The mental health sequelae of mass shootings on affected children, adolescents and young adults - a scoping review.

While the incidence of school shootings is highest in the US worldwide, these events also occur in Europe, such as the recent fatal school shooting in Graz in Austria, highlighting the importance of evidence-based care for the survivors. This study aims to synthesize existing evidence on the short- and long-term effects of mass shootings on the mental health of children, adolescents, and young adults, and to identify risk factors that predispose individuals to psychological sequelae to inform appropriate aftercare recommendations. After conducting a literature search in PubMed, Medline, Scopus and the Cochrane Library, 483 references were identified, which were screened by two independent raters according to inclusion criteria, resulting in 15 eligible studies. Most shootings examined took place in the US, with some focusing on shootings in Finland. All studies examined either adolescents or young adults. No studies examining the effects on children were found. The results showed that directly after such an event, a large proportion of the affected show posttraumatic stress symptomatology (PTSS); in the long-term most recuperate without intervention, however a small percentage remain symptomatic and later develop PTSD. Key risk factors include female sex, younger age, previous traumatic experiences, an avoidant attachment style and a higher grade of exposure. Social support is an important protective factor. Based on the findings, a multitiered approach tailored to the needs of affected individuals is recommended, supported by a coordinated screening process to identify those with relevant risk factors.