OBJECTIVE: The World Trade Center disaster was of unprecedented magnitude and impact in U.S. history. The authors conducted a pilot survey investigating these effects. METHOD: A questionnaire regarding the disaster was sent to responders to an advertisement. It included demographic and disaster-exposure questions and three scales applied to "during and shortly after" the disaster. RESULTS: Despite widely ranging exposure, scores for distress (Peritraumatic Distress Inventory), dissociation (Peritraumatic Dissociative Experiences Questionnaire), and posttraumatic stress (Impact of Event Scale-Revised) were markedly elevated (N = 75). After covariance for exposure, the distress factor of loss of control most strongly predicted both early dissociation and posttraumatic stress. Life threat specifically contributed to arousal. Dissociation did not contribute beyond distress to posttraumatic stress, with the exception of re-experiencing. CONCLUSIONS: This survey of reactions to the World Trade Center disaster revealed high levels of early symptoms and suggested similar but independent pathways toward dissociation and posttraumatic stress. [Author Abstract]

This study examined a convenience sample of 562 Nairobi school children exposed to the 1998 bombing of the American Embassy in Nairobi, Kenya. Posttraumatic stress reactions to the bombing were related to posttraumatic stress reactions to other trauma and to peritraumatic reaction. Self-reported functional impairment was minimal. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

To assess medication use in New York after the September 11th attacks, a telephone survey was conducted in October 2001 (N = 1,008). The prevalence of psychiatric medication use 30 days before the disaster was 8.9 and 11.6% 30 days after, a small but significant increase. The most important factor predicting postdisaster use was predisaster use -- 92% of those who used medications postdisaster used them predisaster. In addition, 3.3% used psychiatric medications 30 days postdisaster, but not 30 days before. Those who had panic attacks, PTSD, and insurance coverage, were the most likely medicated (26.5%). However, among those who used postdisaster medications (n = 129), new users tended to be those with panic attacks (44.1%) and those with panic attacks and PTSD (69.2%). [Author Abstract] KEY WORDS: pharmaceuticals, PTSD, disasters, panic attack, service utilization

With the increase in terrorism in several parts of the world, more people are exposed to traumatic events that could cause psychiatric injury either to them or to members of their families. In Britain, terrorist attacks or other catastrophes are not unknown; indeed, the case law relating to psychiatric injury is vast. However, the intersection between medicine and the law is minimal. The result is a law that lags behind the scientific evidence and, on occasion, may seem unfair. [Author Abstract]

OBJECTIVE: Posttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11. MATERIALS AND METHODS: The authors performed a random digit dial telephone survey of adults in the New York City (NYC) metropolitan area 6 to 9 months after September 11, 2001. 2755 demographically representative adults including 364 asthmatics were recruited. The authors assessed self-reported asthma symptom severity, emergency room (ER) visits, and unscheduled physician office visits for asthma since September 11. RESULTS: After adjustment for asthma measures before September 11, demographics, and event exposure in multivariate models PTSD were a significant predictor of self-reported moderate-to-severe asthma symptoms (OR = 3.4; CI = 1.2-9.4), seeking care for asthma at an ER since September 11 (OR = 6.6; CI = 1.6-28.0), and unscheduled physician visits for asthma since September 11 (OR = 3.6; CI = 1.1-11.5). The number of PTSD symptoms was also significantly related to moderate-to-severe asthma symptoms and unscheduled physician visits since September 11. Neither a panic attack on September 11 nor depression since September 11 was an independent predictor of asthma severity or utilization in multivariate models after September 11. CONCLUSIONS: PTSD related to the September 11 terrorist attacks contributed to symptom severity and the utilization of urgent health care services among asthmatics in the NYC metropolitan area. [Author Abstract] KEY WORDS: asthma; disaster; mental health; posttraumatic stress

The September 11th terrorist attack in New York City is an event that will live on in history. Its occurrence has impacted the world forever. As a psychologist who has given mental health support at disaster sites around the country and the world, most recently at Ground Zero and the Family Assistance Center after 9/11, and who has heard many tragic stories as a radio call-in advice host for over twenty years, nothing can compare to the experiences, feelings, and consequences of 9/11. In this paper, I reflect upon that event, and terrorism in general, as it impacted my personal and professional life, and explore the relevance of some fundamental, as well as newer psychological principles with regard to helping people cope with terrorism. [Author Introduction]

To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases. Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors' institutions (pediatric triage); and (3) Israel Trauma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate. During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources. During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5-10 minutes in urban areas and 15-20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained "first-responders" and volunteer, off-duty professionals, in addition to "scoop and run" on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by fo

The authors investigated trends in probable PTSD prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population. [Author Abstract] KEY WORDS: disasters; disease progression; PTSD; terrorism

Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article.

A purported pathogenic mechanism for the development of fibromyalgia, a medically unexplained syndrome involving widespread pain, is stress and associated psychiatric disorder. The major stressor of recent World Trade Center terrorist attacks provides a natural experiment for evaluating this mechanism. This study sought to determine whether symptoms consistent with fibromyalgia increased post-September 11 and whether exposure to specific terrorism-related events or prior depression predicted symptom increase. In a large community sample of women in the New York/New Jersey metropolitan area (n = 1312), a cohort initially surveyed for pain and psychiatric symptoms before September 11th were recontacted approximately 6 months after the attacks to assess current symptoms and specific terrorism-related exposures. 'Fibromyalgia-like' (FM-L) four-quadrant pain reports consistent with a diagnosis of fibromyalgia were compared at baseline and follow-up. Result showed that FM-L rates did not increase significantly between baseline and post-attack follow-up. Event exposure did not relate to FM-L onset at follow-up, nor did depressive symptoms at baseline interact with event exposure. Depressive symptoms did not predict new onsets better than the extent of their comorbidity with FM-L at baseline. The failure to detect a significant increase in symptoms consistent with a diagnosis of fibromyalgia and the failure of new onsets of such symptoms to be accounted for by exposure to major stressors or prior depressive symptoms suggests that these hypothesized risk factors are unlikely to be of major importance in the pathogenesis of fibromyalgia. [Author Abstract] KEY WORDS: fibromyalgia; World Trade Center terrorist attacks; community survey; stress; depression