To explore psychological resilience and recovery following the 1995 Oklahoma City bombing, we assessed reactions to the incident in residents of Oklahoma City and a comparison city over 3 years. Concerned that the bombing might have preconditioned Oklahoma City residents to adverse reactions to later events, we also examined psychological responses to the September 11 terrorist attacks on Oklahoma City residents. We surveyed psychological responses to the bombing in residents of Oklahoma City and Indianapolis in 1995, 1996, and 1998 and psychological responses to the September 11 attacks in Oklahoma City as part of a national sample in 2002. Univariate and bivariate analyses were conducted. Oklahoma City residents reported significantly more posttraumatic and general stress compared to Indianapolis residents in the months following the bombing, but differences decreased over time. Oklahoma City respondents were no different from the rest of the nation on most measures after the September 11 attacks. Results suggest optimism regarding psychological resilience and recovery from terrorism in affected communities and nationally. [Author Abstract] KEY WORDS: community resilience; disasters; Oklahoma City bombing; posttraumatic stress; terrorism

Medical school is a very stressful environment with multiple sources of stress, including academic, social and other issues. International medical students are exposed to additional stressors such as homesickness and culture shock. In order to assess the influence of cultural background on the level of perceived distress, we examined Israeli and American students studying at the same university during a period of terror. We found clear differences between the 2 groups of students, with Americans reporting a higher level of anxiety and a poorer level of social functioning than the Israelis. Although there was no significant difference between the 2 groups in terms of their sense of safety, the American students reported a higher level of fear and more change in their daily activities to a greater extent than did the Israelis. These findings underscore the effect of culture on students' responses to the same stressful stimuli and to a perceived dangerous environment. Faculty needs to be aware that cultural factors may affect students' adjustment to the medical school environment.

This study explored the mechanism by which trait negative affect and alcohol coping motives are associated with alcohol-related problems in a sample of American Red Cross workers who participated in the relief operation following the attacks in New York City, the Pentagon, and the Pennsylvania crash site on Sept. 11th 2001. The results supported the mediation but not moderation model of coping motives. The support for the mediation model was fairly strong, including small to moderate associations between negative affect and alcohol problems, moderate to strong associations between negative affect and coping motives, and evidence of coping motives mediating the negative affect to alcohol problems relationships. The association between negative affect and coping motives was stronger among younger participants.

This is the first article of a two-part series dealing with the effects of terrorism on the elderly. Part I addresses specific data as it relates to the medical impact of biological, chemical, nuclear, and bombing attacks on senior citizens. Part II will review the literature as it relates to the occurrence of psychiatric disorders in the elderly following terrorist attacks. The authors will attempt to identify and review data specific to senior citizens, and to provide the clinician with useful information regarding differential diagnosis, the nature of symptoms likely to be encountered, time course, and unusual presentations seen in the elderly population. The specific health issues that arise from terrorism and its effect on the elderly have rarely been directly studied. The available literature suggests that the elderly experience a higher physical morbidity and a more complicated hospital course post-injury when affected by terrorism. They are at increased risk due to many of the physiological changes associated with aging, the presence of comorbidities, decreased mobility, and a lack of physiological reserve. Psychiatrically, the elderly face different challenges than the general population due to their past experiences, a potential for reduced independence, and restricted access to services. [Text, p. 26]

This is the second of a two-part article that examines the effects of terrorism on the elderly. Part I reviewed the medical complications caused by biologic, nuclear, chemical, and bombing attacks. This article focuses on the practical issues of resilience and the identification of those elderly persons who are prone to developing psychiatric disorders following a terrorist attack. The three most commonly occurring psychiatric disorders following such an attack -- PTSD, acute stress disorder, and depression -- are reviewed. Special note is made of areas where these conditions are similar in their presenting symptoms and the high comorbid overlap between them. Specific research from recent terror events, such as the Oklahoma City bombing, the Tokyo subway sarin attack, the September 11, 2001, attacks, and the London subway bombings of July 7, 2005, are examined. [Text, p. 17]

In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. This results in many victims and in cases of explosions in closed or semi-closed areas, often results in complex medical problems in many of the victims. An explosion that occurs as the result ofa bomb detonating can result in 4 patterns of injury: the primary explosion injury caused by the pressure of the blast, the secondary injuries caused by flying debris, the tertiary injuries caused by the explosion wind, and the quaternary caused by heat and fire. Common injuries seen following an explosion include: lung damage, neurological damage, abdominal injuries, bone fractures and skeletal damage and crush-syndrome. The triage occurs at the site of the explosion as well as on arrival in hospital. One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.

This study examines ethnic and gender differences in open-ended immediate responses to an online prompt provided by a nationwide sample of 1,559 individuals in the days following the 9/11 terrorist attacks. These responses were used to predict longitudinal outcomes over the following 2 years. Results show that African Americans and women responded with more emotions (e.g., sadness, sympathy) than did Whites and men. African Americans and women also endorsed violent retaliation less often than did their White, male counterparts. Responding with sadness and sympathy and endorsing violent retaliation were, in turn, associated with higher distress and posttraumatic stress (PTS) symptoms over time. Results reveal considerable ethnic and gender differences in immediate responses to traumatic events that have long-term mental health consequences. [Author Abstract]

This study examined the associations between physical and psychological proximity to terrorist attacks and posttraumatic symptoms (PTS), depressive symptoms, and alcohol use among Israeli youth. Self-administered questionnaires were completed under anonymous conditions by 1,150 high and junior high school students (51.3% boys and 48.7% girls) in a town in the Tel Aviv metropolitan area. Standardized, validated scales were used to measure psychological symptoms and alcohol use. High levels of exposure to terrorism were reported. Physical and psychological proximity to terrorist attacks were associated with more PTS symptoms and alcohol consumption. Physical proximity was also associated with symptoms of depression. The implications of terror-associated early drinking for later alcohol problems should be explored. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)

BACKGROUND: To obtain prevalence estimates and identify factors associated with psychological problems and receipt of help by a geographically proximate population in which some persons had direct exposure but the overall prevalence of direct exposure was low, 5-15 months after the September 11th, 2001 terrorist incidents. METHOD: Telephone survey data from the Behavioral Risk Factor Surveillance System (BRFSS) (Connecticut Module) with a randomly selected cohort of 2741 women and 1899 men aged 18 and older were examined using bivariate Chi Square and multivariate logistic regression analyses of weighted data. RESULTS: 1 in 3 respondents reported 9/11-related psychological problems, 26% of whom reported receiving formal services or peer support. Risk factors for reporting psychological problems included being surveyed earlier, female gender, age 64 or younger, Hispanic ethnicity, disability, recent depression, and reporting 1 day or more in the past 30 of poor mental health, sleep problems, or worry. Poor mental health was associated with receipt of formal services, and increased alcohol use was associated with receipt of peer support. CONCLUSION: In the post-impact recovery period following mass trauma, psychological problems by persons with ongoing mental health conditions or increased alcohol use warrant continuing public and professional attention. Women, Hispanics, and disabled adults also may be under-served. [Author Abstract] KEY WORDS: terrorism; disaster; mental health; health services; utilization; epidemiology; social support

To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD). We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats. We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 years old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having grea