Mitigating the mental health consequences of mass shootings: An in-silico experiment.

Background: There is emerging evidence that mass shootings are associated with adverse mental health outcomes at the community level. Data from other mass-traumatic events examined the effectiveness of usual care (UC), (i.e., psychological first aid approaches without triage), and stepped care (SC) approaches, with triage, in reducing the burden of post-traumatic stress disorder (PTSD) in a community. Methods: We built an agent-based model of 118,000 people that was demographically comparable to the population of Parkland and Coral Springs, Florida, US. We parametrized the model with data from other traumatic events. Using simulations, we then estimated the community prevalence of PTSD one month following the Stoneman Douglas High School (Florida, US) shooting and reported the potential reach, effectiveness, and cost effectiveness of different what-if treatment scenarios (SC or UC) over a two-year period. Findings: One month following the mass shooting, PTSD prevalence in the community was 11.3% (95% CI: 11.1-11.5%). The reach of SC was 3461 (95% CI: 3573-3736) per 10,000 and the reach of UC was 2457 (95% CI: 2401-2510) per 10,000. SC was superior to UC in reducing PTSD prevalence, yielding, after two years, a risk difference of -0.044 (95% CI, -0.046 to -0.042) and a risk ratio of 0.452 (95% CI, 0.437-0.468). SC was also superior to UC in reducing the persistence of PTSD, yielding, after two years, a risk difference of -0.39 (95% CI, -0.401 to -0.379) and a risk ratio of 0.452 (95% CI, 0.439-0.465). The incremental cost-effectiveness of SC compared to UC was $2718.49 per DALYs saved, and $0.47 per PTSD-free day. Interpretation: This simulation demonstrated the potential benefits of different community-level approaches in mitigating the burden of PTSD following a mass shooting. These results warrant further research on community-based interventions to mitigate the mental health consequences of mass shootings. Funding: None.

Media Exposure and the Risk of Post-Traumatic Stress Disorder Following a Mass traumatic Event: An In-silico Experiment.

Introduction: Following mass traumatic events, greater exposure to traditional media like television (TV) about the event is associated with higher burden of post-traumatic stress disorder (PTSD). However, we know little about how social media exposure, combined with other media sources, shapes the population burden of PTSD following mass traumatic events. Materials and Methods: We built a microsimulation of 1,18,000 agents that was demographically comparable to the population of Parkland and Coral Springs, Florida that experienced the Stoneman Douglas High School shooting in 2018. We parametrized the model using data from prior traumatic events and built an internal social network structure to facilitate the estimation of community PTSD prevalence following exposure to TV and social media coverage of the shooting. Results: Overall, PTSD prevalence in the community due to exposure to TV coverage of the shooting was 3.1%. Shifting the whole population's hours of TV watching to the lower half of the population distribution decreased PTSD prevalence to 1.3% while increasing TV watching to the upper half of the distribution increased the prevalence to 3.5%. Casual (i.e., viewing posts) social media use in addition to exposure to TV coverage increased PTSD prevalence to 3.4%; overall prevalence increased to 5.3% when agents shared videos related to the shooting on social media. Conclusion: This microsimulation shows that availability and exposure to media coverage of mass traumatic events, particularly as social media becomes more ubiquitous, has the potential to increase community PTSD prevalence following these events. Future research could fruitfully examine the mechanisms that might explain these associations and potential interventions that can mitigate the role of media in shaping the mental health of populations following traumatic events.

Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study.

BACKGROUND: Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restoration of residential and housing-related financial resources on recovery from PTSD in post-disaster contexts. METHODS: We built an agent-based model, empiricised with observational and experimental data, to test the effects of differing health service approaches on PTSD recovery, measured by prevalence and persistence. We tested a social services case management (SSCM) approach similar to Psychological First Aid, featuring shelter-based social service provision and linkage to mental health treatment for people who were displaced and had income loss, by comparing the treatment effectiveness of usual care alone, usual care with SSCM, stepped care alone, and stepped care with SSCM. FINDINGS: An SSCM approach to restore housing and provide linkage to mental health services among people who were displaced and had income loss after a large-scale natural disaster resulted in between 1·56 (95% CI 1·55-1·57) and 5·73 (5·04-6·91) times as many remitted PTSD cases as non-SSCM conditions at the end of the first year, and between 1·16 (1·16-1·17) and 2·28 (2·25-2·32) times as many remitted cases at the end of the second year. INTERPRETATION: Restoring economic and housing resources to populations affected by a natural disaster would significantly reduce the mental health burden in populations, particularly those with resource loss, after a disaster. FUNDING: US Department of Health and Human Services.

Comparison of Simulated Treatment and Cost-effectiveness of a Stepped Care Case-Finding Intervention vs Usual Care for Posttraumatic Stress Disorder After a Natural Disaster.

Importance: Psychiatric interventions offered after natural disasters commonly address subsyndromal symptom presentations, but often remain insufficient to reduce the burden of chronic posttraumatic stress disorder (PTSD). Objective: To simulate a comparison of a stepped care case-finding intervention (stepped care [SC]) vs a moderate-strength single-level intervention (usual care [UC]) on treatment effectiveness and incremental cost-effectiveness in the 2 years after a natural disaster. Design, Setting, and Participants: This study, which simulated treatment scenarios that start 4 weeks after landfall of Hurricane Sandy on October 29, 2012, and ending 2 years later, created a model of 2 642 713 simulated agents living in the areas of New York City affected by Hurricane Sandy. Interventions: Under SC, cases were referred to cognitive behavioral therapy, an evidence-based therapy that aims to improve symptoms through problem solving and by changing thoughts and behaviors; noncases were referred to Skills for Psychological Recovery, an evidence-informed therapy that aims to reduce distress and improve coping and functioning. Under UC, all patients were referred only to Skills for Psychological Recovery. Main Outcomes and Measures: The reach of SC compared with UC for 2 years, the 2-year reduction in prevalence of PTSD among the full population, the 2-year reduction in the proportion of PTSD cases among initial cases, and 10-year incremental cost-effectiveness. Results: This population of 2 642 713 simulated agents was initialized with a PTSD prevalence of 4.38% (115 751 cases) and distributions of sex (52.6% female and 47.4% male) and age (33.9% aged 18-34 years, 49.0% aged 35-64 years, and 17.1% aged ≥65 years) that were comparable with population estimates in the areas of New York City affected by Hurricane Sandy. Stepped care was associated with greater reach and was superior to UC in reducing the prevalence of PTSD in the full population: absolute benefit was clear at 6 months (risk difference [RD], -0.004; 95% CI, -0.004 to -0.004), improving through 1.25 years (RD, -0.015; 95% CI, -0.015 to -0.014). Relative benefits of SC were clear at 6 months (risk ratio, 0.905; 95% CI, 0.898-0.913), with continued gains through 1.75 years (risk ratio, 0.615; 95% CI, 0.609-0.662). The absolute benefit of SC among cases was much stronger, emerging at 3 months (RD, -0.006; 95% CI, -0.007 to -0.005) and increasing through 1.5 years (RD, -0.338; 95% CI, -0.342 to -0.335). Relative benefits of SC among cases were equivalent to those observed in the full population. The incremental cost-effectiveness of SC compared with UC was $3428.71 to $6857.68 per disability-adjusted life year avoided, and $0.80 to $1.61 per PTSD-free day. Conclusions and Relevance: The results of this simulation study suggest that SC for individuals with PTSD in the aftermath of a natural disaster is associated with greater reach than UC, more effectiveness than UC, and is well within the range of acceptability for cost-effectiveness. Results should be considered in light of limitations inherent to agent-based models.