Psychiatric Sequelae for Community Providers One Year after a Mass Shooting

Background: Over the past decade, increases in tragedies of mass violence has drawn attention to the long-lasting consequences not only for survivors and victims’ families but also professionals responding to these events. First responders and health care professionals have experienced persistent traumatic stress. Further, secondary (vicarious) trauma is linked to practitioners working directly with people experiencing a traumatic event. Yet, there is scant research on the mental health concerns for the professionals and other staff at impacted agencies working with families, survivors, and the broader community after a mass casualty event, nor attention to differences among staff at these agencies. These professionals, embedded in communities, provide crucial and ongoing support.

This study comprises staff at agencies in the neighborhood where 11 congregants were murdered October 2018 in the Tree of Life synagogue in Pittsburgh, Pennsylvania. We describe the prevalence of positive screens for mental health disorders and substance use among employees and examine differences among staff working directly with the community, senior-level administrators, and support staff.

Methods: Eleven months after the shooting at the Tree of Life synagogue, we emailed executives of 12 social service and educational agencies in the effected community, we asked that that they distribute a scripted email to their staff which included a link for an anonymous online survey focused on assessing mental health status and well-being. A reminder was emailed one month later. Eight agencies distributed the emails to their staffs (N=374); 156 (41.7%) provided information on their mental health.

Mental health measures included validated screens for depression (PHQ-2), suicidal ideation (from PHQ-9), generalized anxiety disorder (GAD-7), post-traumatic stress disorder (PC-PTSD-5), alcohol misuse (AUDIT-C), marijuana use, and drug use for non-medical reasons. Each measure was dichotomized based on screen outcome. Primary work role was characterized as administrator (63; 40.4%); working directly with community members (60; 38.5%); and support staff (33; 21.2%). Items related to employment burnout, age, and gender were included. The survey averaged 20 minutes to complete.

Results: One-third of the respondents (33.3%) screened positively for having at least one mental health concern (depression, anxiety, post-traumatic stress or suicidal ideation). The prevalence of existing positive screens included: depression (10.9%); suicidal ideation (9.6%); GAD (19.2%); PTSD (19.9%); alcohol misuse (24.4%); marijuana use (22.2%); and non-medical drug use (9.5%). There were no statistically significant differences between the three primary work roles and mental health concerns, substance use, or burnout from work activities.

Implications: The percentage of respondents having any mental health condition is nearly two times the percentage found in national surveys of adults. The consistent result across different work positions suggests that a mass shooting is a collective trauma within community-based agencies and that professionals and nonprofessionals regardless of position within an organization are not immune from the effects. Agencies should assess their organizational capacity for addressing secondary trauma and related mental health concerns among their staff. With a focus on becoming a trauma-informed organization, prevention and intervention strategies should focus on all levels of the organization to promote staff health and wellness.