Adequate preparedness for acts of terrorism and mass violence requires a thorough understanding of the postdisaster mental health needs of all exposed groups, including those watching such events from a distance. This study examined emergency psychiatric treatment-seeking patterns following media exposure to four national terrorist or mass casualty events. An event was selected for study if (a) it precipitated local front-page headlines for >5 consecutive days and (b) emergency service psychiatrists identified it as specifically precipitating help-seeking in the study hospital. Four events qualified: the Oklahoma City bombing (1995), the Columbine High School (1999) and Wedgewood Baptist Church (1999) shootings and the terrorist attacks of September 11, 2001. Time-series analyses were used to correct for autocorrelation in visit patterns during the postdisaster week, and equivalent time periods from years before and after each event were used as control years. Overall, disaster week census did not differ significantly from predisaster weeks, although 3-day nonsignificant decreases in visit rate were observed following each disaster. Treatment-seeking for anxiety-related issues showed a nonsignificant increase following each disaster, which became significant in the "all disaster" model (t=5.17; P=.006). Intensity of media coverage did not impact rate of help-seeking in any analysis. Although these sentinel US disasters varied in scope, method, geographic proximity to the study site, perpetrator characteristics, public response, sequelae and degree of media coverage, the extent to which they impacted emergency department treatment-seeking was minimal. Geographically distant mass violence and disaster events of the type and scope studied here may require only minimal mental health "surge capacity" in the days following the event. Copyright © 2011 Elsevier Inc. All rights reserved.

Terrorist attacks combine features of a criminal assault, a mass casualty disaster, and an act of war. Accordingly, this article presents a model for prevention, response, and recovery from the psychological impact of a terror attack. The nature of terrorism is delineated and the various psychological effects are described, including diagnostic clinical syndromes, as well as individual reactions. Interventions in the immediate aftermath of a terrorist attack include on-scene crisis intervention, short-term psychological stabilization, and longer-term psychotherapeutic approaches. Special techniques are described for individuals, families, children, and large groups of survivors and responders. Finally, the ways that mental health clinicians can serve as valuable consultants to community recovery efforts are discussed. [Author Abstract] KEY WORDS: crisis intervention; mass casualty psychology; psychology of terrorism; September 11 anniversary; terrorism; trauma therapy

OBJECTIVE: The aim of this study was to prospectively examine the long-term course of psychiatric disorders, symptoms, and functioning among 113 directly exposed survivors of the Oklahoma City bombing systematically assessed at 6 months and again nearly 7 years postbombing. METHODS: The Diagnostic Interview Schedule/Disaster Supplement was used to assess predisaster and postdisaster psychiatric disorders and symptoms and other variables of relevance to disaster exposure and outcomes. RESULTS: Total prevalence of PTSD was 41%. 7 years postbombing, 26% of the sample still had active PTSD. Delayed-onset PTSD and new postdisaster alcohol use disorders were not observed. PTSD nonremission was predicted by the occurrence of negative life events after the bombing. Posttraumatic symptoms among survivors without PTSD decayed more rapidly than for those with PTSD, and symptoms remained at 7 years even for many who did not develop PTSD. Those with PTSD reported more functioning problems at index than those without PTSD, but functioning improved dramatically over 7 years, regardless of PTSD or remission from PTSD. No survivors had long-term employment disability based on psychiatric problems alone. CONCLUSIONS: These findings have potentially important implications for anticipation of long-term emotional and functional recovery from disaster trauma. [Author Abstract]

This article reports on the American public's perceptions of terrorist threats in the post-9/11 era. It presents poll data from September 11, 2001, to the early months of 2010. The report addresses issues including the importance of terrorism as an issue facing the country; concern about terrorist attacks over different time horizons and in different places; the effect of terrorism on respondents personally; and approval of the President and his administration's handling of terrorism. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Background: Smoking is one of the varied psychological reactions to stress. This study examined the rate and changes in cigarette smoking among former Gaza and current West Bank Jewish settlers subjected to direct and indirect terrorist attacks during the Al-Aksa Intifada. The relationship with degree of religious observance and emotional distress was explored as well. Methods: In this cross-sectional study, the respondents were settlers randomly selected and interviewed by telephone ( N = 706). The interview schedule included socio-demographic items, information on direct exposure to terrorist attacks (e.g. threat to life or physical integrity, personal losses, property damage) and on steady and changes in smoking habits, and a scale to measure emotional distress. Results: In contrast with the country population, a larger percentage of settlers who smoked increased the number of cigarettes consumed with exposure to terrorism (10 and 27%, respectively). Respondents who were injured or had their home damaged reported a higher rate of smoking during the preceding year (30 and 20%, respectively). Emotional distress was related to cigarette smoking, but not in the controlled analysis. Religious observance had no effect. Conclusion: Direct or indirect exposure to terrorist attacks had an impact on smoking prevalence rates and on changes in smoking habits. Studies investigating reactions to traumatic events should include a detailed section on smoking while mental health interventions should address the needs of smokers. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

A repeat-length polymorphism of the serotonin promoter gene (5-HTTLPR) has been associated with depression and posttraumatic stress disorder (PTSD) in trauma-exposed individuals reporting unsupportive social environments. We examine the contributions of the triallelic 5-HTTLPR genotype and social constraints to posttraumatic stress (PTS) symptoms in a national sample following the September 11, 2001 (9/11) terrorist attacks. Saliva was collected by mail from 711 respondents (European American subsample n = 463) of a large national probability sample of 2,729 adults. Respondents completed web-based assessments of pre-9/11 mental and physical health, acute stress 9 to 23 days post-9/11, PTS symptoms, and social constraints on disclosure regarding fears of future terrorist attacks 2'“3 years post-9/11. Social constraints were positively associated with PTS symptoms 2'“3 years post-9/11. The triallelic 5-HTTLPR genotype was not directly associated with PTS symptoms, but it interacted with social constraints to predict PTS symptoms 2-3 years post-9/11: Social constraints were more strongly associated with PTS symptoms for individuals with any s/lg allele than for homozygous la/la individuals. Constraints on disclosing fears about future terrorism moderate the 5-HTTLPR genotype-PTS symptom association even when indirectly exposed to collective stress. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Many studies attempt to gauge population prevalence of PTSD following a major catastrophe. However, little is known about the validity of these estimates in the increasingly common situation of ongoing trauma. During the period of the Second Intifada in Israel, which involved frequent and widespread terrorist attacks, several studies generated estimates of PTSD prevalence in the Israeli population, but yielded widely discrepant findings. A number of focused surveys using symptom checklists estimated population prevalence of PTSD or probable PTSD diagnosis at about 9%. However a large population health study conducted during this same time period using a structured diagnostic interview yielded a very low estimated prevalence of PTSD (0.5%). We examine methodological differences that might account for these striking discrepancies. Inherent limitations of both checklist and structured interview methods may be especially problematic in the context of ongoing trauma. Findings regarding PTSD and associated factors obtained during ongoing trauma should be interpreted with caution. [Author Abstract] KEY WORDS: trauma; PTSD; ongoing; terrorism; prevalence; diagnosis

This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1'“2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

Man-made disasters such as acts of terrorism may affect a society's resiliency and sensitivity to prolonged physical and psychological stress. The Israeli Tel Aviv stock market TA-100 Index was used as an indicator of reactivity to suicide terror bombings. After accounting for factors such as world market changes and attack severity and intensity, the analysis reveals that although Israel's financial base remained sensitive to each act of terror across the entire period of the Second Intifada (2000-06), sustained psychological resilience was indicated with no apparent overall market shift. In other words, we saw a 'normalisation of terror' following an extended period of continued suicide bombings. The results suggest that investors responded to less transitory global market forces, indicating sustained resilience and long-term market confidence. Future studies directly measuring investor expectations and reactions to man-made disasters, such as terrorism, are warranted. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

BACKGROUND: Few longitudinal studies have examined the trajectory of and the risk factors for depression in a representative sample of the population exposed to terrorism. A 12 month prospective study was conducted among a sample of Madrid city residents after the March 11, 2004 terrorist attacks. We aimed to document the trajectories of depressive symptoms and determine the risk factors associated with these trajectories. METHODS: We conducted telephone surveys among a representative sample of Madrid citizens (N = 1,589) to recruit baseline respondents approximately 1 month after the March 11 terrorist attacks. Participants were re-contacted at 6 and 12 months after baseline for further telephone interviews. RESULTS: Findings reveal heterogeneity in the longitudinal trajectories of depression ranging from the absence of depressive symptoms over time, to transient or chronic depression. Life and recent stressors, experiencing direct exposure to the attacks, personality traits, poor physical health, and other psychological disorders were principally associated with a worse trajectory of depression after this event. [Author Abstract] KEY WORDS: depression; trajectories; terrorism; disaster; mental health