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Active Shooter and Terrorist Event-Related Posttraumatic Stress and Depression: Television Viewing and Perceived Safety

Published online by Cambridge University Press:  17 December 2018

Carol S. Fullerton ,
Holly B. Herberman Mash ,
Joshua C. Morganstein  and
Robert J. Ursano
Carol S. Fullerton
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Holly B. Herberman Mash*
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Joshua C. Morganstein
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Robert J. Ursano
Affiliation:
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
*
Correspondence and reprint requests to Holly B. Herberman Mash, Uniformed Services University of the Health Sciences, Department of Psychiatry, 4301 Jones Bridge Road, Bethesda, MD 20814 (e-mail: [email protected]).
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Abstract

Objective

This study examined the relationship of sniper-related television viewing (TV) and perceived safety to posttraumatic stress (PTS) and depressive symptoms during the Washington, DC sniper attacks.

Methods

Participants were 1238 Washington, DC area residents assessed using an internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, hours of TV, and perceived safety.

Results

Almost 40% (n = 459) of participants watched at least 2 hours of sniper-related TV daily. TV viewing was associated with lower total perceived safety. After adjusting for demographics, more TV viewing and decreased perceived safety were related to increased PTS and depressive symptoms. TV viewing modified the effect of safety on PTS and depressive symptoms. Among participants with low and high perceived safety, hours of TV were positively associated with PTS; however, the effect was stronger among those with low perceived safety. The relationship of TV to increased depressive symptoms was identified only in participants who reported low perceived safety.

Conclusions

The influence of media exposure and perceived safety have implications for intervention by community leaders and mental health care providers. Recommendations include limiting media exposure during a terrorist event, particularly among those who perceive that their safety is at risk, and targeting safety in communication strategies. (Disaster Med Public Health Preparedness. 2019;13:570-576)

Keywords

terrorismPTSDdepressionperceived safetymedia exposure
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 3 , June 2019 , pp. 570 - 576
Copyright
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

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References

REFERENCES

1. Blair, JP, Schweit, K. A study of active shooter incidents in the United States between 2000 and 2013. Homeland Security Digital Library. https://www.hsdl.org/?abstract&did=757920. Published September 16, 2013. Accessed February 28, 2018.Google Scholar
2. Lowe, SR, Galea, S. The mental health consequences of mass shootings. Trauma Violence Abuse. 2017;18:62-82.Google Scholar
3. Morganstein, JC, Ursano, RJ, Fullerton, CS, et al. Textbook of Disaster Psychiatry, 2nd ed. Ursano RJ, Fullerton CS, Weisaeth L, et al., eds. New York: Cambridge University Press; 2017:193-212.Google Scholar
4. Ferrando, L, Galea, S, Corton, ES, et al. Long-term psychopathological changes among the injured and members of the community after a massive terrorist attack. Eur Psychiatry. 2011;26:513-517.Google Scholar
5. Henriksen, CA, Bolton, JM, Sareen, J. The psychological impact of terrorist attacks: examining a dose-response relationship between exposure to 9/11 and Axis I mental disorders. Depress Anxiety. 2010;27:993-1000.Google Scholar
6. Hughes, M, Brymer, M, Chiu, WT. Posttraumatic stress among students after the shootings at Virginia Tech. Psychol Trauma. 2011;3:403-411.Google Scholar
7. Norris, FH, Friedman, MJ, Watson, PJ, et al. 60,000 disaster victims speak, part I: an empirical review of the empirical literature, 1981-2001. Psychiatry. 2002;65:207-239.Google Scholar
8. Silver, RC, Holman, EA, McIntosh, DN, et al. Nationwide longitudinal study of psychological response to September 11. JAMA. 2002;288:1235-1244.Google Scholar
9. North, CS, Nixon, SJ, Shariat, S, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282:755-762.Google Scholar
10. North, CS, McCutcheon, V, Spitznagel, EL, et al. Three year follow-up of survivors of a mass shooting episode. J Urban Health. 2002;79:383-391.Google Scholar
11. Zhang, G, North, CS, Narayanan, P, et al. The course of postdisaster psychiatric disorders in directly exposed civilians after the US Embassy bombing in Nairobi, Kenya: a follow-up study. Soc Psychiatry Psychiatr Epidemiol. 2013;48:195-203.Google Scholar
12. Busso, DS, McLaughlin, KA, Sheridan, MA. Media exposure and sympathetic nervous system reactivity predict PTSD symptoms after the Boston Marathon bombings. Depress Anxiety. 2014;31:551-558. doi: 10.1002/da.22282Google Scholar
13. Mash, HBH, Fullerton, CS, Benevides, KN, et al. Identification with terrorist attack victims: association with television viewing and prior life threat. Disaster Med Public Health Prep. 2018;12(3):337-344. doi: 10.1017/dmp.2017.72Google Scholar
14. Pfefferbaum, B, Nixon, SJ, Tivis, RD, et al. Television exposure in children after a terrorist incident. Psychiatry. 2001;64:202-211. doi: 10.1521/psyc.64.3.202.18462Google Scholar
15. Silver, RC, Holman, EA, Andersen, JP, et al. Mental- and physical-health effects of acute exposure to media images of the September 11, 2001, attacks and the Iraq War. Psychol Sci. 2013;24:1623-1634. doi: 10.1177/0956797612460406Google Scholar
16. Ahern, J, Galea, S, Resnick, H, et al. Television images and psychological symptoms after the September 11 terrorist attacks. Psychiatry. 2002;65:289-300. doi: 10.1521/psyc.65.4.289.20240Google Scholar
17. Ahern, J, Galea, S, Resnick, H, et al. Television images and probable posttraumatic stress disorder after September 11: the role of background characteristics, event exposures, and perievent panic. J Nerv Ment Dis. 2004;192:217-226. doi: 10.1097/01.nmd.0000116465.99830.caGoogle Scholar
18. Bernstein, KT, Ahern, J, Tracy, M, et al. Television watching and the risk of incident probable posttraumatic stress disorder. J Nerv Ment Dis. 2007;195:41-47.Google Scholar
19. Breslau, N, Bohnert, KM, Koenen, KC. The 9/11 terrorist attack and posttraumatic stress disorder revisited. J Nerv Ment Dis. 2010;198:539-543. doi: 10.1097/NMD.0b013e18ea1e2fGoogle Scholar
20. Cardenas, JE, Dennis, M, Winkel, M, et al. A snapshot of terror: acute posttraumatic responses to the September 11 attacks. J Trauma Dissociation. 2005;6:69-84. doi: 10.1300/J229v06n02_07Google Scholar
21. Holman, EA, Garfin, DR, Silver, RC. Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proc Natl Acad Sci USA. 2014;111:93-98.Google Scholar
22. Marshall, RD, Bryant, RA, Amsel, L, et al. The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears. Am Psychol. 2007;62:304-316.Google Scholar
23. Schlenger, WE, Caddell, JM, Ebert, L, et al. Psychological reactions to terrorist attacks: findings from the National Study of Americans’ Reactions to September 11. JAMA. 2002;288:581-588. doi: 10.1001/jama.288.5.581Google Scholar
24. Schuster, MA, Stein, BD, Jaycox, LH, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med. 2001;345:1507-1512. doi: 10.1056/NEJM200111153452024Google Scholar
25. Torabi, MR, Seo, DC. National study of behavioral and life changes since September 11. Health Educ Behav. 2004;31:179-192.Google Scholar
26. Ursano, RJ, Fullerton, CS, Norwood, AE. eds. Planning for Bioterrorism: Behavior and Mental Health Responses to Weapons of Mass Destruction and Mass Disruption. Bethesda, MD: Defense Technical Information Center (available from authors on request); 2001.Google Scholar
27. Ursano, RJ. Post-traumatic stress disorder. N Engl J Med. 2002;346:130-132.Google Scholar
28. Peters, A, McEwen, BS, Friston, K. Uncertainty and stress: why it causes diseases and how it is mastered by the brain. Prog Neurobiol. 2017;156:164-188.Google Scholar
29. Fullerton, CS, Mash, HBH, Benevides, KN, et al. Distress of routine activities and perceived safety associated with PTSD, depression, and alcohol use: 2002 Washington, D.C. sniper attacks. Disaster Med Public Health Prep. 2015;9:509-515.Google Scholar
30. Grieger, TA, Fullerton, CS, Ursano, RJ. Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the Pentagon. Psychiatr Serv. 2003;54:1380-1382.Google Scholar
31. Fullerton, CS, Gifford, RK, Flynn, BW, et al. Effects of the 2002 sniper attacks on the homeless population in Washington, D.C. Disaster Med Public Health Prep. 2009;3:163-167.Google Scholar
32. Grieger, TA, Fullerton, CS, Ursano, RJ, et al. Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks. Psychiatr Serv. 2003;54:1383-1387.Google Scholar
33. Schulden, J, Chen, J, Kresnow, M-J, et al. Psychological responses to the sniper attacks: Washington, D.C. area, October 2002. Am J Prev Med. 2006;31:324-327.Google Scholar
34. Weiss, DS, Marmar, CR. The Impact of Event Scale- Revised. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook. New York: Guilford Press; 1997:399-411.Google Scholar
35. Creamer, M, Bell, R, Failla, S. Psychometric properties of the Impact of Event Scale-Revised. Behav Res Ther. 2003;41:1489-1496.Google Scholar
36. Kroenke, K, Spitzer, RL, Williams, JBW. The PHQ-9: validity of a brief depression measure. J Gen Intern Med. 2001;16:606-613.Google Scholar
37. Spitzer, RL, Kroenke, K, Williams, JBW. Validity and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA. 1999;282:1737-1744.Google Scholar
38. Brewin, CR, Andrews, B, Valentine, JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68:748-766. doi: 10.1037/0022-006X.68.5.748Google Scholar
39. Fullerton, CS, Ursano, RJ, Wang, L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry. 2004;161:1370-1376.Google Scholar
40. Kennedy, C, Charlesworth, A, Chen, J-L. Disaster at a distance: impact of 9.11.01 televised news coverage on mothers’ and children’s health. J Pediatr Nurs. 2004;19:329-339.Google Scholar
41. Kessler, RC, Sonnega, A, Bromet, E, et al. Posttraumatic stress disorder in the National Comorbidity Study. Arch Gen Psychiatry. 1995;52:1048-1060. doi: 10.1001/archpsyc.1995.03950240066012Google Scholar
42. Olff, M, Langeland, W, Draijer, N, et al. Gender differences in posttraumatic stress disorder. Psychol Bull. 2007;133:183-204. doi: 10.1037/0033-2909.133.2.183Google Scholar
43. Tolin, DF, Foa, EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132:959-992.Google Scholar
44. Corp, IBM. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp; 2016.Google Scholar
45. Fullerton, CS, Ursano, RJ, Norwood, A. Planning for the psychological effects of bioterrorism. In: Ursano RJ, Norwood AE, Fullerton CS, eds. Bioterrorism: Psychological and Public Health Interventions. Cambridge, UK: Cambridge University Press; 2004:2-14.Google Scholar
46. Freh, FM, Chung, MC, Dallos, R. In the shadow of terror: posttraumatic stress and psychiatric co-morbidity following bombing in Iraq: the role of shattered world assumptions and altered self-capacities. J Psychiatr Res. 2013;47:215-225.Google Scholar
47. Perrin, A, Duggan, M. Americans’ internet access: 2000-2015. Pew Research Center website. http://www.pewinternet.org/2015/06/26/americans-internet-access-2000-2015/. Published 2015. Accessed June 22, 2017.Google Scholar
48. Sax, LJ, Gilmartin, SK, Bryant, AN. Assessing response rates and nonresponse bias in web and paper surveys. Res High Educ. 2003;44:409-432.Google Scholar
49. Brosschot, JF, Verkuil, B, Thayer, JF. Generalized unsafety theory of stress: unsafe environments and conditions, and the default stress response. Int J Environ Res Public Health. 2018;15:1-27. doi: 10.3390/ijerph5030464Google Scholar