This study investigated the presence of a stress response after the September 11th terrorist attacks in a sample of indirectly affected college students living in Boston, Massachusetts. Anxiety was examined at two time intervals, approximately 2 and 4 months after the attacks. Methods of coping with the stress of the attacks (assessed using the COPE Inventory) and their impact on initial and longer-term anxiety were also examined. Results demonstrated that the majority of college students in the study were severely psychologically impacted initially by the terrorist attacks. However, this initial impact appears to decay over time for most people. Several potentially maladaptive coping strategies were found to be predictive of initial anxiety, including denial, behavioral disengagement, mental disengagement, and focus on and venting of emotions. However, only focus on and venting of emotions was found to be uniquely predictive of longer-term anxiety. [Author Abstract] KEY WORDS: terrorism, September 11th, anxiety & coping

This study examined age and gender differences and similarities in stress responses to September 11th. Adolescents, young adults, and adults reported using a variety of strategies to cope with the terrorist attacks including acceptance, positive thinking, and emotional expression. In addition, involuntary stress responses such as physiological arousal, rumination, and emotional numbing were common. A number of age trends emerged, showing increases across the three groups in emotion-based coping strategies and decreases in some forms of disengagement coping. In addition, rumination decreased with age, whereas intrusive thoughts were more prevalent in the older groups. Females in both the adolescent and young adult samples reported using emotion-based strategies more than males, and these strategies were related to better functioning for females only. In addition, males reported higher levels of disengagement responses; and these responses were related to worse functioning, but only for females. The utility of using the Responses to Stress Questionnaire to examine coping and involuntary stress responses in reference to terrorism and across a wide age range was examined. Implications for coping theory and empirical research are explored. [Author Abstract]

The mental health effects of disaster and terrorism have moved to the forefront in the recent past following the events of 11 September 2001 in the United States. Although there has been a protracted history by mental health researchers and practitioners to study, understand, prevent, and treat mental health problems arising as a result of disasters and terrorism, there still is much to learn about the effects and treatment of trauma. Continued communication among disaster workers, first-response medical personnel, and mental health professionals is part of this process. This paper outlines current knowledge regarding the psychological effects of trauma and best cognitive-behavioral practices used to treat trauma reactions. More specifically, the information presented is a summary of Cognitive-Behavioral Therapy (CBT) interventions that are relevant for responding to and dealing with the aftermath of disasters.

This paper aims to explore psychological aftermath of traumatic exposure in emergency personnel involved in rescue efforts and first aid after the March 11, 2004, terrorist attacks in Madrid. A group of 165 individuals (30.1% males and 69.9% females), with a mean age of 34.9 years, including psychologists, policemen, physicians, social workers, etc, was interviewed in detail. Data regarding prevalence rates of panic attack, PTSD, depression, and drugs and alcohol consumption one-month and six-months after the terrorist attacks are presented and discussed. Generally, emergency personnel manifested intense peri-traumatic reactions, with higher prevalences than in general population, due to a high degree of exposition to traumatic consequences of the train bombings; however, due to they were mostly well-trained professionals and with previous experience in disaster management, there was a good emotional management that did not allow chronification of such reactions, that could facilitated the onset and development of PTSD and depression, lower prevalence than in general population. [Author Abstract] KEY WORDS: PTSD; depression; drug and alcohol consumption; emergency personnel; rescue workers; terrorism

A longitudinal investigation of psychological responses to the September 11, 2001 terrorist attacks was conducted on a U.S. national probability sample. Using an anonymous Web-based survey methodology, data were collected among over 1,900 adults at 2 weeks and 12 months post-9/11 to consider whether direct and proximal exposure were necessary preconditions for high levels of acute and posttraumatic stress symptoms, and whether greater exposure/proximity led to greater traumatic stress symptoms. Results suggest that the requirement of direct and proximal exposure to the attacks and the expectation of a dose-response relationship between exposure and traumatic stress response are myths. [Author Abstract] KEY WORDS: terrorism; September 11th; acute stress response; posttraumatic stress response; exposure

Should mental health practitioners expect lasting posttraumatic stress symptoms in the general population after future terrorist attacks or other disasters? Serendipitous random assignment of families allowed assessment of the effects of the September 11, 2001, terrorist attacks on parent and child trauma-related symptoms and parenting. Surprisingly, there were no differences between pre- and post-September 11 groups on measures of parent and child anxiety, depression, and feelings of safety. However, levels of parental monitoring and beliefs about family were higher in the group assessed after September 11, 2001. Implications for practitioners' responses to terrorism and disaster are discussed. [Author Abstract]

PURPOSE: To assess ethnic differences in the risk of PTSD after a disaster, and to assess the factors that may explain these differences. METHODS: We used data from a representative survey of the New York City metropolitan area (n = 2616) conducted 6 months after September 11, 2001. Linear models were fit to assess differences in the prevalence of PTSD between different groups of Hispanics and non-Hispanics and to evaluate potential explanatory variables. RESULTS: Hispanics of Dominican or Puerto Rican origin (14.3% and 13.2%, respectively) were more likely than other Hispanics (6.1%) and non-Hispanics (5.2%) to report symptoms consistent with probable PTSD after the September 11 terrorist attacks. Dominicans and Puerto Ricans were more likely than persons of other races/ethnicities to have lower incomes, be younger, have lower social support, have had greater exposure to the September 11 attacks, and to have experienced a peri-event panic attack upon hearing of the September 11 attacks; these variables accounted for 60% to 74% of the observed higher prevalence of probable PTSD in these groups. CONCLUSION: Socio-economic position, event exposures, social support, and peri-event emotional reactions may help explain differences in PTSD risk after disaster between Hispanic subgroups and non-Hispanics. [Author Abstract] KEY WORDS: PTSD; Race; Ethnicity; Hispanic; Disaster

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and follow-up; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

This article highlights findings on terrorism's impacts in countries outside of the United States. It reviews preceding articles and other published reports, and describes interventions and programs. It introduces the topic of "medically unexplained symptoms" that arise after terrorist attacks to explain some of the wide cultural variation in responses to terrorism. The article concludes with recommendations to expand our understanding of the impacts of terrorism: (a) adopt a broader framework, (b) increase emphases on studies of intervention and program development, and (c) recognize and seek to enhance resilience and the potential for growth in the aftermath of terrorism. [Author Abstract] KEY WORDS: terrorism; PTSD; cultural factors; somatic symptoms; resilience

Introduces a special issue devoted to "The human reaction after the trauma: condequences of the 11 March 2004" terrorist attack. [FAL]