How terrorist attacks affect mental health

Terrorist attacks have widespread effects on people's mental health, even on communities at a distance from the attacks.

An editorial in the February 2007 issue of the British Journal of Psychiatry, reviewing the current research on mental health following terrorist attacks, has found that although these effects are mainly short-lived, a few people not directly involved in the incidents will continue to experience symptoms of post-traumatic stress disorder (PTSD).

30%-40% of people directly affected by terrorist action are likely to develop PTSD, and at least 20% are still likely to be experiencing symptoms 2 years later.

Less is known about the impact on children, but this also appears to be considerable.

In contrast, there is less evidence that rescue workers and members of the emergency services are at high risk of developing PTSD.

Terrorist activity reached a peak in the UK during the 30 years from the late 1960s to the late 1990s, with hundreds of incidents associated with the conflict in Northern Ireland. More recently, Islamic terrorist groups have targeted London, Madrid and New York City, as well as many other cities in Europe, Asia and North America.

It is only comparatively recently that there has been systematic research into the effects of terrorist attacks on victims and on the wider community. Several studies show that rates of 'substantial stress' are extremely high in the first few days after an incident, but are already in decline in the first 2 weeks. By 6-8 weeks, they have fallen by two-thirds.

However, a significant minority of people are affected for considerably longer. Over 6 months after the 11 September 2001 attacks, 5.3% of New York City residents continued to meet criteria for 'sub-syndromal' PTSD, a condition associated with substantial problems in functioning properly.

Rates of PTSD in response to single attacks may be as high as 11%-13% in the first 6 weeks, declining to below 3% 2 months after the incident.

Those reporting more symptoms include members of minority groups, people with previous experience of adversity, and people who have developed psychiatric disorders in response to past stresses. Intense media coverage and general concern about terrorism may increase general levels of stress.

In New York City, 6 months after the September 11 attacks, 28.6% of children had agoraphobia, separation anxiety or PTSD.

"In the US they found an increase in anxiety across the country after September 11, and even in the UK, British schoolchildren were looking at images of the twin tower wreckage, so there was more anxiety across the world, and it increased people's feelings of threat," said one of the authors, Professor Chris Brewin of University College London.

"Children could well be affected more than adults because it may be harder for them to think through and discount the long term effects, so they may be more prone to thinking that they are in danger and that it might happen again."

Direct victims of terrorist attacks are most affected, and several studies have found that within 2 years of the incident, 30%-40% of the people closest to the site of the attack are likely to develop a psychiatric disorder. "The most important thing that determines how badly you are affected is how close you were to the attack. The closer you were, the more likely you are to experience symptoms," said Prof. Brewin.

Research among emergency workers has usually shown considerably lower levels of psychiatric disorder than in direct victims, despite their being exposed to similar experiences after the event. "If you're a professional you know what you're going to and you're training for it, but if it happens without you being prepared, you may see or hear some horrible things that you weren't prepared for. A lot of people say that it changes their lives forever," Professor Brewin explained.

There is a significant risk of psychological disorder in children who are direct victims, suffer bereavement or other losses, or have to witness repeated reminders of the attacks, including parental distress.

The authors of the review conclude that their findings have important implications for health services. Whereas some direct victims are likely to be in contact with providers of psychological services, in New York City after 11 September only around a quarter to a third of adults and children with significant PTSD symptoms received any treatment at all.

A targeted, active outreach programme should be developed - for example, using a 'screen and treat' approach - to improve this level of unmet need, they suggest.

Whalley MG and Brewin CR.
Mental health following terrorist attacks
Br J Psychiatry 2007;190:94-96.   [Abstract]

tags: post traumatic stress disorder  ptsd  

links: digg this    del.icio.us    technorati    reddit