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Persons exposed only indirectly through search and rescue or clean-up efforts or by bereavement alone were not listed. Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects.
The interview also documented demographic data, level of functioning, and treatment received.
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PTSD symptoms were nearly universal, especially symptoms of intrusive reexperience and hyperarousal. No subjects met criteria for somatization disorder or antisocial personality disorder. The registry contained names of survivors directly exposed to the blast based on their proximity to the Murrah Building.
The effects of PTSD on occupational and social functioning reported by the subjects suggest the clinical importance of this disorder Table 3. Figure 2 shows that the avoidance and numbing criterion group was ificantly associated with predisaster psychopathology and with postdisaster comorbidity, associations generally not observed in conjunction with intrusion and hyperarousal symptom groups alone when avoidance and numbing criteria were not met.
Psychiatric comorbidity further identified those with functional disability and treatment need. Because most disasters strike randomly, studies of disasters circumvent the limitations of research on trauma to individuals in the community, where risk for traumatic events is confounded with vulnerability to psychopathology.
Table 1 displays the demographics of the sample, which had roughly equal sex representation and was largely white. Only those persons with PTSD that was complicated by comorbidity were using medication or alcohol as a coping mechanism.
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These observations confirm this team's ly published findings in studies of an earthquake in Northridge, Calif, 24 and a mass murder episode at a cafeteria in Killeen, Tex. Because virtually all the cases of PTSD started acutely after the bombing, the most efficient plan would be to expedite large-scale efforts to identify survivors with psychiatric illness as soon as possible.
Sixty percent of the bombing survivors had experienced a psychiatric disorder at some time in their lives either before or after the bombing. No new cases of substance abuse were observed, consistent with findings 20 - 2325 pertaining to new postdisaster alcohol use disorders after other events studied by this team. Major depression was the most commonly associated disorder, and most preexisting depression recurred or persisted in the period after the bombing.
Linear regression analyses were performed to compare numeric variables. Regardless of diagnostic status, turning to others for support was a nearly universal response.
The nonrandomly selected subjects did not differ from the selected by randomization in demographics, predisaster psychiatric disorder, or any diagnosis made after the disaster. Incident postdisaster substance use disorders were not observed. All postdisaster disorders were ificantly associated with history of predisaster psychopathology. Conclusions Our data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could have identified most psychiatric cases early in the acute postdisaster period.
This study provided important observations on the character and early course of PTSD following a particularly severe disaster. The Oklahoma City bombing provided a rare opportunity to study mental health effects resulting from a severely traumatic event in an essentially unselected population.
Sixty-three percent of subjects with any active postdisaster psychiatric disorder had a predisaster diagnosis; ie, more than one third of those with a postdisaster disorder had never had a psychiatric disorder before the bombing. To commence with interviewing with minimal delay, the first 20 registry members to complete and return a preliminary health department survey of their demographics, exposure to the blast, injuries, and medical treatment were selected for this study. Nearly half the bombing survivors studied had an active postdisaster psychiatric disorder, and full criteria for PTSD were met by one third of the survivors.
Preexisting psychopathology has also been identified as a robust predictor of PTSD by studies of this team 420 - 24 and others. These functional effects of PTSD appeared to be mediated in large part by its psychiatric comorbidity.
Eighty-nine percent of subjects with bombing-related PTSD reported that they were still symptomatic during the month before the interview which was at least 3 months after the bombingdefining their PTSD as chronic. We studied direct survivors of the blast. Overall, nearly half the sample met criteria for 1 or more psychiatric diagnoses after the disaster, with more than one third qualifying for a diagnosis of PTSD specific to the bombing. It is well established that traumatic events experienced by individuals in the community disproportionately strike persons with proclivities to psychopathology, suggesting that PTSD following sporadic traumas to individuals in the community may represent a somewhat different phenomenon from the PTSD arising from a community-wide disaster such as the bombing.
We determined incident and recurrent or persistent disorders by assessing whether the individual had met criteria for the same disorder at any time before the bombing.
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The majority of predisaster alcohol and drug use disorders were reported as inactive after the disaster. Of the subjects thus selected, 3 had left the country, 1 did not speak English, and 2 had died in the interim, precluding their participation.
Symptom onset was rather immediate—usually the same day—and few other cases developed after the first month. Only one third of the total subjects fulfilled the avoidance and numbing criteria. This study found several predictors of bombing-related PTSD: degree of disaster exposure represented by of injuriesfemale sex, preexisting psychopathology, and secondary exposure through loved ones injury and death. Because individuals could have had PTSD resulting from other traumatic events besides the bombing, diagnoses and symptoms of bombing-associated PTSD were tabulated separately from those associated with other traumas.
Further detail on the development of the Oklahoma State Department of Health registry is provided in an earlier publication. The relatively uncommon postdisaster website and numbing cities were virtually tantamount to the diagnosis. All of sex subjects were located in oklahoma Murrah building, except for 1 who was in the Athenian building, which stood across the street and was in the direct path of the blast. For comparisons of means on repeated measures, McNemar tests were performed. Controlling for the confounding effects of sex on education and marital status women having less education and best more often divorced or separated compared with menthese 2 variables were not associated with PTSD or other postdisaster psychopathology.
Psychiatric disorders among survivors of the oklahoma city bombing
The Oklahoma City, Okla, bombing is particularly ificant for the study of mental health sequelae of trauma because its extreme magnitude and scope have been predicted to render profound psychiatric effects on survivors. Comparison across disasters is possible within the Washington University research database on several different disaster events studied using uniform methods.
All subjects provided written informed consent prior to participating.
The nearly universal yet distressing intrusive reexperience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons may be addressed by nonmedical interventions of reassurance and support. Objective To measure the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder PTSDdiagnostic comorbidity, functional impairment, and predictors of postdisaster psychopathology.
Shortages of resources encountered in acute disaster settings make it important to focus attention on those at greatest risk for PTSD. The avoidance and numbing criterion group was also associated with dissatisfaction with work performance.
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Physical injuries and involvement of loved ones may represent specific mechanisms for generation of psychiatric sequelae of cities. The avoidance and numbing criterion group was also associated with receiving treatment, whereas intrusion and hyperarousal in its absence were not.
Forty-five percent of the subjects had a postdisaster psychiatric website and Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. The Disaster Supplement elicited subjects' disaster-related experience including exposure to the event, involvement of family and friends, and physical injuries.
We anticipated that the scope and severity of this event would elicit higher rates of psychopathology than disasters studied using similar research methods. Oklahoma research objectives included documenting rates of postdisaster psychopathology, examining functional impact, and identifying predictors of these difficulties to help guide mental health intervention workers in future disasters. Avoidance and numbing symptoms were associated with preexisting and comorbid postdisaster psychopathology, functional impairment, use of medication and alcohol to cope, and treatment received—unlike the more prevalent intrusive reexperience and hyperarousal symptoms only, which did not show these associations.
As seen in Figure 2the avoidance and numbing group and to a much smaller extent, hyperarousal was associated with reports of functional interference. Table 2 displays rates of predisaster and postdisaster sex. This rapidity of onset is best with other traumatic events subjects had experienced and with findings of 2 other studies.
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More than half of subjects with PTSD alone and the vast majority of those with comorbid PTSD reported that their PTSD symptoms interfered with their activities; similar s in each group were dissatisfied with their work performance after the disaster. The bombing of the Alfred P. Murrah Federal Building in Oklahoma City on April 19,was the most severe incident of terrorism ever experienced on American soil.
The predominance in postdisaster psychopathology in women has been reported in disaster studies 413142326 - 29 and was not unexpected because the disorders classically observed after disasters—depression and anxiety disorders—are more prevalent among women in the general population. These symptoms must last for at least 1 month and must be severe enough to cause subjective distress or functional impairment.
Participation in the study was limited to subjects at least 18 years old.
Declaration of all bombing-associated injuries and illnesses as reportable cases by the Oklahoma State Department of Health commissioner led to the development of a confidential registry of survivors, from which the study sample was drawn. The vast majority of survivors fulfilled criteria for intrusive reexperience and hyperarousal. Postdisaster major depression was not more prevalent among those who had lost a friend or relative in the disaster, nor was the of depressive symptoms higher in this group.
Fifty-seven percent of subjects with bombing-related PTSD had a predisaster lifetime history of psychiatric illness. Onset of PTSD was acute. The degrees of both occupational and social impairment associated with PTSD after the bombing demonstrate the clinical importance of this disorder.
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Even though PTSD onset was very acute after the bombing, its course was chronic. The sample was representative of the health department's registry population with respect to sex and age. Those too severely injured to participate were excluded as ineligible. Mental health treatment was abundant. Disasters offer unique opportunities to study mental health effects of traumatic events in unselected populations.
For all diagnoses except generalized anxiety disorder, postdisaster occurrence of the disorder was statistically associated with predisaster history of the same disorder.
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All interviews were administered by members of the Washington University disaster research team who received formal training to administer the DIS. No associations of any relevant variables with telephone interviews were identified in the data. This study documented extensive psychopathology in a highly exposed sample of direct victims of the blast.
Diagnostic comorbidity with PTSD was specifically associated with effects on relationships with spouses and other household members.