{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:59:55Z","timestamp":1785347995677,"version":"3.55.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Mass casualty events (MCE), such as campus shootings, can severely impact the mental health of students, faculty, and staff. This study examined the psychological effects of an MCE at a minority-serving institution and explored how sense of belonging, cardiorespiratory fitness, and treatment preferences influenced recovery. To measure the impact of the MCE on mental health an anonymous survey was administered four to five months post-MCE to university students, faculty and staff. Within the survey, participants were asked to retrospectively report their depression (PHQ-9) and anxiety (GAD-7) symptoms as they recalled them two weeks prior to the MCE\n                    <jats:bold>,<\/jats:bold>\n                    and as they experienced them in the two weeks preceding survey completion. The survey also included current measures of sense of belonging (SBS), perceived discrimination (PEDQ), estimated cardiorespiratory fitness (eCRF), and intervention preference to cope with the impacts of the MCE. Participants reported significant perceived increases in PHQ-9 and GAD-7 scores from the pre-MCE recall to current time-periods. Increases in depression (PHQ-9 scores) from pre-MCE to recent recall were larger among respondents with lower pre-MCE anxiety (GAD-7 scores), higher perceived discrimination (PEDQ), and those currently receiving treatment for anxiety or depression; respondents not receiving treatment showed no significant change. Among students, lower belonging scores were associated with greater increases in depression. Neither belonging nor perceived discrimination were strongly linked to individual variables, indicating their multifactorial nature. Most participants reported a preference to learning about alternative interventions such as exercise or meditation over pursuing university counseling services.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0353453","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:21:53Z","timestamp":1785345713000},"page":"e0353453","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Supporting recovery: Intersections of health, belonging, and help seeking after a campus mass casualty event"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2684-4466","authenticated-orcid":true,"given":"Sharon","family":"Jalene","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Ciccotelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9002-1375","authenticated-orcid":true,"given":"Lauren","family":"Gatto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9160-5536","authenticated-orcid":true,"given":"Jaime","family":"Carbajal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8705-3759","authenticated-orcid":true,"given":"Andrew","family":"Hooyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"pone.0353453.ref001","author":"L Welding"},{"issue":"1","key":"pone.0353453.ref002","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1146\/annurev-clinpsy-081122-010256","article-title":"Epidemiology of Mass Shootings in the United States","volume":"20","author":"JK Peterson","year":"2024","journal-title":"Annu Rev Clin Psychol"},{"key":"pone.0353453.ref003","unstructured":"Investigative Assistance for Violent Crimes Act of 2012. 6&nbsp;U.S.C. 455. 2012."},{"key":"pone.0353453.ref004","author":"EB Wolfe"},{"issue":"3","key":"pone.0353453.ref005","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s11920-021-01222-2","article-title":"Effects of Mass Shootings on the Mental Health of Children and Adolescents","volume":"23","author":"V Cimolai","year":"2021","journal-title":"Curr Psychiatry Rep"},{"key":"pone.0353453.ref006","article-title":"School Shootings in the United States: 1997-2022","volume":"153","author":"LJ Rapa","year":"2024","journal-title":"Pediatrics"},{"issue":"3","key":"pone.0353453.ref007","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jpsychires.2012.11.015","article-title":"A systematic review of studies of depression prevalence in university students","volume":"47","author":"AK Ibrahim","year":"2013","journal-title":"J Psychiatr Res"},{"issue":"4","key":"pone.0353453.ref008","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1080\/07448481.2021.1920954","article-title":"Depression and anxiety among college students: Understanding the impact on grade average and differences in gender and ethnicity","volume":"71","author":"A Asher BlackDeer Msw PhD Candidate","year":"2023","journal-title":"J Am Coll Health"},{"key":"pone.0353453.ref009","first-page":"1","volume-title":"The Healthy Minds Study 2023-2024","author":"D Eisenberg","year":"2024"},{"key":"pone.0353453.ref010","author":"NIMH"},{"issue":"4","key":"pone.0353453.ref011","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1037\/0002-9432.77.4.534","article-title":"Prevalence and correlates of depression, anxiety, and suicidality among university students","volume":"77","author":"D Eisenberg","year":"2007","journal-title":"Am J Orthopsychiatry"},{"issue":"5","key":"pone.0353453.ref012","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1207\/s15327752jpa4905_10","article-title":"An analysis of anxiety and depression scales","volume":"49","author":"KS Dobson","year":"1985","journal-title":"J Pers Assess"},{"key":"pone.0353453.ref013","volume-title":"ProQuest. Clinical handbook of psychological disorders: a step-by-step treatment manual, Sixth edition","author":"DH Barlow","year":"2021"},{"issue":"4","key":"pone.0353453.ref014","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1007\/s10900-020-00918-5","article-title":"Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order","volume":"46","author":"C Coughenour","year":"2021","journal-title":"J Community Health"},{"key":"pone.0353453.ref015","doi-asserted-by":"crossref","first-page":"480","DOI":"10.4103\/jehp.jehp_1421_20","article-title":"Depression, fitness, and student willingness to pursue university counseling and alternative antidepressant options","volume":"10","author":"S Jalene","year":"2021","journal-title":"J Educ Health Promot"},{"key":"pone.0353453.ref016","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.4598","article-title":"Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials","volume":"6","author":"R Winzer","year":"2018","journal-title":"PeerJ"},{"key":"pone.0353453.ref017","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-075847","article-title":"Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials","volume":"384","author":"M Noetel","year":"2024","journal-title":"BMJ"},{"key":"pone.0353453.ref018","first-page":"1","article-title":"A systematic review of the effectiveness of physical activity interventions for improving mental health and wellbeing in university students","author":"F Malagodi","year":"2025","journal-title":"J Coll Stud Ment Health"},{"key":"pone.0353453.ref019","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.3389\/fphys.2019.01191","article-title":"Estimated Cardiorespiratory Fitness Is Associated With Reported Depression in College Students","volume":"10","author":"S Jalene","year":"2019","journal-title":"Front Physiol"},{"issue":"7","key":"pone.0353453.ref020","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1080\/07448481.2021.1954012","article-title":"Perceived racial\/ethnic discrimination among young adult college students: Prevalence rates and associations with mental health","volume":"71","author":"AJ Bravo","year":"2023","journal-title":"J Am Coll Health"},{"key":"pone.0353453.ref021","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s10943-018-0684-1","article-title":"Perceived discrimination and major depression and generalized anxiety symptoms: In Muslim American college students","volume":"58","author":"SR Lowe","year":"2019","journal-title":"J Relig Health"},{"key":"pone.0353453.ref022","article-title":"Emotional Intelligence, Belongingness, and Mental Health in College Students","author":"WM Robert","year":"2020","journal-title":"Front Psychol"},{"issue":"7","key":"pone.0353453.ref023","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1177\/09567976211073135","article-title":"Lack of Belonging Predicts Depressive Symptomatology in College Students","volume":"33","author":"JM Dutcher","year":"2022","journal-title":"Psychol Sci"},{"key":"pone.0353453.ref024","doi-asserted-by":"crossref","first-page":"37196","DOI":"10.1007\/s12144-024-07099-7","article-title":"Perceived racism and well-being in university racial\/ethnic minority students: the complex roles of racial\/ethnic identity and self-esteem","volume":"43","author":"Y Hu","year":"2024","journal-title":"Curr Psychol"},{"issue":"4","key":"pone.0353453.ref025","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1037\/1099-9809.14.4.326","article-title":"The impact of perceived racial discrimination on the mental health of Asian American and Latino college students","volume":"14","author":"W-C Hwang","year":"2008","journal-title":"Cult Divers Ethn Min Psychol"},{"issue":"6","key":"pone.0353453.ref026","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.1080\/07448481.2023.2286462","article-title":"Perceived discrimination and mental health outcomes in college students: the mediating effect of preventive health behaviors and social support","volume":"73","author":"SCM Morton","year":"2025","journal-title":"J Am Coll Health"},{"key":"pone.0353453.ref027","volume-title":"College students\u2019 sense of belonging: A key to educational success for all students","author":"TL Strayhorn","year":"2019","edition":"2"},{"issue":"1","key":"pone.0353453.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/07448481.2011.552537","article-title":"A comparative study of campus experiences of college students with mental illnesses versus a general college sample","volume":"60","author":"MS Salzer","year":"2012","journal-title":"J Am Coll Health"},{"issue":"6","key":"pone.0353453.ref029","doi-asserted-by":"crossref","first-page":"276","DOI":"10.3200\/JACH.53.6.276-284","article-title":"Social support and physical health: the importance of belonging","volume":"53","author":"CJ Hale","year":"2005","journal-title":"J Am Coll Health"},{"key":"pone.0353453.ref030","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/1078390316648777","article-title":"American college students\u2019 views of depression and utilization of on-campus counseling services","volume":"22","author":"N D\u2019Amico","year":"2016","journal-title":"J Am Psychiatr Nurses Assoc"},{"issue":"2","key":"pone.0353453.ref031","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1080\/07448481.2011.619611","article-title":"Help seeking and treatment use among suicidal college students","volume":"60","author":"MF Downs","year":"2012","journal-title":"J Am Coll Health"},{"key":"pone.0353453.ref032","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1559-1816.2005.tb02124.x","article-title":"The Perceived Ethnic Discrimination Questionnaire: Development and Preliminary Validation of a Community Version","volume":"35","author":"E Brondolo","year":"2005","journal-title":"J Appl Soc Psychol"},{"issue":"11","key":"pone.0353453.ref033","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1249\/MSS.0b013e31821d3f6f","article-title":"Estimating V\u00b7O 2peak from a nonexercise prediction model: the HUNT Study, Norway","volume":"43","author":"BM Nes","year":"2011","journal-title":"Med Sci Sports Exerc"},{"issue":"18","key":"pone.0353453.ref034","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and utility of a self-report version of prime-md: The phq primary care study","volume":"282","author":"RL Spitzer","year":"1999","journal-title":"JAMA"},{"issue":"10","key":"pone.0353453.ref035","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"1","key":"pone.0353453.ref036","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/1520-6807(199301)30:1<79::AID-PITS2310300113>3.0.CO;2-X","article-title":"The psychological sense of school membership among adolescents: Scale development and educational correlates","volume":"30","author":"C Goodenow","year":"1993","journal-title":"Psychol Schools"},{"issue":"6","key":"pone.0353453.ref037","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1249\/MSS.0000000000000219","article-title":"A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality","volume":"46","author":"BM Nes","year":"2014","journal-title":"Med Sci Sports Exerc"},{"issue":"4","key":"pone.0353453.ref038","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s12187-016-9414-y","article-title":"Initial development and validation of the school belongingness scale","volume":"10","author":"G Arslan","year":"2017","journal-title":"Child Ind Res"},{"issue":"2","key":"pone.0353453.ref039","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.mayocp.2016.10.007","article-title":"Prediction of Cardiovascular Mortality by Estimated Cardiorespiratory Fitness Independent of Traditional Risk Factors: The HUNT Study","volume":"92","author":"J Nauman","year":"2017","journal-title":"Mayo Clin Proc"},{"issue":"3","key":"pone.0353453.ref040","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4300\/JGME-D-12-00156.1","article-title":"Using Effect Size-or Why the P Value Is Not Enough","volume":"4","author":"GM Sullivan","year":"2012","journal-title":"J Grad Med Educ"},{"issue":"4","key":"pone.0353453.ref041","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1111\/j.1744-6155.2011.00301.x","article-title":"Relationships between physical activity and depressive symptoms among middle and older adolescents: a review of the research literature","volume":"16","author":"KE Johnson","year":"2011","journal-title":"J Spec Pediatr Nurs"},{"key":"pone.0353453.ref042","doi-asserted-by":"crossref","DOI":"10.3402\/ejpt.v5.25339","article-title":"Resilience after trauma: from surviving to thriving","volume":"5","author":"NR Nugent","year":"2014","journal-title":"Eur J Psychotraumatol"},{"key":"pone.0353453.ref043","volume-title":"Psychological First Aid: Field Operations Guide","author":"M Brymer","year":"2006","edition":"2"},{"key":"pone.0353453.ref044","doi-asserted-by":"crossref","first-page":"1385639","DOI":"10.3389\/fpubh.2024.1385639","article-title":"Study on anxiety, depression, and sleep conditions and their interrelations among vocational college students during the COVID-19 pandemic management normalization","volume":"12","author":"R Gao","year":"2024","journal-title":"Front Public Health"},{"issue":"47","key":"pone.0353453.ref045","article-title":"Comparative efficacy of seven exercise interventions for symptoms of depression in college students: A network of meta-analysis","volume":"99","author":"S Guo","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"pone.0353453.ref046","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jpsychires.2016.02.023","article-title":"Exercise as a treatment for depression: A meta-analysis adjusting for publication bias","volume":"77","author":"FB Schuch","year":"2016","journal-title":"J Psychiatr Res"},{"key":"pone.0353453.ref047","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jad.2024.10.039","article-title":"Association between 24-hour movement behavior and depression in college students: A compositional data analysis","volume":"369","author":"Z Huang","year":"2025","journal-title":"J Affect Disord"},{"key":"pone.0353453.ref048","article-title":"The effect of physical exercise on depression among college students: a systematic review and meta-analysis","volume":"12","author":"H Zhang","year":"2024","journal-title":"PeerJ"},{"issue":"1","key":"pone.0353453.ref049","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1590\/1517-8692202228012021_0489","article-title":"Physical activity in the treatment of depression in college students","volume":"28","author":"X He","year":"2022","journal-title":"Rev Bras Med Esporte"},{"key":"pone.0353453.ref050","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1037\/rev0000394","article-title":"Mood-congruent memory revisited","volume":"130","author":"L Faul","year":"2023","journal-title":"Psychol Rev"},{"key":"pone.0353453.ref051","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/0272-7358(92)90116-P","article-title":"Mood-congruent recall of affectively toned stimuli: A meta-analytic review","volume":"12","author":"GE Matt","year":"1992","journal-title":"Clin Psychol Rev"},{"key":"pone.0353453.ref052","doi-asserted-by":"crossref","DOI":"10.1177\/21582440251389262","article-title":"Comparing self-reported symptoms of anxiety and depression among Canadian post-secondary students to the general Canadian population during the COVID-19 pandemic: A national repeated cross-sectional trend analysis","volume":"15","author":"A Ecclestone","year":"2025","journal-title":"Sage Open"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353453","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:22:01Z","timestamp":1785345721000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353453"}},"subtitle":[],"editor":[{"given":"Jiaci","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353453","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}