Media Consumption and Mass Violence-Related Distress in Communities Affected by Mass Violence.

Importance: Mass violence incidents (MVIs) occur at alarming rates in the US. MVIs have immense impact on direct survivors and broader communities; less is known about worry or avoidance behaviors related to concerns about future MVIs. Objective: To examine the association between media consumption and worry and avoidance behaviors related to concerns about future MVIs in individuals living in communities that experienced an MVI. Design, Setting, and Participants: In this cross-sectional study, a survey was completed from February 1 to September 31, 2020, by a household probability sample of adults from 6 communities that experienced an MVI from January 1, 2015, to December 31, 2019. Participants were not present at the MVI but reported consuming MVI-related media coverage within 1 month of the event. Address-based sampling was used. Of 6867 participants who accessed the survey, 87.2% completed the survey, 6.5% were ineligible, and 6.3% did not finish the survey. Data analysis was performed from December 2024 to May 2025. Main Outcomes and Measures: The following outcomes were assessed via the self-report survey: (1) worry about future MVIs and (2) avoidance of public places or large crowds because of such worries. Results: A total of 5141 participants (mean [SD] age, 46.2 [17.5] years; unweighted number [weighted percentage]: 3581 [54.2%] female) completed the survey; an unweighted number (weighted percentage) of 3383 (65.5%) reported worrying about future MVIs and 1447 (28.5%) reported avoiding public places due to MVI-related concerns. In weighted multilevel logistic models, greater media consumption was associated with higher odds of worrying about future MVIs (odds ratio, 1.38; 95% CI, 1.31-1.46) and avoidance of public places (odds ratio, 1.33; 95% CI, 1.26-1.40). Media source moderated the association between media consumption and worry but not the association between media consumption and avoidance. Exposure to potentially traumatic events moderated neither association. Conclusions and Relevance: In this cross-sectional study of adults from communities impacted by MVIs, many respondents reported avoiding public places due to concerns of future MVIs, and most reported worrying about future attacks; amount of media consumption was associated with greater risk of these outcomes. These findings can inform the dissemination of information on MVIs and education on consumption of media information; such efforts may mitigate the development of psychological disorders in adults from these communities.