Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Abstract

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

PTSD and Partial PTSD among First Responders One and Five Years after the Paris Terror Attacks in November 2015

“…Indeed, attack-related psychological disorders such as PTSD change over time, and improving knowledge on mental health evolution is needed [11]. In addition, intentional events such as terrorism lead to a greater persistence of PTSD symptoms over time compared to unintentional events [12]. The bulk of studies have shown an increase in PTSD symptoms among FR, such as among FR to the 2001 World Trade Centre (WTC) terrorist attacks, with PTSD prevalence of 12.1% in wave 1 (2-3 years after the attacks) and 19.5% in wave 2 (5-6 years after the attacks).…”

Integrating general practitioners into crisis management would accelerate the transition from victim to effective professional: Qualitative analyses of a terrorist attack and catastrophic flooding

“…In 2021, floods in Western Europe killed more than 200 people and destroyed many buildings and infrastructure in Germany, Belgium, Luxembourg, and the Netherlands [ 2 ]. General practitioners (GPs) are also confronted with these crises on a personal and professional level, both in the context of early acute stress and longer-term problems such as posttraumatic stress disorder (PTSD) [ 3 , 4 ].…”

The impact of a terrorist attack: Survivors’ health, functioning and need for support following the 2019 Utrecht tram shooting 6 and 18 months post-attack

“…When we look more specifically at the consequences of terrorist attacks, we know from previous reviews that their impact on the affected can be extensive. Among directly exposed (direct witnesses and those injured in the event), a large minority develops significant levels of posttraumatic stress symptoms ( García-Vera et al, 2016 ; Stene et al, 2016 ; Rigutto et al, 2021 ), including PTSD. Other psychological consequences, such as (major) depression or anxiety disorders are also common among directly involved victims ( Whalley and Brewin, 2007 ; Salguero et al, 2011 ; Dyb et al, 2014 ; Stene et al, 2016 ; Lowell et al, 2018 ; Rigutto et al, 2021 ).…”

“…Among directly exposed (direct witnesses and those injured in the event), a large minority develops significant levels of posttraumatic stress symptoms ( García-Vera et al, 2016 ; Stene et al, 2016 ; Rigutto et al, 2021 ), including PTSD. Other psychological consequences, such as (major) depression or anxiety disorders are also common among directly involved victims ( Whalley and Brewin, 2007 ; Salguero et al, 2011 ; Dyb et al, 2014 ; Stene et al, 2016 ; Lowell et al, 2018 ; Rigutto et al, 2021 ). In addition, victims often suffer from physical complaints (e.g., Van den Berg et al, 2005 ; Yzermans et al, 2009 ; Stene et al, 2016 ; Glad et al, 2021 ).…”

“…In addition, victims often suffer from physical complaints (e.g., Van den Berg et al, 2005 ; Yzermans et al, 2009 ; Stene et al, 2016 ; Glad et al, 2021 ). Among the indirectly exposed, the prevalence of problems is generally lower ( Salguero et al, 2011 ; García-Vera et al, 2016 ; Rigutto et al, 2021 ). An indirect group still affected to a considerable degree consists of relatives and friends of the deceased ( García-Vera et al, 2016 ).…”