Psychiatric Sequelae Among Community Social Service Agency Staff 1 Year After a Mass Shooting | Psychiatry and Behavioral Health | JAMA Network Open | JAMA Network
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Table.  Participant Demographic Characteristics and Mental Health Positive Screening
Participant Demographic Characteristics and Mental Health Positive Screening
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    Research Letter
    August 25, 2020

    Psychiatric Sequelae Among Community Social Service Agency Staff 1 Year After a Mass Shooting

    Author Affiliations
    • 1School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
    JAMA Netw Open. 2020;3(8):e2014050. doi:10.1001/jamanetworkopen.2020.14050

    The past 3 years have seen a record number of mass shootings that have long-lasting consequences for survivors, victims’ families, and those who address the aftermath of the shooting.1,2 There is increased awareness of the prevalence and persistence of traumatic stress for first responders and health care professionals responding to mass casualty events.3,4 Typically, secondary or vicarious trauma is assessed with practitioners working directly with people experiencing a traumatic event.5 There is scant research on the mental health well-being of professional staff at social service agencies embedded in the impacted communities. Staff may provide immediate and then ongoing social and educational services either directly or indirectly to families, survivors, and the broader community after a mass casualty event.

    This study comprises staff at human service organizations and educational institutions in the neighborhood where 11 congregants were murdered on October 27, 2018, at the Tree of Life synagogue in Pittsburgh, Pennsylvania. We describe the prevalence of positive screens for mental health disorders and substance use among employees and examine differences among staff working directly with the community, senior-level administrators, and support staff.


    This cross-sectional study was approved by the University of Pittsburgh institutional review board as exempt from the need for informed consent because the survey was anonymous and the study posed minimal risk to the participants. Eleven months after the shooting at the Tree of Life synagogue, we emailed executives of 12 nonprofit social service agencies and educational institutions located in the impacted community. Eight agency executives agreed to email their staff (374 individuals) the study purpose and a survey link. A reminder was emailed 1 month later. The survey averaged 20 minutes to complete.

    Mental health measures (specific measures are listed in the Table footnotes) included screens for depression, suicidal ideation, generalized anxiety disorder, posttraumatic stress disorder, alcohol misuse, marijuana use, and drug use for nonmedical reasons. Furthermore, items related to employment burnout were included. A 1-sided Pearson χ2 test was used to test primary work role differences in reports of positive screens, and statistical significance was set at P < .05. Data analysis was performed from December 2019 to March 2020 using SPSS statistical software version 25 (IBM).


    Ultimately, 167 staff members (44.6%) completed the anonymous online survey, and 156 (41.7%) provided the necessary information. Participants were primarily women (125 participants [80.1%]). The modal category for age was age 36 to 55 years (65 participants [41.7%]) followed by age 26 to 35 years (43 participants [27.6%]), age 56 years and older (31 participants [19.9%]), and age 18 to 25 years (17 participants [10.9%]). Primary work roles were characterized as administrator (63 participants [40.4%]), working directly with community members (60 participants [38.5%]), and support staff (33 participants [21.2%]).

    One-third of the respondents (52 participants) had at least 1 current positive mental health screen (Table). Specific positive screens included depression (17 participants [10.9%]), suicidal ideation (15 participants [9.6%]), generalized anxiety disorder (30 participants [19.2%]), posttraumatic stress disorder (31 participants [19.9%]), alcohol misuse (38 participants [24.4%]), marijuana use (38 participants [21.8%), and nonmedical drug use (14 participants [9.0%]). There were no statistically significant differences between primary work role and mental health or substance use screen.


    The extent to which there are positive mental health and substance use screens and no differences by work position suggests that a mass shooting is a collective trauma and that professionals within an organization are not immune from the effects, regardless of position. These findings suggest that agencies should assess their organizational capacity for addressing secondary trauma and related mental health concerns among their staff.6 Prevention and intervention strategies should focus on all levels of the organization to promote staff wellness.6 This study has some limitations. Because it is a cross-sectional study, the data only capture a specific point in time, other unmeasured factors might account for these findings, the findings are not generalizable, there was a low response rate, and nonrespondents may differ from respondents. Studies of similar organizations in other communities following a mass trauma event are necessary to examine other factors, such as coping and social support, that might mitigate negative outcomes.

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    Article Information

    Accepted for Publication: June 8, 2020.

    Published: August 25, 2020. doi:10.1001/jamanetworkopen.2020.14050

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Engel RJ et al. JAMA Network Open.

    Corresponding Author: Rafael J. Engel, PhD, School of Social Work, University of Pittsburgh, 2312 Cathedral of Learning, 4200 Forbes Ave, Pittsburgh, PA (

    Author Contributions: Drs Engel and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Engel.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Engel, Lee.

    Administrative, technical, or material support: Engel, Rosen.

    Supervision: Engel, Rosen.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This study received internal funding support from the School of Social Work, University of Pittsburgh.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Padilla  R, Petras  G, Loerhrke  J, Thorson  M, Gelles  K, Sullivan  SJ. Including El Paso and Dayton, there have been 112 people killed in mass shootings this year. USA Today. Published August 7, 2019. Accessed January 8, 2020.
    Helmore  E. 2019 Saw most mass killings on record, US database reveals. The Guardian. Published December 28, 2019. Accessed December 29, 2019.
    Klimley  KE, Van Hasselt  VB, Stripling  AM.  Posttraumatic stress disorder in police, firefighters, and emergency dispatchers.   Aggress Violent Behav. 2018;43(November-December):33-44. doi:10.1016/j.avb.2018.08.005Google ScholarCrossref
    Zimering  R, Gulliver  SB, Knight  J, Munroe  J, Keane  TM.  Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero.   J Trauma Stress. 2006;19(4):553-557. doi:10.1002/jts.20143PubMedGoogle ScholarCrossref
    Hensel  JM, Ruiz  C, Finney  C, Dewa  CS.  Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims.   J Trauma Stress. 2015;28(2):83-91. doi:10.1002/jts.21998PubMedGoogle ScholarCrossref
    Hallinan  S, Shiyko  MP, Volpe  R, Molnar  BE.  Reliability and validity of the vicarious trauma organizational readiness guide (VT-ORG).   Am J Community Psychol. 2019;64(3-4):481-493. doi:10.1002/ajcp.12395PubMedGoogle ScholarCrossref