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Shootings are sudden, unexpected, and violent. Because of this, people often feel fearful, anxious, and powerless, which can contribute to symptoms of PTSD that people may experience after a shooting. (Matthew Tull, PhD, 2021)

https://www.verywellmind.com/shooting-ptsd-from-a-shooting-2797200

Eun Hye Lee

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As people age, the trauma from COVID-19 is exacerbated due to increased mortality rates and underlying health conditions. A weakened immune system makes it harder for seniors to combat the virus, raising the risk of complications like pneumonia, blood clots, and sepsis. These factors contribute to heightened anxiety, fear, frustration, and feelings of helplessness among older adults. To mitigate this trauma, maintaining routines, engaging in outdoor activities, and offering programs for support are essential in caring for the mental health of seniors during the pandemic.

-Reference-

Norman, A. (2022, June 27). Everything older adults need to know about COVID-19. Verywell Health. https://www.verywellhealth.com/covid-19-and-the-elderly-4799861

-Sangpyung Lee-

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From the early days of the COVID-19 pandemic, older adults have been considered at risk of becoming very sick from the virus. If you are a senior or are a caregiver for an older adult, here is what you need to know about staying safe and healthy.

Are Older Adults More at Risk for COVID-19?

Data from the World Health Organization (WHO) shows that the chance of dying from COVID-19 increases with age. People aged 80 and over, as well as those with underlying health problems, have the highest risk of dying if they get the virus.

The risk of any infection, as well as potential complications, is higher if you do not have a strong immune system. Having a chronic illness or receiving medical treatment that dampens the immune system can make you susceptible.

Members of the elderly population are more likely than people in other age groups to have these risk factors, which increases the risks related to COVID-19. A person who was already unwell when they were infected with the virus will be more likely to develop serious complications than someone who was otherwise healthy when they got sick. Possible complications include pneumonia, blood clots, and sepsis.

Chronic Illness

According to the Centers for Disease Control and Prevention (CDC), people with certain health conditions are more likely to become seriously ill or develop complications if they are infected with COVID-19, compared to healthy people.

Conditions That Increase COVID-19 Severity

Heart and cardiovascular conditions or disease: including a history of heart attack, heart failure, arrhythmias or irregular heart rhythms, peripheral artery disease, and high blood pressure

Lung disease: including chronic obstructive pulmonary disease (COPD), asthma, and pulmonary hypertension

Diabetes: including types 1 and 2 and gestational

People may also be at increased risk if they have conditions that affect their immune systems, such as cancer and HIV/AIDS. Additionally, organ transplant recipients taking immunosuppressants and people taking biologics for the treatment of autoimmune diseases may also be higher at risk, since these treatments weaken the immune system.

Nursing Homes, Assisted Living, and Hospice

Elderly people also have certain risk factors that are related to their lifestyle.

Visiting healthcare providers: Many older adults frequently have to go to healthcare settings for assessments or to receive treatment for chronic medical conditions.

Living in community settings: Some older adults live in a nursing home or assisted living facility. While these places are expected to practice infection prevention on par with hospitals, infectious diseases such as COVID-19 tend to spread quickly wherever people live in close quarters.

Living in palliative care: Those who are elderly, frail, and in the final stages of a terminal illness are especially vulnerable to infection.

What Seniors Can Do

Experiencing confusion, worry, and anxiety about your coronavirus-related risk is normal regardless of how old you are or your usual state of health. You may be feeling overwhelmed, frustrated, or helpless.

While you cannot control or know every factor that contributes to your risk, there are some steps you can take to protect yourself and your loved ones.

Talk to Your Doctor

If you are unsure of how your age or health status influences your risk, the best thing you can do is talk to your doctor. If you can't go to the office for your appointment, you may be able to call, send a message through a secure patient portal, or even use a video chat service to have a conversation.

Vaccination is available to protect you from COVID-19 infection. The vaccine is recommended for most elderly adults, and it has been shown to be safe and effective. Vaccination reduces the risk of infection and lowers the likelihood that an infection will be serious.

While you should stay up to date on the recommendations for older adults and people with specific health conditions that are identified by national and global agencies like the CDC and WHO, your own healthcare providers will be able to provide guidance that is most relevant to you because they know your medical history and your social circumstances.

In the event that you are exposed to the virus or experience symptoms, your doctor will be the best resource for information about getting tested and treated where you live.

Limit Exposure

Don't spend any time around anyone who has COVID-19, whether they have symptoms or not.

Talk to your doctor to get advice about how much you can go out around crowds or around other people who could potentially carry the virus. And it's important to consider limiting people coming into your home, which can help reduce your risk of coming into contact with someone who is infected.

Practicing social distancing is important because you may come into contact with someone who does not feel sick, but has been infected with the virus and can spread it to you without realizing it. Likewise, you could be infected and infect someone else.

Try to maintain contact with friends and family by phone, video chat, email, or messaging apps so you won't lose touch with your family and social circle as a result of being cautious.

Beware of Scams

Do not respond to phone calls, emails, or social media messages that ask you for personal information or money, or that offer you vaccinations, medication, or treatment for COVID-19.

Remember that scammers can make a call or message look like it's coming from someone in your community-or even a family member or friend.

If you are not sure about who is contacting you and think it might be a scam, check the Federal Trade Commission's list of COVID-19 scams.

Practice Proper Hand Hygiene

Correctly washing your hands is a habit that can save lives (yours and others)-and not just when there's a global pandemic. Proper hand hygiene doesn't just mean always washing your hands before you eat and after you use the bathroom; it also means that you wash your hands in the right way.

If you don't have clean water nearby and your hands are not visibly soiled, using hand sanitizer spray, gel, or wipes that are at least 60% alcohol can help. It's not as good as finding a sink and suds, but it's better than nothing at all.

Sanitizing products can also be useful for wiping down objects and surfaces in your car and home, as well as things that you bring along when you leave the house, like your phone, wallet, and bag.

Take Care of Your Mind, Body, and Spirit

Do your best to continue doing all the things you normally do to stay healthy, like eating well, drinking water, getting enough sleep, and exercising.

Some tips for practicing self-care:

Maintain a routine. Try to maintain a routine and give yourself a bit of a schedule.

Get outside. Unless your doctor specifically advises against it, getting outside each day-whether to work in your garden, read in the backyard, or take your dog for a walk around the block-will also help keep you in good physical and mental shape.

Get involved. If you are feeling isolated and alone, reach out to your local community. Churches and religious organizations, nonprofit groups, businesses, schools, and municipal departments may have programs to help you with your practical needs-and you can also safely volunteer your services if you are up to it.

Tips for Caregivers

If you're caring for an aging loved one, you may have questions about the risk of COVID-19. Many of the steps you're taking to protect yourself and the people in your home will also benefit an elderly family member, but there are additional precautions you may want to consider.

Connect with your loved one's healthcare providers: Find out what you need to know about your loved one's medical needs. Ensure that they have the prescriptions, supplies, and equipment they need and that you know how to get more. Make sure you understand how to help them manage their chronic health conditions, and know which scenarios warrant calling the doctor's office, going to the ER, or calling 911.

Know your local guidelines: Keep up to date with state and local guidelines related to COVID-19. If your loved one is showing signs of illness or has been exposed to someone who is sick, make sure you know when, where, and how to get care in your community.

Stay in touch remotely: If your elderly loved one lives independently, set up a way to stay in touch remotely. You might set up a schedule for calling them each day, set up a video camera, or do daily check-ins via Skype or Facetime. Arrange for them to have an emergency call button or medical alert device.

Involve others: You may also want to notify your loved one's friends or neighbors, who may be willing to keep an eye on things for you.

If you have a loved one who has a limited ability to communicate: Make sure that you are monitoring them for signs of illness (for example, checking their temperature). A person who has speech or cognitive difficulties may not tell you that they feel sick.

If you have a loved one in a nursing home or assisted living facility: Talk to their physician about the safest option for their continued care. If you are concerned about the risk of exposure in a facility and would prefer to care for them in your home, understand that their medical needs may prevent this from being possible. It's also important that you are realistic about the potential safety risks of having them in your home beyond exposure to the COVID-19 virus.

If a healthcare professional visits them at home: Make sure you speak to the healthcare organization or agency about what steps are being taken to protect employees and patients. Work with them to put a plan in place for continued care in the event that the person who usually provides care for your loved one becomes ill.

Know Your Own Risk

If you are responsible for caring for someone else, you need to prioritize your own health and safety to ensure that you can be there for them. This encompasses everything from addressing your physical and mental wellbeing to assessing your own risk.

Taking steps to reduce your risk of exposure to COVID-19 helps you avoid spreading the virus to a vulnerable loved one and reduces the risk that you'll become sick yourself. These outcomes are of equal importance to ensuring that you, your family, and the people in your community are safe.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

Additional Reading

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Everything Older Adults Need to Know About COVID-19

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Older adults are at increased risk for the new coronavirus (COVID-19). If you are concerned about how age affects the risk for you or a loved one, here's what you need to know.

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Trauma is an emotional response to a terrible event like an accident, crime, or natural disaster. Reactions such as shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and physical symptoms.

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The recovery of trauma -         Jaylene moreno 

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The recovery of trauma -         Jaylene moreno 

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Recovering from trauma is a mentally difficult process followed by physical pain. Trauma begins with disturbing/unpleasant events leading to emotional and physical distress. Trauma may be more commonly caused by natural disasters, tragic deaths, any form of abuse, and much more. Traumatic events take a big toll on the body destroying the body and the mind's tranquility causing the individual not to live a normal life. Trauma goes beyond fear, trauma harms a person's sense of safety for a long period. Side effects include flashbacks, nightmares, headaches, fatigue, racing heart, sweating, chronic pain, sleeping problems, and more. Recovery is a long difficult process. The more unpleasant the event was, the longer it may take to recover. Your lifestyle choices play a crucial role in your recovery process. It is recommended to maintain a good sleep schedule and a healthy diet, pick up a hobby, spend time with supportive and caring people, meditate, etc. During recovery, your body cannot afford the side effects of unhealthy choices such as drinking, doing drugs, losing sleep, eating unhealthy, etc. Speaking to your DR is also a good idea to go over a treatment plan as well as all the options of care there are for you. It is very important to take care of yourself and always reach out for help to live a better quality of life.

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Trauma is a person's emotional response to a distressing experience. Few people can go through life without encountering some kind of trauma. Unlike ordinary hardships, traumatic events tend to be sudden and unpredictable, involve a serious threat to life-like bodily injury or death-and feel beyond a person's control.

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Mass shootings continue to erupt in schools, grocery stores, restaurants, and other public places we visit every week, leaving Americans living in fear. (Newsome, K., et al., Journal of Surgical Research, Vol. 280, 2022).

https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas

Eun Hye Lee

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As mass shootings repeatedly erupt in schools, grocery stores, and other establishments we visit every week, Americans are living in fear. For children and teens, whose mental health is already in crisis, the ongoing backdrop of violence is steadily eroding the sense of well-being, safety, and efficacy known to be essential for healthy development.

On top of recent surges in depression, anxiety, and suicides, a majority of teens now say they worry about a shooting happening at their school ( Pew Research Center, 2018). Those concerns have been linked with elevated anxiety levels and fear among students (O'Brien, C., & Taku, K., Personality and Individual Differences, Vol. 186, 2022). Meanwhile, clinical psychologists, including Erika Felix, PhD, of the University of California, Santa Barbara, say the young people they treat are on high alert, constantly planning their escape route if violence breaks out in public.

"These tragedies are happening far too often, and the result is that many young people are feeling this constant back-of-the-mind stress," Felix said.

That stress is, of course, embedded within the context of the pandemic, economic challenges, political polarization, climate-related disasters, and other factors, which combine to create what psychologist Roxane Cohen Silver, PhD, of the University of California, Irvine, calls a "cascade of collective traumas" that the nation is facing together.

"We're not starting at a place where everybody is healthy and thriving," said Rinad Beidas, PhD, a professor of psychiatry, medical ethics and health policy, and medicine at the University of Pennsylvania's Perelman School of Medicine. "Our reserves are depleted as a nation and our young people are suffering."

Fear of mass shootings has left a large majority of Americans feeling stressed, including a third of adults who say they now avoid certain places and events as a result (Stress in America: Fear of mass shootings, APA, 2019). Experts say the frequency of mass shootings, amplified by our near-constant access to media coverage of such events, amounts to an accumulation of exposure that is harming everyone's mental health.
[Related: APA resources for coping with mass shootings]
"The more catastrophic events we're exposed to as a nation, the more impacted we're going to be on a psychological level," said Jonathan S. Comer, PhD, a professor of psychology and psychiatry at Florida International University.

While some people report panic and distress, others feel numb. Psychological reactions to a crisis vary from one person to the next, based on factors such as age, trauma history, and proximity to an incident. But research has started to reveal who is most likely to be affected, what the long-term mental health problems will be, and what role media exposure plays. Psychology offers guidance about how to channel concern into action amid these atrocities.

"We're at a really important inflection point as a country where we all understand that what's currently happening with regard to mass shootings cannot continue," said Beidas, who also directs the Penn Medicine Nudge Unit and Penn Implementation Science Center. "I come to this with a lot of hope that we're all recognizing that it's time to do things differently."

A cycle of distress

Mass shootings account for about 1% of annual firearm deaths in the United States, but they occupy an outsize space in the public consciousness.

"These events are still relatively rare, but it doesn't feel that way," said school psychologist Franci Crepeau-Hobson, PhD, an associate professor and director of clinical training at the University of Colorado Denver's School of Education and Human Development. "I think that everybody's sense of security has been threatened."

For survivors and witnesses of mass shootings, suffering tends to be particularly severe. Studies have documented increases in posttraumatic stress disorder (PTSD), major depression, anxiety disorders, substance use disorder, and other conditions among people who have survived a mass shooting.

"A common theme is that more exposure tends to be associated with more severe symptoms," said clinical psychologist Sarah Lowe, PhD, an assistant professor of social and behavioral sciences at Yale School of Public Health, who led a 2015 literature review on the mental health consequences of mass shootings (Trauma, Violence, and Abuse, Vol. 18, No. 1, 2015).

But the research is still very limited. In Lowe's review, PTSD prevalence ranged from 3% to 91%, depending on the study, and methodological questions remain, such as what even constitutes a mass shooting.

Though relatively few people will witness or survive mass shootings, many more will experience them through news reports and social media.

"There's a great deal of evidence that individuals who are far away from mass shootings can face anxiety and impairments, and this is often correlated with the amount of media exposure they have," Comer said.

Such findings are highly concerning given how intertwined people's lives are with media, researchers say. Silver and her colleagues have studied that link for more than 20 years, showing how high levels of exposure to media coverage of 9/11 and the Boston Marathon bombings predicted symptoms of acute stress and posttraumatic stress (Psychological Science, Vol. 24, No. 9, 2013; PNAS, Vol. 111, No. 1, 2014).

Over time, media exposure to mass violence can even fuel a cycle of distress, where persistent worry about future violence predicts more media consumption and more stress, the researchers found (Thompson, R. R., et al., Science Advances, Vol. 5, No. 4, 2019). That constant worry, known as "perseverative cognition," has been linked to declines in physical health, including cardiovascular problems (Ottaviani, C., et al., Psychological Bulletin, Vol. 142, No. 3, 2016; JAMA Psychiatry, Vol. 65, No. 1, 2008).

In addition to the risks of media exposure, people with a history of trauma are more likely to experience posttraumatic stress (PTS) symptoms following a new exposure, such as a terrorist attack or mass shooting (Garfin, D. R., et al., Psychological Science, Vol. 26, No. 6, 2015). Physical proximity to an incident also carries a higher risk of mental health problems. One study of 44 school shootings found that antidepressant use increased more than 20% among young people who lived within 5 miles of a shooting, versus those who lived 10 to 15 miles away (Rossin-Slater, M., et al., PNAS, Vol. 117, No. 38, 2020).

Psychological proximity-the degree to which we relate to another person or an event-also increases the risk for PTS symptoms (Thoresen, S., et al., European Journal of Psychotraumatology, Vol. 3, No. 1, 2012).

"Oftentimes, the more one identifies with the victims, the more difficulty they have in the aftermath of an event like this," Comer said.

Going numb

While some people worry regularly about mass shootings, many are fatigued by the seemingly endless cycle of violence that moves rapidly through the media and public discourse.

"There's not one single way people are experiencing these tragedies, and there's no one-size-fits-all response," Silver said. "One person might be very impacted by an event, and another may not be concerned about it at all."

Research by cognitive psychologists helps explains how we perceive mass violence and why it can leave some people feeling numb. Paul Slovic, PhD, a professor of psychology at the University of Oregon, and his colleagues have shown that in many cases, the more people who die in an incident of mass violence, the less we care. They call this phenomenon the " deadly arithmetic of compassion."

Their research shows that people's intuitive feelings of concern for victims of violence don't respond well to statistics and don't scale up. In other words, the horror people felt when 19 children and two adults were shot and killed at Robb Elementary School in Uvalde, Texas, isn't 21 times greater than what people feel when one child is murdered. Slovic and other psychologists call this dampening of the emotional response "psychic numbing."

At the same time, people often have a false sense of inefficacy in the face of very large problems, which can lead to inaction and disengagement. In one study, participants who saw statistics about the magnitude of the hunger crisis in Africa donated about half as much money as those who saw a photo of a single child in need (PLoS ONE, Vol. 9, No. 6, 2014).

"If we believe there's a problem that we can't do anything about, it makes sense that we don't attend to it, because it's very distressing to dwell on things you can't fix," Slovic said.

Finally, research on what's known as the "prominence effect" shows how people often struggle to make decisions when they require weighing complex tradeoffs (University of Illinois Law Review Slip Opinions, 2015). In the case of gun legislation, this helps explain why the complex calculus of lives saved versus freedoms sacrificed has largely resulted in inaction at the policy level.

And on top of this deadly arithmetic, our attention is a scarce resource. Time passes, memories fade, and we're inclined to shift our attention elsewhere if we don't see progress. National surveys have shown that support for gun legislation spikes in the immediate aftermath of a mass shooting but fades within a few weeks (Jose, R., et al., Psychology of Violence, Vol. 11, No. 4, 2021; Filindra, A., et al., Social Science Quarterly, Vol. 101, No. 5, 2020).

"Our mind deceives us into underreacting to the most important problems in the world, including mass violence," Slovic said. "But when one of these events occurs, we do have a window of opportunity when people are awake, emotionally engaged, and motivated for action."

Youth on high alert

The stress of mass shootings may weigh particularly heavily on children and teens, whose mental health is already in turmoil. In 2021, three leading pediatric organizations declared a national emergency, while the U.S. Surgeon General issued a special advisory on youth mental health, citing a 57% increase in suicides between 2007 and 2018 (Curtin, S. C., National Vital Statistics Reports, Vol. 69, No. 11, 2020).

Research shows that at least some of that distress can be attributed to mass violence. One study of more than 2,000 teens found that greater concern about school shootings and violence predicted increases in anxiety and panic six months later (Riehm, K. E., et al., JAMA Network Open, Vol. 4, No. 11, 2021).

"When I talk to kids about this, I am shocked by how inured and accepting they are," said Don Grant, PhD, the executive director of outpatient services for Newport Academy in Santa Monica, California, and is president of APA's Division 46 (Society for Media Psychology and Technology). "They don't know a world where there's not an active shooter drill at school."

In the educational context, that constant vigilance can be particularly problematic, and research on threat perception suggests that prolonged heightened anxiety may interfere with learning, said Crepeau-Hobson. Students who are constantly worried about a toxic stressor, such as gun violence, devote more mental resources to emotions and fewer to executive functions, including learning, memory, and sustaining attention (Dettmer, A. M., & Hughes, T. L., Education Week, 2022).

"When threat perceptions are escalated and stress responses are activated, we can't access the higher parts of our brain," Crepeau-Hobson said.

Data suggest those effects could be far-reaching. A 2020 report from the National Bureau of Economic Research found that school shootings increased absenteeism, reduced high school and college graduation rates, and decreased retention of teachers. Those effects persisted into the mid-20s of young adults who attended schools where a shooting occurred; they had lower employment rates and earnings than their peers (Cabral, M., et al., NBER Working Paper 28311, 2022).

"It's not just that individual young people experience these really deleterious effects, but there is also a societal effect," Beidas said.

Because mass shootings impact children and teens at the individual, institutional, and societal levels, experts say a tiered approach is needed to minimize harm.

In the family context, it's important to initiate conversations with children and teens after an incident, even if they aren't part of the affected community, said Comer.

"When kids hear about these events from their parents, they tend to do better than when they hear about it from their friends or the media first," he said.

If a child or teen becomes hypervigilant or starts to avoid certain places or activities, that may indicate a need for professional support, said Grant.

Educators and policymakers also need empirical data on what makes schools safe-both physically and psychologically, said Crepeau-Hobson, a member of the APA's Division 16 (School Psychology) executive committee.

"A number of schools are wasting their resources on strategies that aren't particularly helpful, without thinking about their psychological impact on children who are coming to school to learn," she said.

School districts across the nation are spending billions of dollars to enhance security, installing emergency alert systems and hiring additional personnel. But many of the new approaches lack evidence and could even cause harm. For example, a law enforcement presence may make some students feel safer but may undermine a sense of safety in others, such as students of color. Early studies of active shooter drills-which are now nearly ubiquitous-suggest they may increase anxiety, stress, and depression symptoms in children and adolescents (" The Impact of Active Shooter Drills in Schools," Everytown Research and Policy, 2020).

Communities also need to be prepared to support children in the immediate aftermath of a mass shooting. Last year, Comer launched the Network for Enhancing Wellness and Disaster-Affected Youth (new day), which delivers large-scale professional training on disaster mental health across the country. new day teaches Psychological First Aid and other skills to teachers, coaches, nurses, and others who work with children and teens.

Sustaining engagement

More research is also needed on how mental health services can best support survivors, families, and affected communities in the aftermath of a mass shooting, experts say. Richer firearm-injury and mortality datasets can also help researchers better understand the conditions surrounding these crises.

But many feel change is urgently needed, and that partnering with the firearm community-to promote more secure storage of firearms, for example-is one way to start reducing firearm injuries and deaths right away, Beidas said.

More than 7 million Americans bought firearms for the first time between January 2019 and April 2021, mostly for self-protection (Miller, M., et al., Annals of Internal Medicine, Vol. 175, No. 2, 2022). That suggests many people need education on secure storage (see " Talking to patients about firearm safety," April 2022 Monitor), and that the recommended method of storing a gun unloaded and locked, with ammunition locked separately, might not be acceptable to all firearm owners.

"We need to establish a shared mission with the firearm community," Beidas said, "and keep in mind that a harm reduction approach is the most effective way to change behavior."

At the policy level, a majority of Americans support stricter gun laws, but progress in that domain may be incremental (Jose, R., et al., Psychology of Violence, Vol. 11, No. 4, 2021). Slovic said it's important to stay engaged and not to let a false sense of inefficacy prevent us from taking steps in the right direction.

"Just because we can't fix a problem in its entirety doesn't mean that we shouldn't do what we can do to make a difference," he said. "We cannot afford to let our minds deceive us into underreacting."

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Stress of mass shootings causing cascade of collective traumas

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As mass shootings repeatedly erupt in schools, grocery stores, and other establishments we visit every week, Americans are living in fear. For children and teens, whose mental health is already in crisis, the ongoing backdrop of violence is steadily eroding the sense of well-being, safety, and efficacy known to be essential for healthy development.

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Eun Hye Lee

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The Psychology of Mass Murder

Mass murder is the act of killing multiple people, typically either simultaneously or over a short period. It is often an act of vengeance against society, carried out by a desperate and fatalistic individual who has no intention of quietly disappearing or returning to commit more crimes later. (Mass shootings, 2022).

https://www.psychologytoday.com/us/basics/mass-shootings

Eun Hye Lee

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The Psychology of Mass Murder

The individual motives for mass murder vary greatly. A common motivation is retaliation or revenge; others include grandiosity and the desire for attention or fame. On rare occasion, a mass murder occurs when the perpetrator, who may be deeply troubled, suffers a psychotic break from reality and strikes out at his perceived tormentors.

Unlike serial killers, mass murderers are frequently, but not always, killed at the scene of the crime. Sometimes they are shot by law enforcement officers called to the scene, while other times mass murderers take their own lives in a final and deliberate act of suicide.

Mass murder is frequently an act of vengeance against society committed by a desperate and fatalistic individual who has no intention of going away quietly or returning to kill another day.

Mass murder and serial murder are two different types of crime with different motivations and goals on the part of the perpetrator. Definitions of serial murder share common elements, but they differ on specific requirements such as the number of murders required, the types of motivation, and the temporal aspects of the murders. Typically, definitions of serial murder specify a certain number of murders, varying from two to ten victims. The classic definition of serial murder required a period of time to elapse between the murders.

Mass murder, by contrast, is the act of murdering multiple people, typically simultaneously or over a relatively short period of time. Mass murder may be committed by either individuals or organizations. Mass murder may also be defined as the intentional and indiscriminate murder of a large number of people by government agents. The FBI defines mass murder of this type as killing four or more persons with no cooling-off period between the murders.

There is no single profile of the "lone wolf terrorist," but research suggests that several characteristics are common. These include vocational problems, high stress levels, problems with intimate partner relationships, social awkwardness, violent communication, high intelligence, and a mental illness. Many lone actors have had difficulties functioning adequately in everyday life and maintaining healthy relationships. However, not all group members have every characteristic, such as mental illness. (Only a small minority of people with mental illnesses are violent.)

A copycat crime is a criminal act that is modeled after or inspired by a previous crime that has been reported in the media or published in fiction. Few copycat crimes are exact replicas of the event that inspired them. Instead, the imitator lifts and copies certain elements-motivation, technique, or setting. While most copycat crimes occur within two years of the initial incident, a crime can occur anytime after the original crime.

For individuals predisposed to violence, crime-related media can lead to violence in two ways. First, it can lower people's natural inhibition against killing by allowing them to create psychological distance from what they're about to do. Taking on a persona or character makes it easier to harm others. Second, crime media can be a teaching tool, directing the motivated person to discover where, what, and how to succeed. It can also reinforce the notion that reproducing the original crime, or "outdoing it," will lead to the attention and publicity that the first received.

Crimes can easily be misidentified as copycats. Therefore, the only way to determine if a crime is a copycat crime is to catch the criminal and find out why they did it. Such research found that 22 percent of a sample of incarcerated criminals admitted having committed a copycat crime. Approximately 20 percent of the criminals saw the media as a valuable resource for learning how to commit a crime.

Several motivations help explain why some people turn violent. Humans have basic psychological needs, and if those needs consistently aren't met in someone's job, relationships or life, they may turn to other strategies-like substance use, self-harm, or violence-to remove or redirect their frustration. These psychological needs include:

* Goal attainment: People may turn to violence when they believe they lack of control over their life and the outcomes they want are unattainable.

* Instant gratification: The inability to consider long-term consequences. The consequences of a shooting, by contrast, are instantaneous.

* Recognition of competence: Competence serves as the foundation for accomplishment and recognition. Killers are often described as loners who experienced disrespect and little recognition. Committing horrific crimes, however, leads to immediate global recognition.

* Social reciprocity: The desire for payback may continue until a maligned individual believes they have corrected any perceived inequity.

* Lack of emotional intelligence: Individuals who commit aggression generally lack the ability to regulate their emotions.

Mass Shootings and Mental Health

What's the relationship between violence and psychosis?

A study published in the journal Psychology, Public Policy, and Law examined the mental health histories of 176 mass shooters between 1966 and 2020. The research showed that psychosis was deemed to have played a major role in 11 percent of shootings, a moderate role in 9 percent of cases, and a minor role in 11 percent of cases. The role of psychosis in mass shootings has been relatively stable over time, even as the number of mass shootings has risen sharply in the past few years.

The results indicate that while mental illness is often blamed for the recent rise in mass shootings, psychosis alone doesn't appear to be a significant factor.

While not all murderers are psychopaths and not all psychopaths are murderers, psychopaths commit a disproportionate number of murders. Furthermore, murderers generally seem to have unusually high levels of psychopathic traits compared to most people. Psychopathic traits, such as lack of empathy, callousness, coldness, recklessness, and a criminal lifestyle facilitate the commission of the most horrific crimes.

Researchers performed a meta-analysis of 22 studies of more than 2,600 homicide offenders in six countries, in which each offender's psychopathy score was assessed. They found that the average psychopathy scale score for someone who had committed murder in these studies was 21.1. The average score in the general non-offender population is 4 or 5. This means that all the offenders were at least somewhat higher than the community average and that most murderers studied could be considered at least moderately psychopathic.

Coping with Tragedy and Grief

Each person's experience is unique. Biology, coping skills, past experiences, level of social and emotional support, and other factors impact the ability to cope and heal following a tragedy. For example, attending a support group for grieving families may be helpful and supportive for some yet stressful re-traumatizing for others.

Those affected by a mass shooting may feel irritable, sad, angry, anxious, shameful, regretful, or helpless, among other emotions. They may eventually feel stronger, empowered, or driven. They may weave in and out of these feelings at different points in time. They may feel like they were in a dream or altered state, as if they were detached from their body. Some people refer to it as an "out of body experience," as if the experience was happening to someone else.

What people were directly exposed to and how it affected them will impact how they feel. If they lost a loved one, they may be going through various stages of grief. All people experience this differently, and there's no right or wrong way to grieve.

Exposure to gun violence affects children in ways beyond the direct impact of mass shootings in schools. First, gun violence impacts children through their parents. For example, mothers who are exposed to gun violence experience more mental health problems, such as depression, than do mothers who aren't exposed. Second, children who have direct exposure to gun violence experience more mental health issues than other children, including psychological distress, anxiety, depression, and suicidal ideation. Support through therapy or groupwork is always available for children who are struggling.

Everyone responds differently, and it's normal to feel a range of difficult emotions. People may feel profoundly sad and mournful, anxious about the possibility of gun violence directly affecting them in the future, or angry and enraged at the killer or political system in place. It's normal to feel conflicted between wanting to read about the shooting and honor the victims while simultaneously feeling exhausted or fearful of the emotional toll.

People may contend with challenging questions such as: "Why can't I stop thinking about the shooting?" "Am I numb? Have I become so hardened that I'm immune to this?" "How could I wish that the shooter was dead?" These thoughts can be distressing or unsettling, and even challenge people's ideas of who they are.

After a mass shooting, people can try to cope by acknowledging and processing their emotions, supporting the victims, taking action if that's personally important, and striving to live meaningfully and mindfully. To reflect on how to live meaningfully, people can think about whether they exercise care and compassion toward others, spend enough time with loved ones, practice gratitude for what they have, take risks and challenge themselves, define their purpose and goals, and take care of themselves on a regular basis.

writes Psychology Today

In the aftermath of a school shooting, parents should proactively communicate with and comfort their children. Steps include:

* Prepare for the discussion: Before you talk to a child or teenager, prepare what you want to share with them and what you don't. Collect yourself so you can be calm, truthful, and authentic.

* Initiate conversation: Ask what your kids are feeling and listen carefully so you can respond to their concerns, misconceptions, and fears truthfully. Explain that you will create ongoing opportunities to talk.

* Limit exposure to media: Seeing graphic, disturbing footage repeatedly can be harmful long-term.

* Keep routines in place: Routines are reassuring to children.

* Monitor your child: Signs that they may be struggling include persistent fear, stress, regressive behaviors, difficulty concentrating, sleeping, or eating, and stomachaches or headaches. You may want to find a therapist for your child.

* Discuss your concerns: Balance honesty about your emotions with measured calm. You may want to discuss actions being taken or safety plans in place.

* Take action: For example, this may include supporting the victims or taking political action.

* Take care of yourself: Eating well, sleeping well, journaling, meditating, support from loved ones and therapy can help you stay strong for your children.

Parents should plan in advance what they want to share or not share with their children. This should be based on the child's age and developmental ability to process difficult life situations. In general, telling children the horrific details of school shootings is not necessary or helpful, while making clear that you want them to feel safe talking to you about school violence is important.

Choose a quiet time and location for the conversation. Begin by asking open-ended questions and listening to their answers. You may want to start by saying something like, "Have you heard anything about kids getting hurt at school?" If your child was directly affected, start with something like, "What happened today was a really big deal. How are you feeling about it? Can you tell me about your experience?"

Listen carefully and reflect back what you heard to validate their experience. Ask follow-up questions as needed. Be honest and share your feelings. Emphasize that people are working to help keep your child as safe as possible. Make clear that you are always available to talk.

In the weeks following a shooting, parents can monitor their children for signals that they may be struggling. Signs include avoiding school, social isolation, difficulty concentrating, increased tantrums, regressive behaviors, the inability to sleep or eat, and consistent stomachaches or headaches. These behaviors may portend anxiety, depression, or other conditions, and parents may want to seek support from a mental health professional.

For students who were involved in a school shooting themselves, the transition back to school is complex. Many don't believe that children should be forced back to school if they are scared; instead, they should be eased into school with the support of school staff and mental health staff. Parents and educators should create spaces to discuss the event, allowing children to express their needs and help identify approaches to navigate their challenges. After incidents of trauma and community violence, kids may find it meaningful to know how they can be helpful. And keep in mind that most people who experience symptoms after a traumatic event don't go on to develop a mental health condition such as PTSD. Children are resilient.

In the old days, active shooter drills would've been a thing of a dystopian future. And here we are, all dystopian. But that doesn't mean kids are helpless.

One often hears that violence is either entirely driven by mental health issues, or not linked at all. The reality is a little more complex.

Mass shooters often grab headlines for all of the wrong reasons, but responsible reporting can reverse the trend.

Mass shootings keep happening. Do we actually know anything helpful that could prevent them?

Find a therapist near me.

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Mass murder, typically described as four or more unlawful killings in a single event and location, is among the most heinous acts in which humans engage. In the United States, acts of mass murder, particularly mass shootings, sow fear among individuals and shape culture-and culture wars-more broadly.

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Eun Hye Lee

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The Psychology Behind School Shootings - Gavin de Becker

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Many Americans purchase firearms primarily for self-protection; however, there is a critical need for education on safe storage practices, including keeping guns unloaded and locked, with ammunition stored separately. This is essential to ensure safety and an immediate way to reduce gun-related injuries and deaths. (Miller, M., et al., Annals of Internal Medicine, Vol. 175, No. 2, 2022)

https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas

Eun Hye Lee

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Eun Hye Lee

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The public and policymakers have struggled with responses to mass shootings, often focusing primarily on gun ownership issues. The book suggests a broader analysis and approach, advocating for greater attention to mental health, violent media, and security policies, rather than only concentrating on gun rights. (Jaclyn, 2021, p. 7).

https://rockinst.org/wp-content/uploads/2021/07/Public-Mass-Shootings-Brief.pdf

Eun Hye Lee

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Eun Hye Lee

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School shooting survivors reflect on life after tragedy from Sandy Hook to Uvalde  | GMA

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How might abuse & neglect adversely impact a child or young person’s mental health? | NSPCC learning. (2022, July 8). YouTube. https://youtu.be/r3Oncys6NV4

Helen Nwokedi

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How might abuse & neglect adversely impact a child or young person’s mental health? | NSPCC Learning

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Recognizing child abuse and neglect. (2022, June 8). YouTube. https://youtu.be/CBBVd6zoYtA

Helen Nwokedi

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Alleviating childhood trauma. (2017, August 4). Verywell Mind. https://www.verywellmind.com/what-are-the-effects-of-childhood-trauma-4147640

Helen Nwokedi

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Childhood trauma involve aversive, distressing experiences that can affect a child's ability to function and cope. Unfortunately, it is all too common. An estimated 46% of children experience trauma at some point in their young lives.

While kids are resilient, they're not made of stone. Adults often say things like, 'They were so young when that happened, they won't even remember it as an adult.' However, it is important to recognize that childhood trauma can have a lifelong effect.

"As children's brains develop, they are learning how safe or unsafe the world is through their experiences," says psychotherapist Yolanda Renteria, LPC. "A child has to develop a way to protect itself from what it deems unsafe; the ways in which a child protects itself shape their adult personality."

Because of this, it's important to recognize when a child may need professional help for dealing with their trauma. Early intervention can also prevent the ongoing effects of the trauma into adulthood.

What Is Childhood Trauma?

Childhood trauma is an event experienced by a child that evokes fear and is commonly violent, dangerous, or life-threatening. Also sometimes referred to as adverse childhood experiences or ACEs, there are many different experiences that can lead to trauma.

Physical or sexual abuse, for example, can be traumatic for children. One-time events like a car accident, natural disaster (like a hurricane), the loss of a loved one, or a major medical incident can take a psychological toll on children as well.

Ongoing stress, such as living in a dangerous neighborhood or being the target of bullying, can also be traumatic for a child-even if it just feels like daily life to an adult.

Childhood trauma doesn't even have to involve experiences that occur directly to the child. Watching a loved one endure a major health issue, for instance, can be extremely traumatic for children. Violent media can have this effect too.

Childhood Trauma and PTSD

As many as 15% of girls and 6% of boys develop post-traumatic stress disorder (PTSD) following a traumatic event. Children with PTSD may re-experience the trauma in their minds over and over again. They might also avoid anything that reminds them of the trauma or re-enact the trauma in their play.

Sometimes children believe that they missed warning signs predicting the traumatic event. In an effort to prevent future traumas, they become hypervigilant in looking for signs that something bad is going to happen again.

Children with PTSD may also:

Act younger than they are (such as by sucking their thumb)

Experience trouble focusing

Feel more depressed or anxious

Find it difficult to be affectionate with others

Have increased anger and aggression

Have issues in school

Have trouble sleeping

Lose interest in activities they once enjoyed

Lose touch with reality

Seem detached, numb, or non-responsive

Worry about dying young

Even children who don't develop PTSD may still exhibit emotional and behavioral issues following a traumatic experience. Here are some things to watch for during the weeks and months after an upsetting event:

Anger issues

Attention problems

Changes in appetite

Development of new fears

Increased concerns about death or safety

Irritability

Loss of interest in normal activities

Problems sleeping

Sadness

School refusal

Somatic complaints like headaches and stomachaches

Impacts of Childhood Trauma

Traumatic events can affect how a child's brain develops, which can have lifelong consequences for them physically, mentally, and socially.

Physical Health Impacts

When a child experiences a traumatic event, it can impair their physical development. The stress can impair the development of their immune and central nervous systems, making it harder to achieve their full potential.

Specifically, it notes that exposure to repeated trauma increases a child's risk of developing:

A 2019 review of 134 different research-based articles adds that exposure to adverse experiences as children increases the risk of developing several different conditions-such as autoimmune diseases, pulmonary disease, cardiovascular disease, and cancer-in adulthood, as well as increasing levels of pain.

Mental Health Impacts

Childhood trauma can also have an impact on mental health. Psychological effects of traumatic experiences can include:

Children exposed to complex traumas may even become disassociated. Dissociation involves separating themselves from the experience mentally. They might imagine that they are outside of their bodies and watching it from somewhere else or they may lose memory of the experience, resulting in memory gaps.

Research published in Psychiatric Times further notes that the prevalence of suicide attempts is significantly higher in adults who experienced traumas such as physical abuse, sexual abuse, and parental domestic violence as a child.

Relationship Impacts

A child's relationship with their caregivers-whether they be parents, grandparents, or other familial or non-familial adults-is vital to their emotional and physical health. The attachment children have with their caregivers can help them learn to trust others, manage emotions, and positively interact with the world around them.

When a child experiences a trauma that teaches them that they cannot trust or rely on that caregiver, they're likely to believe that the world around them is a scary place and people are dangerous. This lesson makes it incredibly difficult to form relationships throughout their childhood and into their adult years.

Children who experience trauma are also likely to struggle with romantic relationships in adulthood. A 2017 study in the Journal of Family Psychology found that spouses with a history of child abuse tend to have less satisfying marriages, even when still in the newlywed phase.

Renteria notes that the lasting effects of trauma often depend on the nature and severity of the event. In some cases, it may lead to feelings of anxiety or avoidance coping that some partners may find frustrating or confusion.

Yolanda Renteria, LPC

She also explains that some common relationship struggles that can stem from such trauma include:

Difficulty trusting

Being physically and verbally distant

Defensiveness

Difficulty being vulnerable

Difficulty giving their partner the benefit of the doubt

Difficulty with communication skills

Difficulty seeing their partner as their ally

Other Impacts

Sometimes the impact of childhood trauma extends beyond physical or mental health and relationships. For instance, some studies have connected adverse childhood experiences with an increased risk of becoming a criminal offender by the age of 35, oftentimes committing offenses that are serious and violent.

Additional impacts can include:

Being easily "set off" and having more intense reactions

Engaging in high-risk behaviors (such as driving at high speeds or unsafe sex)

Inability to plan ahead or prepare for the future

Increased risk of self-harm

Lack of impulse control

Low self-esteem

Trouble problem-solving or reasoning

Children experiencing traumatic events may also have a reduced ability to parent their own kids later in life.

Untreated Childhood Trauma

How to Help Children Who Have Experienced Trauma

Social support can be key to reducing the impact trauma has on a child, even as far as reducing their risk of suicidal ideation. Here are some ways to support a child after an upsetting event:

Encourage the child to talk about their feelings and validate their emotions.

Help them understand that they are not at fault.

Answer their questions honestly.

Reassure the child that you'll do everything you can to keep them safe.

Stick to a daily routine as much as possible.

Be patient as each child recovers at their own pace.

Depending on the child's age and needs, they may be referred for services such as cognitive behavioral therapy, play therapy, or family therapy. In some cases, such as when there is a diagnosis of PTSD, medication may also be an option to help treat their symptoms.

How to Heal From Your Own Childhood Trauma

If you experienced trauma as a child and still have some healing to do, there are several actions you can take to help you better cope. Among them are:

Talking to a mental health professional can also help you start to heal. Therapeutic options may include a number of trauma-informed therapies, such as cognitive processing therapy (CPT), trauma-focused cognitive behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), and acceptance and commitment therapy (ACT), among others.

You may also want to reach out to reputable organizations able to help childhood trauma survivors. The Disaster Distress Helpline offered by the Substance Abuse and Mental Health Services Administration (SAMHSA) is one option. If you prefer to communicate via text, the Crisis Text Line is another.

A Word From Verywell

While it's normal to have some level of distress following a traumatic event, it's not out of the question that children can return to a healthy state of functioning-and some kids are less affected by their circumstances than others.

If childhood trauma has created negative effects, it is never too late to get help. Whether you've adopted a teenager who was abused over a decade ago or you've never received help for the traumatic experiences you endured 40 years ago, trauma treatment can still be effective and beneficial.

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The effects of childhood trauma can be debilitating and last a lifetime without early intervention. Here's how to recognize the signs of trauma and get help.

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Understanding child trauma. (2023, March 17). SAMHSA - Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/child-trauma/understanding-child-trauma

Helen Nwokedi

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Fast Facts

At least 1 in 7 children have experienced child abuse and/or neglect in the past year, and this is likely an underestimate. In 2019, 1,840 children died of abuse and neglect in the United States.

Each day, more than 1,000 youth are treated in emergency departments for physical assault-related injuries.

In 2019, about 1 in 5 high school students reported being bullied on school property in the last year.

8% of high school students had been in a physical fight on school property one or more times during the 12 months before the survey.

Each day, about 14 youth die from homicide, and more than 1,300 are treated in emergency departments for violence-related injuries.
It's important to recognize the signs of traumatic stress and its short- and long-term impact.
The signs of traumatic stress may be different in each child. Young children may react differently than older children.

Preschool Children

Fear being separated from their parent/caregiver

Cry or scream a lot

Eat poorly or lose weight

Have nightmares

Elementary School Children

Become anxious or fearful

Feel guilt or shame

Have a hard time concentrating

Have difficulty sleeping

Middle and High School Children

Feel depressed or alone

Develop eating disorders or self-harming behaviors

Begin abusing alcohol or drugs

Become involved in risky sexual behavior

The Body's Alarm System

Everyone has an alarm system in their body that is designed to keep them safe from harm. When activated, this tool prepares the body to fight or run away. The alarm can be activated at any perceived sign of trouble and leave kids feeling scared, angry, irritable, or even withdrawn.

Healthy Steps Kids Can Take to Respond to the Alarm

Recognize what activates the alarm and how their body reacts

Decide whether there is real trouble and seek help from a trusted adult

Practice deep breathing and other relaxation methods

Impact of Trauma

The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that child trauma survivors may experience:

Learning problems, including lower grades and more suspensions and expulsions

Increased use of health and mental health services

Increase involvement with the child welfare and juvenile justice systems

Long-term health problems (e.g., diabetes and heart disease)

Trauma is a risk factor for nearly all behavioral health and substance use disorders.
There is hope. Children can and do recover from traumatic events, and you can play an important role in their recovery.
A critical part of children's recovery is having a supportive caregiving system, access to effective treatments, and service systems that are trauma informed.

Get Help Now
SAMHSA Behavioral Health Treatment Services Locator The National Child Traumatic Stress Network: Get Help Now Healthcare Toolbox: Basics of Trauma-Informed Care
Not all children experience child traumatic stress after experiencing a traumatic event. With support, many children are able to recover and thrive.

As a caring adult and/or family member, you play an important role.

Remember To:

Assure the child that he or she is safe.

Explain that he or she is not responsible. Children often blame themselves for events that are completely out of their control.

Be patient. Some children will recover quickly while others recover more slowly. Reassure them that they do not need to feel guilty or bad about any feelings or thoughts.

Seek the help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral.

Visit the following websites for more information:

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Recognize the signs of child traumatic stress and the impact that trauma may have on children. The infographic developed by SAMHSA's National Child Traumatic Stress Initiative (NCSTI) provides information on the prevalence and impact of traumatic events on children, and what actions can be taken to support children who experience traumatic events.

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Symptoms inflicted by childhood abuse can become long-lasting and life-changing forms of trauma for any man or woman.

Understanding and preventing child abuse and neglect. (2009, September 8). https://www.apa.org. https://www.apa.org/pi/families/resources/understanding-child-abuse

Helen Nwokedi

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Cite this

American Psychological Association. (2009, September 8). Understanding and preventing child abuse and neglect. https://www.apa.org/pi/families/resources/understanding-child-abuse

The Child Abuse and Prevention Treatment Act defines child abuse and neglect or child maltreatment as:

Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.

Neglect is a failure to meet the child's basic needs, e.g., not providing enough food, shelter or basic supervision, necessary medical or mental health treatment, adequate education or emotional comfort.

Physical abuse refers to the injury of a child on purpose, e.g., striking, kicking, beating, biting or any action that leads to physical injury.

Sexual abuse is the use, persuasion or forcing of a child to engage in sexual acts or imitation of such acts.

What factors place a child at risk of abuse or neglect?

Abuse and neglect of children occurs in families from all walks of life, of all incomes, religions and ethnicities. There is no single cause of child maltreatment; rather, it occurs as a result of many forces working together to impact the family.

Parent or caregiver risk factors

Low self-esteem, poor impulse control, depression, anxiety or antisocial behavior.

Experiencing or witnessing violence as a child, which teaches violent behavior or justifies it as proper behavior.

Substance abuse, which interferes with mental functioning, judgment, self-control, ability to be protective of one's child and making the child's needs a priority.

Lack of knowledge about normal child development and unrealistic expectations, frustration and/or inappropriate methods of discipline.

Family risk factors

Children living with single parents are more likely to live in poverty with fewer social supports, which may contribute to stress and increase risks of maltreatment.

Children in violent homes may witness intimate partner violence, may be victims of physical abuse themselves and may be neglected by parents or caregivers who are focused on their partners or unresponsive to their children due to their own fears.

Stressful life events, parenting stress and emotional distress (e.g., losing a job, physical illness, marital problems or the death of a family member) may worsen hostility, anxiety or depression among family members and increase the level of family conflict and maltreatment.

Maltreating parents or caregivers are less supportive, affectionate, playful and responsive with their children and are more likely to use harsh discipline and verbal aggression than positive parenting strategies (e.g., using time outs, reasoning, and recognizing and encouraging the child's successes).

Child risk factors

Infants and young children, because they are small and need constant care, are more likely to experience certain forms of maltreatment such as being shaken by parents or caregivers frustrated or overwhelmed by persistent crying. Teenagers, on the other hand, are at greater risk for sexual abuse.

Children with physical, cognitive and emotional disabilities or chronic illnesses may be at greater risk of maltreatment. Parents or caregivers of children with disabilities are more likely to experience high levels of stress, depression and anger. Children with disabilities may not understand that abusive behaviors are inappropriate and are unable to defend themselves.

Aggression, attention deficits, difficult temperaments and behavior problems in children have been associated with increased risk for maltreatment, especially when parents have poor coping skills, are unable to empathize with the child or have difficulty controlling emotions. Maltreatment often exacerbates the problem. A physically abused child may develop aggressive behaviors that lead to recurring maltreatment.

Environmental risk factors

The vast majority of parents or caregivers who live in these types of environments are not abusive. However, these stresses can increase the risk of abuse for some:

Poverty and unemployment can increase the likelihood of maltreatment, especially in combination with family stress, depression, substance abuse and social isolation.

Parents with less material and emotional support and who do not have positive parenting role models feel less pressure to conform to conventional standards of parenting behaviors.

Children living in dangerous neighborhoods are at higher risk than children from safer neighborhoods for severe neglect, physical abuse and sexual abuse. It is possible that violence may seem an acceptable response or behavior to individuals who witness it more frequently.

What are the consequences of child maltreatment?

Child abuse and neglect can result in physical and psychological developmental delays. A neglectful mother may not feed her baby properly, which can slow brain development, or an emotionally abusive father may damage his child's ability to form trusting relationships. Abused or neglected children can see the world as an unstable, frightening and dangerous place, which can undermine their sense of self-worth and their ability to cope with and adapt to their environments as they grow up. If unaddressed, maltreatment may contribute to later problems, such alcoholism/substance abuse, depression, domestic violence, multiple sexual partners and exposure to sexually transmitted diseases, suicidal thoughts and attempts.

The impact of abuse can vary depending on:

Age and developmental status of the child when the abuse or neglect occurred,

Type of abuse (physical abuse, neglect, sexual abuse, etc.),

Frequency, duration and severity of abuse,

Relationship between the victim and his or her abuser.

What factors protect a child from risk of abuse or neglect?

Children's optimism, high self-esteem, intelligence, creativity, humor and independence, which enhance their coping skills in the face of adversity.

The acceptance of peers and positive influences such as teachers, mentors and role models

The family's access to social supports, neighborhood stability and access to safe schools and adequate health care

The child's experience of love, acceptance, positive guidance and protection from a caring adult, which encourages trust that their parents or caregivers will provide what they need to thrive

Parent's or caregiver's respectful communication and listening, consistent rules and expectations, and safe opportunities that promote independence

Parents or caregivers who can cope with the stresses of everyday life and have the inner strength to bounce back when things are not going well.

Parents or caregivers with a social network of emotionally supportive friends, family and neighbors

Families who can meet their own basic needs for food, clothing, housing and transportation and know how to access essential services such as childcare, health care and mental health services

What types of prevention are there for child maltreatment?

Psychologists are heavily involved in the development and implementation of prevention programs for child abuse and neglect. Primary prevention programs raise awareness among the public, service providers and policymakers about the scope of issues involved in child maltreatment. Secondary prevention programs target populations with one or more risk factors for child maltreatment.

Tertiary prevention programs target families where maltreatment has already taken place and aim to reduce the impact and prevent it from reoccurring.

If you suspect someone is abusing or neglecting a child, take action:

Child Welfare Information Gateway
Children's Bureau/ACYF
1250 Maryland Avenue, SW
Eighth Floor
Washington, DC 20024
(800) 394 3366

Child Help USA
15757 North 78th Street
Scottsdale, AZ 85260
(800) 4-A-CHILD

American Professional Society on the Abuse of Children
350 Poplar Avenue
Elmhurst , IL 60126
(877) 402 7722

Tennyson Center for Children
2950 Tennyson Street
Denver, CO 80212
(877) 224 8223

Rape, Abuse, and Incest National Network
2000 L St., NW
Suite 406
Washington, DC 20036
(800) 656-HOPE

Information

Books

Resolutions

Contact the Office on Children, Youth, and Families

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Understanding and preventing child abuse and neglect

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Acts or failures to act that result in death, serious physical or emotional harm, sexual abuse or exploitation, or that present an imminent risk of serious harm.

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Child abuse. (2019, March 22). Spotify. https://open.spotify.com/track/1nTCP222f5W9SuKsDiU7ZG

Helen Nwokedi

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Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.

Reference

404. (n.d.). World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/child-maltreatmentlo

Helen Nwokedi

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WHO fact sheet on child maltreatment providing key facts and information on the scope of the problem, consequences, prevention and WHO response.

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How your childhood affects your mental health. (2020, September 4). YouTube. https://youtu.be/Cu6kt3Yjii8

Helen Nwokedi

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How Your Childhood Affects Your Mental Health

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Unseen wounds

An important study finds that children who have been psychologically maltreated suffer effects that are equal or greater than children who have been physically or sexually abused.Unseen wounds. (n.d.). https://www.apa.org. https://www.apa.org/monitor/2015/07-08/ce-corner

Helen Nwokedi

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Children who have been psychologically maltreated suffer effects that are equal or greater than children who have been physically or sexually abused.

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Most, if not, all have experienced traumatic grief. There are many possible causes but there is also a way to seek help and treatment. Living with uncertainty, especially dealing with loss, can be hard for a lot of us. It affects our daily life and how we function emotionally. It is important to find ways to cope with such matters and to know we are not alone.

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Traumatic Grief: What it Is, Symptoms, and How to Cope

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Traumatic Grief: What it Is, Symptoms, and How to Cope

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Traumatic grief is a form of grief that happens in response to a sudden, unexpected loss.

Grieving is always difficult. And when a loss is sudden, coping in the aftermath can feel impossibly hard.

Everyone grieves at some point in their life, and it affects people in all sorts of ways. When grieving, you may find it difficult to move forward.

But while it can feel tough right now, there are ways to heal and manage the grief you're feeling.

Traumatic grief can happen in response to a sudden, unexpected loss.

For example, maybe you lost a child, or experienced the violent death of someone close to you. It might also involve losing your support system.

Traumatic grief is different from the grief that happens from an expected loss, such as when someone passes away after a long chronic illness.

That doesn't mean that other forms of grief are any less difficult to deal with. In some people, it may even lead to prolonged grief disorder, also called complicated grief.

Traumatic grief is more likely to lead to complicated grief. And the feelings that come with traumatic grief are also much more intense.

"The shock and unexpected nature of the loss can be traumatizing and trigger intrusive, preoccupying thoughts or bodily responses that are essentially distorted survival mechanisms in addition to the mourning of whatever was unexpectedly lost," says Michael Roeske, PsyD and executive director at Newport Healthcare Connecticut.

Traumatic grief is also related to prolonged grief disorder, says Roeske. Sometimes, people use the terms interchangeably. Prolonged grief disorder involves a deep longing for the lost loved one and constant thoughts about them, which can interfere with your everyday life.

Evidence suggests that people are more likely to develop complicated grief disorder if the circumstances of the loss are traumatic in some way, like an accident or natural disaster. For many people, the loss of a child may be the most traumatic form of family loss.

According to Roeske, finding out about an unexpected death can also cause grief that leads to post-traumatic stress disorder (PTSD), a mental health condition that causes disturbing, intrusive thoughts related to the initiating traumatic event.

Research involving adults who lost someone during 9/11 found that about 43% had what could be categorized as complicated grief with PTSD 3 years after the event.

PTSD relating to grief is also especially likely if you have an existing mental health condition at the time you experience a traumatic loss, adds Roeske.

If you're living with depression, for example, you may have a more pronounced reaction to a loss.

We all experience grief differently. There's no right or wrong way to grieve a loss. But if you're experiencing traumatic grief, it may look different from other forms of grieving. Symptoms can include:

According to Roeske, people experiencing traumatic grief may also feel angry and that what's happened is unfair. They may also feel like they have unfinished business or something they need to work on.

The symptoms are more intense, pervasive, and persistent than regular grief. "Those experiencing traumatic grief are also more likely to feel fear for themselves and/or others," adds Roeske.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), physical symptoms may also include:

shakiness or trembling

nausea

loss of appetite

dry mouth

problems sleeping

trouble breathing

muscle weakness

People deal with grief in different ways, but some things may be more helpful than others in getting you through this difficult time.

Focus on routine and maintaining structure

"It is best to first stabilize the trauma by focusing on how to regulate emotions and calm the nervous system before trying anything else," says Roeske.

Soothing the nervous system looks different for everybody, but doing things that you enjoy is a good place to start. For some people, grounding exercises help them feel more connected to their bodies and surroundings.

Following a routine helps people to feel safe and cared for. Keeping regular mealtimes and prioritizing sleep may give you a greater capacity to regulate your emotions throughout the day.

Know that your feelings are not uncommon

Everyone deals with grief at some point and handles it differently. There's nothing wrong with you if you're experiencing traumatic grief that's impacting your usual activities. You just might need extra support.

Acknowledge how you're feeling

By understanding and identifying traumatic grief, you're better equipped to deal with and manage those feelings, adds Roeske.

Think about it

Avoid trying to ignore your pain and grief. "Allow yourself to think about what happened instead of numbing or blocking it out," Roeske says.

Express yourself

If you're finding it tough to make sense of your feelings, journaling about your grief may help. It may even be a good first step before opening up to others.

Lean on others

Share how you're feeling with people around you. Some people find it particularly helpful to talk with people who have experienced the same type of loss by joining grief support groups.

If you're supporting someone who has experienced a sudden loss, try being a good listener. It can help to let the person talk about their loved one and grief.

In a 2021 study on forms of support for traumatic grief, responders commonly said that they appreciated it when people let them mention the name of the person they lost without being made to feel awkward.

"Grief is different for every person and every loss. It can last for weeks, months, or even years. This is why working with a mental health professional can be so important and beneficial in healing," says Roeske.

He recommends seeing a mental health professional if your grief is having a negative impact on your life. If you're having trouble eating, sleeping, or otherwise taking care of yourself, that's a sign it's time to talk with someone about how you're feeling.

If you're looking for extra support, these resources may help:

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Traumatic Grief: What it Is, Symptoms, and How to Cope

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Traumatic grief can happen after a sudden or unexpected loss. Learn about ways to cope here.

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Survivors of trauma struggle to move on from the loss of loved ones

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Survivors of trauma struggle to move on from the loss of loved ones

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WASHINGTON - Among individuals who survive a trauma that resulted in the loss of a close friend or loved one, symptoms of post-traumatic stress disorder can predict complicated grief-a sense of persistent sadness and an inability to cope-years after the trauma, according to research published by the American Psychological Association.

"Grief is a normal response to the loss of someone close, but traumatic losses may severely harm survivors for years," said Kristin Alve Glad, PhD, a researcher at the Norwegian Centre for Violence and Traumatic Stress Studies and lead author of the study. "Our findings suggest that when treating trauma survivors, targeting symptoms of PTSD early might help them avoid complicated grief later on."

For most people who experience grief, feelings of distress and bereavement tend to diminish over time, according to Glad. In the case of complicated grief, instead of fading, symptoms can often linger or worsen and can impair or prevent people from living their normal lives.

"Complicated grief has been defined as a persistent, intense yearning, longing and sadness, usually accompanied by insistent thoughts or images of the deceased and a sense of disbelief or an inability to accept the painful reality of the person's death," said Glad.

In the study, published in the journal Psychological Trauma: Theory, Research, Practice and Policy, researchers interviewed survivors of a 2011 domestic terrorist attack on Utøya, an island in Norway, who lost someone close to them in the attack. Of the 275 participants, 256 lost a close friend, six lost a family member and 13 lost a close friend and a family member/partner.

Participants took part in individual, face-to-face interviews with experienced health care personnel three times following the attack on Utøya: 4-5 months, 14-15 months and 30-32 months after the attack. The interviews included questions about the post-traumatic stress symptoms and complicated grief reactions (e.g., trouble accepting the death of their loved one, interference of grief in their daily life, troubling thoughts relating to death, avoidance of reminders of the loss and feelings of isolation or distance from others).

Researchers found that participants who reported symptoms of PTSD were significantly more likely to report symptoms of complicated grief as well. They also found that participants who experienced early symptoms of PTSD a year after the attack experienced even greater symptoms of complicated grief years later.

"The fact that we found that PTSD symptoms predicted complicated grief reactions at a subsequent time point, but complicated grief did not predict the development of PTSD, is interesting, because it suggests that targeting PTSD symptoms may hinder later development of complicated grief," said Glad. "This may have important implications for clinicians working with bereaved trauma survivors."

The researchers believe that the effects of the terrorist attack on the survivors were particularly severe because they did not just lose a loved one - they were directly exposed to the attack as well. This dual burden of the unexpected loss and the survivors' high exposure to trauma may result in a different trajectory of PTSD symptoms and complicated grief than for bereaved who are not directly exposed to the trauma.

These findings could apply to anyone who has lost a loved one in a potentially traumatizing way, according to Glad. Knowledge about the relationship between symptoms of PTSD and complicated grief over time may help clinicians develop more effective treatment strategies and formulate better treatment plans for the survivors who struggle the most to cope, the researchers said.

Article: "The Longitudinal Association Between Symptoms of Posttraumatic Stress and Complicated Grief. A Random Intercepts Cross-Lag Analysis," by Kristin Alve Glad, PhD, Synne Stensland, MD, PhD, and Grete Dyb, PhD, Norwegian Centre for Violence and Traumatic Stress Studies; and Nikolai O. Czajkowski, PhD, University of Oslo, and Paul A. Boelen, PhD, Utrecht University. Psychological Trauma: Theory, Research, Practice and Policy , published online Aug. 16, 2021.

Kristin Alve Glad can be reached via email.

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Survivors of trauma struggle to move on from the loss of loved ones

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WASHINGTON - Among individuals who survive a trauma that resulted in the loss of a close friend or loved one, symptoms of post-traumatic stress disorder can predict complicated grief-a sense of persistent sadness and an inability to cope-years after the trauma, according to research published by the American Psychological Association.

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Traumatic Bereavement: Helping children and young people who are struggling in schools & colleges

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Traumatic Bereavement: Helping children and young people who are struggling in schools & colleges

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Traumatic Bereavement: Helping children and young people who are struggling in schools & colleges

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BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF

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BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF

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BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF

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When people lose intimates unexpectedly, in particular from malicious acts of violence, they are at risk for chronic grief reactions. The phenomenology, clinical symptoms, clinical needs, and risk factors associated with loss by traumatic means and the…

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Faith is something most of us hold on to when things get tough. We pray and ask for guidance because we can't do it alone. He give us strength and purpose to continue on in our journey no matter how hard it gets.

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Trauma SURVIVOR finds HOPE in God | Faith Speaks

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There are many others going through the same journey that are continuously finding a reason to keep moving forward. Support from family and close friends, even people that can relate to us helps us find meaning in life and gives us hope to continue on. Working on our faith and relying on God to give us strength to carry on can help most of us that believe in a higher power. A lot of options. A lot of resources. A lot of ways to keep our mind at bay and strong. It may take a while for a lot of us, but there will always be a light at the end of the tunnel.

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Counselors are trained and experienced in responding to the aftermath of suicide and are available for telephone support and guidance, or face-to-face services.

In addition, Crisis Services can also direct you to helpful on-going services in your area. The Trauma Response Program includes suicide survivors that you can speak with as well. These volunteers have experienced the loss of a loved one to suicide and can assist you during this difficult time.

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Crisis Services Trauma Support & Response Program provides intervention to individuals, families and groups that have been exposed to a traumatic event. This is a process aimed at reducing the long-term effects of the traumatic event as we also provide education and symptom management techniques.

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Long-term outcomes for survivors of mass shootings are improved with the help of community connections and continuing access to mental health support. (Amy Novotney, 2018).

https://www.apa.org/monitor/2018/09/survivors

Eun Hye Lee

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Since 1966, 1,102 Americans have been killed in mass shootings, according to an analysis by The Washington Post. Thousands more have been injured-both physically and psychologically.

These survivors come from nearly every race, religion and socioeconomic background, living otherwise normal lives in Parkland, Florida; Aurora, Colorado; or the scores of other towns whose names have become etched in our minds.

Although mass shootings account for only a tiny fraction of the country's gun deaths, they are uniquely disturbing because they happen without warning in the most routine of places: schools, churches, office buildings and concert venues.

"Simply by definition, mass shootings are more likely to trigger difficulties with beliefs that most of us have, including that we live in a just world and that if we make good decisions, we'll be safe," says Laura Wilson, PhD, co-author and editor of "The Wiley Handbook of the Psychology of Mass Shootings" and an assistant professor of psychology at the University of Mary Washington in Fredericksburg, Virginia.

Most survivors show resilience. But others-particularly those who believed their lives or those of their loved ones were in danger or who lack social support-experience ongoing mental health problems, including post-traumatic stress, depression, anxiety and substance abuse.

The National Center for PTSD estimates that 28 percent of people who have witnessed a mass shooting develop post-traumatic stress disorder (PTSD) and about a third develop acute stress disorder.

Research also suggests that mass shooting survivors may be at greater risk for mental health difficulties compared with people who experience other types of trauma, such as natural disasters. A study led by former Northern Illinois University (NIU) graduate student Lynsey Miron, PhD, after the 2008 shootings on NIU's campus, found that although a large percentage of mass shooting survivors were either resilient or displayed only short-term stress reactions, about 12 percent reported persistent PTSD, a number that's higher than the average prevalence of PTSD among trauma survivors as a whole ( Behavior Therapy , Vol. 45, No. 6, 2014).

What's critical, psychologists' research suggests, is to ensure that victims feel connected to their communities in the aftermath of mass violence and that they have ongoing support available to them.

Memorial events-particularly those that are student and community initiated and led-are most helpful to survivors in terms of recovering after a mass violence event, suggests a study conducted after a murderer opened fire, stabbed passersby and then rammed his car into a crowd near the campus of the University of California, Santa Barbara, in 2014, killing six people and wounding 14 others ( Psychological Trauma: Theory, Research, Practice, and Policy , Vol. 10, No. 1, 2018 ). These events included a candlelight vigil the night after the tragedy and a memorial "paddle-out," where thousands of the community's surfers joined together in the ocean to remember the victims of the event.

"As a community psychologist, I've seen firsthand the importance of mental health promotion efforts that have nothing to do with counseling per se, but that help the community heal together," says University of California, Santa Barbara, assistant psychology professor Erika Felix, PhD, who led the study.

Stages of a shock and healing

In the aftermath of a shooting, people typically go through three stages of healing, according to a 2017 research bulletin compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA): the acute phase immediately after the event, the intermediate phase several days to weeks afterward and the long-term phase. The agency developed the report to help public health, behavioral health and emergency management professionals improve their disaster behavioral health preparedness plans.

In the acute phase-often characterized by denial, shock and disbelief-mental health professionals can best help survivors by providing them with resources and information. Through interventions such as psychological first aid, they can help normalize survivors' immediate feelings of fear, anxiety and helplessness.

"Simply ensuring victims are aware that support is available and accessible to them-even if they never take advantage of it-can help immensely," says psychologist Dan Mosley, EdD, an American Red Cross disaster mental health services volunteer who most recently provided support to victims of the Las Vegas shootings. This is likely due to the empirically supported benefits of connection over isolation, he says, noting that knowledge of resources is one way of feeling connected, and that people are less anxious and worried if they know help is available should they need or want it.

Psychologists can also help families determine whether they want to speak with the media and help survivors understand which medical, funeral and mental health treatment costs might be covered by the U.S. Department of Justice's Office for Victims of Crimes, says psychologist James Halpern, PhD, founding director of the Institute for Disaster Mental Health at the State University of New York at New Paltz (SUNY New Paltz).

The intermediate phase is often characterized by fear, anger, anxiety, difficulty paying attention, depression and disturbed sleep, according to the SAMHSA report. In this phase, psychologists can play a critical role in helping communities get set up to provide more long-term support to survivors, says Halpern.

That means training local mental health professionals, schools, faith-based organizations, recreation centers and other community organizations about the importance of trauma-informed resource building and information sharing, Halpern says. Providing trauma-informed care, experts note, involves understanding, recognizing and responding to the effects of all types of trauma and emphasizes physical, psychological and emotional safety for both consumers and providers, to help survivors rebuild a sense of control and improvement.

Two evidence-based programs are often used to help survivors manage their stress: the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) and the Skills for Psychological Recovery (SPR) programs. Both teach survivors tools, such as breathing and writing exercises to help manage their distress, and encourage them to increase their participation in meaningful and positive activities. They also teach survivors how to rebuild and enhance their social connections and community supports.

Survivors enter the long-term phase several months after the event. While people in this phase continue to experience periods of adjustment and relapse, most survivors, particularly children, will no longer need continuous mental health support. Some have even grown from the experience, reporting greater self-worth and sense of life purpose and expressing feelings of gratitude for having survived the shooting, experts say.

But for others, this can be the time when untreated behavioral health reactions-flashbacks, debilitating anxiety or self-medication-can solidify into mental health or substance use disorders that require more specialized care, says Karla Vermeulen, PhD, an assistant professor of psychology at SUNY New Paltz.

Some people enter this phase when they realize that others in the community have been able to move forward, while they are still struggling, suggests Heather Littleton, PhD, an associate professor of psychology at East Carolina University in Greenville, North Carolina, who studied student adjustment after the 2007 Virginia Tech shootings. She found that rates of elevated PTSD symptoms persisted among survivors one year post-shooting. This was consistent with the reports of local mental health providers, who noted an influx of survivors who sought treatment as time went on-after community focus and media attention had shifted-compared with in the immediate aftermath of the shooting.

"It leaves them feeling lost and disconnected, so we need to make sure we have longer-term support in place for these individuals when they are ready for it," she says.

Halpern says that means training local mental health professionals in the importance of periodically checking in with their clients to assess how they are doing, staying active in the community to make sure people continue to be aware of trauma's long-term effects and ensuring that they're providing trauma-informed care, even years after an event has occurred.

"No matter how much we emphasize their strength and resilience, these victims and families will suffer from these losses for the rest of their lives," he says.

Who will need long-term help?

Not surprisingly, one factor that predicts how well mass shooting survivors will fare long-term is their proximity to the incident. A meta-analysis Wilson led examining PTSD symptoms among more than 8,000 participants found that those who were most directly exposed to the shooting-those who were physically injured, those who saw someone else get shot or lost a friend or loved one-as well as those who perceived that their own lives were in danger, are at much greater risk for long-term PTSD symptoms and other mental health consequences than survivors who may have been hiding nearby or otherwise farther from the incident ( Journal of Traumatic Stress , Vol. 27, No. 6, 2014).

In addition, prior trauma exposure, as well as how well people were functioning before an incident, also predisposes survivors to PTSD and poor long-term outcomes, according to a review of 49 studies examining the mental health consequences of mass shootings ( Trauma, Violence, & Abuse , Vol. 18, No. 1, 2017).

"If you already have mental health symptoms such as a pre-existing anxiety disorder or are on the borderline for depression, you're going to be more vulnerable to psychiatric adversity after exposure," says Sarah Lowe, PhD, the review's lead author and an assistant psychology professor at Montclair State University in New Jersey.

Previous trauma may also be a reason why women are more likely to develop PTSD than men after mass shootings, since research shows women are more likely to experience particular forms of interpersonal violence. "It may be that women are more likely to have had multiple forms of trauma exposure-perhaps the survivor had also experienced sexual assault previously in her life-and faced additional trauma in the shooting," Wilson says.

Victims' coping strategies and support systems are also strong predictors of their long-term health and wellness. People who engage in self-blame for the tragedy-believing they should have done more to try and save friends who died, for example-are at greater risk for long-term poor psychological outcomes.

On the other hand, those who have strong social support systems, particularly from family, appear to do better, Littleton says. In a survey she conducted with more than 300 female Virginia Tech students after the shootings there, she found that the more students felt like they had good support from their families, the better off they were in terms of adjustment ( Psychological Trauma: Theory, Research, Practice, and Policy , Vol. 1, No. 3, 2009).

A group of Virginia Tech researchers led by psychologist Andrew J. Smith, PhD, also found that when mass violence events occur on college campuses, a collective identity often forms that can help boost a sense of social support in the aftermath and perhaps promote seeking support ( Anxiety, Stress, & Coping , Vol. 28, No. 3, 2015). This communal feeling contrasts with the secrecy, isolation and shame that survivors of individual traumas may face, such as people who experience sexual assault and domestic violence, the authors note. The grief process is also shared, often leading to healthy mourning and coping.

"Bringing people together to promote connections and collective healing after a tragedy is often what strengthens families and communities the most," Felix says. It's also another area in which psychologists can play an important role by promoting ongoing events to bring communities together, she notes.

Building more supports

Psychologists are also working with educators to improve the mental health of children affected by mass shootings. Much of that work centers on giving teachers the tools and support they need after such traumatic events, says Robin Gurwitch, PhD, a child psychologist at the Duke University School of Medicine who studies resilience in children after trauma. "Teachers are one of the best supports that children have after these events," says Gurwitch, a member of the U.S. Department of Health and Human Services' National Advisory Committee on Children and Disasters. "We have to make sure they are getting the support they need as well as information on how to best help the children in their classroom."

Psychologists also help schools affected by shootings operate in a way that's sensitive to the needs of staff and students, says Melissa Brymer, PsyD, PhD, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress. That includes screening students to determine who needs more intensive mental health services, monitoring those who are chronically absent and working with school nurses to investigate kids who report headaches, stomachaches or other concerns who hadn't reported these symptoms before the event.

Psychologists are especially needed to help schools affected by a shooting adjust emergency drills so that they don't trigger thoughts of past trauma. More research in this area is needed, but in the meantime, psychologists can talk to schools about how to make these drills less traumatic, Brymer says.

For example, instead of announcing a drill over an intercom or whatever communication technique had been used in the real emergency, an assistant principal could go to each classroom to calmly announce a drill. Also, for students who are already prone to anxiety, schools might consider doing practice drills only with them and checking in with them the next day.

Psychologists are conducting research to inform other interventions as well. Armed with a grant from the National Institute of Justice, Brymer and her team are conducting a community-based participatory research examination of the adjustment and recovery efforts that took place in response to 12 recent mass shooting events-six school shootings and six community events. By examining multiple school shootings and mass violence events, this project will identify gaps in services and policies, refine recovery protocols in school and community emergency plans, foster collaboration among different responding organizations and agencies, and ensure that funding is available during critical phases of recovery.

"The goal is to examine the similarities and differences between these events to better understand where practices might need to be altered to provide a better national response and recovery component when these events happen," Brymer says.

Psychologists are also eager to study other questions about survivor well-being, including how such experiences-particularly at a young age-shape one's sense of safety and self-efficacy.

"Those are the more existential consequences that I'd love to see more researchers start to examine," Vermeulen says.

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long-term outcomes for survivors of mass shootings are improved with the help of community connections and continuing access to mental health support

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Long-term outcomes for survivors of mass shootings improve with the help of community connections and continuing access to mental health support.

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Eun Hye Lee

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Eun Hye Lee

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Eun Hye Lee

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We all grow old someday..

-Sangpyung Lee-

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-Sangpyung Lee-

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The COVID-19 pandemic caused trauma in the elderly by amplifying both psychological and physical impacts. The rapid spread of misinformation and rumors increased their anxiety, while media focus on the elderly being at higher risk reinforced negative stereotypes. This portrayal worsened their sense of social isolation, depression, and helplessness, contributing significantly to the emotional trauma experienced by seniors during the pandemic.

-Reference-

Cachicatari-Vargas, E., Mutter Cuellar, K. J., Condori Chipana, W. F., Miranda Socasaire, F. de M., Acevedo-Duque, Á., & Arpasi-Quispe, O. (2022, September 12). The mental health of older adults in the densely populated areas of Tacna Region-Peru, 2021: Implications of the COVID-19 information. MDPI. https://www.mdpi.com/1660-4601/19/18/11470

-Sangpyung Lee-

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The Mental Health of Older Adults in the Densely Populated Areas of Tacna Region—Peru, 2021: Implications of the COVID-19 Information

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The purpose of this research was to analyze the implications of exposure to various news channels that broadcast information on COVID-19 and their impact on the mental health of older adults in the sparsely populated area of the Tacna Region during the year 2021. The present study used a descriptive correlational type of quantitative approach on a sample of 389 older adults aged 60 years and over, who were recruited by non-probabilistic convenience sampling. For the application of the survey technique, the instrument used was a questionnaire modified by the authors. In terms of research ethics for the development of the study, the respondents provided informed consent, and other ethical considerations were addressed. In relation to sociodemographic variables of mental health, it was found that women had a greater incidence of anxiety (p < 0.01) and that people with fewer years of study had a greater incidence of depression (p < 0.01) and anxiety in sparsely populated areas. Exposure to news through television was associated with depression, and news obtained from other people was associated with depression (p < 0.001). An association was also found between the number of hours of television news and stress (p < 0.05), and radio news was associated with anxiety (p < 0.05). In terms of psychological consequences, the highest mean for television exposure was fear, while the greatest psychological consequence of radio news was fear, followed by stress and awareness. Finally, negative, inverse, and significant relationships were found that indicate protective factors, such as depression with awareness and indignation, and anxiety was inversely related to awareness.

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An example of portraying elderly people negatively during the COVID-19 pandemic is using terms like "boomer remover." Such societal biases create trauma for the elderly, reinforcing feelings of worthlessness and amplifying their anxiety, fear, and isolation. These harmful stereotypes contribute to the emotional and psychological distress, deepening the trauma experienced by older adults throughout the pandemic.

-Sangpyung Lee-

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This website shares early data on how older adults handled mental health during the COVID-19 pandemic. Despite facing challenges, they showed resilience to anxiety, depression, and stress, which may be due to their life experience, social connections, and positive daily routines. However, while this resilience may have helped, the emotional strain caused by isolation and fear still contributed to trauma. With more attention and support, the trauma experienced by older adults can be mitigated, improving their mental well-being during such crises.

-Reference-

Ipsit V. Vahia, M. (2020, December 8). Older adults and the mental health effects of covid-19. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2773479

-Sangpyung Lee-

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Older Adults and the Mental Health Effects of COVID-19

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This Viewpoint summarizes evidence suggesting that, counter to expectation, older adults as a group may be more resilient to the anxiety, depression, and stress-related mental health disorders characteristic of younger populations during the COVID-19 pandemic.

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This video showcases the real lives of elderly individuals impacted by COVID-19, offering a tangible glimpse into the trauma they have experienced. It emphasizes the emotional and psychological toll, such as isolation and anxiety, while highlighting the importance of society’s attention and response to their needs.

-Reference-

YouTube. (n.d.). YouTube. https://www.youtube.com/watch?v=_ayICbZCF2g&t=2s

-Sangpyung Lee-

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COVID-19 and its impact to the elderly`s mental health

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Effects of Trauma

The effects of traumatic events place a heavy burden on individuals, families, and communities. Although many people who experience a traumatic event will go on with their lives without lasting negative effects, others will have difficulties and experience traumatic stress reactions. How someone responds to a traumatic experience is personal. If there is a strong support system in place, little or no prior traumatic experiences, and if the individual has many resilient qualities, it may not affect his or her mental health.

Research has shown that traumatic experiences are associated with both behavioral health and chronic physical health conditions, especially those traumatic events that occur during childhood. Substance use, mental health conditions, and other risky behaviors have been linked with traumatic experiences. Because these behavioral health concerns can present challenges in relationships, careers, and other aspects of life, it is important to understand the nature and impact of trauma, and to explore healing.

Alternatives to Seclusion and Restraint

Seclusion and restraint were once perceived as therapeutic practices in the treatment of people with mental and/or substance use disorders. Today, these methods are viewed as traumatizing practices and are only to be used as a last resort when less-restrictive measures have failed and safety is at severe risk.

Seclusion is defined as the involuntary, solitary confinement of an individual. Restraint refers to any method, physical or mechanical device, or material or equipment that immobilizes or reduces an individual's ability to freely move his or her arms, legs, body, or head. A drug or medication also might be used to restrict behavior or freedom of movement.

Studies have shown that the use of seclusion and restraint can result in psychological harm, physical injuries, and death to both the people subjected to and the staff applying these techniques. Injury rates to staff in mental health settings that use seclusion and restraint have been found to be higher than injuries sustained by workers in high-risk industries. Restraints can be harmful and often re-traumatizing for people, especially those who have trauma histories. Beyond the physical risks of injury and death, it has been found that people who experience seclusion and restraint remain in care longer and are more likely to be readmitted for care.

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SAMHSA addresses the impact of trauma on individuals, families, and communities as a behavioral health concern that requires a healing and recovery process.

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This book discusses the negative psychological and biological impacts of COVID-19 on elderly individuals. It examines how cytokine storms caused by the virus can worsen mental health issues in older adults, contributing to trauma by exacerbating conditions such as anxiety and depression. The book also suggests interventions to reduce the effects of this trauma, highlighting the importance of addressing both the physical and mental health of seniors during the pandemic.

-Reference-

Grolli, R. E., Mingoti, M. E., Bertollo, A. G., Luzardo, A. R., Quevedo, J., Réus, G. Z., & Ignácio, Z. M. (2021). Impact of covid-19 in the mental health in elderly: Psychological and biological updates. Molecular Neurobiology, 58(5), 1905–1916. https://doi.org/10.1007/s12035-020-02249-x

-Sangpyung Lee-

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Impact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates

Roberta Eduarda Grolli 1,2,

Maiqueli Eduarda Dama Mingoti 1,2,

Amanda Gollo Bertollo 1,2,

Adriana Remião Luzardo 1,3,

João Quevedo 4,5,6,7,

Gislaine Zilli Réus 4 &

...

Zuleide Maria Ignácio orcid.org/0000-0002-1417-1308 1,2,4

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Abstract

Since December 2019, the world has been experiencing the challenge of facing coronavirus disease-19 (COVID-19), a severe infectious disease caused by the new coronavirus, SARS-CoV-2. The individuals with the most severe symptoms and the highest risk of death are the elderly and those with chronic illness. Among chronic conditions, those with a certain degree of chronic inflammation may predispose to a more severe evolution of COVID-19. Elderly with psychiatric disorders can present a persistent inflammatory state, a characteristic of the age's immunological senescence, but the disorder can accentuate that. Social isolation is still the safest way to avoid contamination. However, isolated older people may have or worsen mental health conditions due to isolation and health concerns. In this scenario, a SARS-CoV-2 infection may progress to more severe disease. Conversely, COVID-19 can predispose or aggravate psychiatric disorders, as it induces a cytokine storm, causing systemic hyper inflammation. It may damage the blood-brain barrier, resulting in inflammation in the central nervous system. Besides, SARS-CoV-2 is likely to reach and trigger an inflammatory process directly in the nervous system. This review makes an update about research on the mental health of the elderly during the pandemic. Also, it discusses the vulnerability of these individuals in the face of stress and in the case of contracting COVID-19, considering mainly the stress's hormonal and inflammatory mechanisms. Finally, the review points out possible care and attention strategies and entertainment and activities that can reduce the damage to mental and physical health and improve the elderly's quality of life.

Isolation and concerns about COVID-19 may harm elderly mental health. Immunosenescence and pandemic stress increase the risk of psychiatric disorders. Stress and disorders may potentiate the elderly's inflammation and COVID-19 symptoms. SARS-CoV-2 hyperinflammation is a risk factor for elderly psychiatric disorders

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Introduction

Still, without palliative or preventive treatment, it is essential to isolate patients, minimize face-to-face relationships, and perform quarantine. These actions imply a drastic change in routine. Consequently, waves of anxiety and insecurity have affected the elderly, leaving them susceptible to disorders' onset or aggravation during this period [ 5].

More than 20% of the world population over 60 years lives with a psychiatric disorder or neurological disease. Dementia, major depressive disorder (MDD), and anxiety are the most prevalent [ 6].

This review encompasses the increased vulnerabilities of the elderly population when exposed to COVID-19. Besides, COVID-19 exposure and the relationship between psychiatric disorders and stressors inherent in the elderly population (including environmental, psychological, and social) have been examined. Relevant pathophysiological characteristics underlying the situation of psychiatric disorders, which can be aggravated or worsened by a SARS-CoV-2 infection, are also reviewed. Biological mechanisms such as changes in the immune system, inflammation, and the relationship with the hypothalamus-pituitary-adrenal (HPA) axis are discussed. Emphasis has been placed upon the involvement of mechanism(s) in conditions related to advanced age, mental disorders, stress, and infectious disease, such as COVID-19.

About COVID-19

In December 2019 were recorded the first cases of coronavirus in humans. Wuhan, a metropolitan region in the Chinese province of Hubei, was the pandemic's initial focus. Current data account for 68,845,368 diagnosed cases and 1,570,304 deaths worldwide. The numbers continue to increase exponentially [ 11]. Severe acute respiratory syndrome (SARS), identified 18 years ago, was associated with coronavirus existing in animals [ 12]. Complete genomic sequences were performed in 5 patients in the pandemic's initial phase, identifying that COVID-19 is 96% identical to the bat coronavirus genes. Human infection typically presents in alveolar cells. The virus uses angiotensin-converting enzyme 2 (ACE2) and replicates in the upper airways, facilitating transmission [ 13]. In addition to inducing viral pneumonia, SARS-CoV-2 can affect other organs. Main complications can include severe myocardial changes, arrhythmias, and shocks, especially in elderly individuals [ 14]. In addition to the high possibility of affecting crucial organic functions, the prevalence and risk of death increases in the elderly with chronic medical comorbidities, such as type 2 diabetes mellitus, hypertension, cerebral and vascular heart diseases, and obstructive pulmonary diseases, among others [ 15, 16].

The immunosenescence that occurs in aging is accompanied by an increase in pro-inflammatory cytokines, leading to a chronic inflammatory state. Chronic stress, caused by isolation and worries during the pandemic, can deregulate the negative feedback from the hypothalamus-pituitary-adrenal (HPA) axis, increasing the release of glucocorticoids by the adrenal glands. This condition is accompanied by an increase in cytokines, such as interleukin (IL) IL-1β, IL-6, and tumor-necrosis factor-α (TNF-α), among other pro-inflammatory molecules. In turn, pro-inflammatory cytokines contribute to the unbalance of the HPA axis, which may induce resistance to glucocorticoids, thus constituting a vicious cycle that contributes to the increase or maintenance of a chronic pro-inflammatory state. These associated conditions may culminate in a higher degree of chronic inflammation, predisposing the elderly to impair mental health. Images were extracted from Biorender app

Anxiety and MDD: What Factors Are Predisposing During COVID-19?

It is estimated that about 192 million people over the age of 60 have some mental or neurological disorder level. About 7% are affected by MDD and 3.8% by anxiety. MDD and anxiety are the most prevalent disorders in this age group [ 6]. Some studies have observed that anxiety increases death's risk associated with several comorbidities in people over 75 years old [ 27].

Santini et al. [ 31] point to social disconnection as a catalyst for a negative spiral, which leads to seclusion. The symptoms of some disorders may start or worsen, such as MDD and anxiety. A negative cycle occurs with social isolation, trapping the affected person within that spiral. Older people make up the most exposed group, especially those who live alone. If they stay in the negative spiral, they may have aggravated anxiety and depression symptoms, damaging their mental state.

Individuals with MDD and other disorders are prone to develop autoimmune and inflammatory diseases [ 33, 34]. Chronic inflammation can contribute to relevant neurotransmitter dysfunctions related to MDD and other psychiatric disorders [ 35], as well as impaired neurogenesis [ 36]. The increase in inflammation, which occurs with age and in psychiatric disorders, may be associated with other factors inherent to both conditions. This state of hyper inflammation can culminate in some degree of blood-brain barrier rupture. In these conditions, chronic microglial activation and neuroinflammation may occur [ 37]. Persistent microglial activation can lead to neuronal death and reduced neurogenesis [ 38].

Several studies have observed the involvement of inflammation in the beginning and in the maintenance of depression. Thus, researchers postulate the inflammatory hypothesis of depression [ 39]. The inflammation hypothesis considers that the inflammatory challenges in the CNS activate the microglia. The activated microglia releases several inflammatory cytokines, such as IL-1β, IL-6, TNF-α, IL-2, IL-18, and INF-γ. The cytokines activate the HPA axis and induce an increase in the indoleamine-2,3-dioxygenase (IDO) activity. In turn, IDO deviates tryptophan metabolism, reducing the synthesis of serotonin and liberating toxic metabolites. These metabolites alter the integrity of the blood-brain barrier and cause neurodegeneration and depression [ 39].

The routes by which inflammation can reach the CNS and contribute to trigger or worsen MDD include the following: cytokine trafficking through leaks in the blood-brain barrier; active transport through saturable molecules; activation of endothelial cells and perivascular macrophages, which secrete cytokines and other inflammatory mediators; binding to cytokine receptors present in afferent fibers of the vagus nerve; and allowing the sending of signals to specific regions, such as the nucleus of the solitary tract and hypothalamus. An important question concerning age is whether vascular insults at the end of life may have an essential role in bringing inflammatory cytokines to the CNS [ 40]. The nuclear factor kappa beta (NF-κB) appears to have a relevant role in communicating peripheral inflammation with the CNS [ 40].

Other Disorders-Predisposing Factors During COVID-19

Noteworthy are the studies on neuropsychiatric diseases before SARS-CoV-2 infection. In a series of case studies, the authors observed that older adults with a history of neuropsychiatric disease had delirium as a severe manifestation of COVID-19. Subsequently, these individuals manifested motor and cognitive changes, such as agitation, rigidity, abulia, and alogia. Parallel to neurological and cognitive changes, patients showed an increase in systemic C-reactive protein (CRP). The authors suggest that these patients should be monitored in order to promote mental health and diagnose forehand the development or increase neuropsychiatric and cognitive damages [ 58].

Can Disorders Increase the Severity of COVID-19 Symptoms?

An important mediator of inflammatory cytokines and the immune system is the HPA axis, often deregulated in individuals with stress-related psychiatric disorders [ 51, 63]. Studies with rodents show that corticosterone levels are positively related to vulnerability to stress [ 64, 65]. MDD is one of the pathologies associated with chronic stress, and, therefore, in many patients, the HPA axis is unregulated, also involving the dysregulation of the inflammatory process. In addition to activating the inflammatory pathways, cytokines act as regulators of the HPA axis [ 60, 66] and can induce glucocorticoid resistance [ 60]. This condition harms the negative feedback of the axis, which triggers a vicious cycle, leading to a chronic process involved in inflammation and organic dysfunctions [ 56].

Prolonged stress situations cause an overload of corticosteroids [ 60] and increase the susceptibility to contracting viral infections. Long-lasting changes in the HPA axis and the immune system can trigger epigenetic changes in the innate immune system's stem cells and adaptive immunity from a viral infection. This situation can culminate in prolonged neuropsychiatric changes after the disease. On the other hand, the effects of prolonged stress on the HPA axis can induce epigenetic changes that make the individual more susceptible to the worsening of viral infections and greater susceptibility to activation of latent viruses [ 56, 67]. Immunosenescence naturally causes dysregulation in the immune system, and, when associated with stress, this vulnerability is amplified [ 68]. The significant decrease in circulating B cells and antibodies [ 69] as well as an increase in IL-6 and CRP [ 70] are factors that contribute to impaired immune responses in the elderly [ 68, 71, 72]. These conditions increase the risk of mortality associated with infections [ 68]. IL-6 and CRP levels systematically increase in an age-dependent manner [ 70]. CRP is also high in older people with depression and dementia [ 73]. The biological mechanisms involved in depression and anxiety disorders, associated with advanced age, become important aggravating factors for the progression of COVID-19.

Renin-angiotensin-aldosterone system (RAAS) also is a mechanism involved in COVID-19 infection. This system is responsible for regulating the variation of extracellular fluid and blood pressure. Researches indicate that RAAS is directly affected by SARS-CoV-2 because the angiotensin-converting enzyme 2 (ACE2), a regulator of the vasopressor axis, is the molecule that allows the communication, entry, and replication of the virus into the cell [ 56, 75].

ACE2 is expressed in all districts of the human body, including brain tissue, comprising a possible explanation for the central nervous system (CNS) involvement, although studies are still speculative. It is suggested that therapies that involve a decrease in the expression of ACE2 may lead to hyperactivation of the renin-angiotensin system and the HPA axis and, in the long term, culminate in MDD, anxiety, and post-traumatic stress [ 56]. Studies with mice revealed that overexpression of ACE2 in CRH target cells decreased anxiety in plus-maze and open field tests [ 76].

Some populations may be more prone to develop neurological problems as a result of COVID-19. Brain aging is the leading risk factor for neurodegenerative diseases and cognitive decline. Such clinical conditions increase the risk of complications associated with COVID-19. Felice et al. [ 77] observed different types of coronavirus (CoV-OC43 and CoV-229E) in brain tissue and cerebrospinal fluid in patients with Parkinson's disease (PD). PD mainly affects the elderly and induces a decrease in movement. Thus, repercussions of their pathophysiology can compromise the respiratory system, worsening the infectious condition of Covid-19 [ 78].

Can COVID-19 Worsen the Symptoms of Psychiatric Disorders in the Elderly?

The remodeling of relationships puts at risk the elderly who are already prone to depression and anxiety and increase the possibilities of "amplifying pre-existing conditions" [ 81]. Mehra et al. [ 5] report the case of an older adult who has been with depression for more than 50 years. For 3 weeks, he was too anxious about COVID-19. On physical examination, no abnormalities were identified. The mental status exam pointed to "excessive concern about becoming infected with COVID-19." It was necessary to increase the dose of antidepressant and psychotherapy sessions to control the manifestations. The same author brings the case of an older woman diagnosed with recurrent depression for 7 years, without medication and symptom control. After the outbreak of COVID-19, she showed anxiety about her health. The patient needed emergency care due to depressive and psychotic symptoms and treatment with antidepressants and antipsychotics.

Both cases exemplify that the pandemic's social changes cause emotional suffering and frustration in older people with mental disorders [ 29]. Simple day-to-day activities become stressors, and, with the increasing burden of health systems, there is an imminent risk of discontinuing the monitoring of elderly in mental suffering.

Kavoor [ 30] points to recurrences that result in non-compliance of preventive actions, such as social detachment, lack of personal hygiene, and interruption of adequate treatment without intentions of seeking specialized help. Even for those who do not have a psychiatric condition, isolation is a resilience challenge. It is estimated that between one-third and half of the population will develop psychopathological manifestations in this period if preventive measures are not taken to minimize the impact [ 82].

In addition to the emotional burden caused by isolation, the reduction or complete interruption of physical activity also comes up with an additional charge harmful to health. Thus, the older adult isolated in an impoverished environment of regular social, cognitive, and sensorimotor stimulation will worsen health conditions and, even, can lead to a lonely and premature death [ 8].

Considering that the main physiological mechanisms stimulated by SARS-CoV-2 are familiar to those elicited by chronic stress, psychiatric disorders, and advancing age, COVID-19 can intensify, both by triggering limbic brain mechanisms in the combat of stress and by triggering physiological mechanisms inherent to disease and age situations.

Procedures and Health Care to Reduce the Damage to Mental Health of the Elderly Through Pandemic

Among the treatments to improve quality of life, social interaction and therapy groups are essential strategies for coping with the symptoms of dementia and mental disorders. The social connection is directly related to neural and hormonal mechanisms. The feeling of loneliness caused by isolation results in a lowering of mood and cognition, altering the regulation of inflammatory responses in the body, which damages the immune system, the ability to concentrate, and sleep habits [ 31].

Given the context of worsening psychiatric symptoms driven by the pandemic, it is crucial to focus on the necessary care to maintain the mental health of the elderly, considering the characteristics of people who already lived with suffering, as well as those who developed emotional damage. Among the most vulnerable groups are those who live in nursing homes or recovery clinics. Because their assistance requires several professionals, they are unable to perform isolation [ 4]. In general, measures to prevent the risks of mental illness must offer the necessary support thanks to family and social support networks, in addition to the care provided by health professionals and services. In this sense, it is imperative to convey information to prevent psychiatric effects, considering that this information can be understandable and straightforward to reduce barriers and facilitate understanding.

The elderly and their family members must manage their daily needs, such as the continuous use of medications and guidance from health professionals regarding pharmacological and non-pharmacological treatments. It is beneficial in this period that the elderly can perform physical activity at home and that they seek ways to communicate with family and friends during this period. It is convenient for those who have technological tools to use them to maintain safe distance contact [ 92].

Cellular devices and computers can compose crucial mental health care tools during this period. Its use facilitates communication with the family and social circle, counseling sessions, and information on medical and psychological needs [ 93]. Direct contact, based on calls to mental health centers, can screen the symptoms of anxiety and depression and reduce the impact of pandemic context in the mental health of the elderly [ 94].

It is well suited to maintain the daily activities performed by the elderly. It is also essential to create other practices that enrich their daily lives, create leisure moments at home, and use painting, music, literature, and other options that they have easier access. These recommendations provide an opportunity for the elderly to remain active and healthy when contemplating the biopsychosocial dimensions. Such actions must be integrated and carried out as long as they are adequately supported by health professionals and public policies [ 95].

On the other hand, it should be in mind that not all older people can ease the pandemic moment's tension. For some, even exercise is challenging due to confinement [ 4]. There are several situations of social and individual vulnerability. The low capacity for resilience can impair mental health. Looking for the different demands is necessary to integrate the health services that provide care at that time and palliative actions and to insert mental health at the epicenter of the care provided [ 3].

It is also essential to observe simple guidelines that can help maintain mental health in the elderly, reduce stress and anxiety, and promote self-care for the elderly and those around them during the COVID-19 period. Among the guidelines is to remain physically healthy, including physical exercises, among other attitudes [ 96].

Physical exercises can be a strategy for controlling MDD and other psychiatric disorders and other chronic diseases, which, besides being associated with the conditions, can predispose greater severity to the symptoms of COVID-19. With the regular practice of physical activities, many physiological mechanisms involved in the endocrine axis and immune function can be improved, reducing both the severity of psychiatric disorders and the possible severity of SARS-CoV-2 infection. Among the critical mechanisms affected by regular physical exercise are the reduction of oxidative stress and pro-inflammatory cytokines, with consequent beneficial changes in the biological processes of degradation of tryptophan. The increased availability of tryptophan and, consequently, serotonin levels are important factors for reducing symptoms related to depression and other disorders. Furthermore, the reduction of peripheral inflammation and neuroinflammation improves brain dynamics in the limbic circuit and may be achieved through regular physical exercises [ 60].

Here, in addition to not intending to exhaust the possibilities of improving the quality of life, it is also important to highlight that any initiative and care is impossible for a large percentage of the elderly population. Therefore, these are issues that will still demand public health concerns and future research needs.

Considerations and Conclusions

Several studies on the biological processes that emerge with age, stress, psychiatric disorders, and the SARS-CoV-2 infection suggest that there may be a synergism in these situations, leading to an increase in severity, both for COVID-19 and for damage mental health of the elderly. The stress involved in the psychosocial environment and the condition inherent to the disease triggers the HPA axis and the immune system's inflammatory processes. Advanced age can bring immunosenescence, which is also related to a chronic inflammatory degree. These associated conditions alone can culminate in a higher degree of chronic inflammation, predisposing the elderly to psychiatric disorders, such as anxiety and MDD, among others. Studies report that social isolation has been linked to increased depression and suicide, increased inflammation, and reduced immune response to viral infections. These conditions also predispose the elderly to more severe conditions when they contract SARS-CoV-2 [ 94].

It is essential to pay attention to the mental damage resulting from the synergism between a possible unfavorable biological condition related to aging and a SARS-CoV-2 infection. This combination can converge to a state of hyper inflammation, a more significant change in the function of the HPA axis, and the onset or worsening of psychiatric disorders. (Fig. 2).

Immunosenescence in aging is accompanied by a chronic inflammatory state. Simultaneously, chronic stress during a pandemic may deregulate negative feedback from the hypothalamic-pituitary-adrenal (HPA) axis. The chronic increase in glucocorticoids (cortisol) is accompanied by an increase in cytokines and other pro-inflammatory molecules. In turn, pro-inflammatory cytokines contribute to the imbalance of the HPA axis, which can culminate in resistance to glucocorticoids, contributing to an increase or maintenance of a chronic pro-inflammatory state. These associated conditions predispose the elderly to trigger or worsen major depressive disorder (MDD) and other psychiatric disorders, as well as make them more vulnerable to the severity of COVID-19 symptoms. On the other hand, the pro-inflammatory cytokine storm, a condition of the severity of SARS-CoV-2 infection, can trigger or worsen psychiatric disorders in the elderly. CRH ➔ corticotropin-releasing hormone; ACTH ➔ adrenocorticotropic hormone; IL ➔ interleukin; TNF-α ➔ tumor-necrosis factor-α; CRP ➔ C-reactive protein. Images were extracted from Biorender app

In addition to the suggestions for attention and care for the elderly during the pandemic, it is essential to note that both health organizations worldwide and science should consider an increase in mental impairment in the elderly population worldwide from the conditions listed in this and other studies. Paying attention to these issues is essential for studies and ways to understand and alleviate mental suffering and further damage to the elderly's health.

Data Availability

Not applicable in this study.

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Acknowledgments

The Translational Psychiatry Program (USA) is funded by the Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth). Translational Psychiatry Laboratory (Brazil) is one of the members of the Center of Excellence in Applied Neurosciences of Santa Catarina (NENASC). Its research is supported by grants from CNPq (ZMI, JQ and GZR), FAPESC (ZMI, JQ, and GZR), UFFS (ZMI), Instituto Cérebro e Mente (JQ and GZR), and UNESC (JQ and GZR). JQ is a 1A CNPq Research Fellow.

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Authors and Affiliations

1. Undergraduate Nursing Course, Federal University of the Southern Frontier, Chapeco, SC, Brazil

Roberta Eduarda Grolli, Maiqueli Eduarda Dama Mingoti, Amanda Gollo Bertollo, Adriana Remião Luzardo & Zuleide Maria Ignácio

2. Laboratory of Physiology, Pharmacology, Psychopathology, Postgraduate Program in Biomedical Sciences, Federal University of Southern Frontier, Chapeco, SC, Brazil

Roberta Eduarda Grolli, Maiqueli Eduarda Dama Mingoti, Amanda Gollo Bertollo & Zuleide Maria Ignácio

3. Laboratory of Innovation and Health Technologies, Federal University of the Southern Frontier, Chapeco, SC, Brazil

Adriana Remião Luzardo

4. Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciuma, SC, Brazil

João Quevedo, Gislaine Zilli Réus & Zuleide Maria Ignácio

5. Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

João Quevedo

6. Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

João Quevedo

7. Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA

João Quevedo

Contributions

All authors participated in the construction of the review. REG, MEDM, and AGB searched for references and started writing the manuscript; ARM wrote the last topic and contributed others; ZMI outlined the article and wrote the part of COVID-19's physiological mechanisms; GZR helped in writing about stress and inflammation; JQ reviewed and made suggestions for improving the manuscript; JQ, GZR, and ZMI reviewed the final manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Zuleide Maria Ignácio.

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Highlights

* Isolation and concerns about COVID-19 may harm elderly mental health.

* Immunosenescence and pandemic stress increase the risk of psychiatric disorders.

* Stress and disorders may potentiate the elderly's inflammation and COVID-19 symptoms.

* SARS-CoV-2 hyperinflammation is a risk factor for elderly psychiatric disorders.

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Grolli, R.E., Mingoti, M.E.D., Bertollo, A.G. et al. Impact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates. Mol Neurobiol 58, 1905-1916 (2021). https://doi.org/10.1007/s12035-020-02249-x
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Impact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates - Molecular Neurobiology

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Since December 2019, the world has been experiencing the challenge of facing coronavirus disease-19 (COVID-19), a severe infectious disease caused by the new coronavirus, SARS-CoV-2. The individuals with the most severe symptoms and the highest risk of death are the elderly and those with chronic illness.

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(n.d.). Commonwealth of Pennsylvania. https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/contact/dhs-offices/documents/Responding%20to%20Childhood%20Trauma%20The%20Promise%20and%20Practice%20of%20Trauma%20Informed%20Care.pdf

Helen Nwokedi

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Hodas, G.R. (2006) Responding to childhood trauma The promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Ser vices, Pennsylvania. - References - Scientific Research Publishing

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Hodas, G.R. (2006) Responding to childhood trauma The promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Ser vices, Pennsylvania.

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The website is from the National Institutes of Health (NIH) explains how COVID-19 has severely affected the mental health of elderly survivors. Approximately 26.9% of those who recovered from COVID-19 experienced symptoms of post-traumatic stress disorder (PTSD). The article stresses the long-lasting psychological impact on this vulnerable group, emphasizing the importance of mental health care and support to help them deal with trauma and other related conditions.

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Sarangi, A., Javed, S., Karki, K., & Kaushal, A. (2021). Covid-19-associated PTSD in the elderly—lessons learned for the next global pandemic. Middle East Current Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242287/#:~:text=26.9%25%20of%20older%20adults%20surviving,%2Drelated%20PTSD%20%5B14%5D.

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Relevant. https://rockinst.org/wp-content/uploads/2021/07/Public-Mass-Shootings-Brief.pdf

School shooting survivors reflect on life after tragedy from Sandy Hook to Uvalde | GMA. (2022, December 14). YouTube. https://youtu.be/-JokheVpUmU

Stress of mass shootings causing Cascade of collective traumas. (2022, September 1). https://www.apa.org. https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas

What happens to the survivors? (Amy Novotney, 2018). https://www.apa.org. https://www.apa.org/monitor/2018/09/survivors

Eun Hye Lee

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Survivors of trauma struggle to move on from the loss of loved ones

https://www.apa.org/news/press/releases/2021/08/post-traumatic-stress-symptoms

Traumatic Bereavement: Helping children and young people who are struggling in schools & colleges

https://www.youtube.com/watch?v=EutvrbCHi_k

BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637930/

Trauma SURVIVOR finds HOPE in God.

https://m.youtube.com/watch?v=oe8Hnn5kfPE

Trauma Support | Crisis Services

https://crisisservices.org/trauma-support/

Surviving Traumatic Grief

https://apmha.com.au/wp-content/uploads/Surviving-Traumatic-Grief-vol1.pdf

Traumatic Grief: What it Is, Symptoms, and How to Cope

https://psychcentral.com/health/traumatic-grief

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References

2024 American Psychological Association. (2024). Trauma. https://www.apa.org. https://www.apa.org/topics/trauma

2024 American Psychological Association. (2024). Students exposed to trauma. https://www.apa.org. https://www.apa.org/ed/schools/primer/trauma

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2019, October 30). How to cope with traumatic stress. https://www.apa.org. https://www.apa.org/topics/trauma/stress

Psychology Today © 2024 Sussex Publishers, LLC. (2024). Trauma. Psychology Today. https://www.psychologytoday.com/us/basics/trauma

—Jon Kabat-Zinn, professor of medicine emeritus, UMass Medical School; author of Full Catastrophe Living. (2014). the body keeps the score. Directory listing for ia601604.us.archive.org. https://ia601604.us.archive.org/35/items/the-body-keeps-the-score-pdf/The-Body-Keeps-the-Score-PDF.pdf

Jaylene Moreno

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Childhood trauma: The lives of the neglected children. (2022, February 1). YouTube. https://youtu.be/Hj1d8xJdPvU?si=OPaP5t32-Yq4md3t

Helen Nwokedi

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Childhood Trauma: The Lives of the Neglected Children

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Impact of trauma