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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.)

Trauma is thought to interfere with normal grief by superimposing symptoms of posttraumatic stress disorder. This exploratory pilot study examined the association between traumatic grief and objectively measured physiological reactivity to a trauma interview in 73 children who lost relatives in the Oklahoma City bombing as well as a potential link between children and their maternal figures in physiological reactivity. Although the authors found no association between posttraumatic stress and objectively measured physiological reactivity among children, they found significant differences in objectively measured reactivity associated with loss and grief. Children who lost "close" relatives evidenced greater objectively measured reactivity than those who lost "distant" relatives. For the most part, children with higher levels of grief evidenced greater objectively measured reactivity than those with lower levels of grief. The most interesting of the findings was the parallel pattern in objectively measured physiological reactivity between children and their maternal figures along with a positive association between children's objectively measured physiological reactivity and maternal figures' self-reported physiological reactivity. Research using larger representative samples studied early and over time is indicated to determine the potential significance of these findings.

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.)

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: 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.

Objective: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast., Method: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments., Results: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects., Conclusions: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems.

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.

Trauma is thought to interfere with normal grief by superimposing symptoms of posttraumatic stress disorder. This exploratory pilot study examined the association between traumatic grief and objectively measured physiological reactivity to a trauma interview in 13 children who lost relatives in the Oklahoma City bombing as well as a potential link between children and their maternal figures in physiological reactivity. Although the authors found no association between posttraumatic stress and objectively measured physiological reactivity among children, they found significant differences in objectively measured reactivity associated with loss and grief. Children who lost "close" relatives evidenced greater objectively measured reactivity than those who lost "distant" relatives. For the most part, children with higher levels of grief evidenced greater objectively measured reactivity than those with lower levels of grief. The most interesting of the findings was the parallel pattern in objectively measured physiological reactivity between children and their maternal figures along with a positive association between children's objectively measured physiological reactivity and maternal figures' self-reported physiological reactivity. Research using larger representative samples studied early and over time is indicated to determine the potential significance of these findings. (Contains 1 table.)

Focus groups with 23 New York City children examined their reactions to the September 11 terrorist attacks, their parents' reactions, and their expectations about the future. We identified an initial set of six topics; these topics were reviewed and assigned to a final set of thematic categories--understanding the events and motives, emotional responses, boredom, and coping. This final set was used to independently code the transcripts. The children reported using distraction and avoidant emotion-focused coping strategies. They were confused about some aspects of the events, but they understood the magnitude and gravity of what had occurred. (Contains 1 table.)

This study explored television viewing of the September 11 attacks in 99 survivors of the Oklahoma City bombing and examined the relationships of event-related television viewing with concerns about safety and danger in survivors with and without bombing-related posttraumatic stress disorder. The number of hours of viewing September 11 television coverage was related to worry about personal and family danger and to increased checking on loved ones but not to September 11–related posttraumatic responses. Some bombing survivors discontinued September 11 media contact due to fear. The findings suggest the importance of monitoring television viewing in survivors of prior incidents. [ABSTRACT FROM PUBLISHER]

Focus groups with 23 New York City children examined their reactions to the September 11 terrorist attacks, their parents' reactions, and their expectations about the future. We identified an initial set of six topics; these topics were reviewed and assigned to a final set of thematic categories - understanding the events and motives, emotional responses, boredom, and coping. This final set was used to independently code the transcripts. The children reported using distraction and avoidant emotion-focused coping strategies. They were confused about some aspects of the events, but they understood the magnitude and gravity of what had occurred. [ABSTRACT FROM AUTHOR]

A focus group of New York City adolescents was conducted 21 months after the September 11, 2001, terrorist attacks to examine their emotional responses to the incidents. The adolescents had vivid memories of the attacks and articulated their reactions, their perspectives on the potential motives for the attacks, and their concerns about ongoing danger. Impressive was the maturity and thoughtfulness of their discourse, which revealed their efforts to process and integrate the events and a realization that their world had changed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 6½ 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. [ABSTRACT FROM AUTHOR]