Parental perceptions of child and family mental health and behavioural adjustment following a mass school shooting in Serbia.

Parents without direct or indirect exposure to the 2023 Serbian school shooting reported high levels of concern for child safety afterward.

• The sample comprised 1,927 parents.
• 85.2% of parents reported moderate-to-high concern for child safety following the shooting.
• Parents were not directly or indirectly exposed to the event.

A substantial proportion of parents reported functional disruption and intrusive thoughts after the shooting.

• 38.7% reported marked difficulty sending children back to school.
• 48.0% reported difficulty controlling intrusive thoughts about child victimization.
• The authors conclude that mass school shootings may be associated with substantial parental distress and functional disruption even without direct or indirect exposure.

Most parents observed no emotional or behavioural changes in their children after the shooting.

• The authors state this should be interpreted as an absence of parent-observed changes rather than clinically defined resilience.
• The finding relies on parental report alone, with no clinical or child self-report assessment.

Children with pre-existing difficulties showed significantly higher rates of post-event worsening.

• The questionnaire assessed pre-event child mental health characteristics and support utilisation.
• The abstract reports the difference as significant but does not give specific statistics.

Mothers reported greater distress and impairment than fathers across all domains.

• The difference was reported across all assessed domains, including threat perception, emotional distress and functional disruption.
• Specific effect sizes are not given in the abstract.

Use of formal mental health services after the shooting was low.

• 3.8% of parents reported using formal services for their children.
• 2.9% reported using formal services for themselves.
• The authors note this supports the importance of accessible, non-stigmatising psychosocial support, particularly school-based psychoeducation, rather than formal clinical treatment alone.

Pre-event psychiatric diagnosis was present in a minority of children, and this rate was lower than epidemiological estimates.

• 11.7% of children had a psychiatric diagnosis before the shooting.
• The authors say the gap between epidemiological estimates and the low diagnosis rate raises concern about possible under-recognition of child mental health needs.

The authors caution that findings must be interpreted in light of methodological limitations.

• The study relies on parental report alone.
• Observed child changes cannot be equated with clinically defined resilience.