The psychological and psychiatric effects of terrorism: lessons from London

Cost-effectiveness of 'screen-and-treat' interventions for post-traumatic stress disorder following major incidents

OBJECTIVES

Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach.

METHODS

A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England.

RESULTS

The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust.

CONCLUSIONS

A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.

Neurological disease in the aftermath of terrorism: a review

The purpose of our review is to discuss current knowledge on long-term sequelae and neurological disorders in the aftermath of a terrorist attack. The specific aspects of both psychological and physical effects are mentioned in more detail in this review. Also, the outcomes such as stress-related disorders, cardiovascular disease, and neurodegenerative disease are explained. Moreover, PTSD and posttraumatic structural brain changes are a topic for further investigations of the patients suffering from these attacks. Not only the direct victims are prone to the after effects of the terroristic attacks, but the rescue workers, physicians, witnesses and worldwide citizens may also be affected by PTSD and other neurological diseases as well. The determination of a whole series of risk factors for developing neurological disorders can be a means to set up early detection, preventative measures, to refine treatment and thus to gain better outcome in the future.

The critical incident technique reappraised

Purpose

The purpose of this paper is to offer a reconceptualization of the critical incident technique (CIT) and affirm its utility in management and organization studies.

Design/methodology/approach

Utilizing a case study from a leadership context, the paper applies the CIT to explore various leadership behaviours in the context of nonprofit boards in Canada. Semi-structured critical incident interviews were used to collect behavioural data from 53 participants – board chairs, board directors, and executive directors – from 18 diverse nonprofit organizations in Alberta, Canada.

Findings

While exploiting the benefits of a typicality of events, in some instances the authors were able to validate aspects of transformational leadership theory, in other instances the authors found that theory falls short in explaining the relationships between organizational actors. The authors argue that the CIT potentially offers the kind of “thick description” that is particularly useful in theory building in the field.

Research limitations/implications

Drawing on interview material, the authors suggest that incidents can be classified based on frequency of occurrence and their salience to organizational actors, and explore the utility of this distinction for broader theory building purposes.

Practical implications

Principally, the paper proposes that this method of investigation is under-utilized by organization and management researchers. Given the need for thick description in the field, the authors suggest that the approach outlined generates exceptionally rich data that can illuminate multiple organizational phenomena.

Social implications

The role of nonprofit boards is of major importance for those organizations and the clients that they serve. This paper shed new light on the leadership dynamics at the top of these organizations and therefore can help to guide improved practice by those in board and senior management positions.

Originality/value

The CIT is a well-established technique. However, it is timely to revisit it as a core technique in qualitative research and promote its greater use by researchers. In addition, the authors offer a novel view of incidents as typical, atypical, prototypical or archetypal of organizational phenomena that extends the analytical value of the approach in new directions.

Increased Incidence Rate of Trauma- and Stressor-Related Disorders in Denmark After the September 11, 2001, Terrorist Attacks in the United States

The terrorist attacks that occurred on September 11, 2001 (hereafter referred to as 9/11) in the United States had a profound impact on the physical and mental health of Americans, but the effects beyond the United States are largely unknown. To understand the wider aftermath, we examined the consequences of the 9/11 attacks on mental disorders in the Kingdom of Denmark. Utilizing population data from the Danish Psychiatric Central Research Register from 1995 to 2012, we used a time-series intervention approach to estimate the change in the incidence rate of mental disorders after the 9/11 attacks. Based on analyses of 1,448,250 contacts with psychiatric services, we found that the attacks were followed by an immediate 16% increase in the incidence rate of trauma- and stressor-related disorders. This surge dissipated approximately a year after 9/11. In contrast, no similar increases were found for other disorders. This is consistent with the prominent role of external stressors in the etiology of trauma- and stressor-related disorders. The results indicate that the effects of 9/11 on mental disorders extended across the Atlantic Ocean to Denmark. Thus, the impact of terrorist attacks on mental health is likely not limited to inhabitants of the country under attack; it also extends to people far away and without immediate relation to it.

Psychometric properties of the Adolescent Dissociative Experiences Scale in a sample of Italian adolescents

The purpose of this study was to examine the psychometric properties of the Italian translation of the Adolescent Dissociative Experiences Scale (A-DES). A sample of 1,806 high-school students between the ages of 13 and 18 years, recruited in 6 Italian cities, completed the A-DES. The A-DES showed high internal consistency, excellent item-to-scale homogeneity, good split-half reliability, and a single-factor structure. The scores of the Italian adolescents were comparable to those found in previous research with the measure. No gender differences were found in mean A-DES scores, but boys and girls showed different patterns of responses on A-DES items. Age differences were also found, with 13- and 18-year-old students scoring higher on the measure than the other participants. A cluster analysis showed that participants could be consistently grouped into 2 clusters of low- and high-dissociative adolescents. This study supports the A-DES as a reliable and valid screening measure for dissociative symptoms in adolescents.