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The psychological harm from mass shootings spilled beyond direct survivors and into their communities, a cross-sectional study found.

Among survey participants -- residents of six U.S. communities affected by recent mass violence incidents (MVIs) -- 23.7% met criteria for presumptive past-year post-traumatic stress disorder (PTSD) and 8.9% met criteria for current PTSD, based on their survey responses.

And these were not just people who said either they or a close friend or family member were on site at the shooting: though most PTSD cases occurred in those with this high exposure to the MVI, respondents with no direct exposure still met the criteria for past-year and current PTSD in 21.0% and 8.9% of cases, according to researchers led by Angela Moreland, PhD, a psychologist at Medical University of South Carolina (MUSC) in Charleston, reporting in .

Moreland's group at MUSC has been responding to various mass shootings in the U.S. by disseminating to survivors and their communities.

"Given the increasing rate of MVIs in the U.S. over the past decade and the major consequences associated with high rates of PTSD among individuals, it is imperative to further examine rates of PTSD among individuals residing in broad communities impacted by mass violence," the group urged.

However, Erika Felix, PhD, a clinical psychologist of University of California Santa Barbara, said it was more important to "ask members of affected communities what services they actually accessed and what they found helpful in supporting their mental and physical health."

"We did that following the MVI that affected my university community and found that the survivor-initiated or community-initiated events were among the most commonly attended events and were rated as most helpful in the weeks that followed. What was rated as most helpful included student-organized candlelight vigils and remembrance events ... and organized supportive and relaxing activities," she wrote in an . "We need to extend this research beyond the initial aftermath to study what is helpful in the months and years to come."

The cross-sectional study was based on a 2020 survey of adults who were living in communities that had MVIs from 2015 to 2019. These were Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernardino, California; and Virginia Beach, Virginia.

Investigators sent invitations to over 110,000 addresses in the affected communities, which yielded 6,867 adults accessing the study website. Ultimately, 5,991 agreed to participate and completed the survey. Participants were promised confidentiality and $15 for completing the survey.

The study cohort was 53.5% women and averaged 45.6 years of age. By race, 70.6% were self-described white.

Moreland's group reported that high exposure to the local mass shooting was reported by 21%.

Women were at significantly greater risk of presumptive past-year PTSD and current PTSD, as were people with a history of physical/sexual assault and other potentially traumatic events, and people with high exposure to the event.

"Within the context of MVIs in particular, certain demographic groups may be targeted specifically, and therefore, the targeted group may understandably show higher rates of distress in the aftermath," Felix noted. "We saw identity-based targeting in the mass murder tragedy that affected my university community, where the perpetrator had a widely disseminated misogynistic manifesto; therefore, it would be understandable that women may report more distress."

Felix's reference was to the in which a man killed six university students and injured 14 others near Felix's institution. He left behind a manifesto explaining that his goal was to punish women for rejecting him, and sexually active men out of envy.

Study authors acknowledged that for their present analysis, past-year PTSD and current PTSD were gleaned from DSM-5 criteria and based on survey items from the National Stressful Events Survey PTSD Module; they could not corroborate the presumptive PTSD diagnoses with clinician interviews.

Additionally, their response rate of less than 10% suggested a possibility of responder bias among participants.

"Overall, our findings suggest that future response and recovery initiatives should assess for sociodemographic characteristics, history of [potentially traumatic events], and access to social support to allocate resources to those individuals most at risk for experiencing PTSD in communities affected by MVIs," Moreland and colleagues maintained.

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