OBJECTIVE: Several studies have provided prevalence estimates of PTSD related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. METHODS: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the DSM-IV-TR. RESULTS: The direct exposure zone was largely concentrated within a radius of 0.1 miles and completely contained within 0.75 miles of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. CONCLUSIONS: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical as

As a consequence of a terrorist attack, children may experience trauma-related internal and external reminders that are directly linked to their physical and psychological health. We assessed PTSD and trauma reminders in 58 school-age children three years after the terrorist attack in Beslan, Russia in 2004, as well as their association with degree of exposure, psychological distress, and coping. Findings revealed a prevalence of situational trauma reminders associated with high levels of distress in more exposed children. The presence of PTSD was predicted by level of exposure to the attack, frequency of exposure to trauma reminders, and support seeking as a coping strategy. Findings are discussed in light of the socio-political climate in Beslan and distress experienced by the population three years after the attack. [Author Abstract] KEY WORDS: post traumatic stress symptoms; trauma reminders; terrorism; children; Beslan; Russia

OBJECTIVE: We present the longest follow-up, to date, of probable PTSD after the 2001 terrorist attacks on the World Trade Center (WTC) in New York City firefighters who participated in the rescue/recovery effort. METHODS: We examined data from 11,006 WTC-exposed firefighters who completed 40,672 questionnaires and reported estimates of probable PTSD by year from serial cross-sectional analyses. In longitudinal analyses, we used separate Cox models with data beginning from October 2, 2001, to identify variables associated with recovery from or delayed onset of probable PTSD. RESULTS: The prevalence of probable PTSD was 7.4% by September 11, 2010, and continued to be associated with early arrival at the WTC towers during every year of analysis. An increasing number of aerodigestive symptoms (hazard ratio [HR] 0.89 per symptom, 95% confidence interval [CI] 0.86-0.93) and reporting a decrease in exercise, whether the result of health (HR 0.56 vs no change in exercise, 95% CI 0.41-0.78) or other reasons (HR 0.76 vs no change in exercise, 95% CI 0.63-0.92), were associated with a lower likelihood of recovery from probable PTSD. Arriving early at the WTC (HR 1.38 vs later WTC arrival, 95% CI 1.12-1.70), an increasing number of aerodigestive symptoms (HR 1.45 per symptom, 95% CI 1.40-1.51), and reporting an increase in alcohol intake since September 11, 2001 (HR 3.43 vs no increase in alcohol intake, 95% CI 2.67-4.43) were associated with delayed onset of probable PTSD. CONCLUSIONS: Probable PTSD continues to be associated with early WTC arrival even 9 years after the terrorist attacks. Concurrent conditions and behaviors, such as respiratory symptoms, exercise, and alcohol use also play important roles in contributing to PTSD symptoms. [Author Abstract] KEY WORDS: World Trade Center; mental health; psychological symptoms; firefighters; PTSD; occupational health; September 11 terrorist attacks; New York City; terrorism; disaster response

The attacks of September 11, 2001, on the World Trade Center were unprecedented acts of terrorism on U.S. soil. The disaster provides an opportunity to understand the responses of young children to a traumatic event of this proportion. This retrospective study took place within a year of the attacks and examined the relationship of levels of exposure to the World Trade Center disaster and family level predictors to trauma symptoms in a highly exposed sample of 180 young children in New York City. Data were collected through interviews with parents of children five years or younger at the time of the attacks. Primary variables included direct exposure and post 9/11 child and parent functioning, including trauma symptoms. Child trauma symptoms were related to direct exposure to the disaster, previous trauma, negative changes in parenting, and increased couple tension. Findings support the conceptualization that children's responses to traumatic events must be addressed within the caregiving context of family relationships. Clinical and preventive intervention for young children should be aimed at multiple levels of the social ecology. [Author Abstract] KEY WORDS: PTSD; parenting; young children; September 11th terrorist attacks; disaster mental health

BACKGROUND: It is important to understand long-term biological and psychiatric correlates of intense exposure to terrorism. METHODS: We assessed psychiatric diagnoses and biological stress measures in 50 healthy, highly exposed Oklahoma City bombing survivors recruited from a bombing registry 6-1/2 to 7 years postdisaster, comparing them with demographically matched, nonexposed community members. The Diagnostic Interview Schedule (DIS) determined Axis I psychiatric diagnoses. Participants' salivary cortisol levels were obtained at 8 am, and physiologic assessment measured participants' heart rate and blood pressure responses to a bombing-related interview. RESULTS: 11 survivors with PTSD had significantly higher cortisol levels than did both non-PTSD survivors and controls. Survivors with and without PTSD did not differ in any autonomic reactivity measure, whereas the total survivor group had significantly higher reactivity than controls in all measures. Positive correlations occurred between several autonomic reactivity measures, but none between cortisol and autonomic measures. CONCLUSIONS: Results differentiate the autonomic and cortisol systems relative to terrorism exposure. Findings support research associating PTSD with hypothalamic-pituitary-adrenal (HPA) axis changes, whereas autonomic reactivity appeared to be a more generalized trauma response. Correlation statistics substantiated a lack of connection between the 2 biological systems. Follow-up could elucidate the long-term course of these stress systems and eventual health status in survivors, in view of the medical morbidity noted in PTSD studies. [Author Abstract] KEY WORDS: cortisol; Oklahoma City bonmbing; psychophysiological assessment; PTSD; terrorism; trauma

The present research experimentally investigated the impact of terrorism salience on authoritarian practices. It was found that terrorist threat cues (induced by reminders of terrorist incidents) had a significant impact upon both attitudes and behaviors regarding authoritarian parenting practices (Studies 1 and 2) as well as their actual occurrence in a real parent-child playing interaction (Study 3). The implications of these findings for the social psychological perspective on threat and parenting style are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

Public risk perceptions of mass disasters carry considerable influences, both psychologically and economically, despite their oft-times imprecise nature. Prior research has identified the presence of an optimistic bias that affects risk perception, but there is a dearth of literature examining how these perceptions differ among cultures'”particularly with regard to mass disasters. The present study explores differences among Japanese, Argentinean, and North American mental health workers in their rates of the optimistic bias in risk perceptions as contrasted between natural disasters and terrorist events. The results indicate a significant difference among cultures in levels of perceived risk that do not correspond to actual exposure rates. Japanese groups had the highest risk perceptions for both types of hazards and North Americans and Argentineans had the lowest risk perceptions for terrorism. Additionally, participants across all cultures rated risk to self as lower than risk to others (optimistic bias) across all disaster types. These findings suggest that cultural factors may have a greater influence on risk perception than social exposure, and that the belief that one is more immune to disasters compared to others may be a cross-cultural phenomenon. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

This study describes the development and psychometric properties of Terrorism Impact Scale (TIS). Items generated were based on two focus groups with journalists, personnel from security forces and experts from different walks of life, in-depth interviews conducted with religious scholars and a preliminary questionnaire administered to the survivors of terrorist attacks, witnesses and general public in Lahore. Initially, a pool of 200 items was generated tapping different types of impact of terrorism in the society (e.g., emotional, psychological, and socio-cultural). An expert opinion based pool of 95 items was retained for initial empirical evaluation on four groups (students, general public, terror attack survivors, and security forces, N = 280). The factor analytic strategy generated 5 clusters with 64 items, labeled as State Affairs, Psychosocial Distress, Civic Affairs, Governance Issues, and Resilience. TIS demonstrated significant construct validity and reliability overall and for its 5 subscales. Item analysis and alpha coefficients revealed significantly high internal consistency for the measure. Further analysis of data revealed significant differences among participant groups for impact of terrorism. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

The 11 September 2001 terrorist attacks on the World Trade Center and the Pentagon marked the advent of an unprecedented preoccupation with terrorism. Although Australia's actual terrorist risk profile remains marginal in comparison with other mortality risks, in times of crisis, the reasoned negotiation of risk is marginalized. Drawing on the findings of qualitative research, this article offers an analysis of how Australians are responding to the threat of terrorism embodied in a developing discourse of the war on terror and how they construct their perceptions of terrorist risk. The findings implicate community fear as a factor that should be considered in the development of counter terrorism strategies that emphasize community engagement as a mechanism for challenging radicalization in democratic states. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

BACKGROUND: During the past few decades, terrorist acts have been an unfortunate reality worldwide. There is a striking paucity of research investigating the multitude of long-term outcomes after severe physical injury due to terrorist attacks, a unique subgroup of trauma patients. The purpose of this study was to provide a profile of the long-term health-related quality of life (HR-QOL) after injury due to terrorist attacks and to explore the relationships between PTSD, occupational status, and injury severity with HR-QOL METHODS: We included 35 survivors of terrorist attacks living in the community, two years on average after the injury, mean age at follow-up = 32.1 (13.8), mean Injury Severity Score (ISS) = 27 (14.2). The subjects were recruited from consecutive admissions to a rehabilitation department in a tertiary care center between September 2000 and June 2004. Most of the subjects suffered multiple trauma. The main outcome measures were the Short-Form Health Survey (SF-36), Post Traumatic Diagnostic Scale and return to work rates. RESULTS: The mean scores on 6/8 of the SF-36 subscales were significantly lower among the survivors compared to normative population norms. PTSD was found in 39% of the sample and 43% did not resume their main occupation two years after the injury. Multivariate analysis of variance of PTSD and occupational status (returned vs. did not return to work) on quality of life scores revealed significant main effects for both PTSD (p = .000) and occupational status (p = .005) with no interaction effect (p = .476). No significant correlations were found between injury severity and the SF-36 scores. CONCLUSIONS: This study demonstrated the long-term impact of injury due to terrorism. Results showed independent effects of PTSD and occupational status on health related quality of life, two years after injury. These findings suggest that this group may benefit from intervention focusing on their emotional and occupational status in order to im