Academic journal article Hong Kong Journal of Psychiatry

Post-Traumatic Stress Reaction Symptoms among Turkish Students: Assessments One and Six Months after a Terrorist Attack in Istanbul

Academic journal article Hong Kong Journal of Psychiatry

Post-Traumatic Stress Reaction Symptoms among Turkish Students: Assessments One and Six Months after a Terrorist Attack in Istanbul

Article excerpt


Objective: This study investigated high school students' symptoms of post-traumatic stress disorder one and six months after a terrorist attack in Istanbul, Turkey on November 2003, and the relationship between the severity of the post-traumatic stress disorder symptoms and the level of depression and anxiety.

Patients and Methods: 113 students filled in questionnaires and were assessed by use of Child Post-traumatic Stress Reaction Index, Children's Depression Inventory, and State-Trait Anxiety Inventory for Children.

Results: We found high rates of post-traumatic stress reactions at the end of the first month (51.3%). The assessment of the students at the end of six months revealed that the symptoms of posttraumatic stress disorder tended to persist, although the total scores of Child Post-traumatic Stress Reaction Index were decreased. Post-traumatic stress disorder scores were significantly correlated with the scores of depression and anxiety at both assessments (p < 0.05).

Conclusion: These results indicate that post-traumatic stress disorder symptoms can be seen after a stressful event that was perceived as life-threatening by at least some of the children, even though the children did not experience major losses, injury, or ongoing disruption in the community.

Key words: Adolescent, Child, Stress disorder, Post-traumatic, Terrorism, Turkey


Terrorism is defined by the US Department of Defense (1) as "the calculated use of violence or threat of violence to inculcate fear intended to coerce or to intimidate governments and societies in the pursuit of goals that are generally political, religious, or ideological". The goal of terrorism is not only to cause visible disaster, but also to inflict psychological fear and intimidation at any time, during periods of peace or conflict. The few studies available on the subject of terrorism and children emerged in the aftermath of several terrorist events. An early descriptive study of the children kidnapped from their school bus in Chowchilla indicated that circumstances of extreme life threat could strongly affect child victims. (2,3) State terrorism in Guatemala between 1981 and 1983, (4,5) Scud missile attacks and terrorist activities in Israel, (6-8) bombing of the Alfred P. Murray Building in Oklahoma City (9,10) and the September 11, 2001, terrorist attacks (11-13) are some of the events evaluated in studies in the literature.

Children vary in their reactions to traumatic events. (14) Some may suffer from worries and bad memories that dissipate with time and emotional support. Other children may be more severely traumatised and experience long-term problems. Children's emotional reactions may develop immediately after the trauma or may occur later. Acute stress disorder is the most common psychiatric disorder following traumatic events.

Post-traumatic stress disorder (PTSD) is a reaction that may occur after a period of time. (1, 2,10) PTSD rarely occurs in isolation. Children with PTSD may be more likely to have comorbid conditions because traumatic insults occur in developmental stages that are particularly sensitive to disruptions. Psychological disorders that commonly occur in conjunction with PTSD in children include depression, feeling of guilt and hopelessness, acute stress disorder, and generalised anxiety disorder. (2,10) Furthermore, depression and anxiety were reported to be prevalent among traumatised children, similar to the case in traumatised adults as depicted by other researchers. (2,10,14)

On November 20, 2003, a bomb exploded in Istanbul, Turkey; 14 people died and a greater number were injured in the attack. The students of a high school, not far from the site of attack, were in their classrooms during the explosion. No one was injured in the school. Telephone contact was established between school and parents, and parents learned that their children were safe. …

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