Search

Objective: This study explored the effects of media coverage of a terrorist incident in individuals remote from the location of a major attack who had directly experienced a prior terrorist incident., Method: Directly-exposed survivors of the 1995 Oklahoma City bombing, initially studied six months after the incident, and indirectly-affected Oklahoma City community residents were assessed two to seven months after the September 11, 2001, attacks. Survivors were assessed for a diagnosis of bombing-related posttraumatic stress disorder (PTSD) at index and follow up, and emotional reactions and September 11 media behavior were assessed in all participants., Results: Among the three investigated forms of media (television, radio, and newspaper), only television viewing was associated with 9/11-related posttraumatic stress reactions. Exposure to the Oklahoma City bombing was associated with greater arousal in relation to the September 11 attacks, and among survivors, having developed bombing-related PTSD was associated with higher scores on all three September 11 posttraumatic stress response clusters (intrusion, avoidance, and arousal). Although time spent watching television coverage of the September 11 attacks and fear-related discontinuation of media contact were not associated with Oklahoma City bombing exposure, discontinuing September 11 media contact due to fear was associated with avoidance/numbing in the full sample and in the analysis restricted to the bombing survivors., Conclusion: Surviving a prior terrorist incident and developing PTSD in relation to that incident may predispose individuals to adverse reactions to media coverage of a future terrorist attack., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to examine psychiatric illness and physiological indicators in the children of Oklahoma City bombing survivors seven years after the event., Methods: A study of 17 Oklahoma City bombing survivors and their 21 adolescent and young-adult children conducted seven years after the disaster used structured diagnostic interviews to examine psychiatric outcomes. Physiological measurements included heart rate, systolic blood pressure, diastolic blood pressure, and physiological reactivity measured in response to a semi-structured bombing-reminder interview., Results: Results revealed a statistically significant positive association between survivors and their children with respect to both post-disaster and current posttraumatic stress disorder (PTSD). Also, children whose parents met diagnostic criteria for either post-disaster or current major depression were more likely to meet criteria for a post-disaster behavior disorder and for any post-disaster psychiatric disorder than children whose parents did not meet criteria for post-disaster or current major depression. Survivors' children meeting criteria for any post-disaster psychiatric diagnosis had higher heart rates during the pre-test, test, and post-test periods than children who did not meet criteria for any disorder. Children whose survivor parents met criteria for bombing-related PTSD and for any post-disaster psychiatric disorder had greater heart rate reactivity than those whose parents did not., Conclusion: Findings of this study support previous literature on the relationships between children's psychiatric illness and physiological reactions and suggest interactions between disaster survivors' psychiatric illness and their children's psychiatric and physiological status., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The objective of this exploratory pilot study was to examine autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of highly exposed survivors of the 1995 Oklahoma City bombing., Methods: This study compared psychiatric diagnoses and biological stress markers (physiological reactivity and cortisol measures) in spouses of bombing survivors and matched community participants. Spouses were recruited through bombing survivors who participated in prior studies. Individuals with medical illnesses and those taking psychotropic medications that would confound biological stress measures were excluded. The final sample included 15 spouses and 15 community participants. The primary outcome measures were psychiatric diagnoses assessed with the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Biological stress markers were physiological reactivity and recovery in heart rate and blood pressure responses to a trauma interview and cortisol (morning, afternoon, and diurnal variation)., Results: Compared to the community participants, spouses evidenced greater reactivity in heart rate, systolic blood pressure, and diastolic blood pressure; delayed recovery in systolic blood pressure; and higher afternoon salivary cortisol., Conclusions: The results support the need for further research in this area to clarify post-disaster effects on biological stress measures in the spouses of survivors and the potential significance of these effects and to address the needs of this important population which may be overlooked in recovery efforts., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To explore the effects of hurricane exposure and forced relocation on the mind and body, we compared psychiatric diagnoses and symptoms with heart rate variability (HRV) for 34 relocated Katrina survivors and 34 demographically matched controls., Methods: All participants were healthy and free of psychiatric and cardiovascular medications. We measured symptoms of posttraumatic stress disorder (PTSD) (Clinician-Administered PTSD Scale 1) and depression (Beck Depression Inventory), Axis I psychiatric diagnoses (Structured Clinical Interview for DSM-IV), psychosocial disability (Sheehan Disability Scale), and power spectral analysis HRV reactivity to trauma reminders., Results: Katrina-related PTSD occurred in 38% of survivors and 12% of controls. Survivors reported higher levels of PTSD and depression symptoms, within diagnostic ranges, and greater psychosocial disability than controls. Survivors had higher resting heart rate (80.82 [standard deviation = 13.60] versus 74.85 [10.67], p = .05), lower parasympathetic (high-frequency [HF] normalized unit) baseline HRV activity (40.14 [23.81] versus 50.67 [19.93], p = .04) and less reactivity with trauma cues (-2.63 [20.70] versus -11.96 [15.84], p = .04), and higher baseline sympathovagal activity (low frequency/HF ratio) (2.84 [3.08] versus 1.35 [1.08], p = .04) than controls. Survivors with depression (n = 12) and with depression and PTSD combined (n = 7), but not those with PTSD (n = 13), had flattened parasympathetic responsiveness to trauma cues. HRV indices correlated with depressive (low frequency/HF, p = .01; HF normalized unit, p = .046) but not PTSD symptoms (p values > .05)., Conclusions: Results showed this multilayer trauma's impact on emotional health and HRV-based measures of autonomic nervous system dysregulation. Specifically, dysregulation of depressed survivors' HRV in response to trauma reminders supports more autonomic involvement in traumatic loss/depression than in PTSD. Diagnostic criteria for PTSD include physiologic reactivity, and the present findings suggest that, in this setting, altered physiologic reactivity observed when PTSD coexists with depression.

The objective of this study was to examine terrorism media coverage and psychiatric outcomes in directly-exposed terrorism survivors. The study used (1) self-report questionnaires to retrospectively assess event-related media behaviors and reactions in a cross sectional design and (2) longitudinal structured diagnostic interviews to assess psychopathologic outcomes. The participants were 99 directly-exposed Oklahoma City bombing survivors who were initially studied six months after the 1995 incident. Though a fear reaction to bombing-related television coverage and fear-driven discontinuation of bombing-related media contact were associated with diagnostic outcomes, the number of hours viewing bombing-related television coverage in the first week after the event was not associated with the prevalence of bombing-related posttraumatic stress disorder or post-bombing major depressive disorder during the seven years post event. The results raise doubt about the effects of quantified incident-related television viewing on clinically-significant emotional outcomes in directly-exposed terrorism survivors.

Background: Relatively few studies of children exposed to trauma have used objective indicators such as heart rate and blood pressure measurements to assess physiological reactivity., Methods: This pilot study examined physiological reactivity (heart rate, systolic blood pressure, and diastolic blood pressure) and emotional indicators (posttraumatic stress and depressive symptoms) in 17 children of directly exposed Oklahoma City bombing survivors and in 17 demographically matched community comparison children, 7 years after the incident., Results: Despite generally low levels of subjectively reported posttraumatic stress and depressive symptoms 7 years after the disaster, the children of survivors showed heightened objectively measured physiological reactivity relative to the comparison group. The extent to which this heightened physiological reactivity in the children of survivors was pathologic is unclear. Only 1 participant reported high levels of posttraumatic stress and depressive symptoms; this individual also demonstrated physiological reactivity., Conclusions: Results suggest children of disaster survivors may experience physiological reactivity despite absence of direct exposure to the trauma or acknowledgement of symptoms. These findings indicate the physiological effects of trauma may endure separate from subjective affect in the offspring of highly exposed disaster survivors. More research is needed to determine the potential consequences of persistent physiological reactivity.

Aims: This study demonstrates that auxiliary and exclusion criteria variables increase the effectiveness of missing imputation in correcting underestimation of physiologic reactivity in relation to post-traumatic stress disorder (PTSD) caused by deleting cases with missing physiologic data., Methods: This study used data from survivors of the 1995 Oklahoma City bombing and imputed missing heart rate data using auxiliary and exclusion criteria variables. Logistic regression was used to examine heart rate reactivity in relation to current PTSD., Results: Of 113 survivors who participated in the bombing study's 7-year follow-up interview, 42 (37%) had missing data on heart rate reactivity due to exclusion criteria (medical illness or use of cardiovascular or psychotropic medications) or non-participation. Logistic regression results based on imputed heart rate data using exclusion criteria and auxiliary (the presence of any current PTSD arousal symptoms) variables showed that survivors with current bombing-related PTSD had significantly higher heart rates at baseline and recovered more slowly back to baseline heart rate during resting periods than survivors without current PTSD, while results based on complete cases failed to show significant correlations between current PTSD and heart rates at any assessment points., Conclusions: Suggested methods yielded an otherwise undetectable link between physiology and current PTSD., (© 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.)

Background: It is important to understand long-term biological and psychiatric correlates of intense exposure to terrorism., Methods: We assessed psychiatric diagnoses and biological stress measures in 50 healthy, highly exposed Oklahoma City bombing survivors recruited from a bombing registry 6 1/2 to 7 years postdisaster, comparing them with demographically matched, nonexposed community members. The Diagnostic Interview Schedule (DIS) determined Axis I psychiatric diagnoses. Participants' salivary cortisol levels were obtained at 8 am, and physiologic assessment measured participants' heart rate and blood pressure responses to a bombing-related interview., Results: Eleven survivors with posttraumatic stress disorder (PTSD) had significantly higher cortisol levels than did both non-PTSD survivors and controls. Survivors with and without PTSD did not differ in any autonomic reactivity measure, whereas the total survivor group had significantly higher reactivity than controls in all measures. Positive correlations occurred between several autonomic reactivity measures, but none between cortisol and autonomic measures., Conclusions: Results differentiate the autonomic and cortisol systems relative to terrorism exposure. Findings support research associating PTSD with hypothalamic-pituitary-adrenal (HPA) axis changes, whereas autonomic reactivity appeared to be a more generalized trauma response. Correlation statistics substantiated a lack of connection between the 2 biological systems. Follow-up could elucidate the long-term course of these stress systems and eventual health status in survivors, in view of the medical morbidity noted in PTSD studies.

Objectives: The authors assessed relocated Hurricane Katrina survivors' emotional and biological stress measures 20 months postdisaster to understand effects of both hurricane exposure and forced relocation on emotional and physical health., Design: Psychiatric diagnoses, post-traumatic stress disorder (PTSD) and depressive symptoms, and biological stress measures were compared for total survivor and control groups and subgroups by PTSD diagnoses and lifetime trauma., Setting: Outpatient university psychiatry clinics in Oklahoma City and Tulsa., Participants: Thirty-four healthy adult Katrina survivors relocated to Oklahoma, and 34 healthy, demographically matched Oklahoma comparison participants., Main Outcome Measures: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, assessed Axis I psychiatric disorders. Clinician-Administered PTSD Scale and Beck Depression Inventory quantified PTSD and depression symptoms. Biological stress measures were physiologic reactivity (heart rate and blood pressure responses to a trauma interview), interleukin-2 (IL-2; cell-mediated immunity), and interleukin-6 (IL-6; proinflammatory cytokine)., Results: Both groups had high lifetime trauma exposure. Among survivors, current hurricane-related and predisaster PTSD were diagnosed in 35.3 and 11.8 percent. Controls had current (11.8 percent) and lifetime (14.7 percent) PTSD. Survivors' PTSD and depression symptom levels were higher than controls and within illness ranges. The survivors had higher IL-6 than nontraumatized controls, higher IL-6 in the presence of PTSD, and higher baseline heart rates and mean arterial blood pressure reactivity than controls., Conclusions: Higher IL-6 and autonomic measures for several Katrina survivor subgroups than control subgroups may confer future cardiovascular risks. The results are discussed relative to increased myocardial infarct rates in New Orleans after Katrina. Even healthy survivors should be assessed for cardiovascular risks and mental health sequelae.