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Acute stress disorder in victims after terror attacks in Mumbai, India

Published online by Cambridge University Press:  02 January 2018

Vanshree Patil Balasinorwala
Affiliation:
Department of Psychiatry, Grant Medical College, c/o S.A. Balasinorwala, 57, Sarang Street, Fourth Floor, Room 36, Burhani Building, Mumbai 400003, India. Email: [email protected]
Nilesh Shah
Affiliation:
Department of Psychiatry, L. T. M. Medical College and General Hospital, Sion, Mumbai, India
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2009 

In November 2008, 164 people were killed and at least 308 were physically injured in terror attacks on Mumbai, India. 1 One of the common psychiatric disorders in victims of terror is acute stress disorder. Out of 74 victims admitted to a public hospital, 70 were assessed by a senior psychiatrist (V.P.B.) for the presence of acute stress disorder in the week following hospitalisation. Four patients who were too severely injured were excluded. Victims were directly brought to the hospital because of its proximity to the terror sites or were transferred from other hospitals owing to space, facility and staff (medical/non-medical) constraints.

After obtaining informed consent, patients were individually interviewed and their demographic data (gender, age, address, socioeconomic status (as per B.G. Prasad classification), Reference Agarwal2 religion, education, marital status and occupation), and details of the injuries sustained (initial gravity score) Reference Verger, Dab, Lamping, Loze, Deschaseaux-Voinet and Abenhaim3 were recorded. Patients were specifically evaluated for the presence of acute stress disorder using DSM–IV–TR criteria. 4 Details of past psychiatric history and family history of psychiatric disorders were also collected. The collected data were then tabulated and analysed using the chi-squared test.

The mean (s.d.) age of the victims was 33.5 (12.95) years. There were 52 males and 18 females. Acute stress disorder was found in 21 (30%) of the 70 victims assessed. Other similar studies on victims of terror attacks have found a prevalence of acute stress disorder varying from 12.5 to 47%. Reference Bryant5Reference Muñoz, Crespo, Pérez-Santos and Vázquez7 According to Bryant, Reference Bryant5 human-caused trauma has higher rates of acute stress disorder. According to Stern Reference Stern8 and Janoff-Bulman, Reference Janoff-Bulman and Figley9 this is because the usually indiscriminate and random nature of terrorist attacks create extreme anxiety and helplessness, and destroy individuals' beliefs in their own invulnerability and in the justness of the world.

There were some interesting observations and differences between the patients with and without acute stress disorder on various demographic and clinical variables, although none of the differences reached the level of statistical significance. Acute stress disorder was more common in: females (female, 44.4% v. male, 25.0%); younger victims (<33.5 years, 34.9% v. >33.5 years, 22.2%); victims who were following the Muslim religion (Muslim, 33.3% v. Hindus, 29.6%); residents of Mumbai (residents, 36.6% v. immigrants, 20.7%); divorcees and single victims (divorcees and single, 50.0% and 46.7% v. married and widows, 25.5% and 0%); unemployed (unemployed, 37.5% v. employed, 28.0%); those of low socioeconomic status (low socioeconomic status, 31.7% v. middle socioeconomic status, 20.0%); patients with more than 6.5 years of education (>6.5 years, 39.1% v. ≤6.5 years, 25.5%); and those with severe injury (severe injury, 31.0% v. moderate injury, 25.0%). None of the victims had any past history or family history of any psychiatric disorders.

References

1 Government of India. HM announces measures to enhance security. Press Information Bureau, 11 December 2008 (http://pib.nic.in/release/release.asp?relid=45446).Google Scholar
2 Agarwal, AK. Social classification: the need to update in the present scenario. Indian J Community Med 2008; 33: 50–1.CrossRefGoogle ScholarPubMed
3 Verger, P, Dab, W, Lamping, DL, Loze, JY, Deschaseaux-Voinet, C, Abenhaim, L, et al. The psychological impact of terrorism: an epidemiologic study of posttraumatic stress disorder and associated factors in victims of the 1995–1996 bombings in France. Am J Psychiatry 2004; 161: 1384–9.CrossRefGoogle ScholarPubMed
4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM–IV–TR). APA, 2000.Google Scholar
5 Bryant, RA. Acute stress disorder. PTSD Research Quarterly 2000; 11, 17.Google Scholar
6 Silver, RC, Holman, EA, McIntosh, DN, Poulin, M, Gil-Rivas, V. Nationwide longitudinal study of psychological responses to September 11. JAMA 2002; 288: 1235–44.Google Scholar
7 Muñoz, M, Crespo, M, Pérez-Santos, E, Vázquez, JJ. 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 [Presence of acute stress symptoms in the general population of Madrid in the second week after the terrorist attack of March 11, 2004]. Ansiedad y Estrés 2004; 10: 147–61.Google Scholar
8 Stern, J. The Ultimate Terrorists. Harvard University Press, 1999.Google Scholar
9 Janoff-Bulman, R. The aftermath of victimization: rebuilding shattered assumptions. In Trauma and Its Wake: Vol. 1. The Study and Treatment of Posttraumatic Stress Disorder (ed Figley, C): 1535 Brunner/Mazel, 1985.Google Scholar
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