Identification With Terrorist Victims of the Washington, DC Sniper Attacks: Posttraumatic Stress and Depression

Types of COVID-19 Disaster Work and Psychological Responses in National Guard Service Members

INTRODUCTION

The National Guard (NG) served as a critical component of the U.S. response to the coronavirus disease 2019 pandemic. Understanding the impact of types of pandemic-related disaster work on mental health responses can aid in sustaining NG service members' health and preparation for subsequent activations and future pandemics.

MATERIALS AND METHODS

We surveyed 1,363 NG unit (NGU) service members (88% Army; 80% enlisted; 32% 30 to 39 years old; 84% male) following activation in response to the pandemic. Surveys were administered between August and December 2020, which was approximately 2 to 3 months post-activation. Surveys assessed overall activation stress, participation in different types of disaster work, probable post-traumatic stress disorder (PTSD), anxiety and depression, and anger. A disaster work stress scale assessed different types of disaster work during activation and associated stress levels. For each individual, we calculated an overall work task stress (WTS) scaled score, with a maximum score of 100. Logistic regression analyses were conducted to examine the relationship of high-stress disaster work tasks to post-activation PTSD, anxiety and depression, and anger, adjusting for socio-demographic and service-related variables. The study was approved by the Institutional Review Board of the Uniformed Services University (USU) in Bethesda, MD.

RESULTS

Among NGU service members, 12.7% (n = 172) described their activation as very/extremely stressful. The work tasks with the highest scaled scores were as follows: (1) Patient transportation (WTS scaled score = 100); (2) working with the dead (WTS = 82.2); and (3) working with families of coronavirus disease 2019 patients (WTS = 72.7). For each individual's work tasks, we identified the work task associated with the highest WTS score. The top one-third of WTS scores were classified as the high-stress group. Approximately 9% of participants (n = 111) had probable PTSD, 6.7% (n = 85) had clinically significant anxiety and depression, and 12.3% (n = 156) had high anger. Multivariable logistic regression analyses, adjusting for covariates, found that NGU service members exposed to the highest level of disaster WTS were more likely to report PTSD (odds ratio [OR] = 1.48 [95% confidence interval [CI] = 1.13-1.94], χ2 = 7.98), anxiety and depression (OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67), and anger (OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66) post-activation.

CONCLUSIONS

Identifying work tasks associated with high levels of stress can help detect individuals at risk for adverse mental health responses post-exposure. Distinguishing features of high-stress work conditions can be generalized to other types of work conditions and disaster response and are important targets for planning and preventive efforts.

Shared social identity and media transmission of trauma

When an individual or group trauma becomes a shared public experience through widespread media coverage (e.g., mass violence, being publicly outed), sharing a social identity with a targeted individual or group of victims may amplify feelings of personal vulnerability. This heightened perceived threat may draw people to engage with trauma-related media because of increased vigilance for self-relevant threats, which can, in turn, amplify distress. We studied this possibility among two U.S. national samples following the 2016 Pulse nightclub massacre in Orlando, FL (N = 4675) and the 2018 Dr. Christine Blasey Ford and Judge Brett Kavanaugh Supreme Court Senate hearings (N = 4894). Participants who shared LGBT or Hispanic identities with Pulse massacre victims reported greater exposure to massacre-related media and acute stress. Participants who shared Dr. Blasey Ford's identities as a victim of interpersonal violence and a Democrat reported more hearings-related media exposure and acute stress. Indirect effects of shared single identity on acute stress through self-reported event-related media exposure emerged in both studies. Results for sharing dual identities with victims were mixed. These findings have implications for media use and public health.

A stenography of empathy: Toward a consensual model of the empathic process

Empathy has gained popularity in the general population and the scientific world during the past decade. Recently, several researchers found a significant decrease in empathy scores of healthcare students (notably medical students) and recommend promoting empathy skills in several fields of education. The current paper presents a new model of the empathic process: a stenography of empathy compelling scientific data and contemporary conceptions. Indeed, we combined all pioneer researchers' conceptions of empathy (Davis, Decety, Batson, Preston & de Waal) into an integrative model. This model is centered on the empathizer (i.e., a person observing a target experiencing emotions) and displays how all empathy components are articulated, explaining the individuals' general functioning and how the process might become dysfunctional. We illustrated applications of the model with three clinical examples (i.e., burnout, psychopathy, and borderline personality disorders) to display how empathy is related to psychopathological symptoms. We believe this new dynamic and sequential model would be helpful in explaining how empathy works, which is of great interest to healthcare students, clinicians, researchers, and academics.

Attribution of Blame Toward Offenders: Victim and Offender Ethnicity, and Observer Ethnic and Religious Background

This study focuses on the effects of victim/offender ethnic affiliation and cultural background of observers on attitudes toward offenders. To examine the effect of cultural background, we compared offender attribution among Christian Arabs (n = 51), Muslim Arabs (n = 249), and Jews (n = 285). The participants were students from several Israeli universities and colleges. The age range was 18 to 33 years (M = 20.23, SD = 2.67), and the majority were female (75.6%). The participants read a version of a vignette describing a case of a stabbing, and then rated the offender's blame. In different versions of the crime scenario, we manipulated victim and offender ethnicity: two victim (Arab/Jewish) and three offender (African/Arab/Jewish) types. The results indicate that, in general, participants blamed African offenders more than Arab or Jewish offenders. Although the results show that differences in offender blaming between Arab and Jewish participants were not statistically significant, there is an interaction between participant cultural background and victim ethnicity in regard to offender blaming: Participants attributed more blame to offenders who stabbed a victim belonging to the same ethnic group as the participants. Overall, the results support defensive attribution theory, suggesting that observer attitudes toward offenders tend to be affected by similarity in ethnic affiliation. The discussion addresses the findings through the perspectives of cultural reciprocity, defensive attribution theory, and minority threat theory. It also acknowledges the limitations related to the specific cultural and geopolitical context of this research. Practical implications for practitioners and policymakers include training and increased ethnic diversity among professionals and experts working within the criminal justice system.

Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

Enhancing Psychological Sustainment & Promoting Resilience in Healthcare Workers During COVID-19 & Beyond: Adapting Crisis Interventions From High-Risk Occupations

COVID-19 is a unique disaster, which has placed extreme stress on Healthcare Workers (HCWs) and the systems in which they work. Eradicating the pandemic requires sustainment of the healthcare workforce through actions that mitigate stress, promote resilience, and enhance performance. A major barrier is the lack of organizational practices and procedures designed to sustain HCWs during prolonged crisis events, such as COVID-19. Adapting existing best practices from other high-risk occupations allows for a more rapid, efficient response to optimize workforce well-being and preserve healthcare organizational functioning. This paper discusses current and emerging literature on the unique impacts of COVID-19 on HCWs and provides actionable, evidence-informed recommendations for individuals, teams, and leaders to enhance sustainment of HCWs that is critical to the preservation of national and global health security.

Grief and Solidarity Reactions 1 Week After an On-Campus Shooting

The impact of interpersonal violence extends beyond the victims and perpetrator(s). The purpose of this research was threefold: (a) to identify whether college students' very early reactions to an on-campus shooting were associated with well-known predictors of distress, (b) to examine whether grief and distress reactions were distinguishable in the early days following a shooting, and (c) to investigate whether a compassionate self-identity was uniquely associated with grief but not distress. Beginning just 3 days after an early morning shooting that killed one student and injured three others, university students (N = 408) completed an online questionnaire. Grief, but not distress, was associated with a sense of solidarity with other students and a compassionate self-identity. General distress was associated with prior mental health difficulties and exposure to the shooting. Acute stress was positively associated with being female, having prior mental health difficulties, media exposure, perceived similarity to victims, less victim blame, social support, and social strain. Results suggest that grief reactions that arise in the early days following a collective loss may serve as important psychosocial resources in coping with interpersonal violence.

Ecological Disasters and Mental Health: Causes, Consequences, and Interventions

Ecological disasters highlight the importance of understanding natural disasters as they relate to a changing global climate. Such disasters often have a predictable pattern of evolving over time and anticipated psychological and behavioral problems and community disruptions. Various factors enhance transmission of these adverse effects beyond the geographic location of the ecological disaster, with certain populations being particularly vulnerable to these effects. Understanding the range and pattern of these effects can aid in optimizing interventions. The use of evidence-informed interventions can reduce distress, enhance well-being, and improve functioning for affected individuals and communities. Effective preparedness involves an understanding of these factors, incorporation of them at all stages of disaster management, and continuous education and training for disaster planners and responders.

Identification With Terrorist Attack Victims: Association With Television Viewing and Prior Life Threat

OBJECTIVE

A series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. We developed and tested a model that examined the unique and interdependent relationships of sniper-related television viewing, prior life-threatening events, and parental status to identification with attack victims.

METHODS

Participants were 1238 residents of the DC area (aged 18-90 years, mean=41.7 years; 51% female; 68% white) who completed an online survey that assessed identification with sniper attack victims, amount of television viewing, and prior life-threatening events. Identification was measured by using a previously developed scale that assessed to what extent participants identified victims as similar to themselves, a friend, or a family member.

RESULTS

The relationship of television viewing to identification was examined by using multivariate linear regression analyses. In univariate analyses, female gender, having children, higher levels of television viewing, and past life-threatening events were independently related to greater identification. After adjustment for demographics and life-threatening events, sniper-related television viewing continued to be associated with identification (B=0.61, P≤0.001, ∆R2=0.07). Examination of the interactions of television viewing by parental status and television viewing by life-threatening event revealed significant relationships.

CONCLUSIONS

Attention to events preceding and during a terrorist event could help in the recognition of those at particular risk for increased identification with attack victims. These findings also have implications for recommendations for media exposure during an event. (Disaster Med Public Health Preparedness. 2018; 12: 337-344).

The risk factors of possible PTSD in individuals exposed to a suicide attack in Turkey

The aims of this study were to determine both the rate of possible PTSD in individuals who were exposed to a suicide attack in Ankara, Turkey, and the factors that relate to the elevated risk for PTSD in individuals who survived that suicide attack. The researchers carried out the study with 93 participants who had attended a meeting held in Ankara on October 10, 2015. Participants completed a sociodemographic information form, the Traumatic Stress Symptom Checklist (TSSC), the Post-Traumatic Cognitions Inventory, the Beck Depression Inventory (BDI), and the Influence of Perceived Societal Attitudes Questionnaire (IPSAQ). Twenty-three of participants were determined to have possible PTSD (24.7%). Participants who were exposed previously to a suicide attack, who witnessed a life-threatening injury, who had the need for psychological help, and who had suicidal thoughts had significantly higher rates of possible PTSD. The IPSAQ, BDI, and TSSC scores were significantly higher in the participants with possible PTSD. The IPSAQ score was found to be related to the development of possible PTSD. This study demonstrated that in participants who had been exposed to a terrorist attack, the negative impact of perceived societal attitudes toward the victims was related to the possible development of PTSD.

Predictive Validity of ICD-11 PTSD as Measured by the Impact of Event Scale-Revised: A 15-Year Prospective Study of Political Prisoners

The 11^th edition of the International Classification of Diseases (ICD-11; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification-independent measure of posttraumatic stress symptoms, the Impact of Event Scale-Revised (Weiss & Marmar, 1996), to capture the ICD-11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD-11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008-2009 (N = 88) on numerous psychological variables using self-report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD-11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3-factor ICD-11 model of PTSD, as represented by items selected from the Impact of Event Scale-Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD-11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R² = .17), quality of life (R² = .21), internalized anger (R² = .10), externalized anger (R² = .12), hatred of perpetrators (R² = .15), dysfunctional disclosure (R² = .27), and social acknowledgment as a victim (R² = .12) across the 15-year study period. Current findings add support for the factorial and predictive validity of ICD-11 PTSD within a unique cohort of political prisoners.