In this study the authors characterize peritraumatic reactions of residents of New York City during and immediately following the September 11th terrorist attacks, identify predictors of those reactions, and identify predictors of PTSD 4 months later. A cross-sectional sample of New York residents (n = 2,001) responded to questions about sociodemographics, historical factors, event-related exposure; acute cognitive, emotional, and physiological reactions to the September 11th terrorist attacks; and current (past month) PTSD symptoms. Factor analyses of peritraumatic reactions yielded three related, but distinct, peritraumatic response patterns -- dissociation, emotional reactions, and panic/physiological arousal. Several demographic, historical, and exposure-related variables predicted one or more peritraumatic reaction patterns. After controlling for demographic, historical, and exposure factors, each of the peritraumatic reactions factors, one historical factor and one event-related exposure factor remained as significant predictors of PTSD. These results support a growing literature concerning the predictive value of peritraumatic reactions in relation to PTSD. Implications for preventive efforts and suggestions for future research are discussed. [Author Abstract]

As the state mental health authority, the New York State Office of Mental Health (NYOMH) administered and oversaw the design, implementation, and evaluation of Project Liberty, New York's FEMA-funded crisis counseling program that was created to respond to the aftermath of the attacks of September 11, 2001. To support effective program services, NYOMH quickly developed and implemented contracting mechanisms, data collection processes and procedures, public education materials, and curricula and training for thousands in the basics of disaster mental health counseling, all tailored to this event. The articles in this issue of Psychiatric Services summarize evaluation findings related to a number of program dimensions. Their content reflects key policy decisions that were made while the program was being rapidly implemented in response to the aftermath of the September 11, 2001, attacks and highlights how Project Liberty responded to challenges presented by the disaster. This article provides a brief overview of the articles. The immense size and scope of Project Liberty--apparent in the number of people served, the number of participating agencies and counselors, the demographic diversity of served populations, the scale of public awareness of the program, and as the program evolved, the range of services provided--demonstrate that the public sector is capable of mounting a large-scale disaster mental health response to a catastrophic terrorist attack. However, doing so required intense intergovernmental collaboration and flexibility--which fortunately were achieved. Much remains to be learned about the impact of terrorism on affected populations. Enhanced funding is needed to support and increase the pace of clinical and services research concerning the mental health impact of terrorism and effective interventions (clinical and organizational), as scientific knowledge remains limited. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Exposure to traumatic incidents including natural and human-initiated disasters may be an important precipitant for suicide. This article explores suicide ideation in police officers, a reportedly high suicide risk group, who worked in the proximity of the September 11, 2001 (9/11), World Trade Center terrorist attack. Data were obtained for a period of 4 years (2001-2004) from Cop 2 Cop, a statewide New Jersey confidential phone hotline provided exclusively for police officers and their families. Results suggested that calls related to suicide ideation increased from pre-9/11 through 3 years post-9/11 and that the risk for urgent care suicide calls post-9/11 increased 1.65 times (95% confidence interval=0.54-5.04) more quickly over time when compared to pre-9/11 urgent calls. Qualitative as well as descriptive statistical data are presented on suicide ideation and the impact of 9/11 on the personal and occupational lives of officers who called. [Author Abstract] KEY WORDS: terrorism; suicide ideation; police; PTSD; disaster trauma; trauma management

Research on adult reactions to potentially traumatic events has focused almost exclusively on posttraumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n= 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.

The authors evaluated psychological responses to continuous terror. Data were collected after 10 months of escalating hostilities against civilians in Israel. The study's participants were randomly selected adults living in two suburbs of Jerusalem, one frequently and directly exposed to acts of terrorism (N=167) and the other indirectly exposed (N=89). Participants provided information about exposure to terror-related incidents, disruption of daily living, symptoms of posttraumatic stress disorder (PTSD), and general distress (assessed with the Brief Symptom Inventory). Residents of the directly exposed community reported more frequent exposure to terror and deeper disruption of daily living. Notwithstanding, the directly and indirectly exposed groups reported comparable rates of PTSD and similar levels of symptoms: 26.95% of the directly exposed group and 21.35% of the indirectly exposed group met DSM-IV PTSD symptom criteria (criteria B through D), and about one-third of those with PTSD symptoms (35.7% in the directly exposed group and 31.5% in the indirectly exposed group) reported significant distress and dysfunction. Subjects who did not meet PTSD symptom criteria had very low levels of PTSD symptoms, and their Brief Symptom Inventory scores were within population norms. Exposure and disruption of daily living contributed to PTSD symptoms in the directly exposed group. Disruption of daily routines contributed to Brief Symptom Inventory scores in both groups. Continuous terror created similar distress in proximal and remote communities. Exposure to discrete events was not a necessary mediator of terror threat. A subgroup of those exposed developed serious symptoms, whereas others were surprisingly resilient. Disruption of daily routines was a major secondary stressor.

The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.

Reviews the book, On the Ground After September 11: Mental Health Responses and Practical Knowledge Gained edited by Yael Danieli and Robert L. Dingman (see record 2005-09668-000). The book's stated goal is "to provide the mental health community and the American public in general the understanding and the texture of what happened in the mental health response to the terrorist attacks, the range of reactions to these traumatic events, the lessons learned, and what will help us be prepared in the future for possible attacks similar to the devastation and emotional trauma of September 11." The reviewer states that this book is a testament to the outpouring of caring and services that followed the devastating terrorist attacks. It provides a relatively long view of almost three years. The range of human responses along the post-disaster timeline are eloquently presented. It is organized in brief sections that are easily read on their own. The book is a fine source of first-person narrative, including many of the leaders of the immediate and long term relief efforts and many others. The reviewer's reservations about this substantial volume are few. Although it can be challenging to determine when each contribution was written, the quality is so high and the diversity of contributions is so great that this is not so important, and the timing of the writing is often indicated by the authors. Overall, this book should be used regularly by disaster planners around the world and by those preparing and working to relieve the acute and long-term suffering of those affected by disasters, terrorism, and war. The sequelae of Hurricane Katrina suggest that we have a long way to go. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Reviews the books, On the Ground After September 11: Mental Health Responses and Practical Knowledge Gained by Yael Danieli and Robert L. Dingman (Eds.) (see record 2005-09668-000); and The Trauma of Terrorism, Sharing Knowledge and Shared Care: An International Handbook by Yael Danieli, Danny Brom and Joe Sills (Eds.) (2005). These books are two very different but equally important responses to the modern day reality of terrorism. The first book is a series of essays from the survivors and helpers of the 9/11 terrorist attacks. A common theme that emerged from the collection of writings was that from the devastating experience of tragedy and loss rose a collective human spirit that displayed resilience, courage, generosity, caring, and solidarity. This book is a must-read for social workers, mental health professionals, and other agency personnel who work with disaster related trauma counseling and related services. The second book provides a plethora of information that includes the history of terrorism, the short and long term impact of terrorism, intervention and prevention efforts to deal with the aftermath of terrorist attacks, and preparation for future attacks. This book is a definitive text for social workers, mental health professionals, and public officials who are involved in some aspect of disaster preparedness and management. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Reviews the book, Terrorists, Victims, and Society: Psychological Perspectives on Terrorism and Its Consequences by Andrew Silke (Ed.) (2003). The purpose of this book is to present research findings in a clear and readable form. This volume of 13 chapters is divided into three major sections. In the first part of the book the authors review the social, biological, developmental, and cultural factors that contribute to someone becoming a terrorist and explore the psychological issues and sequelae of hostage taking, cyber terrorism, suicidal terrorism, and ultimately deciding to leave a terrorist organization. The second section discusses the traumatizing aspects of terrorism, including the threat or extraordinary use of violence, goal-directed, intentional behavior to harm, the intention to psychologically disorganize and horrify not only the immediate victims but also those around them, and choosing victims for their symbolic value, even their innocence. The final section of the book discusses the implications of retaliating against terrorism, the psychological sequelae of imprisonment and ways in which we can work towards deterring terrorist activity. This volume is appropriate for experienced clinicians, graduate students, and researchers interested in understanding, exploring, and studying terrorism. The chapters stand well on their own, but when presented as a unified body of work provide a good resource for anyone interested in this field of research, policy, and practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Environmental stressors such as mass disasters may contribute to an increased prevalence of depression within the population affected. We examined the prevalence of probable major depression and risk factors for depression in the 6-month period after the September 11, 2001, attacks on the World Trade Center among New York City (NYC) metropolitan residents. A total of 2700 persons who were representative of the NYC metropolitan area were included in this cross-sectional telephone survey. The prevalence of probable major depression in the 6 months after the attacks was 9.4%. Multivariate logistic regression covariates associated with the likelihood of probable major depression included being directly affected by the attacks, having a perievent panic attack, experiencing multiple life stressors, and having been exposed to previous traumatic events. Mass traumatic event exposure appears to be an independent environmental risk factor for depression in the postdisaster context; specific reactions such as perievent panic attacks may have prognostic value.