Abstract
Studies have demonstrated a positive relationship between exposure and posttraumatic stress, but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of posttraumatic stress than more objective measures of exposure. We examined the role of peritraumatic response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Oklahoma City, Oklahoma, bombing. While many children reported hearing and feeling the blast and knowing direct victims, most were in school at the time of the explosion and therefore were not in direct physical proximity to the incident. Physical, interpersonal, and television exposure accounted for 12% of the total variance in our measure of posttraumatic stress when peritraumatic response was ignored. Peritraumatic response and television exposure accounted for 25% of the total variance, and physical and interpersonal exposure were not significant in this context. These findings suggest the importance of peritraumatic response in children's reactions to terrorism. These carly responses can be used to help determine which children may experience difficulty over time.
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Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E. Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:1369–1380.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised. Washington, DC: APA; 1987.
Hubbard J, Realmuto GM, Northwood AK, Masten AS. Comorbidity of psychiatric diagnoses with posttraumatic stress disorder in survivors of childhood trauma. J Am Acad Child Adolesc Psychiatry. 1995;34:1167–1173.
Kinzie JD, Sack W, Angell R, Clarke G, Ben R. A three-year follow-up of Cambodian young people traumatized as children. J Am Acad Child Adolesc Psychiatry. 1989;28:501–504.
Kinzie JD, Sack WH, Angell RH, Manson S, Rath B. The psychiatric effects of massive trauma on Cambodian children: I. The children. J Am Acad Child Adolesc Psychiatry. 1986;25:370–376.
Sack WH, Clarke G, Him C, et al. A 6-year follow-up study of Cambodian refugee adolescents traumatized as children. J Am Acad Child Adolesc Psychiatry. 1993;32:431–437.
Sack WH, Him C, Dickason D. Twelve-year follow-up study of Khmer youths who suffered massive, war trauma as children. J Am Acad Child Adolesc Psychiatry. 1999; 38:1173–1179.
Yule W, Bolton D, Udwin O, Boyle S, O'Ryan D, Nurrish J. The long-term psychological effects of a disaster experienced in adolescence: 1: The incidence and course of PTSD. J Child Psychol Psychiatry. 2000;41:503–511.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC American Psychiatric Association; 1994:424–432.
Breton JJ, Valla JP, Lambert J. Industrial disaster and mental health of children and their parents. J Am Acad Child Adolesc Psychiatry. 1993;32:438–445.
Goenjian AK, Pynoos RS, Steinberg AM, et al. Psychiatric comorbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry. 1995;34:1174–1184.
March JS, Amaya-Jackson, L, Terry R, Costanzo P., Posttraumatic, symptomatology in children and adolescents after an industrial fire. J Am Acad Child Adolesc Psychiatry. 1997;36:1080–1088.
Pynoos RS, Frederick C, Nader K, et al. Life threat and posttraumatic stress in schoolage children. Arch Gen Psychiatry. 1987;44:1057–1063.
McCloskey LA, Walker M. Posttraumatic stress in children exposed to family violence and single-event trauma. J Am Acad Child Adolesc Psychiatry. 2000;39:108–115.
Milgram NA, Toubiana YH, Klingman A, Raviv A, Goldstein I. Situational exposure and personal loss in children's acute and chronic stress reactions to a school bus disaster. J Trauma Stress. 1988;1:339–352.
Pfefferbaum B, Nixon SJ, Krug RS, et al. Clinical needs assessment of middle and high school students following the Oklahoma City bombing. Am J Psychiatry. 1999;156:1069–1074.
Nader KO, Pynoos RS, Fairbanks LA, Al-Ajeel M, Al-Asfour A. A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis. Br J Clin Psychol. 1993;32:407–416.
Pfefferbaum B, Nixon SJ, Tivis RD, et al. Television exposure in children after a terrorist incident. Psychiatry. 2001;64:202–211.
Pfefferbaum B, Seale TW, McDonald NB, et al. Posttraumatic stress two years after the Oklahoma City bombing in youths geographically distant from the explosion, Psychiatry. 2000;63:358–370.
Terr LC, Bloch DA, Michel BA, Shi H, Reinhardt JA, Metayer S. Children's symptoms in the wake of Challenger: a field study of distant-traumatic effects and an outline of related conditions. Am J Psychiatry. 1999;156:1536–1544.
Macksoud MS, Aber JL. The war experiences and psychosocial development of children in Lebanon. Child Dev. 1996;67:70–88.
Saigh PA. The development of posttraumatic stress disorder following four different types of traumatization. Behav Res Ther. 1991;29:213–216.
Silva RR, Alpert M, Munoz DM, Singh S, Matzner F, Dummit S. Stress and vulnerability to posttraumatic stress disorder in children and adolescents. Am J Psychiatry. 2000; 157:1229–1235.
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.
Aaron J, Zaglul H, Emery RE. Posttraumatic stress in children following acute physical injury. J Pediatr Psychol. 1999;24:335–343.
Asarnow J, Glynn S, Pynoos RS, et al. When the earth stops shaking: earthquake sequelae among children diagnosed for pre-earthquake psychopathology. J Am Acad Child Adolesc Psychiatry. 1999;38:1016–1023.
Garrison CZ, Bryant ES, Addy CL, Spurrier PG, Freedy JR, Kilpatrick DG. Posttraumatic stress disorder in adolescents after Hurricane Andrew. J Am Acad Child Adolesc Psychiatry. 1995;34:1193–1201.
Green BL, Korol M, Grace MC, et al. Children and disaster: age, gender, and parental effects on PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 1991;30:945–951.
Schwarz ED, Kowalski JM. Malignant memories: PTSD in children and adults after a school shooting. J Am Acad Child Adolesc Psychiatry. 1991;30:936–944.
Vernberg EM, La Greca AM, Silverman WK, Prinstein MJ. Prediction of posttraumatic stress symptoms in children after Hurricane Andrew. J Abnorm Psychol. 1996;105:237–248.
Freedy JR, Kilpatrick DG, Resnick HS. Natural disaster and mental health: theory, assessment, and intervention. J Soc Behav Pers. 1993;8(special issue):49–103.
Wang A, Pynoos RS, James Q, Wang M. Los Angeles earthquake, 1994: school district reduction of trauma effects. Paper presented at: Annual Meeting of the American Academy of Child and Adolescent Psychiatry; 1994; New York, NY.
Weiss DS, Marmar CR. The, impact of Event Scale-Revised. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD. New York: Guilford Press; 1997:399–411.
Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979;41:209–218.
Zilberg NJ, Weiss DS, Horowitz MJ. Impact of Event Scale. A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psychol. 1982;50:407–414.
Dyregrov A, Kuterovac G, Barath A. Factor analysis of the impact of event scale with children in war. Scand J Psychol. 1996;37:339–350.
Malmquist CP. Children who witness parental murder: posttraumatic aspects. J Am Acad Child Psychiatry. 1986;25:320–325.
Stallard P, Velleman R, Baldwin S. Psychological screening of children for post-traumatic stress disorder. J Child Psychol Psychiatry. 1999;40:1075–1082.
Yule W, Williams RM. Fost-traumatic stress reactions in children. J Trauma Stress. 1990;3:279–295.
Cohen J. Statistical Power Analysis for the Behavioral Sciences Hillsdale, NJ: Lawrence Erlbaum Associates Inc; 1988.
La Greca AM, Silverman WK, Wasserstein SB. Children's predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew. J Consult Clin Psychol. 1998;66:883–892.
Lonigan CJ, Shannon MP, Taylor CM, Finch AJ Jr., Sallee FR. Children exposed to disaster:II. Risk factors for the development of post-traumatic symptomatology. J Am Acad Child Adolesc Psychiatry. 1994;33:94–105.
Tyano S, Iancu I, Solomon Z, et al. Seven-year follow-up of child survivors of a bustrain collision. J Am Acad Child Adolesc Psychiatry. 1996;35:365–373.
Daviss WB, Mooney D, Racusin R, Ford JD, Fleischer A, McHugo GJ. Predicting posttraumatic stress after hospitalization for pediatric injury. J Am Acad Child Adolesc Psychiatry. 2000;39:576–583.
Earls F, Smith E, Reich W, Jung KG. Investigating psychopathological consequences of a disaster in children: a pilot study incorporating a structured diagnostic interview. J Am Acad Child Adolesc Psychiatry. 1988;27:90–95.
Garrison CZ, Weinrich MW, Hardin SB, Weinrich S, Wang L. Post-traumatic stress disorder in adolescents after a hurricane. Am J Epidemiol. 1993;138:522–530.
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Pfefferbaum, B., Doughty, D.E., Reddy, C. et al. Exposure and peritraumatic response as predictors of posttraumatic stress in children following the 1995 Oklahoma City bombing. J Urban Health 79, 354–363 (2002). https://doi.org/10.1093/jurban/79.3.354
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DOI: https://doi.org/10.1093/jurban/79.3.354