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U.S. school shootings rose in frequency over the last 25 years and reached their highest recorded levels, data analyses showed.

Across the 1997-1998 to 2021-2022 school years, there were 1,453 shootings, according to Luke Rapa, PhD, of Clemson University in South Carolina, and colleagues. The number of shootings ranged from a low of 15 in the 2009-2010 school year to a high of 328 in 2021-2022.

In the last 5 years of the study period, there were 794 school shootings -- 135 more than the number of shootings that occurred in the previous 15 years combined, they reported in .

"Gun violence in the United States is a public health crisis, with severe consequences for the nation's youth," Rapa and colleagues wrote.

"Children and adolescents directly exposed to violence and crime face a host of ancillary challenges, including drug and alcohol use and abuse, depression, anxiety, posttraumatic stress disorder, school failure, and involvement in criminal activity," they added. "Moreover, youth indirectly exposed are peripherally impacted through extensive media coverage of school shootings and school mass shootings; this leads to more people suffering the effects of these tragedies, with resultant outcomes tied to worsened mental health consequences among members of communities in which gun violence occurs."

Gun injury became the leading cause of death among children from birth to 19 years of age in 2019. In 2020, the U.S. was the only country among its higher-income peers that saw guns as the leading cause of death among children and adolescents.

Mass school shootings have not increased over the last 25 years, Rapa and colleagues noted, but they have become deadlier.

Across the 1997-1998 to 2021-2022 school years, there were 11 mass shootings in which 122 people were killed and 126 were injured. A mass shooting occurred in eight of the 25 school years examined, with two mass shootings happening in three of those years.

The greatest number of fatalities and injuries from mass shootings combined was in the 2017-2018 year, with 27 fatalities and 30 injuries. The 2021-2022 year had the second highest number, with 25 fatalities and 24 injuries. The most recent 10 years of the study period had more fatalities and injuries (141) than the previous 15 years (107).

On average, there were 7.6 fatalities per mass shooting event from 1997-1998 to 2011-2012, compared with 14.0 fatalities per event from 2012-2013 to 2021-2022.

In an , Rebecca Bell, MD, MPH, of the University of Vermont Children's Hospital in Burlington, pointed out that the mass shooting at Colorado's Columbine High School occurred 25 years ago.

"Since that time, billions of dollars have been poured into school security efforts," Bell wrote. Despite this, "school-related gun incidents are growing, and the fatality rate of school mass shootings has increased," she observed.

"The data are clear that these tragedies cannot be prevented by focusing on school security alone," Bell added. "Schools are extensions of our homes and communities and cannot be expected to be secure fortresses amid the easy availability of firearms. Pediatricians' efforts to make homes and communities safer also make schools safer. Intensifying our counseling and community collaboration efforts and advocating for research funding and policy change are critical measures to stem the tide of increasing gun violence in schools."

Rapa and co-authors analyzed school shooting information from the Center for Homeland Defense and Security's . Data on school mass shootings were collected from the , developed by the Mother Jones news organization.

"Two noteworthy challenges that exist when studying school shootings and school mass shootings are the lack of a central or unified database that contains all incidents of gun violence in the United States, and the varied definitions used, within disparate databases, for what constitutes respective data points -- for example, what counts as a school shooting or a school mass shooting," Rapa and co-authors noted.

In their study, a school shooting was defined as each instance in which a gun was brandished, fired, or when a bullet hit school property for any reason. A school mass shooting was defined as one in which three or more victims were killed. Shootings that occurred before January 2013 were counted if four or more victims were killed, based on the definition at the time.

Databases used in the study were compiled directly from media reports and other publicly available information, which was a limitation, the researchers acknowledged. Accordingly, "there is certainly the potential for undercounting the number of school-related gun violence incidents that occurred each year," they wrote.

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