Another Public Health Crisis Originating From Gun Violence

Yash B. Shah


June 27, 2022

The number of mass shootings in the US has jumped from 272 annually in 2014 to 692 annually in 2021. As these attacks have increased in frequency, averaging more than once daily since 2019, we've slowly become accustomed to their occurrence. Now, guns only reenter the national conversation when there is a particularly devastating event. Most recently, a shooting in an elementary school in Uvalde, Texas, resulted in the deaths of numerous children and their teachers.

Gun violence is a public health concern, causing tens of thousands of deaths annually. Physicians across the country have begun drawing attention to this fact by highlighting the devastating effects of gunshots on the human body. Regardless of medical advancements or surgical skill, physicians are limited in what they can do to help gunshot victims.

While the unacceptable loss of life rightly receives a lot of attention, there are secondary psychological effects on immediate loved ones and surrounding communities that must also be acknowledged. Understandably, the death of a family member or friend can trigger deep, long-lasting emotional stress, grief, and depression. Given the frequency and prevalence of mass shootings in America, the need for both immediate counseling and long-term mental health care to address this secondary public health concern deserves greater recognition.

Perhaps one of the most devastating headlines after the events in Uvalde involved Joe Garcia, a father of four whose wife, a teacher, was murdered that day. Garcia experienced a heart attack soon after the shooting — something known as Takotsubo cardiomyopathy (TCM), or broken heart syndrome. With TCM, intense stress triggers sudden chest pain and shortness of breath. Subsequently, the heart swells and eventually fails to pump blood, and blood flow to the heart itself can decrease. TCM has increased in frequency in recent years, a trend that is largely attributed to elevated emotional stress during the pandemic. What stands out with TCM is that the issue is entirely due to emotional stress, with no underlying biologic abnormalities. This tragedy is a poignant example of the drastic mental health harms on loved ones who may not even have been present at the site of the shooting.

Similarly, witnessing and surviving a mass casualty event firsthand can lead to everlasting fear and psychological harms. It is estimated that around 28% of survivors are expected to develop posttraumatic stress disorder (PTSD) while one third develop acute stress disorder. Other common effects include substance abuse, depression, and self-harm. Watching the murder of classmates, teachers, family members, or any fellow human being will certainly stick.

Moreover, the wider communities where these events occur also face a ripple of psychological consequences. Knowing that such an incident transpired close to one's everyday life greatly affects one's sense of safety and trust. This is exemplified by the planned demolition and replacement of the Uvalde school campus, similar to actions taken after previous school shootings. Survivors and neighbors face ongoing trauma when they routinely look at the building where such a terrible event occurred.

Ultimately, this alarm can spread to all Americans. With easy access to news media and the rapid spread of information, even individuals thousands of miles away rightly feel increasing levels of fear in daily life, wondering if they could be next. Mass shootings occur in routine spaces, such as theaters, offices, stores, and schools, where Americans reasonably expect to be safe. It is impossible to avoid such spaces without altering one's normal life.

What can be done to address this crisis? More people now agree that common-sense gun safety regulations are the key to stemming the issue at the source. However, until society compromises and reaches a solution, there are other, stopgap measures we should take.

Most importantly, we must raise awareness surrounding mental health needs. Immediate support for those close to the incident might prevent long-term psychological consequences, or even death, as seen in the case of Joe Garcia. Simple events such as memorials and candlelight vigils can provide closure and honor the victims. This helps community members draw support from each other by realizing that they are not alone in their trauma. In the long run, comprehensive psychological care can help. Following up with counseling can assist victims in seeking healthy strategies to cope with loss and fear.

Ultimately, raising awareness surrounding the public health crisis and contextualizing the profound loss associated with gun violence can build support toward lasting change for this uniquely American problem.

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About Yash B. Shah
Yash Shah is a first-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. He earned a bachelor of science in premedicine from Penn State University. Prior to attending medical school, Yash worked on clinical and translational research in hematology/oncology at the Children's Hospital of Philadelphia. Yash has long-standing interests in advancing medical education, improving healthcare policy and economics, and working with cancer patients. In his free time, he enjoys playing tennis, rooting for the Eagles, reading, and traveling.


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