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

Article excerpt

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.

Keywords: Post traumatic stress disorder, trauma, PTSD, acute stress disorder, risk factors, September 11, terrorism

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.

Palabras clave: trastorno de estrés posttraumático, trauma, TEPT, trastorno agudo de estrés, factores de riesgo, 11 de septiembre, terrorismo

Until the terrorist attacks of September 11, 2001 (S11), on American soil, there was scarce information on the psychological reactions of the general population, not necessarily affected in a direct manner by the events, subjected to massive attacks. For instance, in former similar events, such as the brutal bombing of a governmental building in Oklahoma City (USA) on April 19, 1995, in which 168 people died, the largest amount of the collected data was focused on the direct victims or on the people directly exposed to trauma (North, Nixon, Shariat et al. …