According to the Federal Bureau of Investigation (FBI), active shooter events and resultant casualties have nearly tripled over the past decade.1x1Blair, J.P. and Schweit, K.W. A study of Active Shooter Incidents, 2000-2013. Texas State University and Federal Bureau of Investigation, US Department of Justice, Washington, DC;

Google ScholarSee all References The days and weeks following such tragedies are marked by a flood of continuous television and Internet media coverage. Stories are told in painstaking detail with vivid images and sounds re-creating the entirety of the event for viewers. Moreover, unrestricted access to 24-hour cable news networks and mobile electronic devices can make avoiding such content difficult. Although the media certainly have a duty to inform and educate the public, there is preliminary evidence to suggest that excessive coverage can be misleading to the public and potentially harmful.

Despite the fact that active shooter events have increased, violent crime on the whole has actually decreased significantly since the mid-1990s.1x1Blair, J.P. and Schweit, K.W. A study of Active Shooter Incidents, 2000-2013. Texas State University and Federal Bureau of Investigation, US Department of Justice, Washington, DC;

Google ScholarSee all References Yet, nearly 70% of individuals surveyed by Gallup this year believe that crime is getting worse nationally, with the majority of respondents believing that crime is extremely serious. Media coverage, which is widely known to disproportionately report violent crime, could be one explanation for this paradoxical finding. Public perception is incredibly important, because it plays a crucial role in shaping larger policy decisions at local and national levels. Inaccurate perceptions of public safety can distract from other very important issues that require funding and attention, such as the physical, mental, and social needs of children and their families.

More than a dozen studies, many of which followed the September 11, 2001, terrorist attacks and the Boston Marathon bombing, have correlated excessive mass casualty media exposure with symptoms of traumatic stress in both children and adults. Holman et al.2x2Holman, E.A., Garfin, D.R., and Silver, R.C. Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proc Natl Acad Sci U S A. ; 111: 93–98

Crossref | PubMed | Scopus (72) | Google ScholarSee all References found that individuals who did not directly experience the event but who viewed 6 or more daily hours of bombing-related media coverage were even more likely to experience acute stress than those who were directly exposed to the bombings themselves. Other authors have found a link between media exposure and heightened risk for the development of posttraumatic stress disorder (PTSD) in mass casualty survivors.

Studies specific to the impact of mass shootings on children’s mental health are preliminary and correlational. A student cohort study following the Virginia Tech shooting correlated the number of psychiatric symptoms from PTSD, depression, and anxiety with more than 3 hours of media exposure.3x3Fallahi, C.R., Austad, C.S., Fallon, M. et al. A survey of perceptions of the Virginia Tech tragedy. J Sch Violence. ; 8: 120–135

Crossref | Scopus (14) | Google ScholarSee all References In a review of 49 peer-reviewed articles written in the aftermath of 15 independent mass shootings, the authors present limited evidence that exposure to media coverage results in increased fears and decreased perceived safety.4x4Lowe, S.R. and Galea, S. The mental health consequences of mass shootings. Trauma Violence Abuse. ; ( )

PubMed | Google ScholarSee all References However, a study of school shooting survivors from Finland suggests that although students following a higher number of media outlets endorsed feeling worse emotionally than their peers, this effect was attenuated when accounting for confounding factors.5x5Haravuori, H., Suomalainen, L., Berg, N. et al. Effects of media exposure on adolescents traumatized in a school shooting. J Trauma Stress. ; 24: 70–77

Crossref | PubMed | Scopus (22) | Google ScholarSee all References Given that much of these data are correlational, the authors present the possibility that students who are at risk for or currently have psychiatric problems may have difficulty disengaging from media coverage of such events and thus consume more. The authors also suggest that for those individuals directly exposed to the shooting, media exposure did have an independent effect on symptoms, and the authors express an overall concern regarding adolescent media consumption following mass shootings.

The aforementioned studies have provided a framework onto which future research efforts can build to provide a more cohesive narrative regarding the relationship between media exposure of mass casualty events and mental health issues in children and their families. As in the national discussion on video games and social media as they relate to violence and a lack of empathy in youth, we need to identify which individuals are especially at risk when exposed to violent media coverage. For such individuals, what efforts might be preventive, and what interventions might prove effective following the development of traumatic stress symptomatology?

In the meantime, it is important for child and adolescent psychiatrists to collaborate with media outlets, legislators, law enforcement, and the general public to develop a set of standardized reporting guidelines for mass shootings. Law enforcement has already begun a number of campaigns aimed at scaling back specific aspects of mass shooting media coverage. Although the evidence for a “copycat effect” in mass shootings is very limited,6x6Towers, S., Gomez-Lievano, A., Khan, M. et al. Contagion in mass killings and school shootings. PLoS One. ; 10: e0117259

Crossref | Scopus (38) | Google ScholarSee all References the FBI has issued statements suggesting that the media fascination with the shooters themselves serves to glorify and idealize violence. In an effort to curb the potential motivation for individuals seeking notoriety through infamy, the FBI joined Texas State University’s Advanced Law Enforcement Rapid Response Training (ALERRT) Center in a joint “Don’t Name Them” campaign. A similar “No Notoriety” campaign was started by family members of Aurora, Colorado shooting victims. The main thrust of the effort is to shift media attention from shooters to the victims, survivors, and heroes with an overall focus on healing, resiliency, and togetherness. Initially it appeared that these campaigns were working. Anderson Cooper has famously declined to name perpetrators of mass casualty events on a number of occasions following the Aurora shooting in 2012. Following the Roanoke shootings in August 2015, CNN made the decision to show killer-related material only once per hour. Law enforcement also appeared to be following suit, as the sheriff investigating the Oregon Umpqua Community College shooting initially refused to release the name of the shooter. Unfortunately, this progress appears to have stalled in recent mass shooting events. The day following the Orlando shooting in June, FBI director James Comey was quoted in a press conference as saying, “You will notice that I am not using the killer’s name. And I will try not to do that. Part of what motivates sick people to do this kind of thing is some twisted notion of fame or glory.” He urged media outlets to do the same, but the killer’s name had already been released the very morning of the shooting, as had the suspected motivation of terrorism, graphic eye witness accounts, and even audio of the gunfire. The US Justice Department and FBI released a partial transcript of the shooter’s 911 call, only to then re-release the full transcript later amid political pressure with the justification of providing “the highest level of transparency possible under the circumstances.” This action came as a surprise to many, especially given the FBI’s recent attempts to limit intimate details regarding mass shootings and the shooters themselves.

Psychiatrists have also been effective in their impact on media coverage in the past. Advocacy efforts in changing media norms around suicide reporting have largely been successful, to the point where the Centers for Disease Control now have official guidelines for news outlets on how to cover suicide without promoting contagion. Yet similar recommendations are sorely lacking in the case of mass shootings and casualty events. Although one limiting factor at this time is the quality of scientific evidence actually showing causation, there are a number of other barriers impeding progress on this front. The single greatest obstacle may be the presence of a ratings-driven media market in which the inflammatory and sensational accounting of events is tied to financial gains and success. This presents an inherent conflict of interest and places the needs of media companies at odds with those of the general public. There is also the issue of our nation’s incredibly important First Amendment rights and the potential for mental health advocacy efforts to be perceived as an attempt to censor free speech. However, in the spirit of the Don’t Name Them and the No Notoriety campaigns, it is possible to balance the media’s journalistic freedom with common-sense reforms that increase public health and safety.

Although providing some checks and balances appears to be necessary for media coverage of mass casualty events, creating an adversarial relationship is not necessary, nor would it be productive; rather, child and adolescent psychiatrists should simultaneously work with and use the media to spread awareness about existing resources such as the AACAP Facts for Families page and the National Child Traumatic Stress Network. An expanded mental health digital footprint could also include efforts to educate parents about the impact that child traumatic stress can have on families, and similarly how parental responses to mass casualty events can likewise affect children. Schools and parents could be better informed about best practices in talking with children in a developmentally appropriate manner following mass casualty events, including information on the importance of limiting media exposure, identifying warning signs, and knowing when and how to refer for additional services. Individual providers can interface with local television channels and newspapers to reach members of their local communities and to spread awareness about user-friendly parent guides such as Common Sense Media. Such efforts would not be difficult to undertake and yet could have high impacts, especially following a mass casualty event.

Even small and subtle shifts in media coverage could have a profound impact on many children and their families across the country. Hopefully these efforts can be part of a larger solution to decrease the frequency of mass casualty events in the near future.