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Post-Traumatic Stress Reactions Following the March 11, 2004 Terrorist Attacks in a Madrid Community Sample: A Cautionary Note about the Measurement of Psychological Trauma

Published online by Cambridge University Press:  10 April 2014

Carmelo Vázquez ,
Pau Pérez-Sales  and
Georg Matt
Carmelo Vázquez*
Affiliation:
Universidad Complutense de Madrid
Pau Pérez-Sales
Affiliation:
Hospital La Paz (Madrid) and Grupo de Acción Comunitaria (GAC), Madrid
Georg Matt
Affiliation:
San Diego State University, USA
*
Address correspondence to: Carmelo Vázquez, Facultad de Psicología, Universidad Complutense, Campus de Somosaguas, 28223-Madrid (Spain). Telephone: (34) 91-3943131. Fax: (34) 91-3943189. E-mail: [email protected]
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Abstract

Posttraumatic stress reactions related to the Madrid March 11, 2004, terrorist attacks were examined in a sample of Madrid residents (N = 503) 18-25 days after the attacks, using multiple diagnostic criteria and different cut-off scores. Based on the symptoms covered by the Posttraumatic Stress Disorder Checklist-Civilian (PCL-C; Weathers, Litz, Herman, Huska, & Keane, 1993), rates of probable posttraumatic stress disorder (PTSD) ranged from 3.4% to 13.3%. Taking into account additional criteria from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 200; i.e., the impact of initial reaction and problems in daily functioning as a consequence of the traumatic event), only 1.9% of respondents reported probable PTSD. These results suggest that inferences about the impact of traumatic events on the general population are strongly influenced by the definition of traumatic response. Our findings also revealed that the magnitude of posttraumatic reactions is associated with several risk factors, including living close to the attacked locations, physical proximity to the attacks when they occurred, perception of one's life being at risk, intensity of initial emotional reactions, and being a daily user of the attacked train lines. The use of different cut-off scores did not affect the pattern of risk to develop traumatic stress. The implications of these results for public health policies related to terrorist attacks are discussed.

Se examinaron reacciones de estrés postraumático, empleando múltiples criterios diagnósticos y puntos de corte, en una muestra de la población de Madrid (N = 503), 18-25 días después de los ataques terroristas de Madrid del 11 de marzo de 2004. En función del punto de corte seleccionado, los porcentajes de probable trastorno de estrés postraumático (TEPT) basado en el Posttraumatic Stress Disorder Checklist-Civilian (PCL-C; Weathers, Litz, Herman, Huska, & Keane, 1993) fluctuaban entre el 3,4% y el 13,3%. Al añadir a los síntomas de TEPT otros criterios del Manual Diagnóstico y Estadístico de Trastornos Mentales (American Psychiatric Association, 2000) requeridos para su diagnóstico (p. ej., el impacto de la reacción inicial y problemas en el funcionamiento cotidiano como consecuencia del evento traumático), sólo el 1,9% presentaba un probable TEPT. Estos resultados demuestran que las inferencias acerca del impacto de eventos traumáticos en la población general pueden depender en gran parte de la definición y medida de la respuesta traumática. Nuestros resultados también revelaron que, aunque la magnitud de las reacciones postraumáticas se relacionaba con varios factores de riesgo (vivir cerca de los lugares atacados, proximidad física a los ataques cuando ocurrieron, percepción de amenaza para la propia vida, intensidad de las reacciones emocionales iniciales, y ser un usuario diario de las líneas de trenes atacadas), el uso de diferentes estrategias de punto de corte no afectó el patrón principal de riesgo para el desarrollo de estrés traumático. Se comentan las implicaciones de estos resultados para las políticas de la salud pública relacionadas con los ataques terroristas.

Keywords

Post traumatic stress disordertraumaPTSDacute stress disorderrisk factorsSeptember 11terrorismtrastorno de estrés posttraumáticotraumaTEPTtrastorno agudo de estrésfactores de riesgo11 de septiembreterrorismo
Type
Articles
Information
The Spanish Journal of Psychology , Volume 9 , Issue 1 , May 2006 , pp. 61 - 74
Copyright
Copyright © Cambridge University Press 2006

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References

Ahern, J., Galea, S., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Television images and psychological symptoms after the September 11 terrorist attacks. Psychiatry, 65, 289–300.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
Blanchard, E.B., Hickling, E.J., Barton, K.A., Taylor, A.E., Loos, W.R., & Jones-Alexander, J. (1996). One-year prospective follow-up of motor vehicle accident victims. Behaviour Research and Therapy, 34, 775–786.CrossRefGoogle ScholarPubMed
Blanchard, E.B., Jones Alexander, J., Buckley, T.C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669–673.CrossRefGoogle ScholarPubMed
Blanchard, E.B., Kuhn, E., Rowell, D.L., Hickling, E.J., Wittrock, D., Rogers, R. L., Johnson, M.R., & Steckler, D.C. (2004). Studies of the vicarious traumatization of college students by the September 11th attacks: Effects of proximity, exposure and connectedness. Behavior Research and Therapy, 42, 191–205.CrossRefGoogle ScholarPubMed
Boscarino, J.A., Galea, S., Ahern, J., Resnick, H., & Vlahov, D. (2002). Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City. International Journal of Emergency Mental Health, 4, 143–155.Google ScholarPubMed
Bracha, H.S., Williams, A.E., Haynes, S.N., Kubany, E.S., Ralston, T.C, & Yamashita, J.M. (2004). The STRS (Shortness of Breath, Tremulousness, Racing Heart, and Sweating): A brief checklist for acute distress with panic-like sympathetic indicators; development and factor structure. Annals of General Hospital Psychiatry, 3, 8.CrossRefGoogle Scholar
Brewin, C.R. (2003). Posttraumatic stress disorder: Malady or myth? New Haven, CT: Yale University Press.Google Scholar
Brewin, C.R., Andrews, B., & Rose, S. (2000). Fear, helplessness, and horror in posttraumatic stress disorder: Investigating DSMIV Criterion A2 in victims of violent crime. Journal of Traumatic Stress, 13, 499–509.CrossRefGoogle ScholarPubMed
Bryant, R.A., & Harvey, A.G. (2000). Acute stress disorder: A handbook of theory, assessment, and treatment. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Cano-Vindel, A., Miguel-Tobal, J. J., González-Ordi, H., & Iruarrizaga, I. (2004). Los atentados terroristas del 11-M en Madrid: la proximidad de la residencia a las áreas afectadas. Ansiedad y Estrés, 10 (2–3), 181–194.Google Scholar
Conejero, S., de Rivera, J., Páez, D., & Jiménez, A. (2004). Alteración afectiva personal, atmósfera emocional y clima emocional tras los atentados del 11 de marzo. Ansiedad y Estrés, 102–3, 299–312Google Scholar
ESEMeD/MHEDEA (2004). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. Acta Psychiatrica Scandinavica, 109, 21–27.CrossRefGoogle Scholar
Fredrickson, B.L., Tugade, M.M., Waugh, C.E., & Larkin, G.R. (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84, 365–376.CrossRefGoogle ScholarPubMed
Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982–987.CrossRefGoogle ScholarPubMed
Galea, S., Vlahov, D., Resnick, H., Ahern, J., Susser, E., Gold, J., Bucuvalas, M., & Kilpatrick, D. (2003). Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology, 158, 514–524.CrossRefGoogle ScholarPubMed
González-Ordi, H., Miguel-Tobal, J.J., Cano-Vindel, A., & Iruarrizaga, I. (2004). Efectos de la exposición a eventos traumáticos en personal de emergencias: consecuencias psicopatológicas del atentado terrorista del 11-M en Madrid. Ansiedad y Estrés, 10, 207–217.Google Scholar
Herman, D., Felton, C., & Susser, E. (2002). Mental health needs in New York State following the September 11th attacks. Journal of Urban Health, 79, 322–331.CrossRefGoogle ScholarPubMed
Iruarrizaga, I., Miguel-Tobal, J.J., Cano-Vindel, A., & González, H. (2004). Consecuencias psicopatológicas tras el atentado terrorista del 11-M en Madrid en víctimas, familiares y allegados. Ansiedad y Estrés, 10, 195–206.Google Scholar
Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.CrossRefGoogle ScholarPubMed
Kilpatrick, D.G., Resnick, H.S., Freedy, J.R., Pelcovitz, D., Resick, P., Roth, S., & van der Kolk, B. (1998). The posttraumatic stress disorder field trial: Evaluation of the PTSD construct -Criteria A through E. In Widiger, T., Frances, A., Pincus, H., Ross, R., First, M., Davis, W., & Kline, M. (Eds.), DSM-IV Sourcebook (Vol. 4, pp. 803–844). Washington, DC: American Psychiatric Press.Google Scholar
Marshall, R.D., Spitzer, R., & Liebowitz, M.R. (1999). Review and critique of the new DSM-IV diagnosis of acute stress disorder. American Journal of Psychiatry, 156, 1677–1685.CrossRefGoogle ScholarPubMed
Matt, G.E., & Vázquez, C. (2006). Psychological distress and resilience among distant witnesses of the 9/11 terrorist attacks: A natural experiment using multiple baseline and follow-up cohorts. Manuscript submitted for publication.Google Scholar
McCarter, L., & Goldman, W. (2002). Use of psychotropics in two employee groups directly affected by the events of September 11. Psychiatric Services, 53, 1366–1368.CrossRefGoogle ScholarPubMed
McNally, R.J., Bryant, R., & Ehlers, A. (2003). Does early psychological intervention promote recovery from traumatic stress? Psychological Science in the Public Interest, 4, 45–79.CrossRefGoogle Scholar
Miguel-Tobal, J.J., Cano-Vindel, A., Iruarrizaga, I., González, H., & Galea, S. (2004). Consecuencias psicológicas de los atentados del 11-M en Madrid. Planteamiento general de los estudios y resultados en la población general. Ansiedad y Estrés, 10, 163–179.Google Scholar
Muñoz, M., Crespo, M., Pérez-Santos, E., & Vázquez, J.J. (2004). Presencia de síntomas de estrés agudo en la población general de Madrid en la segunda semana tras el atentado terrorista del 11 de Marzo de 2004. Ansiedad y Estrés, 10, 147–161.Google Scholar
Murphy, R.T., Wismar, K., & Freeman, K. (2003). Stress symptoms among African-American college students after the September 11, 2001 terrorist attacks. Journal of Nervous and Mental Disease, 191, 108–114.CrossRefGoogle ScholarPubMed
Narrow, W.E., Rae, D.S., Robin, L.N., & Regier, D.A. (2002). Revised prevalence estimates of mental disorders in the United States: Using a clinical significance criterion to reconcile 2 surveys' estimates. Archives of General Psychiatry, 59, 115–123.CrossRefGoogle ScholarPubMed
Norris, F., Byrne, C. M., Diaz, E., & Kaniasty, K. (2001). 50,000 disaster victims speak: An empirical review of the empirical literature, 1981–2001. Report prepared for the National Center for PTSD and the Center for Mental Health Services.Google Scholar
North, C., Nixon, S., Shariat, S., Mallonee, S., McMillen, J., Spitzanagel, E., & Smith, E. (1999). Psychiatric disorders among survivors of the Oklahoma City bombing. Journal of the American Medical Association, 282, 755–762.CrossRefGoogle ScholarPubMed
North, C.S., & Pfefferbaum, B. (2002). Research on the mental health effects of terrorism. JAMA, 288, 633–636.CrossRefGoogle ScholarPubMed
North, C.S., Smith, E.M., & Spitznagel, E.L. (1994). Posttraumatic stress disorder in survivors of a mass shooting. American Journal of Psychiatry, 151, 82–88.Google ScholarPubMed
Office of Behavioral and Social Sciences Research. Assessing the effects of the attacks on America. Retrieved on August 30, 2002 from the National Institutes of Health Website: http://obssr.od.nih.gov/Activities/911/attack.htm/Google Scholar
Pérez Sales, P., Cervellón, P., Vázquez, C., Vidales, D., & Gaborit, M. (2005). Posttraumatic factors and resilience: The role of shelter management and survivors' attitudes after the earthquakes in El Salvador (2001). Journal of Applied Social Psychology, 15, 368–382.Google Scholar
Rosenheck, R., & Fontana, A. (2003). Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. American Journal of Psychiatry, 160, 1684–1690.CrossRefGoogle ScholarPubMed
Rubin, G.J., Brewin, C.R., Greenberg, N., Simpson, J., & Wessely, S. (2005). Psychological and behavioural reactions to the bombings in London on 7 July 2005: Cross-sectional survey of a representative sample of Londoners. Psychological Medicine, 331, 606. (BMJ, doi:10.1136/bmj.38583.728484.3A, published 26 August 2005).Google Scholar
Ruggiero, K.J., Del Ben, K., Scotti, J.R., & Rabalais, A.E. (2003). Psychometric properties of the PTSD Checklist-Civilian Version. Journal of Traumatic Stress, 16, 495–502.CrossRefGoogle ScholarPubMed
Sampedro, J. (2004, March 19). 150,000 madrileños sufrirán trastornos psicológicos leves. El País, p. 30.Google Scholar
Schlenger, W.E., Caddell, J.M., Ebert, L., Jordan, B.K., Rourke, K.M., Wilson, D., Thalji, L., Dennis, J.M., Fairbank, J.A., & Kulka, R A. (2002). Psychological reactions to terrorist attacks: Findings from the National Study of Americans' Reactions to September 11. JAMA, 288, 581–588.CrossRefGoogle ScholarPubMed
Schuster, M.A., Stein, B.D., Jaycox, L., Collins, R.L., Marshall, G.N., Elliott, M.N., Zhou, A.J., Kanouse, D.E., Morrison, J.L., & Berry, S.H. (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine, 345, 1507–1512.CrossRefGoogle ScholarPubMed
Shalev, A.Y. (2004). Further lessons from 9/11: Does stress equal trauma? Psychiatry, 67, 174–177.CrossRefGoogle ScholarPubMed
Silver, R.C., Holman, E.A., McIntosh, D.N., Poulin, M., & Gil-Rivas, V. (2002). Nationwide longitudinal study of psychological responses to September 11. JAMA, 288, 1235–1244.CrossRefGoogle ScholarPubMed
Southwick, S.M., & Charney, D.S. (2004). Responses to trauma: Normal reactions or pathological symptoms. Psychiatry, 67, 170–173.CrossRefGoogle ScholarPubMed
Sprang, G. (1999). Post-disaster stress following the Oklahoma City bombing: An examination of three community groups. Journal of Interpersonal Violence, 14, 169–183.CrossRefGoogle Scholar
Stein, B.D., Elliott, M.N., Jaycox, L., Collins, R.L., Berry, S.H., Klein, D.J., & Schuster, M.A. (2004). A national longitudinal study of the psychological consequences of the September 11, 2001 terrorist attacks: Reactions, impairment, and help-seeking. Psychiatry, 67, 105–117.CrossRefGoogle ScholarPubMed
Stephenson, J. (2001). Medical, mental health communities mobilize to cope with terror's psychological aftermath. JAMA, 286, 1823–1825.Google ScholarPubMed
Vázquez, C. (2005). Stress reactions of the general population after the terrorist attacks of S11 (USA) and M11 (Madrid, Spain): Myths and realities. Annuary of Clinical and Health Psychology, 1, 9–25. (http://www.us.es/apcs/vol1esp.htm).Google Scholar
Vázquez, C., Cervellón, P., Pérez Sales, P., Vidales, D., & Gaborit, M. (2005). Positive emotions in earthquake survivors in El Salvador (2001). Journal of Anxiety Disorders, 19, 313–328.CrossRefGoogle ScholarPubMed
Weathers, F.W., Litz, B.T., Herman, D.S., Huska, J.A., & Keane, T.M. (1993, October). The PTSD Checklist: Reliability, validity and diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
Wessely, S. (2004). When being upset is not a mental problem. Psychiatry, 67, 153–157.CrossRefGoogle ScholarPubMed