Current affairs and the public psyche: American anxiety in the post 9/11 world

The Long-Term Physical-Psychiatric Comorbidities Related to Childhood Exposure to 9/11 Trauma

Extensive research has explored the enduring effects of childhood trauma on health, revealing its potential to produce chronic health problems. Despite findings that adults exposed to 9/11 suffer from enduring concurrent psychiatric and physical illnesses, investigations into the long-term physical-psychiatric comorbidities experienced by children and adolescents affected by the 9/11 trauma remain limited. In our study, we examined individuals directly exposed to 9/11 as children (N = 844 high exposure and N = 104 low exposed) and compared them to a matched unexposed, control group (N = 491). Fourteen years after their 9/11 exposure, we evaluated their physical and mental health conditions using parent- or youth self-reported health questionnaires, including psychiatric assessments. Those individuals with high 9/11 exposure were significantly more likely to have experienced a psychiatric disorder in the past year and a lifetime physical health condition compared to unexposed individuals. Moreover, the prevalence of physical-psychiatric comorbidities was higher among the 9/11-exposed group, with a 3.5-fold increased prevalence compared to the unexposed group. This underscores how exposure to traumatic events during childhood heightens the risk of long-term concurrent mental and physical health issues. Our findings also highlight the importance of early and ongoing interventions to prevent future comorbidities and promote better quality of life throughout the lifespan.

Anniversary reactions among journalists covering terror: stress reactions and well-being 10 years after the terror in Norway

Background: Covering terror and catastrophes can be traumatic for journalists, potentially resulting in long-term impairment. This study investigated 10-year anniversary reactions among Norwegian journalists who covered the Oslo/Utöya terror incident in Norway, 2011.Objective: The study aimed to investigate whether level of traumatic exposure and support actions in 2011 were related to anniversary reactions and current psychological well-being in 2021. It also explored if magnitude of anniversary reactions was related to level of current well-being.Method: A cross-sectional survey was sent to journalists who still work within journalism, eight weeks after the 10-year anniversary (N = 200). Participants reported retrospectively on trauma exposure, ethical dilemmas and social support in 2011, as predictors, and attitude to media anniversary coverage, anniversary-related stress, and well-being, as outcome variables.Results: More ethical dilemmas in 2011 (r = .295, p < .001) were related to a larger degree of anniversary-related stress in 2021. Having received less workplace social support in 2011 was related to more stress reactions (r = -.196, p < .05), while the magnitude of overall traumatic exposure in 2011 was not related to stress. Social support also predicted a higher level of current well-being in 2021 (r = .381, p < .001). More severe anniversary-related stress symptoms were significantly associated with decreased level of current well-being (r = -.259, p < .001).Conclusion: Journalists can experience lasting consequences from demanding experiences at work, including fluctuating stress symptoms during incident anniversaries. It is crucial for both journalists and newsrooms to recognize and be aware of the potential impact of anniversaries on the well-being of those involved in the initial coverage.

Keeping Employees Safe During Health Crises: The Effects of Media Exposure, HR Practices, and Age

Occupational health and safety are critical in promoting the wellness of organizations and employees. The COVID-19 pandemic is one of the most life-threatening viruses encountered in recent history, providing a unique opportunity for research to examine factors that drive employee safety behavior. Drawing from terror management theory, we propose and test a moderated mediation model using data collected from employees working during a peak of the pandemic. We identify two sources of influence - one external (i.e., media exposure), and one internal (i.e., HR practices) to the organization - that shape employees' mortality salience and safety behaviors. We find that COVID-19 HR practices significantly moderate the relationship between daily COVID-19 media exposure and mortality salience, with media exposure positively associated with mortality salience at lower levels of HR practices but its effects substituted by higher levels of HR practices. Moreover, our results also show that mortality salience spurs safety behaviors, with age moderating this relationship such that younger - but not older - employees are more likely to engage in safety behaviors due to mortality salience. Taken together, we offer theoretical implications for the safety behavior literature and practical implications for organizations faced with health crises or having employees who commonly work in hazardous conditions.

A Cross-Sectional Time Course of COVID-19 Related Worry, Perceived Stress, and General Anxiety in the Context of Post-Traumatic Stress Disorder-like Symptomatology

The COVID-19 pandemic within the United States of America resulted in over 800,000 deaths as of February 2022 and has been addressed by social distancing or stay-at-home measures. Collective prolonged multimodal trauma on this scale is likely to elicit symptomatology in the general population consistent with post-traumatic stress disorder (PTSD), somatization, anxiety, and stress. The psychological component of this response contributes substantially to the burden of this disease worldwide. This cross-sectional study examines the relationship between COVID-19-related concern, anxiety, and perceived stress on PTSD-like symptomatology over the course of the COVID-19 pandemic. Participants were recruited via social media within the United States of America between 8th May 2020 and 11th August 2021 to complete an internet questionnaire including mood, personality, and COVID-19-specific scales. General anxiety and PTSD-like symptomatology were above the screening cutoffs for most respondents. These measures increased in severity over the pandemic, with the change point of our Concern scale preceding that of the other significant measures. Measures of COVID-19-related concern, generalized anxiety, and PTSD-like symptomatology were strongly correlated with each other. Anxiety, perceived stress, and PTSD-like symptomatology are strongly interrelated, increase with pandemic length, and are linked to reported levels of concern over COVID-19. These observations may aid future research and policy as the pandemic continues.

Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms

Based on the theoretical view of Terror Management Theory, the current research examines whether higher levels of death anxiety symptoms, in the face of the COVID-19 outbreak, increase the extent to which participants are exposed to information regarding the spread of the pandemic, as well as the fear of contagion and symptoms of hypochondriasis, which all in turn increase symptoms of adjustment disorder. A total number of 302 participants filled out self-report questionnaires regarding death anxiety, adjustment disorder, the extent of exposure to information regarding COVID-19, fear of contagion, hypochondriasis, and demographic information. Structural Equation Modeling analysis indicated a very good fit of the theoretical model with the data, confirming the mediation effect of exposure to information, fear of contagion, and symptoms of hypochondriasis on the association between death anxiety and adjustment disorder symptoms. Implications for practice are discussed.

When a maritime disaster disrupts the community: The longitudinal course of Post-traumatic stress disorder and predicted factors after Sewol ferry disaster in South Korea

BACKGROUND

The present study assessed acute, delayed, and chronic post-traumatic stress disorder (PTSD) in community residents affected by the disaster, as well as the factors related to the manifestation of symptoms.

METHODS

A total of 2,597 community residents who lived in Jindo, where the Sewol ferry disaster occurred, participated in a survey at baseline (1.5 months); 1,228 (47%) of these respondents were followed-up 15 months later. The variables included demographic characteristics, witnessing the rescue scene, being a community volunteer, and lifetime traumatic experiences. PTSD, depression, and anxiety symptoms were measured using the Impact of Events Scale-Revised (IES-R), Center for Epidemiologic Studies Depression (CESD), and Beck Anxiety Inventory (BAI), respectively. An assessment of property loss due to the Sewol ferry disaster was also included in the follow-up evaluation.

RESULTS

The proportion of PTSD cases among community residents at baseline and follow-up were 16.1% and 15.6% (delayed PTSD, 10.1; chronic PTSD, 5.5%), respectively. Depression and anxiety symptoms at each time point were consistently associated with acute, delayed, and chronic PTSD. Logistic regression analyses showed that anxiety symptoms at baseline predicted the delayed and chronic PTSD. Chronic PTSD was independently predicted by the witness rescue and loss of property immediately after the disaster.

CONCLUSIONS

The present findings provide important evidence supporting the need for comprehensive assessment and management of mental health problems in community residents exposed to a disaster. Financial losses experienced by community residents after a trauma must also be addressed, and psychiatric comorbidities such as depression and anxiety should be identified and treated.

Association between feeling threatened by a terrorist attack and subjective health: a web survey a week after the attacks of 22 March 2016 in Belgium

Background: The wave of terrorist attacks over the past years in Europe and other regions may cause problems such as anxiety and depressive symptoms. Some studies suggest that perceived threat might also trigger physical health problems. Objective: To investigate the association between feeling threatened and subjective health during the week following a terrorist attack. Method: Online survey with a self-selected sample in the Belgian population one week after the terrorist attacks in 2016. Participants were invited through the Belgian media to fill in a questionnaire in Dutch, French or English on a website. The main outcomes were the association between 'feeling threatened' and subjective health problems. Perceived threat was measured with the question 'During the week after the attacks … Did you feel threatened?' Subjective health was measured by using standardized scales (ACSA, PHQ-4, PHQ-15). Results: A total of 2620 respondents completed the questionnaire, of whom 69.8% were female, 27.7% lived and 43.1% worked in Brussels. Gender, age, place of living and working, media exposure, religiousness and religious affiliation were associated significantly with higher perceived threat. A total of 21% of the respondents felt much or very much threatened during the week after the attacks. They reported significantly higher levels of mental and physical health problems. The most frequently reported problems were anxiety and depressive symptoms. The health problems that differentiated most markedly between those with low and high levels of perceived threat were fainting spells, chest pain and shortness of breath. Conclusion: In a self-selected sample of respondents, 'feeling threatened' was strongly associated with lower level of wellbeing and higher levels of mental and physical health problems. The most prevalent health problems were mental health problems but the most pronounced differences between people with low versus high levels of perceived threat were physical health problems.

Changes in Affect, Cognition, and Perceived Behavioral Changes Among Vicarious Victims of the Paris Terrorist Attacks of November 13, 2015

Terrorist attacks are supposed to hit not only the direct victims but the entire society. In this prospective longitudinal study, we examined changes in mood, life satisfaction, and terror-related cognitions and perceived behavioral changes 2, 4, and 8 weeks after the terrorist attacks of November 13, 2015, in Paris in a sample of the so-called vicarious victims ( N = 201). Average mood levels dropped significantly after the attacks compared to preattack levels but recovered within 8 weeks. Average levels of life satisfaction did not change significantly across this time period. Level of preoccupation with the attacks, perceptions of the likelihood of future terrorist attacks, and perceived changes in terror-related cognitions and behaviors declined over the 8 weeks after the attacks. Together, these findings indicate that terrorist attacks may impact changes in affect, cognition, and behavior even among vicarious victims; however, these changes are only temporary.

Anticipatory Traumatic Reaction: Outcomes Arising From Secondary Exposure to Disasters and Large-Scale Threats

Two studies, with a total of 707 participants, developed and examined the reliability and validity of a measure for anticipatory traumatic reaction (ATR), a novel construct describing a form of distress that may occur in response to threat-related media reports and discussions. Exploratory and confirmatory factor analysis resulted in a scale comprising three subscales: feelings related to future threat; preparatory thoughts and actions; and disruption to daily activities. Internal consistency was .93 for the overall ATR scale. The ATR scale demonstrated convergent validity through associations with negative affect, depression, anxiety, stress, neuroticism, and repetitive negative thinking. The scale showed discriminant validity in relationships to Big Five characteristics. The ATR scale had some overlap with a measure of posttraumatic stress disorder, but also showed substantial separate variance. This research provides preliminary evidence for the novel construct of ATR as well as a measure of the construct. The ATR scale will allow researchers to further investigate anticipatory traumatic reaction in the fields of trauma, clinical practice, and social psychology.

Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan

BACKGROUND

The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables.

METHODS

In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors.

RESULTS

The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD.

CONCLUSION

In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.

Short-term and medium-term health effects of 9/11

The New York City terrorist attacks on Sept 11, 2001 (9/11), killed nearly 2800 people and thousands more had subsequent health problems. In this Review of health effects in the short and medium terms, strong evidence is provided for associations between experiencing or witnessing events related to 9/11 and post-traumatic stress disorder and respiratory illness, with a correlation between prolonged, intense exposure and increased overall illness and disability. Rescue and recovery workers, especially those who arrived early at the World Trade Center site or worked for longer periods, were more likely to develop respiratory illness than were other exposed groups. Risk factors for post-traumatic stress disorder included proximity to the site on 9/11, living or working in lower Manhattan, rescue or recovery work at the World Trade Center site, event-related loss of spouse, and low social support. Investigators note associations between 9/11 exposures and additional disorders, such as depression and substance use; however, for some health problems association with exposures related to 9/11 is unclear.

The effects of death reminders on sex differences in prejudice toward gay men and lesbians

Terror management research shows that death reminders (mortality salience) increase prejudice toward worldview violators. Two studies investigated whether death reminders exacerbated differences in heterosexual men's and women's reports of sexual prejudice (negative attitudes based on sexual orientation). Results showed that following death reminders, sex differences in anti-gay discrimination and affective prejudice toward gay men (but not toward lesbians) were larger, and that these increased sex differences were mediated by gender role beliefs. The current studies suggest that researchers may attenuate the effects of death reminders by lessening the perceived worldview violation in addition to alleviating the existential terror of death.

Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care

Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs. negative) for GAD symptoms were roughly twice as likely to report having a loved one at the 9/11 disaster site, twice as likely to know someone who was killed by the attacks, and twice as likely to know someone who was involved with the rescue/recovery efforts after the disaster. Implications for treatment and future research are discussed.