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Posttraumatic Stress Disorder in the General Population After Mass Terrorist Incidents: Considerations About the Nature of Exposure
- Sandro Galea, Heidi Resnick
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- Journal:
- CNS Spectrums / Volume 10 / Issue 2 / February 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 107-115
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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.
An Investigation of the Psychological Effects of the September 11, 2001, Attacks on New York City: Developing and Implementing Research in the Acute Postdisaster Period
- Sandro Galea, David Vlahov, Heidi Resnick, Dean Kilpatrick, Michael J. Bucuvalas, Mark D. Morgan, Joel Gold
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- Journal:
- CNS Spectrums / Volume 7 / Issue 8 / August 2002
- Published online by Cambridge University Press:
- 07 November 2014, pp. 585-596
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The September 11, 2001, attack on New York City was the largest human-made disaster in United States history. In the first few days after the attack, it became clear that the scope of the attacks (including loss of life, property damage, and financial strain) was unprecedented and that the attacks could result in substantial psychological sequelae in the city population. Researchers at the Center for Urban Epidemiologic Studies at the New York Academy of Medicine designed and implemented an assessment of the mental health of New Yorkers 5—8 weeks after the attacks. To implement this research in the immediate postdisaster period, researchers at the center had to develop, in a compressed time interval, new academic collaborations, links with potential funders, and unique safeguards for study respondents who may have been suffering from acute psychological distress. Results of the assessment contributed to a New York state mental health needs assessment that secured Federal Emergency Management Agency funding for mental health programs in New York City. This experience suggests that mechanisms should be in place for rapid implementation of mental health assessments after disasters.
Mental Health Outcomes Among Adults in Galveston and Chambers Counties After Hurricane Ike
- Kenneth J. Ruggiero, Kirstin Gros, Jenna L. McCauley, Heidi S. Resnick, Mark Morgan, Dean G. Kilpatrick, Wendy Muzzy, Ron Acierno
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 6 / Issue 1 / March 2012
- Published online by Cambridge University Press:
- 08 April 2013, pp. 26-32
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Objective: To examine the mental health effects of Hurricane Ike, the third costliest hurricane in US history, which devastated the upper Texas coast in September 2008.
Method: Structured telephone interviews assessing immediate effects of Hurricane Ike (damage, loss, displacement) and mental health diagnoses were administered via random digit-dial methods to a household probability sample of 255 Hurricane Ike–affected adults in Galveston and Chambers counties.
Results: Three-fourths of respondents evacuated the area because of Hurricane Ike and nearly 40% were displaced for at least one week. Postdisaster mental health prevalence estimates were 5.9% for posttraumatic stress disorder, 4.5% for major depressive episode, and 9.3% for generalized anxiety disorder. Bivariate analyses suggested that peritraumatic indicators of hurricane exposure severity—such as lack of adequate clean clothing, electricity, food, money, transportation, or water for at least one week—were most consistently associated with mental health problems.
Conclusions: The significant contribution of factors such as loss of housing, financial means, clothing, food, and water to the development and/or maintenance of negative mental health consequences highlights the importance of systemic postdisaster intervention resources targeted to meet basic needs in the postdisaster period.
(Disaster Med Public Health Preparedness. 2012;6:26–32)
15 - Rape and other sexual assault
- from Section 4 - Specific challenges
- Edited by Steven M. Southwick, Brett T. Litz, Boston University, Dennis Charney, Matthew J. Friedman
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- Book:
- Resilience and Mental Health
- Published online:
- 07 September 2011
- Print publication:
- 18 August 2011, pp 218-237
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Summary
Introduction
This chapter describes the prevalence of rape and the risk of associated mental health problems, including definition of key terms such as rape. The particular focus of the chapter is on post-traumatic stress disorder (PTSD) as a primary mental health problem associated with rape. Major methodological approaches to the study of rape, related risk, resilience, and associated mental health problems are described, and advantages and disadvantages and implications of the major approaches are discussed. Findings from the literature related to risk and protective factors for PTSD are reviewed in general, as well as what is known specifically about risk and protective factors for PTSD given exposure to rape. The discussion is concluded by considering the implications for future research related to etiology and/or intervention in relation to the study of resilience.
Prevalence of rape
Rape is a common problem in many countries, including America. Carefully conducted epidemiological studies estimate the proportion of women who have been raped is between 12.6% and 16.1% in the USA (Kilpatrick et al., 1992, 2007a; Tjaden & Thoennes, 2000). Based on the most recent estimates and the 2005 US Census data, an estimated 20.2 million women have been raped, with an estimated 1.1 million women who have been raped within a given year (Kilpatrick et al., 2007b). Furthermore, the incidence of rape is likely to be increasing, with recent lifetime prevalence estimates of rape being higher than those obtained in the early 1990s. There is substantial evidence to support significant untoward consequences of rape. Women who are victims of rape are at a significantly increased risk for mental health problems, substance abuse, and poor physical health compared with non-victims (Steketee & Foa, 1987; Resick, 1993; Resnick et al., 1993, 1997; Kessler et al., 1995; Kilpatrick et al., 1997, 2003). In particular, findings from epidemiological studies indicate that rape or completed sexual assault, compared with other traumatic events, is associated with greatest risk of PTSD (Kilpatrick et al., 1989; Norris, 1992; Resnick et al., 1993; Kessler et al., 1995). While estimates vary, approximately half of rape victims develop PTSD (Breslau et al., 1998); so not all women who experience rape develop emotional problems, but, given the high prevalence of rape and the substantial cost associated with this adverse event, it is not surprising that researchers have focused on predictors of PTSD among rape victims. A significant consequence of this focus is that little is understood about the characteristics of those who appear to endure rape with minimal adverse sequelae. A better understanding of the human capacity to maintain healthy, symptom-free functioning or resilience in the face of significant adversity is of great importance to the study of PTSD. It is useful to identify protective factors as well as risk factors for psychopathology, both to understand resilience in the face of known risk factors and to identify potentially modifiable risk factors that might be targeted in interventions promoting resilience (e.g., providing secondary prevention once a woman has been sexually assaulted). For example, knowing characteristics of rape that elevate risk may help to identify those who are resilient even under high-risk conditions and to identify individual, system response, or social response factors that produce more positive outcomes under those conditions. Consequently, the major objective of this chapter is to review what is known about risk and protective factors for PTSD after exposure to rape, with particular emphasis on factors related to resilience. Prior to this review, important terms will be defined and key methodological issues identified that should be considered in a review of rape and resilience and how well extant research is capable of providing information on resilience. Our review will draw on what existing reviews of the literature tell us about risk and protective factors for PTSD in general, as well as what we know about risk and protective factors for PTSD given exposure to rape specifically.
3 - Post-traumatic stress symptoms in the general population after a disaster: implications for public health
- from Part II - The psychological aftermath of 9/11
- Edited by Yuval Neria, Columbia University, New York, Raz Gross, Columbia University, New York, Randall D. Marshall, Columbia University, New York, Ezra S. Susser, Columbia University, New York
- Foreword by Beverley Raphael
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- Book:
- 9/11: Mental Health in the Wake of Terrorist Attacks
- Published online:
- 27 October 2009
- Print publication:
- 14 September 2006, pp 19-44
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Summary
Introduction
Post-traumatic stress after disasters and after September 11, 2001
Major disasters are associated with increased rates of psychological distress and morbidity among survivors (Norris et al., 2002a, b; Galea et al., 2005). The vast majority of post-disaster research has focused on the groups that are typically considered to be most affected by disasters and a substantial literature has documented the burden of psychopathology faced by survivors of disasters (North et al., 1999; Salcioglu et al., 2003) persons who are involved in the post-disaster recovery efforts (North et al., 2002), and family and friends of persons who are killed or seriously injured in disasters (Stoppelbein & Greening, 2000). Post-traumatic stress disorder (PTSD) is the most commonly studied, and likely the most prevalent mental health problem in these groups after disasters (Green & Lindy, 1994; Galea et al., 2005), although other mental health problems including depression (Kuo et al., 2003), generalized anxiety disorder (Smith et al., 1990), and non-specific psychological stress (Carr et al., 1997) have been studied.
In the aftermath of the September 11 attacks there was every reason to believe that the impact of the attacks among the survivors of the attacks would be comparable to that among survivors of other major disasters. For example, in the aftermath of the bombing of the Murrah Federal Building in Oklahoma City, North and colleagues reported that 34.3% of adult survivors of the bombing who were either in the building at the time of the bombing or in close proximity had symptoms consistent with a diagnosis of PTSD in the first 6 months after the bombing (North et al., 1999). Official estimates of the number of persons who were survivors of the September 11 attacks vary.