(CNN) — As more communities reel from deadly mass shootings — including Dadeville, Alabama, where four people were killed and 28 injured at a Sweet 16 birthday party over the weekend — there's evidence that the trauma of gun violence in the United States is taking a collective toll on the nation's mental health.
Research published this year suggests that the negative effects that mass shootings can have on mental health may extend beyond the survivors and community directly affected to a much broader population.
In the days after a school shooting in Uvalde, Texas, in May, a mental health crisis line received a spike in messages that referenced guns and other related firearm-related terms, according to a study funded by the US Centers for Disease Control and Prevention. Although the study did not track the specific location of the messages coming in, Crisis Text Line — a nonprofit organization offering free confidential crisis intervention — serves people nationwide.
Mass shootings have escalated to a record pace in the US, with at least 162 already reported in 2023. It has been a week since the deadly mass shooting at a bank in Louisville, Kentucky, and there have been more than a dozen since, according to the Gun Violence Archive.
The devastating frequency means more and more people are directly affected, and the general public is regularly exposed to the indirect impacts.
"We know that exposure through the media — which can happen across many different outlets, with the swipe of a finger or a ding on your phone — to some type of traumatic event can result in someone experiencing an acute stress reaction and can trigger underlying post-traumatic stress they may have from something else," said Leah Brogan, a psychologist who works at both the Center for Violence Prevention and the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia.
"So certainly, that constant exposure can be escalating and activating people even when they don't experience something directly."
A recent survey from the Kaiser Family Foundation found that gun violence more broadly has affected most families in the US in one way or another. Nearly 1 in 5 adults has had a family member killed by a gun, including in homicide and suicide, and about 1 in 6 has witnessed an injury from a gun.
Brogan works as a trauma therapist for youth who land in the emergency department after a violence-related injury. Often, she says, beneath the incident that brought them to the hospital is a history of trauma that has instilled negative emotions related to loss of control, loss of predictability and helplessness.
"Many are returning to communities where gun violence is, unfortunately, a reality. And that reality can be quite triggering," she said. "And so a lot of work is done to validate that reality for them and also try to identify where they may have some degree of control within their own life."
As mass shootings and gun-related deaths reach record levels in the US, an underlying trauma may be building up in the broader population that could be creating those same feelings of helplessness at the national level.
After the Uvalde school shooting, the study found, grief become a central point for a significantly larger share of the firearm-related conversations that were coming into the Crisis Text Line.
"People are reaching out so that they can establish a sense of stability and calm in their own lives," said Dr. Shairi Turner, an internist and pediatrician who is also the chief health officer for Crisis Text Line.
Whether they are members of the community affected or just aware of a tragedy that happened across the country, immediate connection helps people find connection and address whatever emotions they may have, she said.
Public health interventions that target feelings of grief specifically may help reduce acute mental health crises that arise immediate after mass shootings, according to authors of the study.
Crisis Text Line primarily serves children and young adults, and the vast majority of messages that the mental health help line receives are from people who are younger than 25.
The CDC and others have called attention to the nation's youth mental health crisis, and experts say that this group is particularly at risk to the negative impacts of a mass shooting.
"Under the age of 20 or 22, our brains are still developing, and we're still formulating our understanding of the world," Turner said. "Children and young adults start to create narratives around their own safety, the safety of their schools and homes and communities based on what they are witnessing. Tragedies can tend to make them think that the world is an unsafe place."
But the adolescent brain is also very malleable, and kids are remarkably resilient, Brogan said.
"What I always stress is that bad things can happen to us, but they don't need to define us," she said. "It goes back to understanding that there are things out of our control, and we're really spinning our wheels when we try to control them. What we do have control over is the way we respond to it."
Seeking help by reaching out to a crisis hotline is one way to do that.
"It can take days to weeks to months to process tragedy," Turner said. "Reach out for support, listen to each other's feelings, and set boundaries around how much you're taking in of current crises."
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