PTSD and depression after the Madrid March 11 train bombings

Abstract

The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.

Predictors of Depressive Symptoms Among Israeli Jews and Arabs During the Al Aqsa Intifada: A Population-Based Cohort Study

“…Greater severity of exposure to war and other traumatic events has been shown to be associated with increasing depressive symptoms (7,28,(40)(41)(42)(43) and with the persistence of depressive symptoms (44). The prevalence of depression tends to be greater among direct victims than among those less affected by traumatic events (3,45).…”

“…Individuals of lower socioeconomic status and lower social support have been found to be at higher risk of depression after traumatic events in several studies (25)(26)(27)(28)(29)(30), perhaps reflecting greater vulnerability of these groups to the consequences of such events. Other studies have also found higher levels of psychological symptoms among ethnic minorities after human-made and natural disasters (4,31,32), which may reflect decreased access to resources and differential reactions to traumatic events in these groups (7,33). Israeli Arabs may be in a particularly difficult situation, identifying with Arab family members or friends living in the occupied territories while experiencing many of the same terror threats as their Jewish counterparts in Israel as well as potential discrimination because of their Arab ethnicity (34), which may contribute to their greater risk of depressive symptoms.…”

“…However, evidence suggests that depressive symptoms also may be increased under conditions of terrorism, as the uncontrollable nature of terrorism may lead to fear and perceptions of loss of control and corresponding feelings of helplessness and hopelessness (2,3). Studies after single instances of terrorism, including the September 11 th attacks in New York City, the March 11 th train bombings in Madrid, and the Oklahoma City Bombing, have demonstrated a high prevalence of depression, especially among direct victims of the attacks (4)(5)(6)(7). In one study of the impact of ongoing terrorism in Israel over half of all respondents reported feeling depressed (8).…”

Methodological challenges in assessing general population reactions in the immediate aftermath of a terrorist attack

“…Nonetheless, numerous studies have demonstrated that the psychological ramifi cations of terrorist attacks can extend far into the community (e.g. Galea et al, 2003;Miguel-Tobal et al, 2006;Schlenger et al, 2002;Schulden et al, 2006). That this is so should come as no surprise.…”

Risikowahrnehmung und psychologische Reaktionen in öffentlichen Krisensituationen am Beispiel von Terrorattentaten

“…Eine Replikation der Studie von Galea kam zu dem Ergebnis, dass ein bis drei Monate nach den Madrid-Attentaten die Zahl der durch ein klinisches Interview erhobenen Depressions-und PTSD-Diagnosen geringer war als in der Population Manhattans. 2,3% der Befragten zeigten Symptome, die eine PTSDDiagnose rechtfertigen, bei 8,0% fanden sich Hinweise auf eine Depression [26]. Auch hier waren die Prävalenzen höher, wenn die Befragten in der Nähe des Orts der Terrorattentate lebten.…”