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U.S. Must Be Better Prepared for Emotional Toll of Terrorism

Conference focuses on psychological impact

FRIDAY, July 2, 2004 (HealthDayNews) -- As the United States braces for possible future terrorist attacks, health professionals must take steps to better deal with the emotional toll exacted by such violent acts.

That was the message from mental health experts attending the "First Annual Conference on Living With Terror: Psycho-Social Effects," which concluded this week in Washington, D.C.

"Acts of terror are meant to cause severe psychological and psychosocial distress," said Dr. Marcus Nemuth, director of the Psychiatry Emergency Service of the VA Puget Sound Health Care System in Seattle, and one of the conference presenters.

"That's their primary purpose. The destruction, physical injuries and deaths that result from terrorist acts have enormous mental health consequences that spread well beyond the individuals directly affected by a specific act. And living under a constant threat of terrorism can be almost as devastating. The effects of both are particularly harmful for vulnerable populations," Nemuth added.

The conference, the first of its kind in the United States, included terrorism experts from the University of Haifa in Israel, who shared their knowledge of recognizing, treating and preventing mental health problems tied to terrorism. Other presenters included representatives from the University of Pennsylvania and 15 U.S. health-care professional organizations.

Nemuth said evidence of the emotional consequences of terrorism and the threat of terrorism in the United States continue to mount.

Within a week of the 9/11 attacks on New York City and Washington, D.C., 44 percent of American adults and 35 percent of children had experienced one or more significant symptoms of stress related to the attacks, a study found. They included intrusive thoughts, substantial emotional upset when reminded of the events, nightmares and other sleep disturbances, poor concentration or angry outbursts, Nemuth said.

Another study surveyed 8,300 New York City public school students in early 2002, several months after the attacks. Twenty-seven percent of the children met the clinical diagnoses for posttraumatic stress disorder, agoraphobia, panic disorder, conduct disorder, depression or generalized anxiety disorder -- in some cases at rates three times higher than generally found in school children, he said.

These are precisely the results that terrorists hoped to achieve, Nemuth said.

The psychological fallout from 9/11 was often related to a person's exposure to the events, he added. The highest levels of distress were seen among those who witnessed the attacks or talked on the phone with someone who later died. Other studies have shown that women generally had worse "short-term outcomes," as did Americans with weak social networks and those with preexisting physical or mental illnesses, he said.

Henry Smith, associate vice president of the University of Haifa, said his institution was well-acquainted with the physical, mental and social consequences of terrorist acts and threats. Bitter experience has led to better training of health and mental health professionals to serve affected children and adults.

"Israelis have had a long history of exposure to terrorist acts and threats of terrorist acts," he said. "This conference allows us to bring our knowledge and experience to this country and share what we know about preparing for, preventing and treating the resulting psychological and psychosocial disorders with American professionals."

Nemuth said approaches shown to be effective include anxiety management, supportive therapy, cognitive behavioral therapy, and drug therapy for acute stress management and depression.

But, he noted, the United States currently has shortcomings in its health-care system's ability to respond to the emotional havoc caused by terrorism. They include gaps in professional training and preparedness, and a lack of coordination between agencies and services.

"We know much more about the health impacts of terrorism and how to address them than we did before September 11," Nemuth said. "But the Israelis have decades of experience to draw upon in shaping medical school and other professional training. That's why this conference has the potential to improve our national preparedness."

Margaret Heldring, a clinical psychologist and executive director of America's Health Together, was another speaker at the conference. She said recent focus groups done by her group across the United States found terrorism is a major concern for Americans of all ages and walks of life.

"It's not just residents of New York City who have been affected by the events of September 11 and the constant reminders of and emphasis on our vulnerability to terrorists," she said. "Even in Nebraska and Wyoming, people are worried about what lies ahead. The daily threats, warnings and reminders that terror can strike anyone, at any time, and the realization that no one is truly safe from its reach, are taking their toll on our physical and emotional health."

Heldring said the nation's primary-care physicians -- including pediatricians, family physicians and internists -- need to become better prepared because they are the front line of American mental health care. "They are the first resource Americans turn to for help with depression, anxiety, grief and stress. All of those are at record-high levels as a consequence of our heightened awareness of terrorism's scope and reach into our lives."

More information

For more about mental health and primary health care in a time of terrorism, visit Facing Fear Together, a site coordinated by America's Health Together.

SOURCES: Marcus Nemuth, M.D., psychiatrist and director, Psychiatry Emergency Service, VA Puget Sound Health Care System, Seattle; Henry Smith, Ed.D., associate vice president, University of Haifa, Israel; Margaret Heldring, Ph.D., clinical psychologist and executive director, June 28-29, 2004, America's Health Together conference, Washington, D.C.
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