Posttraumatic Stress Disorder in the General Population After Mass Terrorist Incidents: Considerations About the Nature of Exposure

Epidemiologically, disasters represent multiple forms of possible exposures, including exposure type (eg, natural versus human-made), intensity, and duration. It has been suggested that the consequences of human-made disasters (eg, terrorist incidents) may be more severe than those of natural disasters; recent evidence suggests that there may be a high prevalence of posttraumatic stress disorder (PTSD) among both direct survivors of such attacks and in the general population. Several studies after the September 11, 2001, terrorist attacks found that the prevalence of PTSD was higher in New York City than it was in the rest of the US and that there was a substantial burden of PTSD among persons who were not directly affected by the attacks. This raises important questions about the meaning of “exposure” to a disaster. Using data from an assessment of PTSD in the first 6 months after September 11th we considered the nature of the PTSD experienced by persons who were not directly affected by the September 11th attacks. These data suggest that persons in the general population may have clinically important posttraumatic stress symptomatology after a mass terrorist incident. Future research should consider mechanisms through which persons in the general population may be at risk for PTSD after such incidents.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40336/2/Galea_Posttraumatic Stress Disorder in the General_2005.pd

Gender Disparities in Posttraumatic Stress Disorder After Mass Trauma

Background: Although several studies have shown that rates of posttraumatic stress disorder (PTSD) are higher in women than in men, less is known about whether women are more vulnerable to PTSD after a major community-wide traumatic event. Objective: The aim of this study was to examine gender disparities in the prevalence of probable lifetime PTSD and probable PTSD after a mass traumatic event. Methods: A representative sample of men and women living in the New York City metropolitan area was selected using random-digit dialing, and subjects were interviewed by telephone 6 to 9 months after the September 11, 2001 (9/11) terrorist attacks. We assessed probable lifetime PTSD and probable PTSD related to the 9/11 attacks using a brief screening instrument and potential correlates. Results: A total of 2752 individuals (1479 women, 1273 men) were interviewed. The lifetime prevalence of probable PTSD was significantly higher for women than for men (17.2% vs 12.1%; P = 0.005). Experiences of sexual assault (P < 0.001), preexisting mental health problems (P = 0.04), race/ethnicity (P = 0.01), marital status (P < 0.001), and having had probable peri-event panic in the first few hours after the 9/11 attacks (P < 0.001) were all significantly related to women’s greater susceptibility to probable lifetime PTSD. However, the prevalence of probable PTSD related to 9/11 was not significantly different between women and men (6.5% vs 5.4%), although women were significantly more likely to report re-experiencing (P < 0.001) and hyperarousal (P < 0.001) symptoms than were men. Women were more likely than men to experience probable peri-event panic during the 9/11 attacks (P < 0.001); this explained, in part, the greater subsequent likelihood of re-experiencing and hyperarousal symptoms among women compared with men. Conclusions: More factors explain the risk of PTSD among women and men after interpersonal trauma than after a disaster. Using peri-event panic symptomatology after a traumatic event to determine the risk of posttraumatic symptoms may suggest avenues for intervention that can decrease the burden of PTSD in women. (Gend Med. 2006;3:54–67) Copyright © 2006 Excerpta Medica, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40296/2/Stuber_Gender Disparities in Posttraumatic Stress Disorder_2006.pd

Television Images and Probable Posttraumatic Stress Disorder After September 11. The Role of Background Characteristics, Event Exposures, and Perievent Panic

Television viewing has been associated with posttraumatic stress disorder (PTSD) symptoms after disasters and traumas; we examined characteristics that may explain this association among New Yorkers after September 11, 2001. Among 2001 respondents to a random-digit dial telephone survey conducted 4 months after September 11, people who viewed more television images in the 7 days after September 11 had more probable PTSD. People in the highest third of viewing had a 2.32 times greater odds of probable PTSD after September 11 compared with people in the lowest third of viewing; after adjustment for explanatory variables, the relative odds of probable PTSD were 1.66. Adjustment for perievent panic accounted for 44% of the reduction in association between television and probable PTSD, suggesting that perievent emotional reactions may play an important role in the television and psychopathology association. Television may merit consideration as a potential exposure to a traumatic event.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40287/2/Ahern_Television Images and Probable Posttraumatic Stress_2004.pd

Mental Health in New York City After the September 11 Terrorist Attacks: Results From Two Population Surveys

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40345/2/Galea_Mental Health in New York city After_2002.pd

Prevalence and risk of psychiatric disorders as a function of variant rape histories: results from a national survey of women

Abstract Purpose Rape is an established risk factor for mental health disorders, such as posttraumatic stress disorder (PTSD), major depressive episodes (MDE), and substance use disorders. The majority of studies have not differentiated substance-involved rape or examined comorbid diagnoses among victims. Therefore, the aim of the present study was to estimate the prevalence of common traumarelated psychiatric disorders (and their comorbidity) in a national sample of women, with an emphasis on distinguishing between rape tactics. A secondary objective was to estimate the risk for psychiatric disorders among victims of variant rape tactics, in comparison to non-victims. Methods A nationally representative population-based sample of 3,001 non-institutionalized, civilian, English or Spanish speaking women (aged 18-86 years) participated in a structured telephone interview assessing rape history and DSM-IV criteria for PTSD, MDE, alcohol abuse (AA), and drug abuse (DA). Descriptive statistics and multivariate logistic regression analyses were employed. Results Women with rape histories involving both substance facilitation and forcible tactics reported the highest current prevalence of PTSD (36%), MDE (36%), and AA (20%). Multivariate models demonstrated that this victim group was also at highest risk for psychiatric disorders, after controlling for demographics and childhood and multiple victimization history. Women with substancefacilitated rapes reported higher prevalence of substance abuse in comparison to women with forcible rape histories. Comorbidity between PTSD and other psychiatric disorders was higher among rape victims in comparison to nonrape victims. Conclusions Researchers and clinicians should assess substance-facilitated rape tactics and attend to comorbidity among rape victims. Empirically supported treatments are needed to address the complex presentations observed among women with variant rape histories

Posttraumatic Stress in Women after the September 11 Terrorist Attacks in New York City

Background: Women have been shown to be at higher risk than men of developing posttraumatic stress disorder (PTSD) after traumatic events. Women in New York City were more likely than men to have probable PTSD 5–8 weeks after the September 11, 2001, terrorist attacks on the World Trade Center. We explored the factors that could explain the higher prevalence of probable PTSD among women in the aftermath of the attacks. Methods: Data from a telephone survey of a randomly selected group of residents of Manhattan living south of 110th street, conducted 5–8 weeks after September 11, were used in these analyses. The survey assessed demographic information, lifetime experience of traumatic events, life stressors, social support, event exposure variables, perievent panic attacks, postevent concerns, and probable PTSD related to the attacks. We determined the contribution of key covariates that could explain the gender-probable PTSD relation through stratified analyses and manual stepwise logistic regression model building. Results: Among 988 respondents, women were two times more likely than men to report symptoms consistent with probable PTSD after the September 11 attacks. When adjusted for potential confounders, the association between gender and probable PTSD diminished from OR 5 2.2 (95% confidence interval [CI] 1.3–3.6) to OR 5 1.2 (95% CI 0.7–2.2). Conclusions: These results suggest that specific behavioral and biographic factors (including previous traumatic experiences and psychological disorders, social responsibilities, and perievent emotional reactions) explained most of the excess burden of probable PTSD among women after a disaster. Isolating the characteristics that place women at greater risk for probable PTSD after disasters can inform public health prevention strategies and spur further research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40341/2/Pulcino_Posttraumatic Stress in WOmen after_2003.pd

Mental Health Service and Medication Use in New York City After the September 11, 2001, Terrorist Attack

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40261/2/Boscarino_Mental Health Service and Medication Use_2004.pd

Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial.

The current study reports results from a pilot randomized controlled trial evaluating the feasibility and efficacy of Risk Reduction through Family Therapy (RRFT) for reducing substance use risk and trauma-related mental health problems among sexually assaulted adolescents. Thirty adolescents (aged 13–17 years; M=14.80; SD=1.51) who had experienced at least one sexual assault and their caregivers were randomized to RRFT or treatment as usual (TAU) conditions. Participants completed measures of substance use, substance use risk factors (e.g., family functioning), mental health problems (i.e., posttraumatic stress disorder, depression, and general internalizing/externalizing symptoms) and risky sexual behavior at four time points (baseline, post-treatment, and 3- and 6-month follow-up). Mixed-effects regression models yielded significantly greater reductions in substance use, specific substance use risk factors, and (parent-reported) PTSD, depression, and general internalizing symptoms among youth in the RRFT condition relative to youth in the TAU condition. However, significant baseline differences in functioning between the two conditions warrant caution in interpreting between-group findings. Instead, emphasis is placed on replication of feasibility findings and within-group improvements over time among the RRFT youth