This study compared the construct of compassion fatigue with the role of attachment as a potential mediator among mental health clinicians working with victims of terrorism in the New York metropolitan region of the United States and Israel. Differences between clinicians practicing within Israel (n = 31) and New York (n = 35), in terms of their symptoms of compassion fatigue, compassion satisfaction, and "burnout", were not significant, as measured by multivariate analyses of variance. Based upon nonsignificant differences, mediational statistical tests could not be run; thus, mediation did not hold. The data failed to support a significant difference between compassion fatigue and attachment avoidance or anxiety. However, data collection resulted in attenuated scores for compassion fatigue and compassion satisfaction within both study groups of clinicians and moderate to average scores for burnout. Israeli clinicians had significantly more avoidant attachment dimensions than their New York cohorts. The strongest predictors of compassion satisfaction were (a) low attachment anxiety and (b) sufficient clinical experience related to treating victims of trauma. The strongest predictors of burnout were (a) minimal clinical experience, (b) minimal experience working with trauma victims, and (c) greater avoidant attachment dimensions. [Author Abstract] KEY WORDS: compassion fatigue, attachment, clinicians, terrorist victims, collective trauma

Little systematic information is available on mental health issues related to bioterrorism. Five focus groups were conducted with Capitol Hill office staff (n = 28 total participants) to learn about their experience of the anthrax incident on October 15, 2001. More than 2,000 verbal passages were coded into categories and themes by using qualitative analysis software. Issues emerging from the discussions included difficulties utilizing customary social supports, concerns over potential long-term dangers created by efforts to eradicate the anthrax, and nonadherence to antianthrax medication regimens. Nonadherence to antibiotic prophylaxis is of immediate concern for response to future bioterrorist events as well as infectious disease epidemics. Other topics that warrant attention are social support and mental health interventions. [Author Abstract]

BACKGROUND: African disaster-affected populations are poorly represented in disaster mental health literature. AIMS: To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa. METHOD: Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n = 227) and the Oklahoma City Federal Building (n = 182). RESULTS: Prevalence rates of PTSD and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs, and alcohol. CONCLUSIONS: Post-disaster psychopathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed. [Author Abstract]

Systematic studies of mental health effects of bioterrorism on exposed populations have not been carried out. Exploratory focus groups were conducted with an exposed population to provide qualitative data and inform empirical research. 5 focus groups of 28 political worker volunteers were conducted 3 months after the October 15, 2001, anthrax attack on Capitol Hill. More than 2000 transcribed focus group passages were categorized using qualitative software. The category with the most items was authorities' response (23% passages), and much of this discussion pertained to communication by authorities. The category with the fewest items was symptoms (4%). Identified issues were less within individuals and more between them and authorities. Risk communication by authorities regarding safety and medical issues was a prominent concern among Capitol Hill office staff workers regarding the anthrax incident on Capitol Hill. This suggests focus on risk communication in developing interventions, but more systematic investigation is needed. [Author Abstract] KEY WORDS: anthrax; bioterrorism; Capitol Hill; mental health; psychological; posttraumatic stress

This prospective study examines the role played by individual coping style in predicting PTSD among 81 undergraduate students exposed to a terrorist explosion on a bus near their university. Using the Multidimensional Coping Inventory (COPE), subjects' coping style was measured two weeks before the attack (trait coping style) and again one month after the attack (state coping style). Both measurements were then examined as PTSD predictors at six months. A multiple logistic regression analysis revealed four PTSD predictors: high levels of trait-avoidance coping style; high levels of state-avoidance coping style; high levels of trait emotion-focused coping style; and low levels of state problem-focused coping style. These findings provide evidence to support the importance of early assessment of coping responses among those exposed to a traumatic event. [Author Abstract] KEY WORDS: avoidance coping style, coping style, emotion-focused coping style, problem-focused coping style, PTSD

BACKGROUND: We conducted a 1-year follow-up of an original mail survey of early reactions to the World Trade Center disaster. METHOD: Of the 75 subjects originally surveyed, 58 (77%) responded. The survey included measures of dissociation (Dissociative Experiences Scale, Cambridge Depersonalization Scale, Clinician-Administered Dissociative States Scale), posttraumatic stress (Impact of Event Scale - Revised), social support (Interpersonal Support Evaluation List - short form), and a life quality measure (Quality of Life Enjoyment and Satisfaction Questionnaire - short form). We hypothesized that dissociative versus posttraumatic symptoms at follow-up could be dissected on the basis of early reactions. RESULTS: Responders and nonresponders did not differ in baseline characteristics. Exposure was not associated with dissociation or posttraumatic stress at follow-up. Of distress, dissociation, and posttraumatic stress at baseline, baseline dissociation was the strongest predictor of outcome dissociation while baseline posttraumatic stress was the strongest predictor of outcome posttraumatic stress. Of 4 peritraumatic distress factors generated in the original survey, "loss of control" and "guilt/shame" were significantly related to dissociation and posttraumatic stress at outcome, while "helplessness/anger" was only associated with posttraumatic stress at outcome. Lesser improvement in posttraumatic stress over the first year was significantly related to less social support and greater comorbid dissociation. Interim social support was associated with better life quality and fewer symptoms at outcome. CONCLUSION: There was evidence for partly independent pathways toward dissociation versus posttraumatic stress 1 year after the disaster. Feelings of guilt and shame, and persistent dissociation, were poor prognostic factors, while social support had a powerful ameliorating influence. [Author Abstract]

PURPOSE: The purpose of this introduction is to review some of the major issues that arose after 9/11 and set the stage for the articles that follow. DESIGN/METHODOLOGY/APPROACH: A literature review was undertaken using both academic and mass media sources. FINDINGS: The events of 9/11 have produced potentially positive as well as negative consequences, some anticipated and others unforeseen. RESEARCH LIMITATIONS/IMPLICATIONS: Relatively little research has been conducted on the events following 9/11, making it difficult to arrive at solid conclusions at this time. PRACTICAL IMPLICATIONS: This special issue links the events of 9/11 with the management of organizations, a topic that has received little attention, and hopefully will encourage more scholarship in this area. ORIGINALITY/VALUE: It is important to more fully understand why 9/11 happened and what measures need to be taken to reduce the likelihood of future terrorist attacks, as well as improve the resiliency of both citizens and their organizational employers in dealing with the aftermath of such attacks should they occur again. [Author Abstract] KEY WORDS: disasters; terrorism; organizational culture; employee attitudes; United States of America

OBJECTIVE: Since September 2000, continuous terrorist attacks have exposed Israeli society to trauma, and the impact of these events on the mental health of the elderly Israeli population remains unclear. The authors sought to assess the prevalence of posttraumatic stress-related symptoms of distress, depression, optimism, self-efficacy, and sense of safety of the young-old and old-old Jewish population after 19 months of intense terrorism in Israel, in order to identify correlates of the psychological sequelae and compare symptoms and coping methods of these populations with those of younger adults. METHODS: Authors did a telephone survey using stratified sampling with a national sample of young-old (65-74 years old), old-old (> 74 years old) and a comparison group of younger adults (18-64 years old). RESULTS: No difference was found in the level of exposure, traumatic stress symptoms, including probable PTSD, except for a nonsignificant tendency toward more depersonalization and emotional numbness in the elderly group, a tendency toward more sleeplessness, more re-experiencing of unwanted thoughts, hyperarousal, fewer avoidance symptoms, and less disengagement-coping in the old-old group. Younger adults were found to be significantly more optimistic. Young-old and old-old people used cigarettes/alcohol and tranquilizers more often to cope with the situation, and old-old people who used disengagement-coping felt less helped by it. CONCLUSIONS: Young-old and old-old people do not differ significantly from the younger adult population with regard to their response to 19 months of intense and recurrent terrorism. [Author Abstract]

BACKGROUND: Debate surrounds the nature of gender differences in rates of PTSD. OBJECTIVE: The goal of this study was to quantify and explore the reasons for gender differences in rates of PTSD in low income, primary care patients after the World Trade Center (WTC) attack of September 11, 2001. METHODS: A survey was conducted at a large primary care practice in New York City 7 to 16 months after the WTC attack. The study involved a systematic sample of primary care patients aged 18 to 70 years. The main outcome measures were the Life Events Checklist, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, all administered by a bilingual research staff. RESULTS: A total of 3807 patients were approached at the primary care clinic. Of the 1347 who met eligibility criteria, 1157 (85.9%) consented to participate. After the addition of the WTC/PTSD supplement to the study, the total number of patients was 992, of whom 982 (99.0%) completed the survey. Both sexes had high rates of direct exposure to the WTC attack and high rates of lifetime exposure to stressful life events. Overall, females had lower rates of exposure to the attack compared with males (P < 0.05). Hispanic females had the highest rate of PTSD in the full sample. Gender differences in rates of PTSD were largely accounted for by differences in marital status and education. The rate of current major depressive disorder (MDD) was higher in females than in males (P < 0.001), and the reverse was true for substance abuse (P < 0.001). Gender differences for MDD and substance abuse persisted even after adjustments for demographic differences between the sexes. CONCLUSIONS: The increased rate of PTSD in women attending a primary care clinic was mediated by their social and economic circumstances, such as living alone without a permanent relationship and with little education or income. The increased rate of MDD in women appeared

School systems face crises of a variety of types and forms, including the suicide death of a student, the death of a teacher, mass shootings, and the aftermath of terrorist attacks. This article examines ways for school systems to deal with the aftermath of those crises, both immediately and in the long term. Suggestions for classroom interventions, group experiences, and homework assignments are included. The impact of terrorism on school personnel is also discussed. [Author Abstract] KEY WORDS: terrorism, schools, crisis, debriefing, defusing, classroom interventions