Long-term psychopathology changes among the injured and members of the community after a massive terrorist attack

Identification With Terrorist Victims of the Washington, DC Sniper Attacks: Posttraumatic Stress and Depression

In October 2002, a series of sniper attacks in the Washington, DC area left 10 people dead and 3 wounded. We examined the association between identification with terrorist victims and psychological and behavioral outcomes. Participants were 1,238 residents of the Washington, DC area (ages 18-90 years; M = 41.73, SD = 12.56) who completed the Impact of Event Scale-Revised, Patient Health Questionnaire-9, and items pertaining to identification with attack victims approximately 3 weeks following the first sniper shooting. We examined 3 types of identification with the victims: (a) as like oneself, (b) as like a friend, and (c) as like a family member. The relationships of identification to posttraumatic stress and depressive symptoms were examined using linear regression analyses. Greater total identification was associated with more posttraumatic stress and depressive symptoms (B = 0.27, p < .001, and B = 0.44, p < .001, respectively), after adjusting for demographics. Those who specifically identified with the victims as either self (B = 0.24, p < .001), friend (B = 0.30, p < .001), or family member (B = 0.27, p < .001) reported more PTSD symptoms (n = 1,101). Identifying with victims as like a friend or family member, but not as like oneself, was associated with increased depressive symptoms (B = 0.61, p < .001, and B = 0.45, p = .01, respectively; n = 1,222). Presence and type of identification play a differential role in psychological and behavioral responses during traumatic events.

Distress of Routine Activities and Perceived Safety Associated with Post-Traumatic Stress, Depression, and Alcohol Use: 2002 Washington, DC, Sniper Attacks

OBJECTIVE

For over 3 weeks in October 2002, a series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. This study examined the relationship of distress associated with routine activities and perceived safety to psychological and behavioral responses.

METHODS

Participants were 1238 residents of the Washington, DC, metropolitan area (aged 18 to 90 years, mean=41.7 years) who completed an Internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, and items pertaining to distress related to routine activities, perceived safety, and alcohol use. Data were collected at one time point approximately 3 weeks after the first sniper shooting and before apprehension of the suspects. Relationships of distress and perceived safety to post-traumatic stress, depressive symptoms, and increased alcohol use were examined by using linear and logistic regression analyses.

RESULTS

Approximately 8% of the participants met the symptom criteria for probable post-traumatic stress disorder, 22% reported mild to severe depression, and 4% reported increased alcohol use during the attacks. Distress related to routine activities and perceived safety were associated with increased post-traumatic stress and depressive symptoms and alcohol use.

CONCLUSION

Distress and perceived safety are associated with specific routine activities and both contribute to psychological and behavioral responses during a terrorist attack. These findings have implications for targeted information dissemination and risk communication by community leaders.

Psychiatric comorbidity, red flag behaviors, and associated outcomes among office-based buprenorphine patients following Hurricane Sandy

In October 2012, Bellevue Hospital Center (Bellevue) in New York City was temporarily closed as a result of Hurricane Sandy, the largest hurricane in US history. Bellevue's primary care office-based buprenorphine program was temporarily closed and later relocated to an affiliate public hospital. Previous research indicates that the relationships between disaster exposure, substance use patterns, psychiatric symptoms, and mental health services utilization is complex, with often conflicting findings regarding post-event outcomes (on the individual and community level) and antecedent risk factors. In general, increased use of tobacco, alcohol, and illicit drugs is associated with both greater disaster exposure and the development or exacerbation of other psychiatric symptoms and need for treatment. To date, there is limited published information regarding post-disaster outcomes among patients enrolled in office-based buprenorphine treatment, as the treatment modality has only been relatively approved recently. Patients enrolled in the buprenorphine program at the time of the storm were surveyed for self-reported buprenorphine adherence and illicit substance and alcohol use, as well as disaster-related personal consequences and psychiatric sequelae post-storm. Baseline demographic characteristics and insurance status were available from the medical record. Analysis was descriptive (counts and proportions) and qualitative, coding open-ended responses for emergent themes. There were 132 patients enrolled in the program at the time of the storm; of those, 91 were contacted and 89 completed the survey. Almost half of respondents reported disruption of their buprenorphine supply. Unexpectedly, patients with psychiatric comorbidity were no more likely to report increased use/relapse as a result. Rather, major risk factors associated with increased use or relapse post-storm were: (1) shorter length of time in treatment, (2) exposure to storm losses such as buprenorphine supply disruption, (3) a pre-storm history of red flag behaviors (in particular, repeat opioid-positive urines), and (4) new-onset post-storm psychiatric symptoms. Our findings highlight the relative resilience of buprenorphine as an office-based treatment modality for patients encountering a disaster with associated unanticipated service disruption. In responding to future disasters, triaging patient contact and priority based on a history of red-flag behaviors, rather than a history of psychiatric comorbidity, will likely optimize resource allocation, especially among recently enrolled patients. Additionally, patients endorsing new-onset psychiatric manifestations following disasters may be an especially high-risk group for poor outcomes, warranting further study.