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Local exposure to school shootings and youth antidepressant use

Significance In the last two decades, over 240,000 American students were on school grounds when a gunman opened fire at their school. While public attention often focuses on the victims who were killed, less is known about the impacts of school shootings on surviving youth. This study represents the largest analysis to date of the effects of school shootings on an important indicator of youth mental health: the use of prescription antidepressants. We find that local exposure to fatal school shootings leads to persistent and significant increases in youth antidepressant use. These impacts are smaller in areas with a higher density of mental health providers who focus on behavioral interventions. While over 240,000 American students experienced a school shooting in the last two decades, little is known about the impacts of these events on the mental health of surviving youth. Using large-scale prescription data from 2006 to 2015, we examine the effects of 44 school shootings on youth antidepressant use. Our empirical strategy compares the number of antidepressant prescriptions written by providers practicing 0 to 5 miles from a school that experienced a shooting (treatment areas) to the number of prescriptions written by providers practicing 10 to 15 miles away (reference areas), both before and after the shooting. We include month-by-year and school-by-area fixed effects in all specifications, thereby controlling for overall trends in antidepressant use and all time-invariant differences across locations. We find that local exposure to fatal school shootings increases youth antidepressant use by 21.4% in the following 2 y. These effects are smaller in areas with a higher density of mental health providers who focus on behavioral, rather than pharmacological, interventions.