Mass shootings are traditionally quantified through the number of victims. Considering that metric, the murder of nine people in a church in Charleston, SC, earlier this week is one of the worst mass shootings in recent American history.
The manhunt for the alleged shooter, 21 year-old Dylann Roof, lasted less than 24 hours. The community response was even faster, with vigils being held across the state barely 15 hours after the shooting occurred. But for many Charleston residents – especially those related to the victims – the psychological impacts of the event could persist long after Mr. Roof's trial is concluded and the media withdraw from the city.
Recent studies have shown that communities experience a host of psychological traumas after mass shootings, from post-traumatic stress disorder (PTSD) and severe depression, to alcoholism and insomnia. For most people these symptoms fade with time, but for a minority they can persist for months and even years. Even those who are only peripherally connected to the event – who may not be from the community or don't know the victims – can experience psychological trauma.
Angela Moreland, a clinical psychologist in Charleston, says she felt an initial response to the shootings similar to most people in the community.
"The first emotional reaction is just fear and shock and horror," she says.
But for Dr. Moreland, who is also an associate professor at the Medical University of South Carolina and an instructor at the university’s National Crime Victims Treatment and Research Center (NCVC) in Charleston, the initial shock quickly gave way to professional instinct.
"I think our first response was to jump in and have services ready," she says.
Thursday morning, just hours after the shooting, Moreland met with her colleagues to begin pulling together resources. By noon, when vigils were being held across the state, the NCVC had flyers and other materials ready to hand out to the hundreds of mourners who had gathered in near-100 degree heat.
Nine deaths make the Mother Emanuel shooting especially heinous, but Moreland says the psychological damage of the shooting could extend far beyond the immediate family members of those who died.
"It can also have big effect on people in the community who don’t perhaps know [the deceased and their family]," she says. "That can come as surprise to [those] people."
And recent studies have shown that those effects can manifest in a variety of ways, and can potentially linger for years.
"These [symptoms] are very normal, for first 48 hours and up until a month," Moreland says. "Those things will decrease naturally for most people. The problem is for some people they don’t decrease."
After a shooting on the Virginia Tech campus in 2007, which killed 33 people and injured 25, Heather Littleton spent a year following over 360 female Virginia Tech students via online surveys. Dr. Littleton, an associate professor of psychology at East Carolina University, and her colleagues found that a year after the shooting, close to 20 percent of the survey respondents were still reporting symptoms of PTSD.
Scientists conducted a similar study on the Northern Illinois University campus after a shooting there in 2008, which killed five people and injured 21. They found that three years after the shooting 8 percent of the students still exhibited persistent moderate symptoms of PTSD, while 2 percent exhibited persistent severe symptoms.
"There seems to be this more general community affect" after a mass shooting, says Littleton. "Those who are members of that community, those individuals also exhibit symptoms despite having less direct exposure."
Experts stress that psychological responses to mass shootings are highly individualized.
People closer to victims are more likely to experience psychological trauma, as are people who have experienced similar trauma in the past. They are also more likely to see their symptoms develop into long-term problems.
But the trauma can follow multiple pathways, experts say. There can be a "delayed trajectory," where a person doesn't start feeling symptoms until weeks or months after the event. Others can see their symptoms fade, only to spike again around the anniversary of the event, or when a similar event occurs somewhere else.
"It's not one-size-fits-all," says Moreland.
Where there is broad agreement is that communities victim to mass shootings need as much emotional and psychological support as they can get, as soon and for as long as possible. In a common and fortunate twist, Littleton says affected communities often see an increase in togetherness and solidarity following mass shootings.
In a soon-to-be-published book chapter on the issue, Littleton writes that the increase in community solidarity "can be enormously beneficial following a tragedy."
"It provides increased social support, tangible resources, and optimism to a community in need," she adds.
Moreland says that Charleston has already shown that togetherness and solidarity in spades, and they can be a crucial resource for people who may not have other forms of support to deal with trauma.
"It shows how close-knit we are, and how willing people are to jump in and help in times of need," she adds. "That’s why those [community events] are so effective, because they're a place of support for people who don’t necessarily have it in their everyday life."
For the next few days and weeks, Moreland says the NCVC will be working in a triage capacity, answering questions and disseminating information for people in Charleston about potential mental health impacts. Over the coming months, however, the real work could begin.
"The needs may change in the community, and we’re well aware of that," she says.
The experts stressed that only a small number of people in a community are likely to develop PTSD, and of those only a small number will see it develop into a long-term problem.
"The biggest thing is for people to not be alarmed if they're experiencing this in any way," she says. "It's in very low percentages that it turns into something more severe, but is important to be aware of it."