OBJECTIVE: Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. METHOD: Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. RESULTS: The prevalence of PTSD related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. CONCLUSIONS: The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem. [Author Abstract]

To measure the psychological and emotional effects of the September 11, 2001, terrorist attacks on the World Trade Center (WTC), Connecticut, New Jersey, and New York added a terrorism module to their ongoing Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of the survey, which suggest widespread psychological and emotional effects in all segments of the three states' populations. The findings underscore the importance of collaboration among public health professionals to address the physical and emotional needs of persons affected by the September 11 attacks.

In this article, we have introduced the concept of shielding as a public mental health intervention. Shielding addresses the core elements of bioterrorism when we consider that bioterrorism is best understood as terrorism, i.e., psychological warefare, which merely employs biologic agents, not to kill, but to terrorize. It is, therefore, to some degree dependent upon widespread contagion. Shielding is not a panacea. It is one aspect of an overall response plan. Nevertheless, it represents a potentially useful "antidote" for the bioterrorist assault. Perhaps most significant among its putative mechanisms of action appears to be controlling contagion, both physical and psychological. In the final analysis, in the wake of a terrorist attack, physicians can physically immunize and treat those who require such attention. Engineers can reconstruct buildings and roads. But who rebuilds the essence of humanity which has been violently ripped away from those who suffered the terrorist attack? How do we reconstruct a belief in justice and safety in the wake of a mass terrorist attack? Without attention to mental health, i.e., the "psychological side of terrorism," we run the risk of rebuilding a nation without a spirit, without a vitality, without a sense of humanity.

Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of the clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and manmade disasters, war and polical violence, workplace homicide, and school shootings. This article reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attakcs. The article describes the psychological syndromes resulting from terrorism and discusses crisis intervention, individucal therapy, and family therapy modalities for treating victims of terror. Last, the role of mental health clinicians in the larger national and international response to terroristic trauma is highlighted. [Author Abstract]

Background The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. Methods We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. Results Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. Conclusions There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

1. Both biological and chemical weapons (BCW) could potentially be used in future terrorist attacks on U.S. workplaces and communities. 2. Threats of BCW terrorism may lead to anxiety, adverse health effects, and the exacerbation of psychiatric symptoms and syndromes in workers and managers. 3. Actual BCW attacks will likely cause both acute and chronic mental disorders in a significant number of surviving victims who may also be employees or employers. 4. Occupational health nurses can help prevent or remediate maladaptive psychological responses by educating themselves and their work forces, assisting in a risk assessment of the workplace, understanding disaster planning, and assisting management in policy formulation and psychosocial triage.

States that methodologically sound data are required to understand the mental health effects of terrorism and must guide all postdisaster mental health activities from clinical interventions to administrative policy. [Adapted from Text, p. 633]

The events of September 11, 2001, have underscored the mental health needs of youth and families, and amplified the advantages of proactively bringing a range of mental health services to them, where they are, in natural settings such as schools. Further, there is increasing momentum for the enhancement of coordinated and comprehensive school-based approaches that seek to effectively respond to significant crises such as terrorist attacks and disaster. This article explores key themes related to school mental health's response to terrorism and disaster. Following review of background literature on child and adult reactions to trauma, we discuss the development of crisis response teams, and present a range of strategies for schools to respond to crises and disaster. The experiences of one elementary school in responding to the events of September 11 are presented, followed by review of critical challenges facing schools and school mental health programs in improving their ability to respond to significant crises. [Author Abstract] KEY WORDS: Terrorism; disaster; trauma; September 11; crisis

The author reports the different types of debriefing which have been carried out to the USS Cole American sailors, victims of a terrorist attempt on October 12, 2000 in the Gulf of Aden. He describes the intervention of the psychiatric teams (American and French) and their different psychological approach, immediate and post-immediate, of traumatized people. [Author Summary] KEY WORDS: debriefing, terrorism, psychiatry

Exposure to graphic television images may exacerbate psychological symptoms in disaster situations. We tested the hypotheses that (1) more frequent viewing of television images of the September 11 terrorist attacks was associated with PTSD and depression, and that (2) direct exposure to disaster events had an interactive effect with media viewing. We recruited 1,008 adult residents of the borough of Manhattan in New York City through a random-digit-dial telephone survey conducted between October 16 and November 15, 2001. Respondents who repeatedly saw "people falling or jumping from the towers of the World Trade Center" had higher prevalence of PTSD (17.4%) and depression (14.7%) than those who did not (6.2% and 5.3%, respectively). Among respondents who were directly affected by the attacks (e.g., had a friend killed), those who watched this television image frequently were more likely to have PTSD and depression than those who did not. Among respondents not directly affected by the attacks, prevalence of PTSD and depression was not associated with frequency of television image viewing. Specific disaster-related television images were associated with PTSD and depression among persons who were directly exposed to a disaster. Future research should address causal directionality of this association. [Author Abstract]