This prospective study examined the role of pretraumatic personality factors, coping style, proximity to a terrorist attack, and its perceived threat to the survivors in the prediction of posttraumatic stress disorder (PTSD) after a suicide bomber's attack on a bus. The study sample consisted of 180 undergraduate students who were coincidentally evaluated 2 weeks before a terrorist explosion in a bus heading toward their university and reevaluated 1 week, 1 month, and 6 months after the explosion. A hierarchal regression model revealed that increased risk for PTSD was associated with direct exposure to the attack, indirect exposure to the attack, preattack harm avoidance personality dimension, state avoidance coping style, and perceived threat posed by the attack. The findings indicate that premorbid personality characteristics, as well as subjective and objective factors related to the traumatic exposure, increased the risk for the development of PTSD.

Protective service professionals are in the front line for exposure to acts of terrorism. Following an outline of the criteria required to apply a risk management to this aspect of police work, discussion commences by identifying sources of risk. These can rarely be discerned from the event (e.g., flying a plane into a building) per se. Rather, they reflect hazards such as threats from biological/radiological agents, body handling, cultural aspects of death and dying, understanding terrorist motivation, and adjusting to the legacy of fear that terror events leave in their wake. The role of interpretive processes and organizational factors (e.g., organizational culture and response procedures such as decision making, multiagency team competencies) in mediating the relationship between these terrorist hazards and stress is discussed. These issues are discussed in the context of how officers' experience of terror events changes as they progress through the alarm and mobilization, response, and reintegration phases of involvement. The implications of each for practical strategies that could be adopted by police organizations are presented. [Author Abstract] KEY WORDS: terrorism; police; traumatic stress; risk management; training; organizational change

The nature of life-threatening trauma has changed considerably in the last several years, as the September 11, 2001 terrorist attack and the war in Iraq exemplify. Abundant research suggests that exposure to severe psychological trauma can precipitate psychological and physical distress. The recent events in the media involving terrorism on an international scale suggest an opportunity for research to determine the psychosocial consequences of these particular events. [Author Abstract] KEY WORDS: PTSD; terrorism; coping

OBJECTIVE: This study investigated high school students' symptoms of PTSD 1 and 6 months after a terrorist attack in Istanbul, Turkey on 20 November 2003, and the relationship between the severity of the PTSD symptoms and the level of depression and anxiety. PATIENTS and METHODS: 113 students filled in questionnaires and were assessed by use of Child Post Traumatic Stress Reaction Index, Children's Depression Inventory, and State-Trait Anxiety Inventory for Children. RESULTS: We found high rates of post-traumatic stress reactions at the end of the first month (51.3%). The assessment of the students at the end of 6 months revealed that the symptoms of PTSD tended to persist, although the total scores of Child Post-traumatic Stress Reaction Index were decreased. PTSD scores were significantly correlated with the scores of depression and anxiety at both assessments (p < 0.05). CONCLUSION: These results indicate that PTSD symptoms can be seen after a stressful event that was perceived as life-threatening by at least some of the children even though the children did not experience major losses, injury, or ongoing disruption in the community. [Author Abstract] KEY WORDS: adolescent; child; stress disorder; post-traumatic; terrorism; Turkey

Posttraumatic stress reactions related to the Madrid March 11, 2004, terrorist attacks were examined in a sample of Madrid residents (N = 503) 18-25 days after the attacks, using multiple diagnostic criteria and different cut-off scores. Based on the symptoms covered by the Posttraumatic Stress Disorder Checklist-Civilian (PCL-C; Weathers, Litz, Herman, Huska, and Keane, 1993), rates of probable posttraumatic stress disorder (PTSD) ranged from 3.4% to 13.3%. Taking into account additional criteria from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 200; i.e., the impact of initial reaction and problems in daily functioning as a consequence of the traumatic event), only 1.9% of respondents reported probable PTSD. These results suggest that inferences about the impact of traumatic events on the general population are strongly influenced by the definition of traumatic response. Our findings also revealed that the magnitude of posttraumatic reactions is associated with several risk factors, including living close to the attacked locations, physical proximity to the attacks when they occurred, perception of one's life being at risk, intensity of initial emotional reactions, and being a daily user of the attacked train lines. The use of different cut-off scores did not affect the pattern of risk to develop traumatic stress. The implications of these results for public health policies related to terrorist attacks are discussed.

This report describes symptoms of PTSD among a group of Beslan's children (N = 22) and their primary caregivers (N = 20) 3 months after the children had been taken hostage in their school by a group of terrorists. Attention and memory were also measured. Children and their caretakers showed high levels of ongoing PTSD symptoms. Children also showed difficulties in sustaining attention and in short-term memory (digit span). These scores strongly indicate the need for appropriate interventions and ongoing monitoring of course of recovery. [Author Abstract] KEY WORDS: terrorism; trauma; cognitive functioning

We assessed the health of workers exposed to the World Trade Center (WTC) site and of a comparison group of unexposed workers, by means of a mail survey. Exposed workers reported higher frequency of symptoms consistent with PTSD, depression, anxiety, and other psychological problems, approximately 20 months after the disaster. PTSD was positively associated with traumatic on-site experiences and with respiratory problems. These findings may have important clinical and public health implications. [Author Abstract] KEY WORDS: September 11; World Trade Center; clean up and recovery; disaster workers; PTSD; depression; respiratory problems; cough

The present study compared rates of PTSD in relief workers at the World Trade Center collapse from two sources: direct exposure to the disaster site and indirect exposure through survivor narratives. Standardized clinical interviews for PTSD were conducted with 109 relief workers 6-8 months after the September 11th terrorist attacks. Rates of acute PTSD from direct and indirect exposure to traumatic stressors were 6.4% and 4.6%, respectively. The findings suggest that indirect exposures can lead to PTSD even when Criterion A1 of the DSM-IV-TR, i.e., experienced by a family member or other close associate, is not met. Further research is necessary to define precisely the parameters of indirect traumatic exposure that may be linked to the development of PTSD. [Author Abstract]

OBJECTIVE: To screen for PTSD in primary care patients 7-16 months after 9/11 attacks and to examine its comorbidity, clinical presentation, and relationships with mental health treatment and service utilization. METHOD: A systematic sample (n = 930) of adult primary care patients who were seeking primary care at an urban general medicine clinic were interviewed using the PTSD Checklist, the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, and the Medical Outcome Study 12-Item Short Form Health Survey (SF-12). Health care utilization data were obtained by a cross linkage to the administrative computerized database. RESULTS: Prevalence estimates of current 9/11-related probable PTSD ranged from 4.7% (based on a cutoff PCL-C score of 50 and over) to 10.2% (based on the DSM-IV criteria). A comorbid mental disorder was more common among patients with PTSD than patients without PTSD (80% vs. 30%). Patients with PTSD were more functionally impaired and reported increased use of mental health medication as compared to patients without PTSD (70% vs. 18%). Among patients with PTSD there was no increase in hospital and emergency room (ER) admissions or outpatient care during the first year after the attacks. CONCLUSIONS: In an urban general medicine setting, 1 year after 9/11, the frequency of probable PTSD appears to be common and clinically significant. These results suggest an unmet need for mental health care in this clinical population and are especially important in view of available treatments for PTSD. [Author Abstract] KEY WORDS: primary care; PTSD; 9/11 attacks

To determine the change in prevalence of posttraumatic stress disorder (PTSD) symptoms in victims of the March 11 attacks and their relatives, 1 and 6 months after the attacks. Evaluation of PTSD symptoms using the Davidson Trauma Scale (DTS) and General Health Questionnaire (GHQ) in a sample of 56 patients admitted to an emergency room of a general hospital, and assessment of PTSD symptoms in relatives of the patients. At Month 1, 41.1% of patients (31.3% of males and 54.2% of females) presented with PTSD. At Month 6, this figure was 40.9% (30.4% of males and 52.4% of females). There was a significant improvement in perception of health among females between Month 1 and Month 6. Relatives presented similar DTS scores at baseline and at 6 months. We verified that rates of PTSD did not vary substantively between the two evaluations. PTSD symptoms positively correlated with psychological health involvement. This correlation points out that both PTSD symptoms and subjective general health involvement are part of the psychological response to trauma. The prevalence of PTSD symptoms was high and remained stable between Month 1 and Month 6, while subjective perception of health improved significantly.