Abdalla Salma M, Cohen Gregory H, Tamrakar Shailesh, Sampson Laura, Moreland Angela, Kilpatrick Dean G, Galea Sandro
Epidemiology Department, School of Public Health, Boston University, Boston, United States.
Epidemiology Department, Harvard T.H. Chan School of Public Health, Boston, United States.
EClinicalMedicine. 2022 Jul 22;51:101555. doi: 10.1016/j.eclinm.2022.101555. eCollection 2022 Sep.
There is emerging evidence that mass shootings are associated with adverse mental health outcomes at the community level. Data from other mass-traumatic events examined the effectiveness of usual care (UC), (i.e., psychological first aid approaches without triage), and stepped care (SC) approaches, with triage, in reducing the burden of post-traumatic stress disorder (PTSD) in a community.
We built an agent-based model of 118,000 people that was demographically comparable to the population of Parkland and Coral Springs, Florida, US. We parametrized the model with data from other traumatic events. Using simulations, we then estimated the community prevalence of PTSD one month following the Stoneman Douglas High School (Florida, US) shooting and reported the potential reach, effectiveness, and cost effectiveness of different what-if treatment scenarios (SC or UC) over a two-year period.
One month following the mass shooting, PTSD prevalence in the community was 11.3% (95% CI: 11.1-11.5%). The reach of SC was 3461 (95% CI: 3573-3736) per 10,000 and the reach of UC was 2457 (95% CI: 2401-2510) per 10,000. SC was superior to UC in reducing PTSD prevalence, yielding, after two years, a risk difference of -0.044 (95% CI, -0.046 to -0.042) and a risk ratio of 0.452 (95% CI, 0.437-0.468). SC was also superior to UC in reducing the persistence of PTSD, yielding, after two years, a risk difference of -0.39 (95% CI, -0.401 to -0.379) and a risk ratio of 0.452 (95% CI, 0.439-0.465). The incremental cost-effectiveness of SC compared to UC was $2718.49 per DALYs saved, and $0.47 per PTSD-free day.
This simulation demonstrated the potential benefits of different community-level approaches in mitigating the burden of PTSD following a mass shooting. These results warrant further research on community-based interventions to mitigate the mental health consequences of mass shootings.
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越来越多的证据表明，大规模枪击事件与社区层面的不良心理健康后果相关。来自其他重大创伤事件的数据研究了常规护理（UC）（即无分诊的心理急救方法）和分级护理（SC）方法（有分诊）在减轻社区创伤后应激障碍（PTSD）负担方面的有效性。
我们构建了一个基于主体的模型，包含118,000人，其人口统计学特征与美国佛罗里达州帕克兰市和珊瑚泉市的人口相当。我们用来自其他创伤事件的数据对模型进行参数化。通过模拟，我们估计了美国佛罗里达州斯托曼·道格拉斯高中枪击事件发生后一个月社区中PTSD的患病率，并报告了不同假设治疗方案（SC或UC）在两年期间的潜在覆盖范围、有效性和成本效益。
大规模枪击事件发生后一个月，社区中PTSD的患病率为11.3%（95%置信区间：11.1 - 11.5%）。SC的覆盖范围为每10,000人中有3461人（95%置信区间：3573 - 3736），UC的覆盖范围为每10,000人中有2457人（95%置信区间：2401 - 2510）。在降低PTSD患病率方面，SC优于UC，两年后产生的风险差异为 -0.044（95%置信区间，-0.046至 -0.042），风险比为0.452（95%置信区间，0.437 - 0.468）。在降低PTSD的持续性方面，SC也优于UC，两年后产生 的风险差异为 -0.39（95%置信区间，-0.401至 -0.379），风险比为0.452（95%置信区间，0.439 - 0.465）。与UC相比，SC的增量成本效益为每挽救一个伤残调整生命年（DALY）2718.
