Nurse Faculty Scholars - Trauma

Nationwide Longitudinal Study of Psychological Responses to September 11

nfs — Wed, 29 Sep 2010 13:25:17 +0000

Published Date:

Wed, 2002-09-11 (All day)

Context The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.

Objective To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11–related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.

Design, Setting, and Participants A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks.

Main Outcome Measures September 11–related symptoms of acute stress, posttraumatic stress, and global distress.

Results Seventeen percent of the US population outside of New York City reported symptoms of September 11–related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre–September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11–1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre–September 11 health variables, global distress was associated with severity of loss due to the attacks ( = .07; P = .008) and early coping strategies (eg, increased with denial: = .08; P = .005; and giving up: = .05; P = .04; and decreased with active coping: = -.08; P = .002).

Conclusions The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.

Context The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.
Objective To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11–related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.

Adolescent Vulnerability following the September 11th Terrorist Attacks: A Study of Parents and their Children

nfs — Wed, 29 Sep 2010 13:23:15 +0000

Published Date:

Thu, 2004-01-01 (All day)

Approximately 2 weeks after September 11th, adolescents from a national sample of households who were indirectly exposed to the terrorist attacks through the media completed a Web-based survey that assessed event-related acute stress symptoms. One year later, these adolescents (N = 142) and a randomly selected parent from their household completed a second survey. On average, adolescents reported mild to moderate acute stress symptoms shortly after the attacks and few trauma-related symptoms, low psychological distress and functional impairment, and moderate levels of positive affect 1 year later. After adjusting for acute stress symptoms reported after the attacks, greater parent-adolescent conflict was positively associated with adolescents' trauma symptoms, distress, and functional impairment at 1 year. Higher levels of adolescent positive affect at 1 year were associated with greater parental positive affect, greater parental support, and higher levels of parenting self-efficacy. Parents may play an important role in adolescents' responses to stressful national events.

Early responses to school violence: A qualitative analysis of students' and parents' immediate reactions to the shootings at Columbine High School

nfs — Wed, 29 Sep 2010 13:20:27 +0000

Published Date:

Thu, 2004-01-01 (All day)

On April 20, 1999, two angry students attacked Columbine High School. The unprecedented murder/suicide resulted in 15 deaths, more than 20 injuries, and thousands of psychologically traumatized individuals. We present a qualitative analysis of interviews conducted two weeks after the incident with 4 Columbine High School students and 7 parents who were directly and indirectly affected. Findings highlight both similarities and variability in immediate emotional, cognitive, and social responses to the mass violence. Helpful and unhelpful support attempts are noted. Implications of the media's heavy involvement in sensational traumas are discussed, emphasizing important considerations for future research on the psychological effects of school violence.

Exploring the Myths of Coping with a National Trauma A Longitudinal Study of Responses to the September 11th Terrorist Attacks

nfs — Wed, 29 Sep 2010 13:17:18 +0000

Published Date:

Thu, 2004-01-01 (All day)

A longitudinal investigation of psychological responses to the September 11, 2001 terrorist attacks was conducted on a U.S. national probability sample. Using an anonymous Web-based survey methodology, data were collected among over 1,900 adults at 2 weeks and 12 months post-9/11 to consider whether direct and proximal exposure were necessary preconditions for high levels of acute and posttraumatic stress symptoms, and whether greater exposure/proximity led to greater traumatic stress symptoms. Results suggest that the requirement of direct and proximal exposure to the attacks and the expectation of a dose-response relationship between exposure and traumatic stress response are myths.

Future-Oriented Thinking and Adjustment in a Nationwide Longitudinal Study Following the September 11th Terrorist Attacks

nfs — Wed, 29 Sep 2010 13:14:52 +0000

Published Date:

Sat, 2005-01-01 (All day)

We conducted a three-year longitudinal study of the mental and physical health of a national probability sample following the September 11th terrorist attacks. Adjustment over the three years following the attacks was associated with higher levels of future-oriented thinking and lower levels of fear about future terrorism (as measured 1, 2, and 3 years post-9/11), even after adjusting for demographics, lifetime trauma, pre-9/11 mental and physical health, and 9/11-related exposure. Future orientation over the three years post-9/11 was associated with fewer pre-9/11 mental health problems, greater frequency of adulthood trauma, and using active coping strategies in response to the attacks. Fear of future terrorism was associated with greater frequency of adulthood trauma, more television watching immediately after the attacks, and using more planning and religion-based coping strategies immediately following the attacks. Thinking about the future can be a double-edged sword: Worrying about future terrorism may undermine well-being, whereas focusing on future goals may enhance it when coping with stressful events like the September 11th attacks.

Nationwide longitudinal study of psychological responses to September 11.

nfs — Wed, 29 Sep 2010 13:12:29 +0000

Published Date:

Wed, 2002-09-11 (All day)

CONTEXT: The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.

OBJECTIVE: To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.

DESIGN, SETTING, AND PARTICIPANTS: A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks.

MAIN OUTCOME MEASURES: September 11-related symptoms of acute stress, posttraumatic stress, and global distress.

RESULTS: Seventeen percent of the US population outside of New York City reported symptoms of September 11-related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11-1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre-September 11 health variables, global distress was associated with severity of loss due to the attacks (beta =.07; P =.008) and early coping strategies (eg, increased with denial: beta =.08; P =.005; and giving up: beta =.05; P =.04; and decreased with active coping: beta = -.08; P =.002).

CONCLUSIONS: The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.

CONTEXT: The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale.
OBJECTIVE: To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time.

Ethnicity and Gender in the Face of a Terrorist Attack: A National Longitudinal Study of Immediate Responses and Outcomes Two Years After September 11

nfs — Wed, 29 Sep 2010 13:10:11 +0000

Published Date:

Sun, 2006-01-01 (All day)

This study examines ethnic and gender differences in open-ended immediate responses to an online prompt provided by a nationwide sample of 1,559 individuals in the days following the 9/11 terrorist attacks. These responses were used to predict longitudinal outcomes over the following 2 years. Results show that African Americans and women responded with more emotions (e.g., sadness, sympathy) than did Whites and men. African Americans and women also endorsed violent retaliation less often than did their White, male counterparts. Responding with sadness and sympathy and endorsing violent retaliation were, in turn, associated with higher distress and posttraumatic stress (PTS) symptoms over time. Results reveal considerable ethnic and gender differences in immediate responses to traumatic events that have long-term mental health consequences.

Expressing thoughts and feelings following a collective trauma: immediate responses to 9/11 predict negative outcomes in a national sample.

nfs — Fri, 24 Sep 2010 16:06:22 +0000

Published Date:

Fri, 2008-08-01 (All day)

Collective traumas can negatively affect large numbers of people who ostensibly did not experience events directly, making it particularly important to identify which people are most vulnerable to developing mental and physical health problems as a result of such events. It is commonly believed that successful coping with a traumatic event requires expressing one's thoughts and feelings about the experience, suggesting that people who choose not to do so would be at high risk for poor adjustment. To test this idea in the context of collective trauma, 2,138 members of a nationally representative Web-enabled survey panel were given the opportunity to express their reactions to the terrorist attacks of September 11, 2001, on that day and those following. Follow-up surveys assessing mental and physical health outcomes were completed over the next 2 years. Contrary to common belief, participants who chose not to express any initial reaction reported better outcomes over time than did those who expressed an initial reaction. Among those who chose to express their immediate reactions, longer responses predicted worse outcomes over time. Implications for myths of coping, posttrauma interventions, and psychology in the media are discussed.

Searching for and finding meaning in collective trauma: results from a national longitudinal study of the 9/11 terrorist attacks.

nfs — Fri, 24 Sep 2010 15:52:20 +0000

Published Date:

Mon, 2008-09-01 (All day)

The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval--the terrorist attacks of September 11, 2001--among a national probability sample of U.S. adults (N=931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism. Results highlight the role of meaning in adjustment following collective traumas that shatter people's fundamental assumptions about security and invulnerability.

Finding social benefits after a collective trauma: Perceiving societal changes and well-being following 9/11

nfs — Fri, 24 Sep 2010 15:48:36 +0000

Published Date:

Thu, 2009-03-12 (All day)

Individuals frequently perceive positive changes in themselves following adversity; after a collective trauma, they may perceive such benefits in others or in their society as well. We examined perceived benefits of the September 11, 2001 (9/11) terrorist attacks in a 3-year study of a national sample of adults (N = 1382). Many individuals (57.8%) perceived social benefits of 9/11, including increased prosocial behavior, religiousness, or political engagement. Individuals who found increased national religiosity as a benefit 2 months post-9/11 reported greater positive affect and life satisfaction and lower distress and posttraumatic stress up to 3 years post-9/11. Pre-9/11 religiousness and Republican political affiliation predicted perceiving religion-related social benefits post-9/11. Perceptions of social change are important but understudied responses to stressful events.