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      Proximity to terror and post-traumatic stress: a follow-up survey of governmental employees after the 2011 Oslo bombing attack

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      BMJ Open

      BMJ Publishing Group

      Epidemiology, Psychiatry, Mental Health

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          To assess the prevalence of post-traumatic stress disorder (PTSD) symptoms among governmental employees after the 2011 Oslo bombing attack targeted towards the Norwegian Ministries, and to explore the importance of proximity to the bomb explosion as a predictor of PTSD.


          A cross-sectional study.


          Data were collected from a survey 10 months after the Oslo bombing on 22 July 2011.


          A total of 3520 employees were invited to the study. Net samples comprised 1927 employees in 14 of the 17 Norwegian Ministries.

          Outcome measures

          The employees reported where they were at the time of the explosion. PTSD was assessed with the Norwegian version of the PTSD checklist (PCL).


          A total of 207 of the 1881 (11%) ministerial employees who completed the survey were present at work when the bomb exploded. Of these, a quarter (24%, 95% CI 18.4 to 30.0) had symptom levels equivalent to PTSD, while the prevalence was approximately 4% among those not present at work. In the latter group the prevalence was similar irrespective of whether their location was in Oslo, other places in Norway or abroad. Leadership responsibility was associated with lower risk for PTSD.


          The risk of PTSD is mainly associated with being present at work at the time of a terror attack. For those not present at work, the risk of PTSD is low and independent of proximity to the terror scene. The findings may have implications for planning and priority of healthcare services after a work place terror attack.

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          Most cited references 24

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          Psychological sequelae of the September 11 terrorist attacks in New York City.

          The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.
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            Traumatic events and posttraumatic stress disorder in an urban population of young adults.

            To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
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              60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001.

              Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                18 July 2013
                : 3
                : 7
                Norwegian Centre for Violence and Traumatic Stress Studies , Oslo, Norway
                Author notes
                [Correspondence to ] Dr Marianne B Hansen; marianne.hansen@
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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                mental health, epidemiology, psychiatry


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