Fellow Stanford University School of Medicine Stanford, California, United States
Background: The Washington Post School Shooting Tracker reports that 357,000 children have been exposed to school shootings since 1999. These incidents have effects beyond the number of victims killed or injured. Our study will use data from California EDs to quantify the impact of school shootings on children’s mental health. Objective: We will estimate the effect of school shooting incidents at K-12 schools on the mental health of children by comparing the number of ED visits for mental health concerns in children from communities that experienced a school shooting incident to communities that did not. Design/Methods: A Human Subjects Research determination was submitted and determined that this project would not need IRB review. We will use 2 databases: the K-12 School Shooting Database, a publicly available registry of school shooting incidents, and the Health Care Access and Information database for California, which contains count data for all ED visits. As the K12SSDB includes all incidents where a gun was brandished on school property, we would first limit the communities under observation to those in which the incident occurred during school hours and resulted in the campus being under lockdown (there are 27 such incidents in California from 2015 to 2022). We will identify the hospitals in the vicinity of the school and isolate the number of visits for mental health diagnoses that occurred in the months that followed the incident. We will then find hospitals with similar attributes (such as acceptance of Medicaid and size) in demographically-matched communities. These “unexposed” hospitals will serve as the reference. We will use a staggered difference-in-differences model to evaluate whether the number of mental health emergency visits had a significant increase after the school shooting incidents. We will adjust for other variables such as the size of the school and socio-economic conditions of the community. Identification of exposed and reference hospitals will take place from November to January, count data will be gathered in February and analysis will be done by March.
