The authors conducted confirmatory factor analyses of reports of posttraumatic stress reactions using a national probability sample of individuals indirectly exposed to the terrorist attacks of September 11, 2001 (n = 675). Reactions at three time points in the year after the attacks were best accounted for by a lower-order, 4-factor solution (Reexperiencing, Strategic Avoidance, Emotional Numbing, and Hyperarousal Symptoms). Indirect exposure to a traumatic event appears to induce a response with a similar symptom structure as responses to direct exposure. [Author Abstract]

International terrorism has become a major global concern. Several studies conducted in North America and Europe in the aftermath of terrorist attacks reveal that international terrorism represents a significant short-term and long-term threat to mental health. In the present article, the authors clarify the concept and categories of terrorism and then present central findings from studies conducted in the United States and Europe, which mainly focus on negative impacts on mental health, such as emotional stress and PTSD. Furthermore, the authors outline experiments that focus on social interaction processes thought to be triggered by international terrorism and which are assumed to be related indirectly to mental health processes. Next, they highlight the potential positive outcomes on the resilience side, in line with the current theory on posttraumatic growth in adversity. Finally, theoretical and practical implications as well as limitations and future directions are discussed. [Author Abstract] KEY WORDS: international terrorism; mental health; posttraumatic stress; posttraumatic growth in adversity

BACKGROUND: PTSD is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. METHODS: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. RESULTS: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]). CONCLUSIONS: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events. [Author Abstract]

OBJECTIVES: We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study. METHODS: Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11. RESULTS: Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre-September 11 distress and drinking. CONCLUSIONS: The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm. [Author Abstract]

Assessing mental health needs following a disaster is important, particularly within high-risk groups such as first responders or individuals who found themselves directly caught up in the incident. Particularly following events involving widespread destruction, ingenuity and hard work are required to successfully study these issues. When considering responses among the general population following less devastating events such as a conventional terrorist attack, or following an event involving a chemical, biological, radiological or nuclear agent, other variables may become more relevant for determining the population's overall psychosocial well-being. Trust, perceived risk, sense of safety, willingness to take prophylaxis, and unnecessary attendance at medical facilities will all be important in determining the overall psychological, medical, economic, and political impact of such attacks. Assessing these variables can help government agencies and non-governmental organizations to adjust their communication and outreach efforts. As there is often a need to provide these data quickly, telephone surveys using short time-windows for data collection or which use quota samples are often required. It is unclear whether slower, more conventional, and more expensive survey methods with better response rates would produce results different enough to these quicker and cheaper methods to have a major impact on any resulting policy decisions. This empirical question would benefit from further study. [Author Abstract] KEY WORDS: general population reactions; aftermath; terrorist attack; chemical, biological, radiological, or nuclear terrorism (CBRN)

This article describes the development and implementation of an empirically-based disaster mental health training program (P-FLASH) developed by Washington University Department of Psychiatry researchers in response to a request from the September 11 Fund. While this training program and its derivatives not only provided training for thousands of health professionals assisting survivors of the 9/11 attacks in the New York City area, it also provided more general disaster mental health training to prepare professionals nationally. [Author Abstract]

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

This study finds that the issue of preventing terrorist attacks has received surprisingly little attention by decision-makers and the news media, and only sporadic interest by pollsters. When it comes to homeland security, how to protect the nation and its people from actual attacks takes a back seat to press coverage of threats and other aspects of terrorism, particularly the administration's arguments for fighting the "war on terrorism" abroad as a means to prevent further terrorism at home. This inattention to the difficult task of preventing further catastrophic terror attacks by taking measures at home may affect the nation's vigilance as time has passed since 9/11. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

The occurrence and impact of terrorist attacks can be dramatic and long lasting. Cognitive-behavioral interventions are effective in alleviating PTSD in survivors of rape, wartime combat, automobile accidents, and natural disasters. Effectiveness of such interventions on victims of terrorist attacks is in the early stages of research. On September 11, 2001, two hijacked planes crashed into the twin towers in New York City, killing approximately 2,750 people and emotionally and physically affecting thousands who witnessed or escaped the attack. This case study illustrates a course of 12 active prolonged exposure (PE) sessions for PTSD with a female survivor. After 15 sessions (3 of which were preparatory), the client improved 75%, as measured by a composite score of measures. Her reported quality of life had improved dramatically posttreatment and remained stable at 6-month follow-up. This cognitive-behavioral therapy intervention, with 15 office sessions and homework assignments for decreasing avoidances, is described and discussed. [Author Abstract] KEY WORDS: CBT; PTSD; prolonged exposure treatment; 9/11; terrorist attacks

Following the 2005 London bombings, a novel public health program was instituted to address the mental health needs of survivors. In this article, the authors describe the rationale for the program, characteristics of individuals assessed within the program, and preliminary outcome data. In addition to validated screening instruments and routine service usage data, standardized questionnaire outcome measures were collected. Seventy-one percent of individuals screened positive for a mental disorder. Of those receiving a more detailed clinical assessment, PTSD was the predominant diagnosis. Preliminary outcome data on 82 patients revealed large effect sizes for treatment comparable to those previously obtained in randomized controlled trials. The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)