9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack

BACKGROUND

The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited.

METHODS

The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies.

RESULTS

Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies.

CONCLUSION

Future directions for research, treatment, and healthcare policy are discussed.

Post-traumatic stress disorder following disasters: a systematic review

BACKGROUND

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated.

RESULTS

We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13).

CONCLUSIONS

The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project

OBJECTIVE

Little is known about the relationship of assaultive trauma to clinical and functional outcome in patients with bipolar disorder.

METHOD

We assessed trauma histories in a cohort of 109 first-admission bipolar patients with psychosis using structured interviews and medical records. Assaultive trauma included rape, physical attacks, and physical threats. Outcome was assessed using standardized ratings.

RESULTS

Forty percent reported a history of assaultive trauma, mostly in childhood (< or =16 years). Exposed patients were more symptomatic at each follow-up than unexposed. Sixteen percent of exposed patients remitted after one episode compared with 38.5% of the non-exposed. Patients exposed as adults were the most symptomatic at 6 months, while patients exposed in childhood were the most symptomatic at 24 months.

CONCLUSION

Our findings supported the salient role of trauma history as a risk factor for poor course in severe bipolar disorder. Given the high prevalence of such exposure, clinical awareness in first-admission psychotic bipolar patients is critical.

Coping with tangible and intangible traumatic losses in prisoners of war

The study of trauma and loss has been biased towards a pathogenic perspective with relatively few investigations assessing resilience. The present paper demonstrates the role of coping, pre-captivity traumatic loss and social support at homecoming in the short and the long-term impact of tangible and intangible traumatic losses of war captivity. Two case descriptions of former prisoners of war suggest that the utilization of active coping enabled good adjustment. On the other hand, emotion-focused, passive coping strategies, pre-captivity unresolved loss, and perceived negative social support at homecoming lead to an enduring and painful psychological toll. The theoretical and clinical implications of coping with traumatic loss are discussed.

Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war

BACKGROUND

This article examines the long-term impact of wartime captivity.

METHOD

One hundred sixty-four prisoners of war (POWs) and 189 matched combatants of the 1973 Yom Kippur War filled out a series of questionnaires that assessed posttraumatic stress disorder (PTSD), general psychiatric symptomatology, and social functioning according to DSM-III-R criteria.

RESULTS

Almost 2 decades after the war, ex-POWs exhibited higher rates and greater intensity of posttraumatic stress reactions, more general psychiatric symptomatology, and more severe problems in functioning at home, at work, and in the military than did the control group (Israeli veterans who were not POWs). They were also more likely to obtain official disability recognition and to seek psychological help. Their recovery was slower and professional help less effective. In addition, the veterans with PTSD in both groups had high rates of comorbid general psychiatric symptomatology.

CONCLUSION

These findings point to the depth, range, and persistence of the stress residuals of wartime captivity.

An eighteen-year follow-up study of Israeli prisoners of war and combat veterans

The current study assesses the psychological and psychiatric aftermath of war captivity; 164 Israeli ex-POWs and 189 comparable controls were assessed for posttraumatic stress disorder, intrusion and avoidance tendencies, and generalized psychiatric symptomatology 18 years after the war. Findings indicated that trauma-related psychopathology and general psychiatric symptomatology were more prevalent among POWs than among their matched controls. In addition, captivity experience, social support at homecoming, and, above all, sociodemographic and military factors were found to be strongly correlated with the outcome measures. Theoretical and clinical implications of the aftermath of captivity are discussed.

[Long-term stress residuals in former prisoners of the Yom Kippur War]

This study examines long-term adjustment following war captivity. 164 former prisoners-of-war (POWs) and 189 other combatants of the Yom Kippur War (1973) filled out a battery of questionnaires, assessing post-traumatic stress disorder (PTSD), trauma-related intrusive and avoidance tendencies, psychiatric symptomatology, and social functioning. Almost 2 decades after the war, 13% of former POWs suffer from diagnosed PTSD. Moreover, long-term residuals of war captivity are not limited to trauma-specific disorders. Former POWs reported more severe psychiatric symptomatology and more problems in functioning than the other combatants.

PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study

OBJECTIVE

The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war.

METHOD

One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile.

RESULTS

Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement.

CONCLUSIONS

These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.

The aftermath of captivity: an 18-year follow-up of Israeli ex-POWs

This is an 18-year follow-up of 164 former prisoners of war (POWs) and 190 controls. The study examined long-term morbidity, psychophysiological complaints, and illness-related behaviors. Psychophysiological complaints were found to be significantly higher among the POWs than among the controls. A significant association was also found between such complaints and symptoms of posttraumatic stress disorder (PTSD). The individual's degree of impairment was associated with both objective and subjective characteristics of captivity. The authors outline differences in types of illness observed in POWs in the current study and in studies conducted in other countries, and consider the implication of characteristics of captivity and culture.