Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT October 4, 2002 "Those who cannot remember the past are condemned to repeat it." - George Santayana
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Basic and Advanced Critical Incident Stress Management Workshops
November 22-23, 2002
Holiday Inn
Casper, WY
Co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd Snowy Range A.S.I.S.T. CISM Team"Religious Aspects of Domestic Violence" November 24, 2002
Holiday Inn
Casper, WY
co-sponsored by:
Rocky Mountain Region Disaster Mental Health InstituteAnd The Governor's Domestic Violence Elimination (DoVE) CouncilThe Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers
ammp@optushome.com.auX Mexican Congress of Psychology
October 23 - 25, 2002
Location: Acapulco, MEXICO
89th International Conference:
Stress and Depression
October 20, 2002
Milan, ITALY
Contact:
Istituto di Psicologia
Clinica Rocca-Stendoro
Corso Concordia 14
Milan 20129, Italy
Tel/Fax: 39-02-782627
E-mail: ist.roccastendoro@libero.itLatino Psychology 2002 conference
October 18-20, 2002
Location: Providence, Rhode Island, USA
Contact: Maria Garrido, Chair
"Latino Psychology 2002"
Adjunct Professor of Psychology
University of Rhode Island Email: mgarrido@etal.uri.edu3rd Ibero-American Congress on
Clinical and Health Psychology
November 20 - 23, 2002
Location: Caracas, VENEZUELA
Contact: Zuleyma Perez
Alcabala a Puente Anauco
Edificio Puente Anauco Piso # 2
Apartamento # 27
La Candelaria, Caracas (Venezuela)
Tel./Fax: (+58) 212-5713060
Email: apicsavenezuela@cantv.net
apicsa@attglobal.net
2002 BERLIN CONFERENCE ON
THE HUMAN DIMENSIONS
OF GLOBAL ENVIRONMENTAL CHANGE
December 6 - 7, 2002
Location: Berlin, GERMANY
Contact: Frank Biermann, Chair
DVPW Environmental Policy and
Global Change Section
biermann@pik-potsdam.de or
Sabine Campe, Manager
2002 Berlin Conference
sabine.campe@pik-potsdam.de
VIII European Conference
on
Traumatic Stress (ECOTS)
May 22 - 25 2003
Location: Berlin
GERMANY
Contact:
Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail:
trauma-conference@kfb-berlin.de
Deadlines:
Registration
31 October 2002
CONFLICT PLACES THE MENTALLY ILL AT RISK OF HARM
Individuals with serious mental disorders have an increased chance of becoming victims of violence because their relationships with others are more likely to provoke conflict, according to a Penn State criminologist. Eric Silver, assistant professor of crime, law and justice and sociology, says that people with serious mental disorders tend to arouse negative responses from those around them, even among family members and friends. In a study that appeared in a recent issue of the journal, Criminology, he points to a critical need for persons interacting with the mentally ill to develop skills or competencies in dealing with them. "Counseling services could teach managerial techniques to family members, friends, neighbors and even members of the medical and criminal justice professions," Silver says. "The ultimate objective is to help families, caretakers and others to cope with the mentally disordered individual while at the same time avoiding conflicts with them that may lead to victimization." For the full story by Paul Blaum, visit http://www.psu.edu/ur/2002/Mentally_Ill_Conflict.html
A BALANCED PERSPECTIVE ON WEST NILE
According to the latest edition of the Medical Minute, a service of Penn State's Milton S. Hershey Medical Center, it's scary to confront unfamiliar health threats like the West Nile Virus. News stories provide basic information, but in the interest of time or ratings, sometimes a balanced perspective is sacrificed. West Nile is caused by a virus that mostly affects birds. Mosquitoes bite an infected bird, pick up the virus and pass it on to more birds or to humans. Though a person may be bitten by an infected mosquito, the chance he or she will actually get the disease is an estimated one in five. Symptoms include joint aches, fever, headache and swollen lymph nodes. Most people recover without problems. A small number develop infection in the brain and spinal cord with symptoms including neck stiffness, muscle weakness and convulsions, confusion or coma and yes, even death. However, the fear factor created by persistent media coverage of West Nile is more likely to spread through communities than the illness itself. For the full Medical Minute, visit http://www.psu.edu/ur/2002/medicalminute005.html
Individual and Family Grant Application Deadline for WTC Victims Now Extended to Nov. 30, 2002
The Individual and Family Grant (IFG) program's registration deadline for victims of the World Trade Center disaster has been extended to Nov. 30, 2002, federal and state recovery officials announced today. http://www.fema.gov/diz01/d1391n154.shtm
President Declares Major Disaster For Louisiana Storm Damage
The head of the Federal Emergency Management Agency (FEMA) announced today that President Bush has declared a major disaster for Louisiana, triggering the release of federal funds to help meet the recovery needs of families and businesses swamped by Tropical Storm Isidore's torrential rains. http://www.fema.gov/diz02/hq02_162.shtm
FEMA Authorizes Federal Funds for California's Croy Fire
The Federal Emergency Management Agency (FEMA) has again moved swiftly to help California fight another wildfire outbreak, authorizing the use of federal funds in two hours of being contacted by the state of the threat posed by the Croy fire to populated areas in Santa Clara County.For further information go to: http://www.fema.gov/regions/ix/2002/r9_16.shtm
President Declares Major Disaster For Indiana Tornadoes
The head of the Federal Emergency Management Agency (FEMA) announced today that federal disaster aid has been made available for people in central and southwestern Indiana ravaged by last Friday's string of violent tornadoes. For further information, go to: http://www.fema.gov/diz02/hq02_158.shtm
NEWS ARTICLES ONLINE CALIFORNIA - Loss of agents hinders effort to secure border http://www.washtimes.com/national/20020927-11559109.htm
VIRGINIA - Malaria Scare In Virginia http://www.cbsnews.com/stories/2002/09/28/health/main523666.shtml
Diluted smallpox vaccine enough to cover all in U.S. http://www.startribune.com/stories/484/3334613.html
International TURKEY - Refined uranium found in Turkey weighs grams, not kilograms http://www.haaretzdaily.com/hasen/pages/ShArt.jhtml?itemNo=214088&contrassID=1&subContrassID=8&sb SubContrassID=0&listSrc=Y
TURKEY - Turkish uranium suspects released
"The two men arrested with the material were released due to lack of evidence and have since disappeared" http://www.cnn.com/2002/WORLD/meast/09/29/ turkey.uranium/index.html
RUSSIA - Chernobyl Uranium for Sale http://www.newsmax.com/archives/articles/2002/9/27/174334.shtml
Alibek Warns of Worldwide Smallpox Catastrophe
"Dr. Alibek said he had no doubt Saddam would unleash the lethal virus upon his enemies, including the United States, if he believes his regime will fall" http://www.newsmax.com/archives/articles/2002/9/26/151752.shtml
YEMEN - Three Die in Gunbattle Near British Embassy in Yemen http://www.voanews.com/article.cfm?objectID=35019833-FCA2-4A32-8444C798E664BBAC
SAUDI ARABIA - German killed in Saudi car blast http://www.globeandmail.com/servlet/ArticleNews/front/ RTGAM/20020929/wsaud929/Front/homeBN/breakingnews
CANADA - FBI can't link Canadians, terror http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c= Article&cid=1028902585843& call_page=TS_News&call_pageid=968332188492&call_ pagepath=News/News
LEBANON - Hizbollah Fires on Israeli Planes over Lebanon http://story.news.yahoo.com/news?tmpl=story&u=/nm/20021001/wl_nm/mideast_hizbollah_israel_dc_1
PAKISTAN - Bomb Explodes Near Pakistan Church http://www.guardian.co.uk/worldlatest/story/0, 1280,-2052196,00.html
ARABS URGE SADDAM TO SPLIT, offer exile to Saddam and sons http://www.nypost.com/news/worldnews/58040.htm
Afghanistan - 2 al-Qaida soldiers brought to Bagram base for questioning, Russian fighter also held http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=29079
LEBANON - Militants Are Said to Amass Missiles in South Lebanon http://www.nytimes.com/2002/09/27/international/ middleeast/27ISRA.html?ex=1033790400&en=71630a58dc5553d4&ei= 5006&partner=ALTAVISTA1
CBS to broadcast proof of Iraq-Iran ties to Palestinian terror http://www.haaretzdaily.com/hasen/pages/ShArt.jhtml?itemNo=213992&contrassID=1&subContrassID=5&sb SubContrassID=0&listSrc=Y
BANGALORE - Terrorist shot dead in Bangalore http://news.sify.com/cgi- bin/sifynews/news/content/ news_fullstory_v2.jsp?article_oid= 11985163&page_no=1
IRAQ - Israeli special forces are operating inside western Iraq to locate missile launchers that could be used against Israel http://www.jpost.com/servlet/Satellite?pagename=JPost/A/JPArticle/ShowFull&cid=1033131982381
SPAIN - Basque Terrorist Group ETA Warns of Attacks http://www.newsday.com/news/nationworld/ world/wire/sns-ap-spain-basques0929sep29,0,1241932. story?coll=sns%2Dap%2Dworld%2Dheadlines
ONGOING TRAUMA: CHILDREN, PTSD AND SEPTEMBER 11
In the aftermath of September 11, Posttraumatic Stress Disorder (PTSD) has been discussed openly and frequently. A great deal has been learned about PTSD within the past year alone. It is important to differentiate PTSD from Acute Stress Disorder (ASD) and from normal stress reactions. The term "posttraumatic stress disorder" has become a universal term for any kind of trauma/stress-related reactions. Proper treatment is dependent on an accurate diagnosis.
Worldwide Concerns
At the recent XII World Psychiatric Congress in Yokohama, Japan, PTSD and other trauma-related issues received a great deal of attention. Topics included the September 11 attacks on the United States as well as reactions to natural disasters such as earthquakes and floods and the trauma from the war in Chechnya.
A survey reported on September 11 that was conducted by the New York Academy of Medicine found that 10% of people in New York City were clinically depressed 1 or 2 months after September 11, 2001. 7.5% were experiencing PTSD at that time. The survey included 8000 people. The number of people with clinical depression or PTSD by February 2002 had declined by one half to two thirds. One person in three continued to report at least some symptoms of depression or PTSD. This was so even though they didn't fit the strict diagnostic criteria.
An important topic of great interest to clinicians following the September 11 attacks has been the effect of trauma on children. This concern was discussed in several presentations at the Yokohama conference.
The New York City Board of Education surveyed 8266 of the 1.2 million students in its public schools. The purpose was to evaluate the impact of the World Trade Center attacks on children's mental health. A special questionnaire was designed to screen for PTSD and several other common psychiatric disorders in children and adolescents. It also gathered information on demographics, different types of exposures to September 11 events, health problems, discrimination, service need and utilization, school performance, and students' perspectives on the future. This survey was conducted by the Mailman School of Public Health at Columbia University in New York. It was done in conjunction with the Board of Education. The results revealed a higher than expected prevalence of a variety of psychiatric disorders. Eleven percent of public school children had a family member or a close friend who had been exposed to the attack. 1% had a family member who was killed in the attack.
About two thirds (64%) had been exposed to one or more traumatic events prior to September 11. 62% reported spending a great deal of time watching the resulting TV coverage. Exposure of a family member and previous exposure to a traumatic experience were more important than personal physical exposure in predicting which children developed PTSD. It was estimated that as many as 75,000 (10.5%) children in New York City in grades 4-12 have multiple symptoms that are consistent with PTSD.
Brief Literature Review
168 people died in the bombing of the Alfred P. Murrah Building in Oklahoma City on April 19, 1995. Nineteen of the victims were children. Hundreds of people were injured and 800 structures and windows were shattered up to a mile away. There were 52 children and a staff of nine at the YMCA which was located near the federal building. All were injured by shattered glass.
Following the event, mental health professionals conducted intervention services at the schools. The local school board agreed to conduct a needs assessment test for the children. In some schools this was not allowed. This was attributed to a case of "teachers/principals underestimating children's needs. This affected everybody."(Gurwitch, 1999).
There were some 6000 children in the schools, of which about 500 were determined to be at risk. Training for dealing with children's trauma was provided for school counselors. Counselors decided that, of the 500 at risk, 300 "don't need extra help and the 200 - nobody has ever figured out what happened to them."(Gurwitch, 1999). In the final place, 53 students received "intensive services". These students were placed into small groups, were debriefed, and did art therapy. Many hundreds of children had contact with mental health specialists over the next months and the following year. Due to FEMA guidelines, many of these children received only crisis intervention. Therapy services were available if requested and continued to be available to all children impacted by the bombing in Oklahoma City.
In planning for future disasters and related children's services, Gurwitch (1999) suggested the following question be addressed: "How do we help the helpers know what children's needs are?"
Gurwitch (1999) addressed issues about the children who had survived and how they dealt with post-traumatic play or the re-experiencing of the event. She provided a number of examples:
One child who was at the re-located YMCA hung Barbie Dolls upside down from the dollhouse.Another child who had survived the explosion created, for many weeks, Lego people with missing upper bodies and lower bodies who lay in beds in the hospital - "legless, armless and headless people". Gurwitch reported that she saw this boy change over time. "The Lego people were full bodies in the hospital bed, with someone next to the bed and everyone had a Lego Christmas tree."
Another situation she discussed occurred at the re-located YMCA. The children were in a "nice room". However, it was located in a weight room. Whenever there was a "thunk!" the children started crying, setting off a "chain reaction".
Gurwitch discussed one four year old boy who explained how he had gotten a scab on his head. He said it was because he had been shot in the head. For him, getting shot was the worst thing that could happen to him. It happened and he concluded that he must have been shot. He was unable to grasp the bombing.
Some of the other children Gurwitch reported on showed symptoms of what she termed "diminished interest". The mother of a three year old girl at the YMCA described her daughter by saying "the sunshine had come out of her eyes."
The initial recovery process lasted many weeks. The final two bodies were not found until the building was imploded on May 23, 1995 at 7 AM. Gurwitch reported that people who watched relived the smells, sound and sights of the explosion. She said that the parents who had taken their children to watch had "spiked a reaction" in them.
Gurwitch reported that there was a good deal of survival guilt among some children. One five year old girl who had recently moved from the "Stars and Stripes" Day Care Center to the YMCA told her "I should have stayed where I was, because I know I could have gotten all my friends out." The mother of this child couldn't drive down a road with any glass buildings without her daughter "going ballistic".
In concluding remarks, Gurwitch said that she hopes Mental Health Professionals could use what they learned from this disaster and that the skills they developed for interacting with children of trauma could be used for any type of disaster - "a shooting, a flood, and, God forbid, a bomb." She stressed that they should also recognize that children have the same unique issues as their parents.
In a final comment, Gurwitch addressed how life in Oklahoma City has changed, "Thanksgiving has changed, but there are still things to be thankful for."
Following natural disasters such as Hurricanes Andrew and Hugo, the Northridge Earthquake, the Oakland fires, and the Loma Prieta Earthquake, and man-made disasters such as crashes of TWA Flight 800 and Valuejet, bombings and terrorist activities, there has been tremendous interest and concern about the impact of such disasters on children and adolescents. A review of recent work by a number of investigators who have studied children's reactions to disasters indicates that disasters represent traumatic events for children. These can result in post-traumatic stress reactions (La Greca, 1999). Findings indicate that children's reactions to disasters can be severe. They are not merely fleeting, transitory events that dissipate quickly. Children's reactions appear to linger and persist. As a result, they are likely to cause much distress for children and their families. Due to the severe and persistent reactions children might have to disasters, efforts to provide effective services and interventions for children and adolescents following a disaster are an important, and frequently overlooked, mental health need.
La Greca (1999) discussed a number of factors surrounding children's reactions following disasters. PTSD in children can result from exposure to Trauma. A re-experiencing of the event can cause reactions which include, over time, Avoidance/Numbing, Hyperarousal, and/or other symptoms of PTSD. She discussed the challenges in identifying post traumatic stress reactions in children. These have implications for post disaster interventions. Describing which children are most likely to be at risk for severe and persistent post traumatic stress reactions is one challenge. Others include understanding factors (at home and in school) that promote children's coping after a major disaster. There are developmental aspects which need to be taken into account. There is also the need for matching intervention strategies with the phase of post disaster recovery (acute, short-term, or long-term).
Recent studies of children's reactions to disasters has suggested that the disasters represent traumatic events for children that can result in the emergence of post-traumatic reactions. La Greca (1999) discussed the prevalence of PTSD in children at three stages - Initial prevalence; Prevalence over time and its developmental course; and the Prevalence of different symptom clusters. The conceptual framework she discussed places considerable emphasis on the importance of characteristics of the individual (e.g. ethnicity, pre- disaster functioning); of the disaster (e.g. degree of exposure, life threat); and of the recovery environment (e.g. availability of social support, intervening life events) in understanding children's short-term and long-term reactions. She discussed differentiating immediate, short-term, and long-term disaster reactions, especially in terms of the types of intervention strategies which might be needed at different points in time.
Some of the other types of reactions La Greca discussed included Anxiety, Fears, Sleep Disturbances, Depression, Problems with academic functioning or school, Vigilance and Security concerns, and how these may vary among types of disasters or traumas.
In discussing the implications of the reactions children have, La Greca listed a number of factors which contribute, including:
* Exposure - Life threat does not mean that the actual loss of life needs to have occurred.~ Loss and disruption of one's life can be immediate and ongoing.* Predisaster characteristics of the individual -
~ Demographics including age, gender (are girls more vulnerable?), and ethnicity (are minority youth affected differently?)~ Levels of pre-disaster functioning. This includes psychological functioning as well as pre-disaster academic functioning.
* Aspects of the recovery environment -
~ Intervening life events can affect the recovery process.~ The social support systems available can facilitate or impede effective recovery (e.g. family, friends, teachers).
* Children's ability to cope with stress -
~ Children have difficulty coping with novel and intense stressors.~ Over time, the negative strategies seem to be most predictive of problems.
The conceptual model put forward by La Greca was suggested as useful in predicting short-term (3 months) and longer-term (7-10 months) reactions. It was also suggested as being useful in identifying children who are slow to recover.
The implications La Greca discussed are that high risk children (and others) should be monitored. Some of the things she suggested looking for include:
* They are at risk for greater life threat during the event.* They experience a greater number of loss/disruption events post disaster.
* Members of ethnic minorities are at higher risk.
* They may experience more major life events post disaster.
* Less social support may be available from family and friends.
* They may use negative coping styles in dealing with disaster related stress.
* They may have lower levels of pre-disaster academic achievement.
* They may present with attention problems.
* They may experience higher levels of pre-disaster anxiety.
La Greca suggested monitoring children who show the above characteristics in order to provide more effective interventions.
In discussing interventions, La Greca pointed out a number of factors to be aware of:
* There are a number of obstacles which can hinder effective intervention.~ The lack of a disaster plan, or one including mental health leaves a gap in how to provide such services effectively.~ The disorganization and chaos immediately following a disaster can make it difficult to provide effective interventions.
~ The lack of coordination among services and providers makes it difficult to implement plans and interventions.
~ There is often competition and/or a lack of coordination between various community agencies and groups.
~ Adults are pre-occupied with other phases of the disaster recovery efforts. They may find it difficult to provide the needed support for children as a result.
~ Adults may deny problems in children or "miss" the problems.
* The impact phase is the phase of the disaster which begins when the disaster event begins and it lasts until the end of the disaster. It is over when there has been an initial assessment of the number of casualties or other losses. When this is communicated to the people who are directly affected, the impact phase can be said to have concluded. La Greca stated that the goals following the impact phase are to restore children's sense of normalcy or routine and their sense of personal safety.
* The next phase La Greca discussed was the short term recovery or Adaptation Phase. This generally lasts up to 3 months post disaster. During this phase, she suggests targeting all children within the affected areas. Some methods she discussed included:
~ Classroom and small group activities~ Family approaches in which expression is encouraged.
~ Provide information to helping professionals. These could include fact sheets, web sites, telephone, mass media, etc. Similar information should be provided to the general public as well.
La Greca suggested monitoring children who are at high risk and providing individual and family interventions for those who are highly distressed. The goals she recommended for the Adaptation Phase include:
~ Normalize day to day routines as much as possible.~ Make sure that children return to their daily routines such as school, sports and friends.
~ Encourage emotional processing of the event by creating an environment which allows children to discuss and express their feelings.
~ Provide opportunities for some fun and distraction.
~ Help parents, teachers, and other adults identify trauma related behaviors.
* The next phase that La Greca discussed was the medium to long term phase which lasts from about 3 months to a year or longer. During this phase, continued assistance is provided to the most affected communities, those who are experiencing persistent symptoms or difficulties are targeted; family, small group and individual interventions are done; and public ceremonies and other disaster related rituals are accomplished. The goals that La Greca suggested for this phase include:
~ Continue to create a "normal" environment.~ Continue with the processing of the event.
~ Work to help strengthen social support networks with friends, family and school.
~ Help to facilitate positive coping with the ongoing stressors.
Finally, La Greca discussed the importance of pre disaster preparedness. She noted that this preparedness and the levels of preparation vary tremendously from community to community. There are many high risk areas she said that are not prepared. She suggested Miami and Japan as examples. There are some things that can be accomplished locally. Every family should be encouraged to develop their own disaster plan. FEMA has a web site for kids that can help with this.
Another suggestion that La Greca made was to provide distractions for children other than TV. Quite often the media uses "scare" tactics to mobilize preparations. Finally, she said that preparation efforts stop at "the event". There is a need to prepare for the aftermath. She likened this to pregnancy. After the event, one needs to act.
Delamater (1999) presented a study which examined post-traumatic stress disorder (PTSD), behavioral adjustment, and developmental outcomes in preschool children who had been exposed to Hurricane Andrew in 1992. His study measured mothers' PTSD, depression, and optimism as predictors of children's responses. His study presents useful conclusions of major interest to clinicians and practitioners in the field of Disaster Mental Health. He concluded that many young children can be expected to exhibit PTSD symptoms and other behavioral disruptions for at least 18 months following exposure to a natural disaster. He also concludes that the symptoms are related to previous trauma, levels of stress during and following the event, and mothers' PTSD. He suggests that maternal optimism is associated with the emotional responses to the disaster. Finally, Delamater concluded that children with PTSD are at risk for developmental delay and suggested that interventions be provided soon following exposure and should target both the children and their mothers.
Schreiber (1999) describes a firestorm which struck Laguna Beach, CA on October 30, 1993 in which 400 homes were lost. He describes a FEMA supported program which provided services for affected children and parents over a 17 month period. The results he reports found that levels of PTSD and comorbid depression were significantly higher in children whose homes were destroyed. Current dissatisfactions with living arrangements and perceptions of greater difficulty in school were seen as being strong correlates of distress. Factors related to sustained vulnerability, post disaster stresses, adversities and traumatic reminders are discussed. The findings presented were suggested as confirming the need for extended mental health services beyond the initial event as the risk from disaster exposure continued to accrue over time. This article presents information about a large-scale traumatic event, its assessment of needs, treatment and outcome data with important implications for disaster mental health professionals in other high risk areas.
There has been relatively little research focusing on residential fires. Jones (1999) briefly reviewed the literature in this area. His review leads to conclusions that potential negative consequences associated with fire on survivors' psychological functioning suggests the need for systematic study in this area. He suggested that the identification of predictors of post disaster functioning would be helpful in determining possible treatment interventions. Additionally, he pointed out that previous research suggests that parents' reactions and their own psychological states are related to their children's adjustment following major disasters.
Jones went on to describe an ongoing study examining the impact of residential fire on children and their parents. The study he discussed is a controlled, cross-sectional, longitudinal study which assesses children's levels of psychological distress using a multi-method assessment strategy. The study he described was also designed to ascertain the effects of family atmosphere and parental functioning on children's levels of psychological distress after residential fire. It used a stress and coping model to help identify predictors of psychological distress in children.
September 11 and PTSD
Even though the latest data concerning September 11 are being presented at conferences and meetings like Yokohoma, there have also been dozens of peer-reviewed studies on PTSD published in the year following the September 11 attacks. It is likely that additional research will be published in due course. However, the results to date offer some important insights into the clinical impact of the attacks. For example, in a randomized cross-sectional survey of adult residents of Manhattan, from October 16 to November 15, 2001, the frequency of viewing "people falling or jumping from the towers of the World Trade Center" was associated with greater rates of PTSD and depression among those who directly experienced loss or witnessed the event. Of those affected directly, respondents who frequently watched this image were more likely to have PTSD (22.5%) and depression (21.3%) than those who did not (3.6% and 11.7%, respectively) (Society for Epidemiology Research).
Thus far, there have not been as many studies on the impact of the attacks outside the New York area. However, anecdotal data from mental health professionals around the country suggest that many people were affected in various ways. Some have developed symptoms consistent with depression, PTSD, or ASD. Impact of the media and 24 hour coverage of the terrorist attacks on individuals who "couldn't turn away" has been of interest to a number of researchers. Avoidance is one of the symptoms of trauma reactions. This includes avoidance of trauma-related cues such as images and sounds. Repeated exposure to this type of news coverage can be extremely distressing to survivors and even to the average person.
There is limited scientific data about the effects of terrorism and media exposure on survivors. The consensus among clinicians is that survivors should monitor their viewing of trauma-related media. They should try to prepare themselves to reduce the stress from anniversary programs. A suggestion is that, rather than viewing these anniversary programs, they tape them and then regulate their exposure at a level that they can handle.
One national study sampled 2773 adults. Researchers found clinically significant distress associated with hours of terrorism-related TV watched per day and number of different types of graphic terrorism-related content watched. The prevalence of general distress was not greater than that which is typically seen in community samples. In a subset of 691 New York City dwellers, the number of hours of terrorism-related TV coverage was significantly associated with higher PTSD symptom endorsement, However, the content index was not (Journal of American Medical Association).
There was no association with the frequency of TV image viewing and the prevalence of PTSD and depression in a random sample of adult Manhattan-dwelling respondents who were not directly affected by the September 11 attacks.
Finally, Garfinkel (1999) provided an account of two studies of elderly civilians living in nursing homes and how they coped with months of Scud Missile attacks on civilian populations of Israeli cities during the Gulf War. These attacks should have led to increased sickness and death rates. However, Garfinkel presented information from two studies that found the opposite to be the case. Not only were morbidity and mortality not increased, but levels of cooperation, empathy, and civility were seen to increase. She reported that the studies examined elements of staff behavior, public policy, communications, formal and informal support, all of which fostered psychological resilience and effective coping when facing a mass threat. She discussed how these elements and principles could be taught and how they could be integrated into disaster preparation, disaster response, and staff training.
In summary, children may appear more resilient in their response and recovery from disaster. However, the research and literature suggest they are at risk for PTSD, depression and anxiety disorders as well as possible developmental delays as a result. Children will follow the leads of their parents, cultural/ethnic groups and belief systems.
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REFERENCES Delamater, A. (Feb 1999). PTSD in Head Start Children After Exposure to Hurricane Andrew. Presentation made at 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. http://www.angelfire.com/biz/odoc/day3.html#M Retrieved September 25, 2002.
Delamater, A. & Applegate, E.B. (1999). Child development and Post-traumatic Stress Disorder after hurricane exposure. TRAUMATOLOGYe http://www.fsu.edu/~trauma/a3v5i3.html Vol. 5, Issue 2, Art. Retrieved September 25, 2002.
Garfinkel, R. (1999b). Surviving disaster: What we can learn from elderly civilians' surprisingly successful coping with missile attack. TRAUMATOLOGYe http://www.fsu.edu/~trauma/a5v5i3.htm Vol. 5, Issue 2, Art. Retrieved September 25, 2002.
Gurwitch, Robin (Feb 1999). Children and Trauma: Lessons From the Oklahoma City Bombing. Presentation made at 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. http://www.angelfire.com/biz/odoc/day3.html#O Retrieved September 25, 2002.
Jones, Russell (Feb 1999). NIMH Residential Fire Study: Case Study Examinations of the Psychological Effects of Fire on Children/Adolescents and Their Parents Presentation made at 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. http://www.angelfire.com/biz/odoc/day3.html#L Retrieved September 25, 2002.
LaGreca, A.M. (Feb 1999). Children's Reactions To Disasters: Lessons Learned From Andrew and Other Disasters. Presentation made at 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY. http://www.angelfire.com/biz/odoc/day3.html#K Retrieved September 25, 2002.
Schreiber, M.D. (February 1999). School-based disaster mental health services in the Laguna Beach firestorm. Paper presented at the 1999 Rocky Mountain Region Disaster Mental Health Conference, Laramie, WY Feb 11-14, 1999.
Additional References concerning Children and Disasters.
Additional References concerning Children and Trauma
Additional References concerning Head Start Children and Disasters
INTERVIEWS ONLINE:
Posttraumatic Stress Disorder Interview with Rachel Yehuda, PhD http://www.medscape.com/viewarticle/408689
Posttraumatic Stress Disorder: An Interview With Marilyn Bowman, PhD Special interview about posttraumatic stress disorder. http://www.medscape.com/viewarticle/408690
Trauma and PTSD: Aftermaths of the WTC Disaster Interview with Bessel A. van der Kolk, MD http://www.medscape.com/viewarticle/408691
Trauma and PTSD: Aftermaths of the WTC Disaster - An Interview With Yael Danieli, PhD http://www.medscape.com/viewarticle/408692
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
http://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
**********************************************************************
George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: http://www.angelfire.com/biz3/news
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