Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
School of Public Health, Boston University, Boston, Massachusetts.
JAMA Netw Open. 2024 Jul 1;7(7):e2423539. doi: 10.1001/jamanetworkopen.2024.23539.
Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown.
To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023.
The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria.
A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD.
In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.
大规模暴力事件（MVIs）在美国很普遍，会对直接幸存者造成深远而持久的心理后果，但在发生 MVI 的更广泛社区中，其后果尚不清楚。
调查经历过 MVI 的社区中成年人过去一年和当前创伤后应激障碍（PTSD）的患病率和相关因素。
设计、地点和参与者：这是一项横断面调查，于 2020 年 2 月至 9 月期间完成，使用 2015 年至 2019 年间经历过 MVI 的 6 个社区的家庭概率样本：俄亥俄州代顿、德克萨斯州埃尔帕索、佛罗里达州帕克兰、宾夕法尼亚州匹兹堡、加利福尼亚州圣贝纳迪诺和弗吉尼亚海滩。基于地址的抽样用于识别随机选择的家庭，邮寄邀请，并选择每个家庭的 1 名成年人完成自我管理的纸质或在线调查。数据分析于 2023 年 9 月至 11 月进行。
主要结局是使用美国精神病学协会《精神障碍诊断与统计手册》（第五版）（DSM-5）创伤后应激障碍标准确定的过去一年 PTSD 和当前（过去一个月）PTSD 的推定诊断水平。
共有 6867 名 18 岁或以上的成年人访问了网站，查看了研究说明和同意书。其中，5991 人（87.2%）同意参加并完成了调查，343 人（6.3%）部分完成了调查，443 人（6.5%）不符合资格标准或拒绝参加。大多数 5991 名受访者为女性（3825 人[53.5%]），平均（SD）年龄为 45.56（17.58）岁。共有 1261 名 5931 名受访者（21.0%）报告高度暴露于 MVI（他们或他们的亲密朋友和/或家庭成员在枪击现场）。近四分之一（23.7%；5977 名报告 PTSD 的参与者中有 1417 人）符合 DSM-5 过去一年 PTSD 的诊断标准，8.9%（530 名参与者）符合当前 PTSD 的标准。回归分析发现，女性（优势比，2.32；95%置信区间，2.01-2.68）和有身体或性侵犯和其他潜在创伤事件史（优势比，9.68；95%置信区间，7.48-12.52）与过去一年 PTSD 的最大风险相关。
在这项对 5991 名参与者的调查研究中，在经历过 MVI 的社区中，成年人在 MVI 发生很久后出现推定 PTSD 的情况相当普遍，这表明 MVI 对社区产生持续和普遍的公共卫生影响，尤其是在那些以前经历过身体或性侵犯和其他潜在创伤事件的人。仅仅关注直接接触 MVI 是不够的。将这些发现纳入筛查应该有助于确定最需要预防或在 MVI 后接受心理健康服务的人。
