Traumatic experiences are relatively common. More than two thirds of persons in the general population may experience a significant traumatic event at some point in their lives, and up to one fifth of people in the United States may experience such an event in any given year (1–5). Although comparable international data are limited, large proportions of populations in many countries have been exposed to terrorism, forced relocation, and violence, which suggests that the overall prevalence of exposure to traumatic events worldwide may be even higher than that in the United States (6, 7).

Disasters (e.g., floods, transportation accidents) are traumatic events that are experienced by many people and may result in a wide range of mental and physical health consequences (8). In one survey of US residents, 13 percent of the sample reported a lifetime exposure to natural or human-generated disaster (9). In the National Comorbidity Survey, 18.9 percent of men and 15.2 percent of women reported a lifetime experience of a natural disaster (4). Post-traumatic stress disorder (PTSD) is the most commonly studied and probably the most frequent and debilitating psychological disorder that occurs after traumatic events and disasters (8, 10).

The growing threat of terrorism worldwide has heightened our awareness of disasters as a potentially important determinant of population health and suggests a pressing need both to identify key areas of consensus in postdisaster research and to highlight areas that require additional study (11). It is our purpose in this review to contribute to this overall goal by comprehensively and systematically assessing the epidemiologic evidence about PTSD after disasters.

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The Epidemiology of Post-Traumatic Stress Disorder after Disasters

Retrospective and prospective studies consistently show that individuals exposed to human-generated traumatic events carry a higher risk of developing Posttraumatic Stress Disorder (PTSD) than those exposed to other kinds of events. These studies also consistently identify perceptions of social support both before and after a traumatic event as an important factor in the determining vulnerability to the development of PTSD. We review the literature on interpersonal traumas, social support and risk for PTSD and integrate findings with recent advances in developmental psychopathology, attachment theory and social neuroscience. We propose and gather evidence for what we term the social ecology of PTSD, a conceptual framework for understanding how both PTSD risk and recovery are highly dependent on social phenomena. We explore clinical implications of this conceptual framework.

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Social bonds and posttraumatic stress disorder.

In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal...

/pdf/does-early-psychological-intervention-promote-recovery-from-2a17vdwal3.pdf

Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress

Purpose
We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.

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Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers

1. Department of Nursing, Peking Union Medical College Hospital, Beijing, China; 2. Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; 3. Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; 4. Department of Psychiatry, Southern Medical University Nanfang Hospital & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China; 5. The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; 6. School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China

/pdf/posttraumatic-stress-symptoms-and-attitude-toward-crisis-spoa9tg06r.pdf

Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China.

OBJECTIVE: Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. METHOD: Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. RESULTS: The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. CONCLUSIONS: The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaste...

https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.159.5.857

Psychiatric Disorders in Rescue Workers After the Oklahoma City Bombing

Studies have not previously considered postdisaster adjustment in the context of psychiatric disorders. After the Oklahoma City bombing, a volunteer sample of 181 firefighters who served as rescue and recovery workers was assessed with a structured diagnostic interview. The firefighters had relatively low rates of posttraumatic stress disorder (PTSD) and described little functional impairment, positive social adjustment, and high job satisfaction. PTSD was associated with reduced job satisfaction and functional impairment, providing diagnostic validity. Turning to social supports, seeking mental health treatment, and taking medication were not widely prevalent coping responses. Postdisaster alcohol use disorders and drinking to cope were significantly associated with indicators of poorer functioning. Surveillance for problem drinking after disaster exposure may identify useful directions for intervention.

Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing

This study explored the impact of the 1995 Oklahoma City, Oklahoma, bombing on the spouses and significant others of a volunteer sample of Oklahoma City firefighters who participated in the bombing rescue effort Twenty-seven partners of Oklahoma City firefighters participated in this study, conducted 42 to 44 months after the bombing These partners were assessed using a structured diagnostic interview and a companion interview to examine exposure, rates of psychiatric disorders and symptoms, functioning, health, and relationships Coping and perception of the firefighter partner's response were also examined Some of the women were exposed directly; most knew someone who had been involved in the disaster, and all reported exposure through the media The rate of psychiatric disorders in the women following the disaster was 22%, essentially unchanged from before the incident One developed bomb-related posttraumatic stress disorder (PTSD) Most were satisfied with their work performance; 15% reported that their health had worsened since the bombing, and more than one third reported permanent changes in relationships as a result of the bombing Most coped by turning to friends or relatives, with less than 10% seeking professional help Many described symptoms in their firefighter mate; all reported that their mate had been affected by the experience, and one half said their mate had fully recovered The mates of these firefighters fared relatively well in terms of psychiatric disorders, symptoms, and ability to function The prevalence of bomb-related post-traumatic stress disorder was considerably lower in this sample than in samples of individuals more directly exposed to the bombing, although some reported changes in relationships and health The results suggest the need for further study of the impact of interpersonal exposure in those who provide support for rescue-and-recovery workers in major terrorist incidents

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The impact of the 1995 Oklahoma City bombing on the partners of firefighters

Twenty-four female partners of firefighters participating in recovery efforts associated with the 1995 terrorist bombing in Oklahoma City were assessed 43 to 44 months later. Disaster experiences, psychiatric diagnoses, posttraumatic stress symptoms, and autonomic reactivity in response to an interview about the bombing were examined. Most of the participants with postbombing disorders suffered from pre-existing conditions. The majority found the bombing a "terrible" or "shocking" experience. One participant met all DSM-III-R symptom group criteria for bombing-related posttraumatic stress disorder, and 40% met both B (intrusive re-experiencing) and D (hyperarousal) criteria. More than one half of the sample exhibited autonomic reactivity on at least one measurement. Those who met symptom group criterion D evidenced greater autonomic reactivity than those who did not, suggesting a link between self-reported posttraumatic stress disorder symptoms of arousal and biological manifestations. Thus, it may be important to assess partners of disaster recovery workers for mental health and physiological consequences related to their indirect exposure as these may persist years after the event, even in the absence of a diagnosable mental disorder. Language: en

Kenneth Bunch

Papers

Psychiatric Disorders in Rescue Workers After the Oklahoma City Bombing

Coping, functioning, and adjustment of rescue workers after the Oklahoma City bombing

The impact of the 1995 Oklahoma City bombing on the partners of firefighters

Persistent physiological reactivity in a pilot study of partners of firefighters after a terrorist attack.