Remembering 911 and the Days After: The Effects of Terrorism

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Remembering 9/11 and the Days After The Effects
of Terrorism

• Connie L. Best, Ph.D.
• Professor and Director, Adult Services
• National Crime Victims Research Treatment
  Center
• Medical University of South Carolina

Sponsored by MUSC College of Nursing and
AHEC September 18, 2004 Mt. Pleasant, South
Carolina
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Colleagues Contributors

• Dean G. Kilpatrick, Ph.D.
• Heidi Resnick, Ph.D.
• Kenneth J. Ruggiero, Ph.D.
• Sandro Galea, M.D.

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Why do Nurses need to know about the
Psychological Responses to Terrorism?

• All Americans need to become better educated
  about terrorism
• Nurses are an integral part of the health care
  team
• People have come to rely on Nurses for accurate
  health information
• Because Nurses are employed in a variety of
  settings (e.g. hospitals, private practice,
  schools, industry, non-profit centers, etc.) they
  may be the first health care professionals that
  the public will come in contact with following a
  terrorist attack
• Nurses need to be more knowledgeable about
  bioterrorism because they may be expected to
  educate / train other nurses

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History of Terrorism

• Biblical Times Poisoning of drinking wells.
• Medieval Times Use of the Plague to capture
  the castles
• Early American Times Use of smallpox infected
  blankets
• More Modern Times in America 1995 Bombing of
  the Murrah Federal Bldg. in Oklahoma City
• 1988 Pan / Am Flight 103 Bombing over
  Lockerbie, Scotland
• 2001 Terrorist Attacks in New York and
  Washington, DC

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Three Mile Island A Silent Disaster Case Study

• In 1979, nuclear reactor at TMI almost
  experienced meltdown, but evidence indicates that
  there was minimal, if any, discharge of
  radioactive material
• This suggests that any effects of the TMI
  incident were likely due to concerns about
  possible exposure or perceptions that they may
  have been exposed rather than actual effects of
  radiation

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Three Mile Island A Silent Disaster Case
Study (continued)

• Baum and colleagues studied approximately 40 TMI
  residents who lived within five miles of the
  plant and a comparison group approximately 17
  months after the incident. The study included a
  five year follow-up.
• The TMI group
• had higher levels of distress, somatic
  complaints, anxiety symptoms, and sleep
  difficulties
• had poorer concentration
• had higher levels of stress hormones including
  epinephrine, norepinephrine, and urinary cortisol
• had increases in blood pressure from pre-to-post
  TMI
• had more physician-rated problems and more
  prescriptions given to them
• many of these problems persisted at the five year
  follow-up

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Three Mile Island A Silent Disaster Case
Study(continued)

• These findings confirm that concerns or
  perceptions about exposure to radiation and toxic
  substances can have a powerful effect on
  psychological and physical health even when there
  has been no actual exposure

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Psychological consequences of the September 11th
terrorist attacks in New York City
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Results of the Psychological Effects of 9/11/01
on New York City Residents
Source Am J. Epidem, 2003
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Predictors of PTSD at 1 Month in NYC

• Female Gender
• Hispanic Ethnicity
• 2 or more prior stressors
• Panic Attack during or shortly after residence
  South of Canal St.
• Loss of possessions

Source N. England J. of Med., March 2002
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Predictors of Depression at 1 Month in NYC

• Female gender
• Hispanic ethnicity
• 2 or more prior stressors
• Panic Attack during or shortly after
• Low level of social support
• Death of a friend or relative during attacks
• Loss of job due to the attacks

Source N. England J. of Med., March 2002
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Physical Health Outcomes

• Researchers have found that exposure to disasters
  and violence is associated with increased
• Substance use problems
• Cigarette use
• Sleep problems
• Health care utilization
• Somatic complaints
• Medical conditions
• Physiological indicators of stress
• HIV-risk behavior

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Factors That Might Influence the Reaction of
Individuals

• Severity of the trauma
• Duration of the trauma
• Perceived life threat
• Serious physical injury
• Recent trauma or life stressors
• Number of lifetime traumas or life stressors
• Presence/absence of social support systems

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Degree of Mass Violence- and Disaster-Related
Mental Health Impact

Number of Affected Individuals
Greater
Mild Transitory Distress
Fewer
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Intervention for Disaster-Related Mental Health
Problems at Each Level
Public Safety Public Education
Family Education Traditional Healing
Rituals
Public Policy Primary
Health Care Family Therapy Mental Health
Treatment
Family
Adapted from Fairbank et al. (2003)
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The News Media Address Terrorism
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Questions and Answers