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Students with Generalized Anxiety or Panic Symptoms Have Higher Concerns About School Violence

Concerns about school violence or shootings are higher among students with generalized anxiety and panic symptoms, researchers found in a study published in JAMA Network Open.

Investigators analyzed data from the Happiness and Health Study of students at 10 public high schools in Los Angeles, California. The study included 2,263 students (55.2% girls) surveyed in the fall of 2015 (11th grade pre-baseline), the spring of 2016 (11th grade, baseline), and the fall of 2016 (12th grade, follow-up).

Students rated their degree of “concern, worry, and stress” about “shootings or violence at your school or other schools” on a 5-point scale (0 [not at all] to 4 [extremely]). Students’ scores were averaged to provide a composite index score.

The Revised Children’s Anxiety and Depression Scale (RCADS) measured whether their symptoms of major depressive disorder, generalized anxiety disorder, and panic disorder were borderline clinically significant or clinically significant. Students reported their sociodemographic characteristics (44.2% Hispanic/Latinx, 19.6% Asian, 16.6% White, 15.6% other, 3.9% Black) and any disruptive and delinquent behaviors.

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The researchers found that 38.2% of students were “very” or “extremely” concerned, 31.8% were “very” or “extremely” worried, and 15.2% were “very” or “extremely” stressed about the violence. Based on the RCADS, 15.9% had at least borderline clinically significant major depressive disorder, 12.4% had at least borderline clinically significant generalized anxiety disorder, and 13.7% had at least borderline clinically significant panic disorder.

Compared with boys, girls had higher composite scores (1.84±1.27 vs 1.27±1.20 P <.001) and were more likely to report that they were “very” or “extremely” concerned (45.2% vs 22.5%), worried (38.5% vs 23.4%), or stressed (19.9% vs 9.4%) about the violence.

Concern about school violence was linked with major depressive disorder (Odds ratio (OR) 1.19), generalized anxiety disorder (OR 1.48), and panic disorder (OR 1.20) prior to adjustment for confounding factors.

After adjusting for mental health problems, the researchers found that concerns were linked with meeting borderline/clinical criteria for generalized anxiety disorder (OR 1.31 95% CI 1.15-1.50) and panic disorder (OR 1.18 95% CI 1.05-1.32) but not major depressive disorder 6 months later.

Concern about school violence was linked with major depressive disorder among Black students (OR 3.15) and White students (OR 1.62). The concern was linked with panic disorder among White students (OR 1.78).

“Our results suggest that these concerns [about violence or shootings both at students’ own schools and at other schools] could represent a new possible explanation for upward trends in the prevalence of internalizing problems among adolescents, adding to a mounting list of potential causes that includes environmental concerns, digital media use, declining sleep duration, and increasing wealth inequality, among others,” the researchers said.

“Together these factors reflect a constellation of social, political, economic, and environmental concerns that may contribute to a perception of ‘social fracture’ among youth.”

The investigators said interventions that include social-emotional learning and tiered school-based services may aid students’ mental health and that targeted interventions could be appropriate for students who may need more care.


Riehm KE, Mojtabai R, Adams LB, et al. Adolescents’ concerns about school violence or shootings and association with depressive, anxiety, and panic symptoms. JAMA Netw Open. Published online November 1, 2021. doi: 10.1001/jamanetworkopen.2021.32131

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Source: Psychiatry Advisor