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Editor's Note: If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 800-273-8255, or text 741-741 for the Crisis Text Line.

Over a period of just 10 days this month, three people directly affected by school shootings committed suicide.

Two were survivors of the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida; the third was the father of a first grader killed in the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut. Sydney Aiello was 19 and a student at Florida Atlantic University, and she was a close friend of Meadow Pollack, who died in the Stoneman Douglas massacre. The identity of the other Stoneman Douglas student, reported to be a sophomore boy, has not been released. Jeremy Richman, 49, was a neuropharmacologist.

The death by suicide of someone connected to a school shooting is, unfortunately, a familiar story line. Carla Hochhalter, the mother of a student injured in the 1999 shooting at Columbine High School in Colorado, took her own life six months afterward; family members later stated that the tragedy had exacerbated her preexisting clinical depression. Greg Barnes, a Columbine student whose best friend died in the massacre, committed suicide a few weeks after its first anniversary. And in 2008, eight months after the shooting at Virginia Tech, a 21-year-old student named Daniel Kim took his own life in an act that his parents said was linked to the shooting.

Some 28 percent of people who survive mass shootings in the United States develop post-traumatic stress disorder, according to the National Center for PTSD at the U.S. Department of Veterans Affairs. (By comparison, 7 to 8 percent of the U.S. adult population will experience PTSD symptoms at some point in their lives.) Research has also linked PTSD to suicide, particularly when it’s paired with depression. In this sense, having survived or having been directly affected by a mass shooting is certainly “a risk factor” for suicide, says Heather Littleton, a professor of psychology at East Carolina University who specializes in recovery from trauma. Additionally, Littleton says that recovery can be made harder by a prevalent misconception that grieving is a linear, incremental process, one that can be completed within the months or years after a tragedy.

Mass shootings often result in a particularly difficult kind of grief known as traumatic grief. Littleton describes traumatic grief as a PTSD reaction that occurs when someone is grieving over another person’s violent or unexpected death; in other words, traumatic grief occurs when someone has PTSD symptoms on top of grief symptoms. And as with PTSD, “a traumatic-grief reaction could last for a number of years,” Littleton says. (Some people do, of course, grieve over traumatic deaths without experiencing traumatic grief, Littleton notes.)

In a traumatic-grief situation, she adds, “those traumatic symptoms then interfere with the resolution of the grief reaction,” which can result in the phenomenon commonly known as “survivor’s guilt”: “The person sort of gets stuck on this idea that ‘I should have been able to prevent this death,’ or ‘Why did this person die instead of me?’” The mother of Sydney Aiello, the 19-year-old who took her own life last week after surviving the shooting at Stoneman Douglas last year, told the press that her daughter had been having thoughts like those.

The nonlinear nature of grief—the fact that it can ebb and spike over time rather than steadily decrease—tends to become clear with the passage of certain milestones. As the author Dave Cullen illustrated in his 2009 book Columbine, school-shooting survivors and the families of victims tend to have a tough time in the days around the anniversary of the tragedy for years afterward. For some, Littleton adds, that “anniversary reaction” can persist into the days and weeks after the anniversary too. The two Parkland survivors who committed suicide did so about 13 months after the shooting at their high school.

One of the best predictors of a positive mental-health outcome after a shooting, Littleton says, is social support for survivors and the victims’ families. “Overall, individuals who have good social support, who report strong feelings of social solidarity after the trauma, who do not have a history of mental-health problems or other traumatic experiences, are those most likely to experience resilience,” she says. But often the social support offered to them—as well as the formal psychological support—seems predicated on the notion that grief is temporary and eventually wanes and dissipates.

“Initially, there’s often an outpouring of support—this increased sense of community solidarity, where [survivors] feel very connected to other members of their community,” Littleton says. But eventually that sense of community solidarity goes away.

“It could be because there are divisions in the community about what [they] should be focusing on, or what direction [the community] should be going in,” she adds. “Maybe the community has a negative identity now, so survivors don’t really want to be associated with that community anymore—you don’t want people to think about you as a student at that school, or ‘You were in that community where that horrible thing happened.’ That can fuel a sort of decline in community solidarity, which naturally tends to happen about six months after communal traumas.”

In addition, much of the mental-health support offered to survivors of shootings and the families of shooting victims dissolves around the same time. Counselors and mental-health practitioners who are integrated into the community immediately after the tragedy may leave before the community has truly healed. One case study of the aftermath of a shooting at Dawson College in Montreal found that counselors were readily available on school premises for six months.

“Separate from the formal support going away, informally, other people are moving on. People aren’t talking about it as much anymore,” she says. “So if you are still struggling—maybe you don’t have those informal supports, and maybe you also don’t have the formal resources anymore—and there’s this expectation that you should be moving on, or that we should not be talking about this anymore. That can fuel more distress.” At Virginia Tech, a “sizable percentage of students” reported elevated symptoms of PTSD one year after the shooting, according to a study Littleton conducted.

“That’s when they noticed a surge [in feelings of distress]—when there was that sense of ‘Well, other people are doing better, but I’m not,’” she says.

The majority of individuals who experience or are affected by mass trauma, Littleton points out, are resilient—they do not develop persistent symptoms. Many report feeling jumpy or edgy or having unwanted thoughts or dreams in the immediate aftermath of the trauma that go away within a few days or weeks, while for others, the symptoms last for a few months and then go away on their own. Survivors who are most likely to show resilience after a shooting are those who had no strong emotional reactions while the shooting was unfolding and those who never felt that they or their loved ones were in danger during the shooting.

Some Virginia Tech students who struggled with anxiety and depression before and at the time of the shooting in 2007, Littleton notes, actually showed improvements in the longer term, seemingly as a result of the solidarity and support they felt. They reported increases in social support, feelings of connection to others, and a sense of purpose in life in the months after the shooting, Littleton says.

Many survivors of mass shootings go on to find purpose through activism against gun violence. Several Parkland students, for example, have lobbied state and federal governments for gun-law reform. Jeremy Richman, the father of a 6-year-old who died in the Sandy Hook Elementary School shooting, started the Avielle Foundation, a violence-prevention nonprofit named for his daughter, in the wake of her death, and as recently as this month, he spoke to students at Florida Atlantic University about how to identify and help people who might be at risk of violence to themselves or others. He told The Atlantic’s Isabel Fattal last year that his activism was a valuable outlet for the sorrow and anger he felt. “You feel like you’re not just broken but you’re missing something that’s part of you,” he said. “You have to find some meaning or action to move, to get out of bed.”

Richman took his own life on Monday, some six years after the shooting at Sandy Hook. For some, finding meaning after a tragedy doesn’t necessarily make it bearable; as many Americans have already learned in the wake of other mass shootings, even survivors and family members who outwardly seem to be coping may need social support and resources.

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