Citation

Garbarino J. New Engl. J. Med. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Massachusetts Medical Society)

DOI

10.1056/NEJMp2209422

PMID

36155630

Abstract

Does gun violence affect the mental health of U.S. children? That question has the same answer as most inquiries about child and adolescent development: it depends. Rarely does a simple cause-effect relationship apply to the same degree to all children, and the same exposures may even have opposite effects on different children. Such variability is an essential truth of the "ecological perspective" on child and adolescent development. But from this perspective, consideration of gun violence's effects on the mental health of young people highlights two issues among the many facing U.S. society: traumatic responses in children directly exposed to gun violence and contamination of the consciousness of young people, particularly those with serious mental health problems.

Witnessing gun violence is clearly traumatic and can lead initially to acute stress reaction and then to post-traumatic stress disorder (PTSD). But the bigger and more socially important story is post-traumatic stress development: How do children and adolescents develop in the wake of trauma? Not surprisingly, the answer is the same: it depends.

In perhaps 85 to 90% of cases, mental health sequelae of a single traumatic incident resolve, typically within a year. That's the good news for kids for whom gun violence is a horrible aberration, a terribly bad day in a generally safe and supportive life. The small proportion of children or adolescents who experience long-term damage from a single incident of traumatic violence tend to be those whose lives were already disrupted beforehand. Many, if not most, of these single incidents of gun violence are the shootings that make the front page, and of course they can indirectly traumatize vast numbers of young people, as images of murder accumulate in their social-media-fed consciousness. But these incidents do not account for most of the gun-violence trauma directly experienced by U.S. children and adolescents. This violence occurs in a subset of neighborhoods, where it often becomes a regular feature of daily life -- multiple-incident chronic trauma rather than single-incident acute trauma...

Language: en