Increased Violence in Toronto and The Prevention of Post Traumatic Stress Disorder

After the recent mass shooting taking place in Toronto, Ontario, the risk of individuals affected by the traumatic event, developing Posttraumatic Stress Disorder(PTSD) became an increased possibility. The traumatic mass shooting, which took place on Danforth Avenue in Toronto, took the lives of three individuals and injured 13 others(Bein, 2018; McQuigge & Thompson 2018). Margaret McKinnon's (2018), article about “How to prevent PTSD after mass violence” originally shared on The Conversation, then later by The National Post, discussed the symptoms and process of developing Post Traumatic Stress Disorder. The article focuses on what to look out for but fails to address what concrete steps individuals can take to reduce the psychopathology of developing this disorder(McKinnon, 2018). McKinnon(2018) is a facility member in the Department of Psychiatry and Behavioral Neuroscience at McMaster University, located in Hamilton, Ontario. The positive aspect of this newspaper article is McKinnon’s academic background allows individuals to be provided with a level of reliable information. However, receiving information from an individual with an extensive academic background does not assume that the information provided is necessarily correct, a critical lens often times be facilitated. This paper will focus on what extent PTSD is preventable and which individuals are most at risk to develop this disorder.

The DSM 5 determines the diagnosis for posttraumatic stress disorder, to those who present or directly experience a traumatic event, which is defined by threatened or exposure to death, sexual assault, or severe injury(DSM 5, 2013 cited by Nolen-Hoeksema & Marroquin, 2017). Which as mentioned by Nolen-Hoeksema & Marroquin(2017) symptoms can include, detachment, re-experiencing the event through nightmares, or hypervigilance. For example, if an individual were to develop symptoms of PTSD after the Toronto mass shooting, they may have extensive nightmares and/or feel detached from their daily lives since the incident. As mentioned by McKinnon(2018), if symptoms are noticed early and addressed by a healthcare professional, it may prevent the severity of the individual's psychopathology.

By reflecting upon the traumatic event of the World Trade Centre bombings, the risk factors which were present in individuals who developed PTSD, in order will be viewed to identify who may be most at risk after the Toronto mass shooting. Since the occurrence of the World Trade Centre bombings, the research on individuals psychological reaction to this traumatic event leading up to PTSD has been extensive(Adams & Boscarino, 2006; Yehuda, 2002). Adams & Boscarino(2006), explore the patterns of risk factors which affected the development of PTSD in response to the World Trade Centre bombings over the course of two years. What was discovered was younger age, female gender, level of exposure, number of additional traumatic experiences, social support, and an individual's self-esteem all played a role in the development and prevalence of PTSD(Adams & Boscarino, 2006). However, it can be argued the fact that this study took place in America and the extent of trauma was vastly greater it may not be applicable to the Toronto mass shooting. This being said, Nolen-Hoeksema & Marroquin (2017), have displayed how many of these factors are prevalent in an individual risk of developing PTSD, such as social which an individual has access too, as well as pre-existing anxiety and depression symptomatology. Although vastly different in magnitude, the pattern of risk factors leaving individuals vulnerable to the development of PTSD can be used to provide aid to those most vulnerable.

This paper will begin by simply examining general risk factors can affect an individual's likelihood of developing a posttraumatic stress disorder. PTSD and related symptoms can result in the aftermath of a traumatic event in an individual's life, such as the mass shooting which has recently occurred in Toronto(Nolen-Hoeksema & Marroquin, 2017). The probability of developing the disorder can be dependent on various factors, such as the severity of the event, how long the event occurred for, and an individual's distance or proximity to the traumatic event(Cardozo, Vergara, Agani, & Gotway, 2000; Ehlers et al., 1998; Hoge et al., 2004; Kessler et al., 1995 as cited in Nolen-Hoeksema & Marroquin, 2017). For example, the severity of the mass shooting, the length of time an individual was exposed to the traumatic event and the distance an individual stood from the shooter or individuals getting shot, can affect the likelihood of an individual developing PTSD. Biological, social and psychological proponents of an individual overall wellbeing prior to the traumatic event can also play a role in the likelihood of developing PTSD(Nolen-Hoeksema & Marroquin, 2017; Nagy, 2018). An individual biological stress response can positively respond to a situation to prevent the individual from developing PTSD, but when this stress response fails to work in accordance it can play a negative role on the individual's ability to cope with such traumatic stress(McEwen, 1998; Shalev and Yehuda, 1998 as cited by Nagy, 2018). The presence of positive social support can be a key component in an individual's ability to cope with such stressful traumatic events(Adams & Boscarino, 2006). Although, as mentioned by Nolen-Hoeksema & Marroquin(2017) pre-existing depression or anxiety symptomatology can increase an individual's probability of developing symptoms of PTSD. The likelihood of an individual developing PTSD after the Toronto mass shooting can fall about factors out of the individual's control, such as distance, seriousness and timespan of the traumatic event. When pre-existing factors such as biological, social, and psychological factors are influences with such extensive stress, it may result in the development of a disorder.

This paper will now go one to understand the prevalence and preventability of PTSD among the children and youth affected. One of the lives which were taken during the Toronto mass shooting was that of a 10-year-old girl(Bein, 2018). As discussed by Lilienfeld et al. (2017), children and adolescent tend to be quite resilient in the light of trauma. Although that may be often the case, Garrett et al. (2012), displayed that PTSD can affect youths emotional development. Also as mentioned by Adams & Boscarino(2006), younger females(18-29) with lower social economic background and low self-esteem were displaced to have an increased PTSD symptomology. Which may point display that particular attention should be positioned at particular youth due to their social environmental state and psychological mindset. Making it crucial to identify which risk factors may place youth in a position to develop PTSD and work toward targeted prevention methods. Research conducted by Carrion, Weems, & Reiss(2002) displayed that the DSM IV's clustering method of a diagnosis may not be the most beneficial way to reach a diagnosis of PTSD, rather focus should be placed upon the frequency and intensity of the symptoms being displayed by the child. This may be a crucial aspect to take into account when symptoms of children and youth affected by the Toronto mass shooting first begin to present themselves. As mentioned by McKinnon(2018), although there is a large possibility of self-recovery after this traumatic event, there is also a possibility of continual symptoms.

This paper will now explore the prevalence and preventability of PTSD among the first responders which were directly involved in the traumatic event. Extensive research has been done on how posttraumatic stress negatively influences the lives of first responders, due to their proximity to severely traumatic events which. First responders suffer similar risk factors for developing PTSD as stated above, for individuals exposed to trauma. However, the extended duration and repeated exposure to extremely traumatic events play a role in the development of PTSD symptomatology, which can be lessened with the presence of support(Benedek, Fullerton & Ursano, 2007; Walker, McKune, Ferguson, Pyne & Rattray, 2016). Support groups can play a vital role in reducing the development of PTSD symptoms for workers in these fields. (van der Velden, van Loon, Benight, & Eckardt, 2012 as cited by Nolen-Hoeksema & Marroquin, 2017; Lilienfeld et al., 2017). Marmar et al. (2006), displayed that individual differences are the vital aspect which places a first responder to be more or less vulnerable when it comes to coping with stress that may lead to PTSD. The key theme among literature displays that social support and individual differences in coping play a vital role in first responders development of PTSD(Nolen-Hoeksema & Marroquin, 2017; Lilienfeld et al., 2017; Benedek, Fullerton & Ursano, 2007; Walker, McKune, Ferguson, Pyne & Rattray, 2016). First responders are often times the ones most severely affected by PTSD and its extensive symptoms, that is why it is integral that focus is placed upon their well being after the Toronto mass shooting, especially since the increased severity and number of traumatic events currently taking place.

The rise of shootings in recent months has extensively increased in recent months, resulting in an increased number of individuals victimized in the presence of these traumatic events. The Toronto mass shooting being the most extensive in the past couple of months may increase the chances of individuals directly involved developing PTSD. The choice of being placed in the situation is not under the control of its victims, but resources to secure the mental health of these victims should be readily available. Understand how much an individual may be affected by PTSD it is crucial to take into account a cumulative perspective, such as mentioned by Nolen-Hoeksema & Marroquin (2017), which views and individuals social environment, psychological disorders pre-existing and biological predisposition. By this means it is possible to target and aid the individuals most in need as well as most traumatized by the event. After the research conducted through this paper, it becomes apparent that in order to secure these victims as well as future individual's mental well being a well-rounded approach must be put into play. the development of PTSD can affect individuals in multiple facets, losing their sense of safety and mental well being. The extent to which the development of posttraumatic stress disorder is preventable falls upon the communities coming together either on the individual level or national, to aid individuals, children and first responders most severely affected.