Psychiatric disorders among survivors of the Oklahoma City bombing

Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombi ng is particularly significant for the study of mental health sequelae of t rauma because its extreme magnitude and scope have been predicted to render profound psychiatric effects on survivors. Objective To measure the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder (PTSD), diag nostic comorbidity, functional impairment, and predictors of postdisaster p sychopathology. Design, Setting, and Participants Of 255 eligible adult survivors selected from a confidential registry, 182 (71%) were assessed systematically by int erviews approximately 6 months after the disaster. between August and Decem ber 1995. Main Outcome Measurer Diagnosis of 8 psychiatric disorders, demographic dat a, level of functioning treatment, exposure to the event. involvement of fa mily and friends, and physical injuries, as ascertained by the Diagnostic I nterview Schedule/Disaster Supplement, Results Forty-five percent of the subjects had a postdisaster psychiatric d isorder and 34.3% had PTSD. Predictors included disaster exposure, female s ex (for any postdisaster diagnosis, 55% vs 34% for men; chi(1)(2) = 8.27; P = .004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for th ose without predisaster disorder; chi(1)(2) = 6.86; P = .009). Onset of PTS D was swift, with 76% reporting same-day onset. The relatively uncommon avo idance and numbing symptoms virtually dictated the diagnosis of PTSD (94% m eeting avoidance and numbing criteria had full PTSD diagnosis) and were fur ther associated with psychiatric comorbidity, functional impairment, and tr eatment received. Intrusive reexperience and hyperarousal symptoms were nea rly universal, but by themselves were generally unassociated with other psy chopathology or impairment in functioning. Conclusions Our data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could ha ve identified most psychiatric cases early in the acute postdisaster period . Psychiatric comorbidity further identified those with functional disabili ty and treatment need. The nearly universal yet distressing intrusive reexp erience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons may be addressed by nonmedical interventions of reassurance and su pport.