Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: A study in primary care

Abstract

Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs. negative) for GAD symptoms were roughly twice as likely to report having a loved one at the 9/11 disaster site, twice as likely to know someone who was killed by the attacks, and twice as likely to know someone who was involved with the rescue/recovery efforts after the disaster. Implications for treatment and future research are discussed.

Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations.

“…Few studies have focused on GAD after the 9/11 attacks. In their study of adult patients seeking care in a large primary care setting in northern Manhattan, Ghafoori et al (2009) found the prevalence of GAD in the entire sample to be 10.5% seven to sixteen months after 9/11. Also, in a survey of Pentagon personnel, 26.9% of the respondents screened positive for GAD (Jordan et al, 2004) approximately one to four months post-9/11.…”

Worry, worry attacks, and PTSD among Cambodian refugees: A path analysis investigation

“…Both generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD) occur at high rates following trauma (on this issue, see Ghafoori et al, 2009; Grant, Beck, Marques, Palyo, & Clapp, 2008). Severe trauma often results in a self-perceived state of extreme vulnerability—a sense of constant threat—in which these two disorders are highly comorbid (Neria, Besser, Kiper, & Westphal, 2010).…”

Acute posttraumatic stress symptoms but not generalized anxiety symptoms are associated with severity of exposure to war trauma: A study of civilians under fire

“…The hazards of such exposure have included elevated cardiovascular disease (Steptoe & Kivimäki, 2012), immune reactions (Tsigos & Chrousos, 2002), and shortened lifespan (Neria & Koenen, 2003). Moreover, the heterogeneity of pathological response in the aftermath of stress is remarkable: not only do individuals respond with posttraumatic stress symptoms (PTSS) (Besser, Weinberg, Zeigler-Hill, & Neria, 2014; Pfefferbaum et al, 1999) and fully diagnosable posttraumatic stress disorder (PTSD) (Foa & Riggs, 1995; Johnson & Thompson, 2008), but they are also at elevated risk for other disorders, including generalized anxiety disorder (GAD) (Feerick & Snow, 2005; Ghafoori et al, 2009; Roemer, Molina, Litz, & Borkovec, 1996). …”

“…The two are, however, thought of as distinct diagnostic entities (APA, 2013), anchored in different psychosocial (Chen & Hong, 2010; Foa, Zinbarg, & Rothbaum, 1992; Grillon et al, 2009) and biological (Greenberg, Carlson, Cha, Hajcak, & Mujica-Parodi, 2013; Hettema, Prescott, Myers, Neale, & Kendler, 2005; Koenigs et al, 2008) factors. Both disorders have been documented in the aftermath of exposure to PTS (Ghafoori et al, 2009), however the question whether they similarly share dose-response relations with PTS remains unclear and has not been directly addressed. Symptoms of psychopathology may diverge some time after initial exposure to a PTS (Neria, Olfson, et al, 2010; Scheeringa, Zeanah, Myers, & Putnam, 2005) or appear immediately following the events (Besser & Neria, 2010; Besser et al, 2014; Besser, Zeigler-Hill, Weinberg, Pincus, & Neria, 2015).…”