper published April 4 by the National Bureau of Economic Research, researchers used data on individuals living in 1402 U.S. counties, employing the K-12 School Shooting Database to measure school shooting events between 1994 and 2005. To measure health, human capital and labor market outcomes of survivors between 23 and 32 years old, researchers utilized the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System survey data from 2003 to 2012. 

School shooting data was restricted to incidents that occurred during school activities and resulted in at least one death; individuals were defined as "exposed" if they currently live in a county where a school shooting occurred and were between 11 and 17 years old during the year of the shooting. All other 23- to 32-year-old respondents living in that county were defined as unexposed.

When the school shooting database was first released several years ago, Partha Deb of Hunter College and Anjelica Gangaram of the University of Michigan recognized an opportunity to investigate the long-run outcomes of school shooting trauma not yet addressed in the literature. Historically, researchers have focused on more proximate effects of school shootings on survivors, including youth antidepressant use, school absence rates, poor test performance and suicide or accidental death in the years immediately following exposure. Given their ample experience with Behavioral Risk Factor Surveillance System data, Deb and Gangaram decided to study adult survivors instead of school-age children. 

"The question was: The K12SSD is great stuff but what can we do with it?" Deb told The Academic Times. "The BRFSS dataset is something I've worked with a lot, a resource that my students and I have often used in the past. So in some sense it was like two pieces of the puzzle came together — one piece that we understood well and the other which was brand new."

Deb and Gangaram consider male and female survivors separately in their study, following the latest literature that suggests men and women are impacted by school shootings in different ways. 

According to Deb and Gangaram's research, both men and women survivors demonstrate a proclivity for risky behavior in early adulthood. Women exposed to one additional shooting casualty have a 3.3% increased likelihood of "nearly always" wearing a seat belt relative to "always" wearing a seat belt, while exposure is shown to increase a man's likelihood of wearing a seat belt "sometimes, seldom, or never" by 2.1%.

The researchers also found exposure to school shootings six to 18 years ago is significantly associated in men with a 1.7% greater risk of smoking daily and a 1.2% increase in the number of days where five or more alcoholic beverages are consumed. Male survivors were also 2% more likely to report being in fair or poor health — as opposed to excellent or very good health — and 1.5% less likely to engage in regular physical exercise.

Unlike in men, the researchers said, the prolonged effects of school shootings in women were not shown to significantly manifest in an increased frequency of smoking, poor quality of rest or significant differences in reported mental health. Women survivors did, however, report detrimental effects pertaining to other risky behaviors and health outcomes. The study found statistically significant evidence that an additional shooting casualty increases an affected woman's risk of consuming five or more drinks per occasion by 1.8% and the likelihood of a woman survivor being underweight by 2%.

Educational and professional impacts are also significant, according to the paper. Each additional shooting casualty renders female survivors 1.1% more likely than their unexposed peers to not graduate high school. Once a woman has entered the labor market, exposure to a school shooting increases her likelihood of unemployment by 2.2% and likelihood of being a homemaker by 1.2%.

Because the county-level data prevents the definitive identification of individuals who were physically present at the schools where and when the shootings occurred, Deb and Gangaram said these results might slightly underestimate the true effects of school shootings. The study's matching process also assumes both that the survey respondent lived in the county of the shooting when it occurred and that no respondent moved to or away from the county following the shooting date. As a result, migration biases are possible, though Deb and Gangaram say observed rates of migration during the time period under consideration were low.

Prashant Bharadwaj of the University of California, San Diego also studied the effects of a mass shooting on survivors in an April 2021 working paper for the National Bureau of Economic Research. While Deb and Gangaram's study occurs in an American context, Bharadwaj and his co-authors studied middle and high school-aged children who were exposed to a 2011 mass shooting incident in Utøya, Norway. 

In the Norwegian context, Bharadwaj found that survivors demonstrated substantial decreases in GPA scores, increased health care visits and a nearly 400% increase in diagnosed mental health conditions in the short run. By their mid-20s and early 30s, survivors were found to have completed fewer years of schooling than their unexposed peers and demonstrated a decrease in labor force participation.

"There are reasons to think the effects of exposure to gun violence are far worse in the U.S. due to lack of [government] support for survivors, but there is also the idea of desensitization, which would make the results more muted. What the net effect of these two opposing forces is, I have no idea, but I am hopeful that future work in this area will consider such issues," Bharadwaj told The Academic Times. "Our study and all these studies are situated in specific contexts and times, but I believe we are adding various different pieces of evidence together."

Looking ahead, Deb and Gangaram said the long-run impact of stress on individuals exposed to school shootings poses an interesting question for future research, as post-traumatic stress disorder could play an important role in survivor outcomes. Bharadwaj also suggested there might be more to the story than is evidenced by the current literature. 

"Children probably experience much more routine forms of trauma that are potentially much worse for them in the medium and long run (like child abuse)," Bharadwaj said. "The way I see this research is to shine a light on one form of trauma, but I would hope that policymakers take into account the wide range of traumas that kids are exposed to and make informed decisions about the appropriateness of government action or inaction."

The working paper "Effects of School Shootings on Risky Behavior, Health and Human Capital," published April 4 by the National Bureau of Economic Research, was authored by Partha Deb, Hunter College and the National Bureau of Economic Research; and Anjelica Gangaram, University of Michigan.