Mental Health Service Utilization Following a Campus Mass Shooting: The Role of Preshooting Emotion Dysregulation and Posttraumatic Cognitions

Objective: This study investigated preshooting emotion dysregulation and posttraumatic cognitions as predictors of mental health service utilization ([MHU]; i.e., therapy/medication) among undergraduate women following a campus mass shooting, controlling for time, age, and postshooting posttraumatic stress (PTS) and depressive symptoms. Method: Undergraduate women (N = 483, M-age = 19.23, SD = 2.39) were engaged in a study when a mass shooting occurred on Northern Illinois University's campus. A separate, longitudinal study was then implemented to monitor postshooting adjustment among these same women. The present study examined predictors of MHU using data from the preshooting assessment and the following postshooting timepoints: 9 months (T1; n = 416); 14 months (T2; n = 416); 20 months (T3; n = 417); 26 months (T4; n = 405); and 33 months (T5; n = 397). Results: Multilevel models showed preshooting emotion dysregulation and postshooting PTS and depressive symptoms positively predicted increased likelihood of MHU while controlling for covariates. Posttraumatic cognitions initially predicted increased therapy utilization, but this relationship became nonsignificant after accounting for preshooting emotion dysregulation. Preshooting emotion dysregulation also weakened the positive relationship between depressive symptoms and therapy utilization and strengthened the positive relationship between age and therapy utilization. Conclusions: Preshooting emotion dysregulation and postshooting mental health symptoms were the most robust predictors of increased MHU following a mass shooting. Findings suggest women exposed to a mass shooting engage in treatment when needed, but preexisting emotion dysregulation may serve as a barrier for those who go on to develop depression. Clinical Impact Statement This study adds unique data on variables that facilitate and inhibit mental health service utilization among women following a campus mass shooting. Findings suggest that clinicians working with women exposed to mass violence may consider how longstanding problems with emotion regulation are interfering with functioning. Colleges, institutions, and communities affected by acts of mass violence may encourage greater mental health service utilization among those in need by acknowledging and normalizing the difficulty of adjusting afterward.