Objective: Children exposed to terrorism are at high risk for developing emotional and behavioral problems, but only a few studies have examined adolescents' long-term psychological adjustment after a terrorist attack. We aimed to assess psychological distress, problem behaviors, and coping in adolescents who survived the terrorist attack on School No. 1 in Beslan, Russia. Method: Seventy-one youths aged 14 to 17 years held as hostages by terrorists completed self-reported measures of psychological symptoms, emotional and behavioral difficulties, and coping behaviors 18 months after the traumatic event. They were compared with 100 adolescents who were not directly exposed to the attack. Data were collected during a 1-month period in May 2006. Results: No significant differences were found between the 2 groups in overall levels of psychological symptoms as well as in emotional and behavioral problems. Girls in both groups reported significantly more psychological distress (p = .0001) and total difficulties (p = .0001) than boys. In the directly exposed group, avoidant coping was related to worse psychological functioning for girls ( r= 0.54, p < .001) and boys ( r= 0.50, p < .01), whereas in the indirectly exposed group this strategy was associated with psychological distress (r = 0.43, p < .01) and total difficulties (r = 0.40, p < .01) for girls only. Conclusions: More than I year after a terrorist attack, adolescents may experience psychological distress regardless of being directly or indirectly exposed. Professionals working with adolescents affected by terrorism should be sensitive to developmental level and gender, consider the cultural context, and foster coping skills that may be differentially effective for girls and boys. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

BACKGROUND: Psychological reactions to terror attacks have been documented as ranging from no symptoms to transient behavioural symptoms to more serious posttraumatic stress. SOURCES OF DATA: A review of representative studies is presented, with a critical analysis of the salient points of the various psychological intervention strategies for terrorist attacks. AREAS OF AGREEMENT: Common aspects of both most intervention approaches include multifaceted models that foster social support and include a preparatory phase, a phase of 'psychological first aid' and a follow-up phase of referral for more severe cases. AREAS OF CONTROVERSY: The notion of intervention for all who may show some symptoms is not universally accepted. Where treatment or intervention is used, the debriefing aspect of CISM (Critical Incident Stress Management) remains highly disputed, with the focus on intrusively revisiting the trauma appearing to have questionable value at best. GROWING POINTS: Some data questions whether formal treatment or intervention is necessary or even desirable. For many who choose not to seek out any help following a trauma, clinical data shows no negative results. Moreover, the preponderance of data shows that conventional 'debriefing' is not recommended. If the debriefing mechanism is refined so that intrusive emotional rehashing of the traumatic event is eliminated, the resultant interventions resemble resilience based approaches. AREAS TIMELY FOR DEVELOPING RESEARCH: Further defining when intervention is called for and refining the mechanisms of intervention in multi-stage intervention. [Author Abstract] KEY WORDS: terrorism; psychological; intervention; debriefing; resilience; social support

To describe the prevalence and correlates of post-traumatic stress disorder (PTSD), depressive and anxiety disorders, or any other mental disorder among adult victims treated in a hospital at different points in time after the 11 March 2004 terrorist attacks in Madrid. A random sample of 56 individuals injured in the attacks was interviewed in person at one, six, and twelve months after the attacks. Current DSM-IV mental disorders: depressive disorders and anxiety disorders (PTSD, generalised anxiety, agoraphobia, social phobia, and panic disorder) were assessed with the Spanish version of the MINI (Mini International Neuropsychiatric Interview), a structured, lay-administered psychiatric interview. PTSD was the most prevalent psychiatric disorder (35.7% at month 1, 34.1% at month 6, and 28.6% at month 12), followed by major depression (28.6%, 22.7%, and 28.6%, respectively). Others relevant conditions were suicide risk, generalised anxiety disorder (GAD), agoraphobia, and panic disorder. No significant differences in the prevalence of the disorders were found between the different assessment times. Patients with a psychiatric history prior to 11 March had a higher prevalence of PTSD, major depression, GAD, and panic disorder at month 1. Females had higher prevalence of PTSD, agoraphobia, and panic disorder at month 1. The only predictive factor for PTSD at month 12 was PTSD at month 6 (OR = 14.007). The only predictive factor for major depression at month 12 was major depression at month 6 (OR = 15.847). The prevalence of PTSD and major depression was high and remained stable between month 1, month 6, and month 12. The only predictive factor for PTSD at month 12 was PTSD at month 6.

After 9/11, studies concerning psychological and psychiatric effects of terrorism have greatly multiplied. Media exposure to terrorism has been shown to be a vital factor in these effects. However, there is a lack of pre-trauma research assessing the resilience of the civilian population in the face of a "mediated" terrorist threat. This article discusses an eight-dimensional conceptual model of terrorism-related issues central to psychosocial resilience to terrorism. Survey results (N = 1040) are provided which present an index of these terrorism-related issues for Flanders (Belgium) in December 2004 and January 2005 and their correlations. They are also related to media use in the case of television, radio, and the internet. The results clearly indicate the psychological repercussions of this terrorism threat in terms of media information-seeking behavior, risk perception, and fear levels. Furthermore, the important role of government communication, the ambiguity of social support, and the opposing outcomes of television and internet use are demonstrated. [Author Abstract] KEY WORDS: Belgium; communication; media; resilience; risk; terrorism

Replies to comments by McNally and Breslau (see record 2008-05553-016) on the current authors' article (see record 2007-07130-003). McNally and Breslau expressed skepticism about the validity of multiple, independent studies showing that thousands of persons who were not directly exposed to the 9/11 attacks nevertheless developed posttraumatic stress disorder (PTSD) symptoms. They mistakenly asserted that these studies are all based on acute symptoms, whereas in fact several studies document symptoms at six months and beyond, post-9/11. Throughout their comment, they reframed the 9/11 experience of persons across the country as a virtual trauma. This is a strategy not usually seen in scientific discourse. The critical point of our review is that many people can develop concerns about safety and other issues following a terrorist attack, and these can be fueled by the media and other influences. It was not our claim that concerns about flying, being in tall buildings, or visiting public monuments after the attacks were necessarily pathological. However, it is difficult to understand why McNally and Breslau (2008) wanted to minimize this and other extraordinary ripple effects of the 9/11 attacks in the first place. Our aim was to develop a model that might be useful in trying to understand and reduce the economic and psychological costs of terrorism. Should we not, as mental health professionals, contribute our expertise toward alleviating this level of fear and its consequences? (PsycINFO Database Record (c) 2016 APA, all rights reserved)

The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval -- the terrorist attacks of September 11, 2001 -- among a national probability sample of U.S. adults (N = 931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism. Results highlight the role of meaning in adjustment following collective traumas that shatter people's fundamental assumptions about security and invulnerability. [Author Abstract] KEY WORDS: meaning; adjustment; terrorism; coping behavior; mental health

The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample. To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years. A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks. Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks. Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years). Using health data collected before 9/11 as a baseline, acute stress response to

The effects of community cohesion were explored following a terrorist attack in Israel, during which an explosion on a public bus in a metropolitan city killed and wounded multiple individuals. Participants were 115 Israelis who resided in three specified perimeters around the area of impact. Data collected immediately following the attack and 1 month later included demographics, proximity and exposure to the terrorist event, community cohesion, and PTSD symptoms. For individuals reporting low and moderate degrees of exposure to the terror event, PTSD symptoms increased as community cohesion increased. However, for those with high exposure, PTSD symptoms and community cohesion were inversely related. Furthermore, for those who lived closest to the terror event, as community cohesion increased, PTSD symptoms decreased. However, for individuals who lived farther away from the terror event, community cohesion was positively associated with PTSD symptoms. One month following the attack, community cohesion did not significantly predict PTSD symptoms. [Author Abstract] KEY WORDS: anxiety, terrorism, community, cohesion, Israel

This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12). Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and PTSD (17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders. [Author Abstract]

Emergency physicians are likely to be first-line responders in any local or regional terrorist event. In addition to preparing for the potential physical conditions and injuries that are associated with terrorism, they should be aware of the behavioral and mental health implications as well. It is helpful to be familiar with the characteristics that predict who may be at increased risk for mental illness after such events and how they may be identified in an Emergency Department setting. Although most people in the general population with behavioral conditions stemming from a terrorist event can be expected to recover spontaneously within several months, other individuals are at increased risk of developing more debilitating mental health conditions that have been associated with post-terrorist and disaster environments. Screening tools are available to help emergency practitioners identify them and refer patients for more formal psychiatric evaluation and potential interventions to facilitate and speed the recovery process.