Cho was a South Korean national who had permanent resident status in the United States, where he arrived at age eight with his family. He was diagnosed with a severe anxiety disorder known as selective mutism in middle school, as well as major depressive disorder. After this diagnosis he began to receive treatment and he continued receiving therapy and special education support until his junior year of high school. During Cho's last two years at Virginia Tech, several instances of his aberrant behavior, as well as plays and other writings he submitted containing references to violence, caused concern among teachers and classmates.
In the aftermath of the Virginia Tech massacre, Virginia Governor Tim Kaine convened a panel consisting of various officials and experts to investigate and examine the response and handling of issues related to the shootings. The panel released its final report in August 2007, devoting more than 30 pages to detailing Cho's troubled history. In the report, the panel criticized the failure of the educators and mental health professionals who came into contact with Cho during his college years to notice his deteriorating condition and help him. The panel also criticized misinterpretations of privacy laws and gaps in Virginia's mental health system and gun laws. In addition, the panel faulted Virginia Tech administrators in particular for failing to take immediate action after the first shootings.
Cho and his family lived in a basement apartment in Seoul, South Korea. Cho's father was self-employed as a bookstore owner, but made minimum wages from the venture. Seeking economic opportunity, Cho's father immigrated to the United States in September 1992 with his wife and three children. Cho was eight years old at the time. The family first lived in Detroit, then moved to the Washington metropolitan area after learning that it had the largest Korean population in the country. Cho's family settled in Centreville, an unincorporated community in western Fairfax County, Virginia about 25 miles (40 km) west of Washington, D.C.. Cho's father and mother opened a dry-cleaning business in Centreville. After the family moved to Centreville, Cho and his family became permanent residents of the United States as South Korean nationals. His parents became members of a local Christian church, and Cho himself was raised as a member of the religion. Although he "railed against his parents' strong Christian faith." According to one report, Cho Seung-Hui had left a note in his dormitory which contains a rant against Christianity and "rich kids". He stated that ""Thanks to you I died like Jesus Christ, to inspire generations of the weak and defenseless people."