Psychosocial adjustment of directly exposed survivors 7 years after the Oklahoma City bombing

Abstract

Objective-To prospectively examine the long-term course of psychiatric disorders, symptoms, and functioning among 113 directly exposed survivors of the Oklahoma City bombing systematically assessed at six months and again nearly seven years post-bombing. Methods-TheDiagnostic Interview Schedule/Disaster Supplement was used to assess predisaster and postdisaster psychiatric disorders and symptoms and other variables of relevance to disaster exposure and outcomes.Results-Total prevalence of PTSD was 41%. Seven years post-bombing, 26% of the sample still had active PTSD. Delayed-onset PTSD and new postdisaster alcohol use disorders were not observed. PTSD non-remission was predicted by the occurrence of negative life events after the bombing. Posttraumatic symptoms among survivors without PTSD decayed more rapidly than for those with PTSD, and symptoms remained at seven years even for many who did not develop PTSD. Those with PTSD reported more functioning problems at index than those without PTSD, but functioning improved dramatically over seven years, regardless of remission from PTSD. No survivors had long-term employment disability based on psychiatric problems alone.Conclusions-These findings have potentially important implications for anticipation of longterm emotional and functional recovery from disaster trauma.

Prevalence and duration of PTSD in survivors 6 years after a natural disaster

“…In comparison, for the non-bereaved participants, there were 10/113 (8.8%) who developed PTSD, which underscores bereavement as a risk factor for long-term PTSD (Arnberg et al, 2011). Further, our prevalence rates were lower than in studies of directly exposed victims from both natural and anthropogenic disasters (Bøe et al, 2011;Favaro, Zaetta, Colombo, & Santonastaso, 2004;Hull et al, 2002;North, Pfefferbaum, et al, 2011;North, Pollio, et al, 2011). This study concerned an event very remote to the homes of the survivors and that the beliefs common in people with PTSD about the world as dangerous (e.g., no place is safe) may have been easier to reevaluate by the survivors in their processing of the event, as compared to the more plausible (and realistic) negative beliefs about the world if the index trauma took place in or close to the survivors' homes.…”

“…Increased alcohol consumption after disasters has also been noted, although recent findings suggest that the onset of alcohol abuse may often precede the disaster exposure (North, Pfefferbaum, et al, 2011). Prevalence estimates of PTSD after natural disasters range from 4 to 60%, with the majority of studies reporting estimates below 30% (Neria et al, 2008).…”

“…Yet, despite consistent findings that PTSD is unlikely to remit if persisting beyond 6 years (Green, Lindy, Grace, & Leonard, 1992;Hull, Alexander, & Klein, 2002;North, Oliver, & Pandya, 2012), the overwhelming majority of studies have been conducted within the first 2 years postdisaster (Norris, 2006). Further, extant studies of long-term PTSD concern events that entailed severe secondary and collateral stressors that may exacerbate or prolong the prevalence rates of PTSD (Arnberg, Eriksson, Hultman, & Lundin, 2011;Brewin, Andrews, & Valentine, 2000): For example, substantial loss of property or possessions (Green et al, 1992), prolonged anxiety and fear because of terrorist attacks (North, Pfefferbaum, Kawasaki, Lee, & Spitznagel, 2011), and unemployment (Bøe, Holgersen, & Holen, 2011;Hull et al 2002). Severe hardships in the wake of disaster confound estimates of the capacity for a lifethreatening experience to produce chronic PTSD (Kessler et al, 2008).…”

Psychometrical assessment and item analysis of the General Health Questionnaire in victims of terrorism.

“…However, several studies have demonstrated the long-term effects of terrorist attacks on direct victims and their relatives (Baca et al, 2002;DiGrande et al, 2011;L. Ferrando et al, 2011;Kawana et al, 2001;North et al, 2011). It appears symptoms may be more stable 1 year after the traumatic event rather than in the immediate aftermath (Brewin, 2005).…”

“…PTSD in particular often follows a chronic course in the general population (Breslau et al, 1998;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) and after exposure to terrorist attacks (DiGrande, Neria, Brackbill, Pulliam, & Galea, 2011;Kawana, Ishimatu, & Kanda, 2001;North, Pfefferbaum, Kawasaki, Lee, & Spitznagel, 2011).…”