Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
JAMA Netw Open. 2021 Nov 1;4(11):e2132131. doi: 10.1001/jamanetworkopen.2021.32131.
The prevalence of internalizing problems among US adolescents has risen in the past decade. The extent to which concerns about school violence or shootings are associated with risk of internalizing problems is unknown.
To examine the prospective association of concern, worry, and stress related to school violence or shootings with internalizing problems and to examine sex and racial and ethnic differences in the magnitude of the associations.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study involved 3 surveys administered 6 months apart (fall of grade 11 [prebaseline]; spring of grade 11 [baseline]; and fall of grade 12 [follow-up]) from 2015 to 2016. Participants included 2263 students from 10 high schools in Los Angeles, California. Analyses were performed from April 29, 2020, to April 8, 2021.
Baseline self-reported level of concern, worry, and stress about shootings or violence at the student's school or other schools, each rated on 5-point scales (ranging from not at all [0] to extremely [4]) with a mean score calculated as a 3-item composite index rescaled into z-score standard deviation units.
Surpassing clinically significant or borderline significant thresholds for major depressive disorder, generalized anxiety disorder, or panic disorder based on symptom ratings on the Revised Children's Anxiety and Depression Scale at 6-month follow-up.
Of the 2263 students included in the analyses (1250 [55.2%] girls; mean [SD] age, 16.5 [0.4] years), appreciable proportions reported being very or extremely concerned (850 0f 2226 [38.2%]), worried (703 of 2209 [31.8%]), or stressed (332 of 2183 [15.2%]) about shootings or violence at their school or other schools. After adjusting for prebaseline covariates, concerns about school violence or shootings were associated with clinically significant generalized anxiety symptoms (odds ratio [OR], 1.31; 95% CI, 1.15-1.50) and panic symptoms (OR, 1.18; 95% CI, 1.05-1.32), but not depressive symptoms (OR, 1.13; 95% CI, 0.99-1.30) at the 6-month follow-up. There was a significant association between concern with school violence or shootings and depressive symptoms for Black youth (OR, 3.15; 95% CI, 1.38-7.19) and non-Hispanic/Latinx White youth (OR, 1.62 [95% CI, 1.25-2.09]) but not for youth of other races and ethnicities (OR for Asian, 1.26 [95% CI, 0.86-1.85]; OR for Hispanic/Latinx, 0.94 [95% CI, 0.76-1.16]; OR for other, 0.93 [95% CI, 0.54-1.61]). Sex did not moderate these associations.
The findings of this study suggest that concern, worry, and stress related to school violence or shootings may be risk factors for internalizing problems among adolescents, with variation in the strength of the association by race/ethnicity.
美国青少年的内化问题患病率在过去十年中有所上升。目前尚不清楚对学校暴力或枪击事件的担忧与内化问题风险之间的关系。
研究与学校暴力或枪击事件相关的担忧、忧虑和压力与内化问题之间的前瞻性关联，并研究关联强度的性别、种族和民族差异。
设计、地点和参与者：这是一项从 2015 年到 2016 年进行的纵向队列研究，共进行了 3 次调查，间隔 6 个月（11 年级秋季[基线前]；11 年级春季[基线]；12 年级秋季[随访]）。参与者包括来自加利福尼亚州洛杉矶 10 所高中的 2263 名学生。分析于 2020 年 4 月 29 日至 2021 年 4 月 8 日进行。
基线时自我报告的对学生所在学校或其他学校枪击或暴力事件的关注、担忧和压力水平，每项均在 5 点量表上进行评分（范围从一点也不[0]到非常[4]），平均得分计算为 3 项复合指数重新调整为 z 分数标准差单位。
根据修订后的儿童焦虑和抑郁量表（Revised Children's Anxiety and Depression Scale）在 6 个月随访时的症状评分，超过了主要抑郁障碍、广泛性焦虑障碍或惊恐障碍的临床显著或边缘显著阈值。
在纳入分析的 2263 名学生中（2226 名中的 1250 名[55.2%]为女孩；平均[SD]年龄为 16.5[0.4]岁），相当大比例的学生表示非常或非常关注（850 名中的 2226 名[38.2%]）、担心（703 名中的 2209 名[31.8%]）或感到压力（332 名中的 2183 名[15.2%]）在他们的学校或其他学校发生枪击或暴力事件。在调整基线前协变量后，对学校暴力或枪击事件的担忧与临床显著的广泛性焦虑症状（比值比[OR]，1.31；95%CI，1.15-1.50）和惊恐症状（OR，1.18；95%CI，1.05-1.32）相关，但与抑郁症状（OR，1.13；95%CI，0.99-1.30）无关。与对学校暴力或枪击事件的担忧与黑人和非西班牙裔/拉丁裔白人青年的抑郁症状（OR，3.15；95%CI，1.38-7.19）和非西班牙裔/拉丁裔白人青年（OR，1.62 [95%CI，1.25-2.09]）相关，但与其他种族和族裔的青年无关（OR 亚洲人，1.26 [95%CI，0.86-1.85]；OR 西班牙裔/拉丁裔，0.94 [95%CI，0.76-1.16]；OR 其他人，0.93 [95%CI，0.54-1.61]）。性别不能调节这些关联。
这项研究的结果表明，与学校暴力或枪击事件相关的担忧、忧虑和压力可能是青少年内化问题的风险因素，种族/族裔之间的关联强度存在差异。
