Psychiatric disorders among survivors of the Oklahoma City bombing

Carol S. North, Sara Jo Nixon, Sheryll Shariat, Sue Mallonee, J. Curtis McMillen, Edward L. Spitznagel, Elizabeth M. Smith

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant 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. 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 (PTSD), diagnostic comorbidity. functional impairment, and predictors of postdisaster psychopathology. Design, Setting, and Participants Of 255 eligible adult survivors selected from a confidential registry, 182 (71 %) were assessed systematically by interviews approximately 6 months after the disaster, between August and December 1995. Main Outcome Measures Diagnosis of 8 psychiatric disorders, demographic data, level of functioning, treatment, exposure to the event, involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement. Results Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; x21= 8.27; P =.004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; x21 = 6.86; P=.009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. 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. Psychiatric comorbidity further identified those with functional disability and treatment need. 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.

Original languageEnglish (US)
Title of host publicationThe Science of Mental Health
Subtitle of host publicationStress and the Brain
PublisherTaylor and Francis
Pages159-167
Number of pages9
Volume9
ISBN (Electronic)9781317970972
ISBN (Print)0815337434, 9780815337522
StatePublished - Jan 1 2013
Externally publishedYes

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Post-Traumatic Stress Disorders
Psychiatry
Survivors
Disasters
Comorbidity
Psychopathology
Mental Health
Interviews
Wounds and Injuries
Mental Disorders
Registries
Appointments and Schedules
Therapeutics
Demography
Outcome Assessment (Health Care)
Population

ASJC Scopus subject areas

  • Psychology(all)

Cite this

North, C. S., Nixon, S. J., Shariat, S., Mallonee, S., Curtis McMillen, J., Spitznagel, E. L., & Smith, E. M. (2013). Psychiatric disorders among survivors of the Oklahoma City bombing. In The Science of Mental Health: Stress and the Brain (Vol. 9, pp. 159-167). Taylor and Francis.

Psychiatric disorders among survivors of the Oklahoma City bombing. / North, Carol S.; Nixon, Sara Jo; Shariat, Sheryll; Mallonee, Sue; Curtis McMillen, J.; Spitznagel, Edward L.; Smith, Elizabeth M.

The Science of Mental Health: Stress and the Brain. Vol. 9 Taylor and Francis, 2013. p. 159-167.

Research output: Chapter in Book/Report/Conference proceedingChapter

North, CS, Nixon, SJ, Shariat, S, Mallonee, S, Curtis McMillen, J, Spitznagel, EL & Smith, EM 2013, Psychiatric disorders among survivors of the Oklahoma City bombing. in The Science of Mental Health: Stress and the Brain. vol. 9, Taylor and Francis, pp. 159-167.
North CS, Nixon SJ, Shariat S, Mallonee S, Curtis McMillen J, Spitznagel EL et al. Psychiatric disorders among survivors of the Oklahoma City bombing. In The Science of Mental Health: Stress and the Brain. Vol. 9. Taylor and Francis. 2013. p. 159-167
North, Carol S. ; Nixon, Sara Jo ; Shariat, Sheryll ; Mallonee, Sue ; Curtis McMillen, J. ; Spitznagel, Edward L. ; Smith, Elizabeth M. / Psychiatric disorders among survivors of the Oklahoma City bombing. The Science of Mental Health: Stress and the Brain. Vol. 9 Taylor and Francis, 2013. pp. 159-167
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N2 - Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant 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. 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 (PTSD), diagnostic comorbidity. functional impairment, and predictors of postdisaster psychopathology. Design, Setting, and Participants Of 255 eligible adult survivors selected from a confidential registry, 182 (71 %) were assessed systematically by interviews approximately 6 months after the disaster, between August and December 1995. Main Outcome Measures Diagnosis of 8 psychiatric disorders, demographic data, level of functioning, treatment, exposure to the event, involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement. Results Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; x21= 8.27; P =.004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; x21 = 6.86; P=.009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. 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. Psychiatric comorbidity further identified those with functional disability and treatment need. 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.

AB - Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant 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. 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 (PTSD), diagnostic comorbidity. functional impairment, and predictors of postdisaster psychopathology. Design, Setting, and Participants Of 255 eligible adult survivors selected from a confidential registry, 182 (71 %) were assessed systematically by interviews approximately 6 months after the disaster, between August and December 1995. Main Outcome Measures Diagnosis of 8 psychiatric disorders, demographic data, level of functioning, treatment, exposure to the event, involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement. Results Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; x21= 8.27; P =.004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; x21 = 6.86; P=.009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. 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. Psychiatric comorbidity further identified those with functional disability and treatment need. 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.

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