Anxiety, Depressed Mood, Self-Esteem, and Traumatic Stress Symptoms among Distant Witnesses of the 9/11 Terrorist Attacks: Transitory Responses and Psychological Resilience

PTSD, depression, and anxiety after the October 7, 2023 attack in Israel: a nationwide prospective study

Background

The magnitude of the Oct 7, 2023 attack in southern Israel was without precedent. More than 1300 civilians were murdered, and 240 civilians were kidnapped and taken hostage. In this national cohort study, for which baseline outcome data were established before the attacks, a prospective assessment of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) was conducted one month after the attack.

Methods

A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 years (mean = 41.01, SD = 13.72) completed the study at two timepoints: T1, on Aug 20-30, 2023 (6-7 weeks before the attack) and T2, on Nov 9-19, 2023 (5-6 weeks after the attack). 30 (4.2%) of the 710 participants had direct exposure to the attack, and 131 (18.5%) had loved ones who were murdered, kidnapped, or injured during the attack.

Findings

Probable PTSD prevalence almost doubled from 16.2% at T1 to 29.8% at T2 (p < 0.0001), with the prevalence of probable GAD and depression also increasing from 24.9% at T1 to 42.7% at T2, and from 31.3% at T1 to 44.8% at T2, respectively. Direct exposure to the attack was found to contribute to probable PTSD (OR = 3.15, 95% CI = 1.48-6.65) and probable depression (OR = 2.18, 95% CI = 1.02-4.87) at T2.

Interpretation

Our study suggests a broad and significant impact of the Oct 7, 2023 attack on the mental health of the Israeli population. The findings underscore the need to provide rapid, nationwide assessments and triage for interventions to address the mental health needs of Jewish and Arab citizens.

Funding

Not applicable.

College, Interrupted: Profiles in First-Year College Students Responses to the COVID-19 Pandemic Across One Year

First-year college students in the 2019-2020 academic year are at risk of having their mental health, identity work, and college careers derailed as a result of the COVID-19 pandemic. To assess emerging and evolving impacts of the pandemic on mental health/well-being, identity development, and academic resilience, we collected data from a racially, ethnically, geographically, and economically diverse group of 629 students at four universities across the US within weeks of lockdown, and then followed up on these students' self-reported mental health, identity, and academic resilience three times over the following year. Our findings suggest that: 1) students' mental health, identity development, and academic resilience were largely negatively impacted compared to pre-pandemic samples; 2) these alterations persisted and, in some cases, worsened as the pandemic wore on; and 3) patterns of change were often worse for students indicating more baseline COVID-related stressors.

Impact of the COVID-19 Pandemic on Mental Health among 157,213 Americans

BACKGROUND

The coronavirus (COVID-19) pandemic presents an unprecedented crisis with potential negative mental health impacts.

METHODS

This study used data collected via Youper, a mental health app, from February through July 2020. Youper users (N = 157,213) in the United States self-reported positive and negative emotions and anxiety and depression symptoms during the pandemic. We examined emotions and symptoms before (pre), during (acute), and after (sustained) COVID-related stay-at-home orders.

RESULTS

For changes in frequency of reported acute emotions, from the pre to acute periods, anxiety increased while tiredness, calmness, happiness, and optimism decreased. From the acute to sustained periods, sadness, depression, and gratitude increased. Anxiety, stress, and tiredness decreased. Between the pre and sustained periods, sadness and depression increased, as did happiness and calmness. Anxiety and stress decreased. Among symptom measures, anxiety increased initially, from the pre to the acute periods, but later returned to baseline.

LIMITATIONS

The study sample was primarily comprised of young people and women. The app does not collect racial or ethnicity data. These factors may limit generalizability. Sample size was also not consistent for all data collected.

CONCLUSIONS

The present study suggests that although there were initial negative impacts on emotions and mental health symptoms in the first few weeks, many Americans demonstrated resilience over the following months. The impact of the pandemic on mental health may not be as severe as predicted, although future work is necessary to understand longitudinal effects as the pandemic continues.

The COVID-19 outbreak and PNES: The impact of a ubiquitously felt stressor

OBJECTIVE

We aimed to assess frequency of functional seizures or psychogenic nonepileptic seizures (PNES) during the COVID-19 outbreak and to recognize possible factors associated with worsening in this population.

METHODS

In this cross-sectional study conducted during the second phase of the pandemic, adult patients with PNES documented by video-EEG and followed up in two tertiary epilepsy centers responded to a structured telephone survey. Data were gathered on demographics, clinical features and frequency of PNES, history of psychiatric comorbidity, access to treatment, as well as on anxiety (GAD-7 items) and depressive symptoms (NDDI-E).

RESULTS

Fifty-four patients (78% female; mean age of 31.36 years [SD = 10.6]) were contacted and 15 (28%) reported increased frequency of PNES during the pandemic. Higher scores of GAD-7 items (p < 0.001) and NDDI-E (p < 0.001) were associated with PNES worsening. There was strong evidence of a correlation between higher stress levels (p < 0.001) and poor sleep quality (p 0.005) with PNES aggravation. After regression, stress was the strongest predictor of PNES increased frequency.

SIGNIFICANCE

Patients with functional neurological disorders are vulnerable during ubiquitously felt stressors. However, the atmosphere of uncertainty did not affect these patients equally. Patients with PNES showing symptoms of anxiety and depression are at higher risk of seizure worsening. Early identification of this subset of patients may prevent this detrimental outcome.

Character Strengths Predict an Increase in Mental Health and Subjective Well-Being Over a One-Month Period During the COVID-19 Pandemic Lockdown

This study examines whether character strengths predict resilience (operationalized as stable or higher mental health and subjective well-being despite an adverse event) over a period of approximately 1 month during the COVID-19 pandemic lockdown in Spain. Using a longitudinal design, participants (N = 348 adults) completed online measures of sociodemographic data, information regarding their situation in relation to the COVID-19, character strengths, general mental health, life satisfaction, positive affect and negative affect. All variables were measured at Time 1 and Time 2, except for sociodemographic and most COVID-related information (Time 1 only). Time 1 data collection was conducted between March 21, 2020 and April 2, 2020, i.e., approximately the second week of lockdown in Spain. Time 2 data collection was conducted between April 24, 2020 and May 18, 2020, after the Spanish government announced its intention to progressively release the lockdown. A principal component analysis of character strengths was conducted. Five character strength factors were extracted: fortitude, goodness, intellectual, interpersonal, and restraint. Factor structures at Times 1 and 2 were highly consistent. All character strength factors at Time 1 correlated positively with life satisfaction and positive affect, and negatively with negative affect and mental health at T2 (higher scores in the mental health measure indicate poorer mental health). Fortitude strengths showed the highest correlations. We conducted a series of regression analyses with strength factors at Time 1 as predictors, and mental health, life satisfaction, and positive and negative affect as dependent variables, controlling for their baseline levels. To test the directionality of the relationship between strengths and the dependent variables, all analyses were reversed. All character strength factors predicted an increase in mental health. They also predicted positive affect, with the exception of strengths of restraint. Fortitude, intellectual, and interpersonal strengths predicted an increase in life satisfaction. Finally, fortitude strengths, interpersonal strengths, and strengths of restraint, predicted a decrease in negative affect. None of the reversed analyses yielded significant effects. Limitations, implications, and possible character strengths-based interventions aimed at promoting mental health in the COVID-19 pandemic are discussed.

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.

Tracking and Analyzing Individual Distress Following Terrorist Attacks Using Social Media Streams

Risk research has theorized a number of mechanisms that might trigger, prolong, or potentially alleviate individuals' distress following terrorist attacks. These mechanisms are difficult to examine in a single study, however, because the social conditions of terrorist attacks are difficult to simulate in laboratory experiments and appropriate preattack baselines are difficult to establish with surveys. To address this challenge, we propose the use of computational focus groups and a novel analysis framework to analyze a social media stream that archives user history and location. The approach uses time-stamped behavior to quantify an individual's preattack behavior after an attack has occurred, enabling the assessment of time-specific changes in the intensity and duration of an individual's distress, as well as the assessment of individual and social-level covariates. To exemplify the methodology, we collected over 18 million tweets from 15,509 users located in Paris on November 13, 2015, and measured the degree to which they expressed anxiety, anger, and sadness after the attacks. The analysis resulted in findings that would be difficult to observe through other methods, such as that news media exposure had competing, time-dependent effects on anxiety, and that gender dynamics are complicated by baseline behavior. Opportunities for integrating computational focus group analysis with traditional methods are discussed.

Consequences of 9/11 and the war on terror on children's and young adult's mental health: a systematic review of the past 10 years

This mixed method systematic review appraises the individual, familial and systemic effect of 9/11 and the war on terror for majority and minority children and youth in North America. The results highlight the broad social consequences of the socio-political transformations associated with the terror context, which cannot be understood only through a trauma focus analysis. The social stereotypes transformed youth experiences of belonging and exclusion. The difference between the consequences for majority and minority youth suggests the need for a broader appraisal of this societal context to support the development of prevention and intervention intersectorial programs.

Taxonomy of the psychosocial consequences caused by the violence of persecution of ETA's network

This paper delimits and analyzes the effects of the harassment perpetrated by ETA's terrorist network in the Basque Country. The aim was to provide a taxonomy of the consequences of psychological violence and to validate this taxonomy, by means of a content analysis of 37 testimonies of victims of terrorist violence. The taxonomy of consequences of psychological violence is made up by four components: 1. the effects on the context of the persons affected, 2. on their emotional state, 3. on cognition and 4. on behavior. Results show a predominance of contextual consequences and negative cognitions. Intra-observer and inter-observer reliability analysis showed high stability and reproducibility coefficients. This study shows that harassment and psychological violence have major consequences not only for victims but also for family members, threatened collectives and even the society as a whole.