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

Research on Trauma and PTSD in the Aftermath of 9/11

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40330/2/Resnick_Research on Trauma and PTSD in the Aftermath_2004.pd

Relations Among Gender, Violence Exposure, and Mental Health: The National Survey of Adolescents

Using a nationally representative sample of 4,008 adolescents, this study examines gender differences in violence exposure, major depressive episode (MDE) and posttraumatic stress disorder (PTSD), and characteristics of violence incidents. It was hypothesized that there would be gender differences in the types of violence exposure reported as well as the prevalence of MDE and PTSD; and that gender would moderate the relationship between violence exposure and mental health outcomes. Results indicated significant gender differences in rates of violence exposure, PTSD and MDE. Additionally, gender was a moderating variable in the relation between sexual assault and PTSD, but not in the other violence exposure-mental health relations examined. It thus appears that the pathways for developing PTSD may be different for male and female victims of sexual abuse. Implications for interventions and future research are discussed

Sustained Increased Consumption of Cigarettes, Alcohol, and Marijuana Among Manhattan Residents after September 11, 2001

We compared reports of increased substance use in Manhattan 1 and 6 months after the September 11, 2001, terrorist attacks. Data from 2 random-digit-dial surveys conducted 1 and 6 months after September 11 showed that 30.8% and 27.3% of respondents, respectively, reported increased use of cigarettes, alcohol, or marijuana. These sustained increases in substance use following the September 11 terrorist attacks suggest potential long-term health consequences as a result of disasters.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40269/2/Vlahov_Sustained Increased Consumption of Cigarettes_2004.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

Risk and protective factors for psychopathology among older versus younger adults after the 2004 Florida hurricanes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48790/1/acierno_risk and protective factors for psychopathology_2006.pd

Taxometric Investigation of PTSD: Data From Two Nationally Representative Samples

Current psychiatric nosology depicts posttraumatic stress disorder (PTSD) as a discrete diagnostic category. However, only one study has examined the latent structure of PTSD, and this study suggested that PTSD may be more accurately conceptualized as an extreme reaction to traumatic life events rather than a discrete clinical syndrome. To build on the existing literature base, the present research examined the latent structure of posttraumatic stress reactions by applying three taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from large nationally representative samples of women (ns = 2684 and 3033) and adolescents (n = 3775). Results consistently provided evidence for a dimensional PTSD solution across samples and statistical procedures. These findings have important implications for the theory, assessment, and investigation of posttraumatic stress reactions