Anxiety Disorders: Pfefferbaum B

Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, Pynoos JD, Zatzick DF, Benedek DM, McIntyre JS, Charles SC, Altshuler K, Cook I, Cross CD, Mellman L, Moench LA, Norquist G, Twemlow SW, Woods S, Yager J, Anonymous00293, Anonymous00294. · No affiliation provided · Am J Psychiatry. · Pubmed #15617511 No free full text.

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North CS, Pfefferbaum B. · No affiliation provided · Epidemiol Psichiatr Soc. · Pubmed #15248388 No free full text.

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North CS, Pfefferbaum B. · No affiliation provided · JAMA. · Pubmed #12150676 No free full text.

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Pfefferbaum B. · No affiliation provided · Arch Pediatr Adolesc Med. · Pubmed #11876661 No free full text.

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Gurwitch RH, Kees M, Becker SM, Schreiber M, Pfefferbaum B, Diamond D. · Department of Pediatrics, University of Oklahoma Health Sciences Center for Terrorism and Disaster Branch, Oklahoma City, Oklahoma 73117, USA. · Prehosp Disaster Med. · Pubmed #15453156 No free full text.

Abstract: When a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.

Pfefferbaum B, Pfefferbaum RL, Gurwitch RH, Nagumalli S, Brandt EN, Robertson MJ, Aceska A, Saste VS. · Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA. · Curr Psychiatry Rep. · Pubmed #12685988 No free full text.

Abstract: The advent of major terrorist assaults has ushered in a sense of insecurity and vulnerability heretofore unknown in the US. There is information about the impact of disasters and trauma on children, but relatively little data on the effects of terrorism. The events of September 11, 2001 have underscored the need to examine this issue. This report summarizes recent studies that address the impact of terrorist incidents on children, and examines issues related to mental health services for children in the post-attack environment. Work related to the 1993 bombing of the World Trade Center, the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, the 1998 bombing of the American Embassy in Nairobi, Kenya, and the September 11 attacks are reviewed. This article indicates significant challenges in the identification, evaluation, and treatment of children potentially in need of attention.

Pfefferbaum B, Nawaz S, Kearns LJ. · Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center-Oklahoma City, USA. · J Okla State Med Assoc. · Pubmed #10423936 No free full text.

Abstract: Posttraumatic Stress Disorder (PTSD) has been described in children exposed to a variety of traumatic experiences. It is relatively common and is often accompanied by comorbid conditions. A number of factors influence the development of symptoms including those related to the traumatic event, the individual child, the family, and the sociocultural environment. Primary care physicians should routinely assess trauma exposure and response in the children they treat.

Pfefferbaum B, Jeon-Slaughter H, Pfefferbaum RL, Houston JB, Rainwater SM, Regens JL. · Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. · J Okla State Med Assoc. · Pubmed #19177993 No free full text.

Abstract: To address the potential for media coverage of traumatic events to generate fear reactions in children, we examined exposure and reactions to media coverage of the 1995 Oklahoma City bombing in children attending a middle school 100 miles from the disaster site two and three years after the event. Many of the children studied recalled feeling "afraid," "sad," or "mad" in relation to initial media coverage. Overall exposure and reactions to bomb-related media coverage declined over the three years. However, these reactions persisted for some children and, when they did, the reactions were related to exposure to coverage right after the bombing. Approximately one-fourth of the children recalled that the bombing made them feel "a lot" less safe in their home, school, and/or neighborhood. These perceptions persisted for approximately 10% of the children. Our Findings suggest the importance of primary care and public health interventions to determine and monitor children's reactions.

North CS, Hong BA, Pfefferbaum B. · Department of Psychiatry, Division of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, USA. · Mo Med. · Pubmed #18300608 No free full text.

Abstract: This article describes the development and implementation of an empirically-based disaster mental health training program (P-FLASH) developed by Washington University Department of Psychiatry researchers in response to a request from the September 11 Fund. While this training program and its derivatives not only provided training for thousands of health professionals assisting survivors of the 9/11 attacks in the NewYork City area, it also provided more general disaster mental health training to prepare professionals nationally.

Pfefferbaum B, North CS, Pfefferbaum RL, Christiansen EH, Schorr JK, Vincent RD, Boudreaux AS. · Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA. · J Nerv Ment Dis. · Pubmed #18277219 No free full text.

Abstract: Telephone survey methodology was used to examine smoking and drinking after the September 11 terrorist attacks in a representative national sample. Most ever smokers and ever drinkers reported no change in substance use after the attacks. Smokers and drinkers who increased substance use were significantly more likely than those who did not to endorse a number of emotional reactions and functional difficulties. The pattern of associations of decreased use with emotional reactions and functional difficulties differed between smokers and drinkers. In general, decreased smoking was associated with denial of emotional reactions and functional difficulties whereas decreased drinking was associated with endorsement of these reactions and difficulties. The results have implications for research, clinical practice, and public health.

Tucker PM, Pfefferbaum B, North CS, Kent A, Burgin CE, Parker DE, Hossain A, Jeon-Slaughter H, Trautman RP. · Department of Psychiatry, OUHSC, WP 3440, P.O. Box 26901, Oklahoma City, OK 73190, USA. · Am J Psychiatry. · Pubmed #17267785 links to  free full text

Abstract: OBJECTIVE: Six and a half to 7 years after the 1995 terrorist bombing in Oklahoma City, the authors assessed autonomic reactivity to trauma reminders and psychiatric symptoms in adults who had some degree of direct exposure to the blast. METHOD: Sixty survivors who were listed in a state health department registry of persons exposed to the bombing and 60 age- and gender-matched members of the Oklahoma City metropolitan area community were assessed for symptoms of PTSD and depression and for axis I diagnoses. Heart rate and systolic, diastolic, and mean arterial blood pressures were measured before, during, and after bombing-related interviews. The two groups were compared on both psychometric and physiologic assessments. RESULTS: Posttraumatic stress but not depressive symptoms were significantly more prevalent in the survivor group than in the comparison group, although symptoms were below levels considered clinically relevant. Despite apparent emotional resilience or recovery, blast survivors had significantly greater autonomic reactivity to trauma reminders on all measures than comparison subjects. CONCLUSIONS: The results suggest that physiologic assessment may capture long-term effects of terrorism that are not identified by psychometric instruments. The consequences of autonomic reactivity despite emotional resilience years after experiencing trauma are unknown but theoretically could range from facilitating a protective vigilance toward future disasters to more maladaptive avoidance behaviors, somatic symptoms, or medical problems.

Pfefferbaum B, North CS, Doughty DE, Pfefferbaum RL, Dumont CE, Pynoos RS, Gurwitch RH, Ndetei D. · Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA. · Death Stud. · Pubmed #16773776 No free full text.

Abstract: Despite the increasingly dangerous world where trauma and loss are common, relatively few studies have explored traumatic grief in children. The 1998 American Embassy bombing in Nairobi, Kenya, provided an unfortunate opportunity to examine this topic. This report describes findings in 156 children who knew someone killed in the incident, assessed 8 to 14 months after the explosion. Bomb-related posttraumatic stress was associated with physical exposure, acute response, posttraumatic stress related to other negative life events, type of bomb-related loss, and subsequent loss. Grief was associated with bomb-related posttraumatic stress, posttraumatic stress related to other negative life events, and type of bomb-related loss. The study supports the developing literature on traumatic grief and the need for studies exploring the potentially unique aspects of this construct.

Pfefferbaum B, Stuber J, Galea S, Fairbrother G. · University of Oklahoma Health Sciences Center, Oklahoma City, 73104, USA. · J Trauma Stress. · Pubmed #16612814 No free full text.

Abstract: A number of factors, including subjective reactions and appraisal of danger, influence one's reaction to a traumatic event. This study used telephone survey methodology to examine adolescent and parent reactions to the 2001 World Trade Center attacks 6 to 9 months after they occurred. The prevalence of probable posttraumatic stress disorder (PTSD) in adolescents was 12.6%; 26.2% met study criteria for probable subthreshold PTSD. A probable peri-event panic attack in adolescents was strongly associated with subsequent probable PTSD and probable subthreshold PTSD. This study suggests that the early identification of peri-event panic attacks following mass traumatic events may provide an important gateway to intervention in the subsequent development of PTSD. Future studies should use longitudinal designs to examine the course and pathogenic pathways for the development of panic, PTSD, and other anxiety disorders after exposure to disasters.

Pfefferbaum B, Tucker P, North CS, Jeon-Slaughter H, Kent AT, Schorr JK, Wilson TG, Bunch K. · Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. · J Nerv Ment Dis. · Pubmed #16477192 No free full text.

Abstract: Twenty-four female partners of firefighters participating in recovery efforts associated with the 1995 terrorist bombing in Oklahoma City were assessed 43 to 44 months later. Disaster experiences, psychiatric diagnoses, posttraumatic stress symptoms, and autonomic reactivity in response to an interview about the bombing were examined. Most of the participants with postbombing disorders suffered from pre-existing conditions. The majority found the bombing a "terrible" or "shocking" experience. One participant met all DSM-III-R symptom group criteria for bombing-related posttraumatic stress disorder, and 40% met both B (intrusive re-experiencing) and D (hyperarousal) criteria. More than one half of the sample exhibited autonomic reactivity on at least one measurement. Those who met symptom group criterion D evidenced greater autonomic reactivity than those who did not, suggesting a link between self-reported posttraumatic stress disorder symptoms of arousal and biological manifestations. Thus, it may be important to assess partners of disaster recovery workers for mental health and physiological consequences related to their indirect exposure as these may persist years after the event, even in the absence of a diagnosable mental disorder.

North CS, Pollio DE, Pfefferbaum B, Megivern D, Vythilingam M, Westerhaus ET, Martin GJ, Hong BA. · School of Medicine, Department of Psychiatry, Washington University, St. Louis, Missouri 63110, USA. · J Nerv Ment Dis. · Pubmed #16082296 No free full text.

Abstract: Systematic studies of mental health effects of bioterrorism on exposed populations have not been carried out. Exploratory focus groups were conducted with an exposed population to provide qualitative data and inform empirical research. Five focus groups of 28 political worker volunteers were conducted 3 months after the October 15, 2001, anthrax attack on Capitol Hill. More than 2000 transcribed focus group passages were categorized using qualitative software. The category with the most items was authorities' response (23% passages), and much of this discussion pertained to communication by authorities. The category with the fewest items was symptoms (4%). Identified issues were less within individuals and more between them and authorities. Risk communication by authorities regarding safety and medical issues was a prominent concern among Capitol Hill office staff workers regarding the anthrax incident on Capitol Hill. This suggests focus on risk communication in developing interventions, but more systematic investigation is needed.

North CS, Pfefferbaum B, Narayanan P, Thielman S, McCoy G, Dumont C, Kawasaki A, Ryosho N, Kim YS, Spitznagel EL. · Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8134, St Louis, Missouri 63110, USA. · Br J Psychiatry. · Pubmed #15928359 links to  free full text

Abstract: BACKGROUND: African disaster-affected populations are poorly represented in disaster mental health literature. AIMS: To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa. METHOD: Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182). RESULTS: Prevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol. CONCLUSIONS: Post-disaster psychopathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.

Tucker P, Pfefferbaum B, Doughty DE, Jones DE, Jordan FB, Nixon SJ. · Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190-3048, USA. · Am J Orthopsychiatry. · Pubmed #15792032 No free full text.

Abstract: Posttraumatic stress and depressive symptoms were assessed in 51 body handlers after Oklahoma City's 1995 terrorist bombing. Although many handlers were inexperienced and knew someone killed, symptoms were low postdisaster and decreased significantly after 1 year. Higher symptomatology and seeking mental health treatment correlated with increases in alcohol use and new physical problems but not with demographics, exposure, or experience. Four respondents with the highest posttraumatic stress symptoms at both time points reported high physical and alcohol use problems and mental health treatment use, suggesting that these should be carefully assessed in body handlers postdisaster. Coping techniques are described, as well as possible reasons for unexpected resilience in the majority.

North CS, Pfefferbaum B, Tivis L, Kawasaki A, Reddy C, Spitznagel EL. · Washington University School of Medicine, Department of Psychiatry, St. Louis, MO 63110, USA. · Ann Clin Psychiatry. · Pubmed #15702569 No free full text.

Abstract: BACKGROUND: The course of posttraumatic stress disorder (PTSD) in populations directly exposed to terrorist attacks is of major importance in the post-9/11 era. Because no systematic diagnostic studies of the most highly exposed individuals of the 9/11 terrorist attacks have yet been done, the Oklahoma City bombing remains a unique opportunity to examine PTSD over time in high-exposure terrorist victims. METHODS: This study assessed 137 survivors in the direct path of the explosion at approximately 6 and 17 months postdisaster, using the Diagnostic Interview Schedule. RESULTS: Combined index and follow-up data yielded a higher (41%) incidence of PTSD than detected at index (32%) or follow-up (31%). All PTSD was chronic (89% unremitted at 17 months) with no delayed-onset cases. The avoidance and numbing symptom group C, unlike groups B and D alone, was pivotal to current PTSD status and was associated with indicators of functioning at index and follow-up. The findings at index were sustainable. CONCLUSIONS: This follow-up study confirmed the immediacy of onset of PTSD and its persistence over time, pointing to the need for early interventions that continue over the long term. Group C avoidance and numbing symptoms may aid in early recognition of PTSD and in predicting long-term functioning.

Pfefferbaum RL, Fairbrother G, Brandt EN, Robertson MJ, Gurwitch RH, Stuber J, Pfefferbaum B. · Terrorism and Disaster Preparedness Center, Phoenix College, 1202 West Thomas Road, Phoenix, AZ 85013, USA. · Fam Community Health. · Pubmed #15596972 No free full text.

Abstract: Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional, but felt ill-equipped to intervene with students and expressed substantial need for assistance.

Pfefferbaum B, Pfefferbaum RL, Gurwitch RH, Doughty DE, Pynoos RS, Foy DW, Brandt EN, Reddy C. · Department of Psychiatry and Behavioral.Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA. · Am J Orthopsychiatry. · Pubmed #15291703 No free full text.

Abstract: This study assessed teachers' reactions to the Oklahoma City bombing. Peritraumatic reactions, the interaction of media exposure with stress from media coverage, feelings toward the perpetrators, and worry about safety predicted posttraumatic stress. Twenty percent reported difficulty handling demands; 5% sought counseling. Outreach efforts should assess and assist teachers.

Fairbrother G, Stuber J, Galea S, Pfefferbaum B, Fleischman AR. · Division of Health and Science Policy, New York Academy of Medicine, New York, New York 10029-5283, USA. · Pediatrics. · Pubmed #15121955 links to  free full text

Abstract: OBJECTIVE: The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services. METHODS: A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N = 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center. RESULTS: Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services. CONCLUSIONS: There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicated.

Pfefferbaum RL, Brandt EN, Patel HP, Gurwitch RH, Schreiber MD, Pfefferbaum B. · Phoenix College, Phoenix, Arizona, USA. · J Okla State Med Assoc. · Pubmed #14699655 No free full text.

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Fairbrother G, Stuber J, Galea S, Fleischman AR, Pfefferbaum B. · Division of Health and Science Policy, The New York Academy of Medicine, New York, NY 10029, USA. · Ambul Pediatr. · Pubmed #14616045 No free full text.

Abstract: OBJECTIVE: To assess the prevalence of posttraumatic stress reactions (PTSR) in New York City (NYC) children following the September 11, 2001, attacks and determine the key predictors of PTSR. METHODS: Cross-sectional random digit-dial survey in NYC of parents of children 4-17 years old 4 months after the attacks. PTSR in children was measured using the 20-item Posttraumatic Stress Disorder Reaction Index-Child Revision, with parents as respondents. RESULTS: Overall, 18% of NYC children had "severe" or "very severe" PTSR, and 66% had "moderate" PTSR. In a multivariate model, parental posttraumatic stress disorder (PTSD; odds ratio [OR] = 4.50; P <.01), the parent crying in front of the child (OR = 3.19; P <.001), seeing 3 or more graphic images of the disaster on television (OR = 3.18; P <.01), and living in Manhattan were associated with severe or very severe PTSR in children. CONCLUSIONS: A substantial proportion of NYC children had severe or very severe PTSR after September 11, and most children exhibited at least moderate PTSR. These findings suggest an enhanced role for primary care physicians, particularly pediatricians, for screening, treatment, and referral (coupled with appropriate training and reimbursement), especially in light of continued terrorist threats. These findings also have implications for advice that pediatricians can give to parents about limiting disaster-related television exposure and children's need for emotional support.

Pfefferbaum B, Seale TW, Brandt EN, Pfefferbaum RL, Doughty DE, Rainwater SM. · Department of Psychiatry and Behavioral Sciences, College of Medicine, Center for Terrorism Studies, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190-3048, USA. · Ann Clin Psychiatry. · Pubmed #12839427 No free full text.

Abstract: This study assessed indirect interpersonal exposure to the 1995 Oklahoma City bombing, broadcast and print media exposure in the aftermath of the explosion, emotional reactions to media coverage, and posttraumatic stress reactions in children distant from the explosion. A survey was administered to 88 sixth-grade students in the public middle school in a community 100 miles from Oklahoma City 2 years after the bombing. Many children reported indirect interpersonal exposure and most reported bomb-related media exposure. Print media exposure was more strongly associated with enduring posttraumatic stress than broadcast exposure. Indirect interpersonal exposure and the interaction of media exposure with emotional reaction to media coverage in the aftermath of the explosion each predicted ongoing posttraumatic stress. The results suggest that children may have lingering reactions to highly publicized terrorist incidents. Concern about the influence of television viewing has long been proclaimed. This study implicates print media exposure as well. Media exposure to terrorist incidents, therefore, should be monitored and those working with children should assess exposure and stress even in children not directly impacted.

Pfefferbaum B, North CS, Doughty DE, Gurwitch RH, Fullerton CS, Kyula J. · Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3048, USA. · Am J Orthopsychiatry. · Pubmed #12769235 No free full text.

Abstract: This study examined a convenience sample of 562 Nairobi school children exposed to the 1998 bombing of the American Embassy in Nairobi, Kenya. Posttraumatic stress reactions to the bombing were related to posttraumatic stress reactions to other trauma and to peritraumatic reaction. Self-reported functional impairment was minimal.