We have learned much since the September 11, 2001 (9/11) terrorist attacks on New York City and Washington DC, concerning the mental health impact of terrorism and how best to respond to the resulting mental health needs of individual victims and the general population. In addition to experiential knowledge from the many thousands of individuals who participated in the 9/11 emergency response programs in those areas most directly affected by the attacks, we have gained new scientific knowledge through the large-scale survey and evaluation activities conducted nationally and within New York State since 9/11. After briefly reviewing the major post-9/11 survey and evaluation activities in New York and at the national level, the remainder of this commentary will highlight some of the important lessons learned from this work and from participating in the 9/11 response efforts. [Text, p. 147]

Disasters are traumatic events that affect many people in substantial ways (loss of relatives or friends, health, economy, residence, work, etc.). The variability of the consequences is enormous, both depending on the stressor (type of disaster, exposure level to trauma, etc.), and the individual characteristics (sex, social support, previous life stressors, etc.) Having one's residence close to the affected areas is a recent topic when investigating the factors associated to the consequences. In a broader research on the psychological consequences of the March 11th, 2004 terrorist attack in Madrid, the differences between the general population of residents in the city of Madrid and people living in three areas (in a radius of 1km around the explosions) were studied. The methodology was similar to that used by Galea et al in the research of September 11th, 2001, terrorist attacks in New York City. Important differences in psychological sequelae related to the proximity of the residence were found in New York, whereas in Madrid, the consequences of living close to the affected areas were very similar to those of the general population living in 21 different districts. [Author Abstract] KEY WORDS: disasters; stress; risk factors; exposure; epidemiology

To find out whether victims of terrorism and their relatives have higher prevalence of affective, anxiety, and alcohol abuse disorders than the general population. Between January 1997 and January 2001, 544 families affected by terrorist violence in Spain were interviewed. Victims and their relatives (n = 1,021) were evaluated by means of the PRIME-MD. They were classified according to the degree of involvement in the attacks as: relatives of victims (RV), direct victims (DV) and direct victims who were also relatives of other victims (DVRV). Their scores were compared with those of a primary health-care sample. Depressive symptoms were more prevalent among victims (DVRV, 59.2%; DV, 57.6%; RV, 50.2%) than among controls (40.0%) (p = 0.036) and their prevalence was directly related to the degree of involvement in the attacks. Similar results were obtained for anxiety disorders (DVRV, 52.6%; DV, 56.5%; RV, 45.0%, and controls 26.4%) (p = 0.017). Alcohol abuse prevalence (DVRV, 6.6%; RV, 5.9%) was very close to that of the primary health-care sample (4.8%) with the exception of direct victims (DV, 15.9%) in whom it was higher (p = 0.016). The prevalence of psychopathology was higher among victims of terrorism than among primary health-care patients and it was directly related to the involvement in the attack. Low perceived social support, family and personal history of psychiatric disease, and type of attack (explosives) increased the risk of suffering mental disorders.

OBJECTIVE: A survey assessed use of mental health services and psychiatric medications in New York City four to five months after the September 11, 2001, attack on the World Trade Center. METHODS: A telephone survey using random-digit dialing was conducted among 2,001 adult householders. RESULTS: During the interviews, 7.6% of respondents reported use of mental health services in the past 30 days and 7.7% reported use of psychiatric medications. Factors associated with service use included experiencing four or more lifetime traumatic events, experiencing two or more stressful life events in the past 12 months, having PTSD, and having depression. African-American and Hispanic respondents were less likely than white respondents to use services. Greater service use after the attack was associated with a graduate education, increased alcohol use after the attack, and depression. Factors associated with medication use included being in either of two age groups (25 to 44 years and 45 to 64 years), having a primary care physician, experiencing two or more stressful life events in the past 12 months, and having depression. African-American and Hispanic respondents were less likely than white respondents to be taking medications. Greater use after the attack was associated with having depression. Mental health visits in Manhattan appeared to decrease compared with the first two months after the attack. However, among respondents with PTSD or depression, those who were nonwhite, younger, without a primary care physician, or without health insurance were less likely to use postdisaster services. CONCLUSIONS: Service use after the terrorist attack was related to mental status and to the amount of trauma and stress experienced. Overall, white respondents, those aged 25 to 64 years, and those with a primary care physician were more likely to use services. [Author Abstract]

Since the terrorist attacks of September 11, 2001 (9-11), terrorism poses a continuous threat to those living in the United States. A substantial number of people may have experienced behavioral and life changes since the attacks, with possible implications for public health. This study investigated behavioral and life changes American people have experienced since the attacks. Using random-digit dialing that included unpublished numbers and new listings, a nationally representative cross-sectional sample of 807 U.S. adults ages 18 or older was interviewed. Logistic regression analyses indicated that gender, age, race/ethnicity, and employment status were significant predictors for experiencing different outcome variables. The qualitative data obtained from an open-ended question regarding life changes were analyzed and synthesized. The 9-11 events have considerably affected Americans' lifestyles and behavior, which may have various implications for public health policy makers and educators. [Author Abstract] KEY WORDS: terrorism; national survey; behavioral changes; public health

This article examines the impact of exposure of ongoing terrorism on PTSD symptoms, functional impairment, somatization, and depression among Israeli adolescents in the context of the Al Aqsa Intifada. An in-school screening of 1,010 adolescents was conducted in Jerusalem and nearby settlements that were subjected to intensive terrorist attacks. The screening procedure proved effective in identifying posttraumatic distress and triaging students for school-based treatments. The relationship between level of exposure and gender and the psychological sequelae, the differences between adolescents in Jerusalem and the settlements, and the role of spirituality and community are discussed. [Author Abstract] KEY WORDS: screening; PTSD; trauma; terrorism; adolescents; PTSD

Dr. Reissman and colleagues found that adult survivors of Bacillus anthracis infection had significantly more psychological symptoms and reduced quality of life after 6 months than did a comparison group of patients with sepsis and chronic illness. However, patients exposed to B anthracis not only had an infectious disease, but were also exposed to bioterrorism, an act of mass violence. Individuals exposed to trauma due to malicious human intent are more likely to be severely impaired compared with those exposed to naturally or accidentally occuring disasters. [Adapted from Text]

There are few studies of the acute and long-term effects of mass trauma on victimized communities. Acute stress reactions are expected, and overall resilience in the aftermath of major disasters is the rule rather than the exception. However, the available literature on mass trauma suggests that certain factors may provide clues to identifying persons at greater risk for posttraumatic stress disorder (PTSD). The severity of the trauma and the accessibility of support systems may affect longterm outcome. In industrialized countries, mass violence caused by malicious human intent may be a more virulent precursor to PTSD than other types of mass trauma, such as natural disasters. School-aged children, women, persons with existing psychiatric illness, those who experienced significant losses or threat to life, those who have insufficient psychological and social support systems, and persons who exhibit symptoms of functional impairment may be at greater risk for PTSD. The findings of a population study of 2 traumatized communities are discussed. Early intervention in communities suffering mass trauma should consist of general support and bolstering of the recovery environment rather than psychological treatment; some forms of early psychological interventions may worsen outcome. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

The aim of this work is to identify acute stress symptoms and general functioning problems in the population of the affected zones after the March 11, 2004, terrorist attack. 1,179 adults (≥ 18 years) were assessed in the second week after the terrorist attack (from March 18 to 24). One-third of the people included in this sample are working or living in the most direct affected zone. Data show high percentages of acute stress symptoms (46.7%), and the 18.1% of the population had general functioning problems. The 12.8% presented functioning problems during 2 or more days that interfered, at least moderately, with daily life activity. Results are discussed in terms of planning services adjusted to population identified needs. [Author Abstract] KEY WORDS: acute Stress Disorder, epidemiology, terrorism, disasters, psychosocial functioning

A major psychological sequel of terrorist attacks is post-traumatic stress disorder. The relation between certain psychological factors specific to terrorist attacks (e.g., perceived control attributed to oneself/to the military, anticipated duration of terrorism) and PTSD symptoms have not been examined. To examine the prevalence, correlates and moderators of PTSD-like symptoms following terrorist attacks in Israel. Soon after a long wave of terrorist attacks in Israel in 2002, a convenience sample of 149 Israelis from five cities was assessed for terrorist attack exposure, perceived control, control attributed to the govemment/military, anticipated duration of the terrorism wave (predictability), and frequency of listening to the news. PTSD-like symptoms were assessed with a brief self-report scale. We found that 15.4% of the sample was directly exposed to a terrorist attack and 36.5% knew someone dose who had been exposed to an attack. "Clinically significant" PTSD-like symptoms were reported by 10.1% of the sample. Correlates of PTSD-like symptoms were: perceived control in men, government control, and education in women (all inversely correlated to PTSD symptoms), and news-listening frequency in women (positively correlated to PTSD symptoms). PTSD-like symptoms were attenuated by the ability to predict the duration of the terrorism wave only in citizens exposed to an attack, and by perceived government control only among citizens listening infrequently to the news. This study revealed that approximately 10% of Israelis in our sample had relatively frequent PTSD-like symptoms. Correlates of PTSD-like symptoms differed between men and women, and moderator effects were found. These findings reveal additional moderators that may have implications for treating PTSD following terrorist attacks.