OBJECTIVE: This study examined the relative risk of arrest among recipients of mental health services in Washington, D.C., during the 23 months before and the 13 months after the terrorist attacks of September 11, 2001, with the purpose of identifying any change in involvement with the criminal justice system after the attacks. METHODS: Analysis of anonymous data sets provided by the local mental health and police departments provided measures of risk of arrest, relative to that of the general population, for the approximately 5,000 people receiving mental health services each month. Interrupted time-series analysis was used to measure change in relative risk during the 36-month study period. RESULTS: Significant increases were noted in relative risk of arrest after September 11, 2001, among male, nonwhite young-adult recipients of mental health services. Significant change was evident for 8 of the 12 age, gender, and racial groups used in this analysis. CONCLUSIONS: Disaster planning and response should include attention to involvement with the criminal justice system among recipients of mental health services. Future research should focus on the nature of the relationship between terrorism and arrest among service recipients. [Author Abstract]

To examine the relationship between exposure to political violence and posttraumatic symptoms, future orientation, and attitudes toward peace. A total of 740 boys and girls aged 11.5-15 years from Jerusalem, Gilo, and the Jewish settlements in the disputed territories were assessed in the summer of 2001 using an exposure to terror questionnaire, Child Posttraumatic Stress Reaction Index, Children's Future Orientation Scale, and a question regarding the future of peace talks. A substantially higher percentage of youths in the settlements (27.6%) than in Jerusalem (12.4%) or Gilo (11.2%) reported moderate to very severe levels of posttraumatic symptoms. Children's Future Orientation responses were moderately optimistic. About two thirds of the adolescents in the settlements rejected the idea of peace talks at any time, whereas around half of the youths in Jerusalem and Gilo supported the continuation of peace talks. Exposure was related to both PTSD symptoms and attitudes toward peace but not to future orientation. Our findings present the complex interrelationship of political violence, posttraumatic stress disorder, and attitudes toward peace and raise the need for a combined mental health and peace education intervention to prevent the often overlooked vicious cycle of violence and traumatization.

This study investigated changes over time in adolescents' and parents' memories for how they felt when they learned of the terrorist attacks on September 11, 2001. Adolescents recalled having felt less negative emotion than parents did both 3 months and 8 months after the attacks. Moreover, the intensity of negative emotion recalled decreased over time for adolescents but increased for parents. Parental anxiety and stress at 3 months predicted adolescent reactions at 8 months, and there was no evidence of bidirectional effects. Adolescents (but not parents) appraised the attacks as having less impact on themselves than on others. Appraising the attacks as having less impact predicted lower recalled negative emotion and fewer posttraumatic stress symptoms. The results suggest that adolescents' tendency to view themselves as less vulnerable than others, which can lead to risky behaviors, may also serve a protective function when adolescents confront distant traumatic events. [Author Abstract] KEY WORDS: adolescence; emotion; memory; risk perception; appraisal; terrorism

This study examined media exposure and adjustment to anthrax bioterrorism attacks and the terrorist attacks on 9/11 in a sample of 300 people who lived distant from the attacks. Measures of direct and indirect exposure to terrorism, perceived risk of anthrax exposure, psychological distress, and outlook were assessed at 2 to 3 months and at 8 months after the first reported anthrax attack. Initial anthrax media exposure was a powerful predictor of distress, whereas subsequent anthrax media exposure only predicted negative changes in outlook over time. Perceived risk of anthrax exposure predicted distress and outlook but did not appear to mediate the effects of media exposure. Determining the nature and consequences of media exposure to threatening and frightening events like terrorism will help predict and manage response to future bioterrorism. [Author Abstract]

The Israeli population has been subjected to the stresses of war and terrorist attacks since long before the state was founded. Confronting this extensive experience of terrorism-related psychological trauma, the Mental Health Services of the Ministry of Health designed and implemented a comprehensive emergency response system that operates in general hospitals and community settings to meet the psychological needs resulting from terrorism at both the individual and the population levels. This article describes general premises, basic elements, administrative structure, and functioning of this system, as well as training programs for various service providers working with the victims. [Author Abstract] KEY WORDS: terrorism, mental health services, emergency situation, policy

There remains concern that survey research after a disaster can precipitate or exacerbate distress among study participants. The authors surveyed 5,774 persons in three random-digit-dial telephone surveys of the general population of New York City conducted 1-2 months, 4-5 months, and 6-9 months after the terrorist attack on September 11, 2001. Overall, 746 (12.9%) people who finished the surveys said that the survey questions were upsetting but only 57 (1.0% overall) were still upset at the end of the interview, and 19 (0.3%) wanted assistance from a counselor. 10 persons who did not finish the survey also received counselor assistance. Persons with mental health symptoms were more likely to find the survey questions emotionally upsetting as were participants who lacked salutary resources, including health insurance and a regular health care provider. Although relatively few of those interviewed found the survey assessment disturbing, the presence of a small number of respondents who wanted mental health assistance suggests the need for a mental health backup system for research conducted soon after exposure to large-scale traumatic events. [Author Abstract]

In October 2002 armed suicide terrorists held over 800 theatergoers hostage for three days. The standoff ended when Russian Special Forces gassed and stormed the theater. The terrorists were killed and hostages were dragged to buses that took them to hospitals where unprepared doctors struggled to revive them. 130 hostages died: 125 from the gas, only 5 directly from the terrorists' actions. An American author collaborated with colleagues from the Russian Academy of Sciences shortly after the event to study acute psychological responses of the hostages. This paper reports on posttraumatic and acute responses following the event in 11 hostages and makes recommendations for short-term interventions following such an ordeal. [Author Abstract] KEY WORDS: hostage, suicide terrorism, Impact of Events Scale, hostage taking, posttraumatic stress, acute stress, grief, dissociation

Cognitive, coping, and trauma symptom predictors of posttraumatic growth (PTG; measured with the Posttraumatic Growth Inventory) were examined in a large convenience sample (n = 1505) participating in a longitudinal Internet-based study following the terrorist attacks of 9/11/01. Results indicate that initial PTG levels (mean 9 weeks post-attacks) were generally associated with higher trauma symptoms (measured with the PTSD Checklist - Specific), positive changes in worldview (measured with the Changes in Outlook Questionnaire), more denial, and less behavioral disengagement (measured with the Brief COPE). Additionally, PTG had a curvilinear association with level of trauma symptoms, such that those reporting symptoms at intermediate levels reported the highest levels of growth. Levels of PTG declined somewhat over time with the exception of Spiritual Change. As expected, PTG levels at follow-up (mean 6.5 months post-attacks) were primarily predicted by initial PTG levels; however, decreases from baseline in trauma symptoms and increases from baseline in positive worldview, acceptance, and positive reframing were also associated with higher reported posttraumatic growth at follow-up. These findings suggest that there may be a range of traumatic experience most conducive to growth and they also highlight the important contributions of cognitive and coping variables to psychological thriving in short- and longer-term periods following traumatic experience. [Author Abstract] KEY WORDS: posttraumatic growth, coping, changes in outlook, worldview, traumatic stress symptoms, curvilinear, terrorism, 9/11/01

As a follow-up to our earlier report on the level of posttraumatic stress symptoms (PTSS), depressive symptoms, and frequency of diagnoses of probable PTSD among college students at three public universities (Albany NY, Augusta GA, and Fargo ND) resulting from the September 11, 2001 terrorist attacks, we surveyed comparable groups of students (total, n = 1313) from these three institutions in the weeks following the first anniversary (2002) of the attacks. We found proximity effects (Albany higher than Augusta which was higher than Fargo) for PTSS and depressive symptoms but not for frequency of diagnoses of probable PTSD. Within the Albany site data, proximity of county of residence to New York City (NYC) also showed a proximity effect on PTSS. Although depressive symptoms were significantly different in 2002 versus 2001, the arithmetic differences in PTSS or in frequency of diagnoses of probable PTSD were not significant. The September 11 attacks continued to exert a psychic toll on college students even a year later. [Author Abstract] KEY WORDS: PTSD; depression; September 11; terrorism; proximity

Disaster exposure may exacerbate psychopathology and substance-related disorders. Four months after September 11, 2001, using random-digit dialing to contact a representative sample of adults (N = 2001) living in New York City, we assessed cigarette smoking and symptoms of probable cigarette dependence using measures from the National Survey on Drug Use and Health. A total of 36.8% of smokers reported increased cigarette use; 10.4% of respondents reported three or more symptoms of cigarette dependence and were considered cases of probable cigarette dependence based on DSM-IV criteria. Cases were more likely to report an increase in cigarette use since September 11 than non-cases (69.4% among cases vs. 2.2% among non-cases, p < 0.001). Cases were more likely to have probable PTSD and depression than non-cases (18.1% vs. 5.7% for PTSD, p < 0.001; 23.6% vs. 6.0% for depression, p < 0.001). Increased cigarette use since September 11 was associated with probable PTSD among cases (23.4% vs. 6.4%, p = 0.011) and non-cases (15.1% vs. 5.5%, p = 0.034) but was associated with probable depression only among cases of probable cigarette dependence (28.3% vs. 13.3%, p = 0.027). This study showed the co-occurrence of probable cigarette dependence with increased cigarette use and the co-occurrence of probable cigarette dependence with probable PTSD and depression after September 11. [Author Abstract]