Presentation on theme: "Psychological Aspects of Bioterrorism Robert J. Ursano, M. D"— Presentation transcript:
1 Psychological Aspects of Bioterrorism Robert J. Ursano, M. D Psychological Aspects of Bioterrorism Robert J. Ursano, M.D. Professor/Chair Department of Psychiatry Uniformed Services University Director Center for the Study of Traumatic Stress
2 Thanks to our Sponsors: University at Albany School of Public HealthCenters for Disease Control and PreventionAssociation of Schools of Public Health
4 Evaluations Please submit your evaluations on-line: or send hardcopy version provided by your site coordinator to theUniversity at Albany School of Public HealthCenter for Public Health Preparedness.Thank you!
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6 Good morning and welcome to the Center for Public Health Preparedness Grand Rounds Series at the University at Albany’s School of Public Health. I’m Peter Slocum and I will be your moderator today.Before we begin, I’d like to remind you that we’ll be taking your calls later in the hour. The toll free number is You may also send your written questions via fax toOur topic today is Pschological Aspects of Bioterrorism, with Dr. Robert Ursano.This program will address the fact that communities and individuals react to the stress of terror, as they do to natural events. We will discuss what public and private health professionals need to consider when dealing with the public’s emotional and psychological health in times of stress and emergency.And now I’d like to welcome our guest, Dr. Ursano, Professor and Chair of the Department of Psychiatry and Director of the Center for the Study of Traumatic Stress, Uniformed Services University School of Medicine. Thank you for joining us today, Dr. Ursano.
7 Uniformed Services University Center for the Study of Traumatic StressUniformed Services UniversityDIRECTORS Robert J. Ursano, M.D Carol S. Fullerton, Ph.D Brian W. Flynn, Ed.D Nancy Vineburgh, M.A SCIENTISTS Harry C. Holloway, M.D. James E. McCarroll, Ph.D. Thomas Grieger, M.D John Newby, Ph.D. Charles Engel, M.D Robert Gifford, Ph.D. Molly Hall, M.D John Stuart, Ph.D. Elizabeth Osuch, M.D Mark Willis, M.S.Welcome, Dr. Ursano, and thank you for joining us today. If you would, please start off by telling us a little bit about the Center for the Study of Traumatic Stress, your colleagues, and what you do.
8 Psychological Goals of Terrorism Erode sense of national securityDisrupt the continuity of societyDestroy social capitalMoraleCohesionShared ValuesThe primary goal of terrorists, it seems, is to induce fear, but what does that really mean to a community, a country, a society?
9 Terrorism Opens the fault lines, the potential cracks in our society Racial/ethnicEconomicReligious
10 The Nation’s Security Military Power Economic Power Information SystemsHealthYou’ve written about health and economic power as critical to our nation’s security as military power - can you elaborate a bit on that for us?
11 Characteristics of Traumatic Events IndividualsExposedIntentionalassaultrobberyrapeUnintentionalaccidentMVAinjuryIs it true that communities, just like individuals, react to stress in somewhat predictable ways?[what is MVA?]
13 Disasters Human Made Natural Terrorism Do people generally seem less fearful about natural threats as opposed to man-made ones?
14 Types of TerrorismSingle Attack (Oklahoma City bombing or Columbine High School shooting)Multisite Attack (WTC-Pentagon attacks)Multisite Continuous/Repeated (Anthrax attack)Continuous/Repeated(DC Metro Sniper attacks)
15 Terrorism and the Public’s Health Public and PrivateOutpatient/ HospitalMedical Care SystemEmergency Response SystemPublic Health SystemHow does the community, as opposed to an individual, respond to terrorism?EMSPolice/FireWater/Electric/ Communication Emerg. ResponseProtectionPreventionPromotion
16 Mental Health in Disaster and Terrorism Change in SafetyChange in TravelDistress ResponsesHumanBehavior inHigh StressEnvironmentsMentalHealth/IllnessWhat behavioral and mental health relationships come into play in response to disasters, or terrorism, and who is affected?Before you move on, can you explain what is meant by ‘over dedication’?And when you refer to ‘Change in Safety and Travel’ what exactly do you mean?PTSDDepressionSmokingAlcoholOver dedication
17 Haddon Matrix Agent: Vector: Population: Malaria Mosquito Person Pre DuringPostAre a community’s vulnerabilities before an event like an individual’s?
21 World Trade Center Explosion February 26, 1993 (March 1993 Survey) 76% thought something serious had happened32% had not begun to evacuate by one hour30% decided not to evacuate36% participated in a previous emergency evacuationHow did people react to the 1993 World Trade Center explosion?Do you think people would react differently since 9/11?Aguirre, Wenger, and Vigo, 1998
22 World Trade Center Explosion February 26, 1993 (March 1993 Survey) Crowds inhibit individual solutions in favor of shared norm, esp. if members knownLarge groups take longerSocial relationships effect responseSmoke, injury speed evacuationHigher in building, slower the responseHow do social relationships effect response?You refer to ‘injury’ as something which speeds evacuation – how so?Aguirre, Wenger, and Vigo, 1998
23 Acute Event Scene Responses Most search and rescue is done by bystanders (50%)Majority of casualties are not transported by ambulance (cars, taxi, walk, police)Least serious casualties arrive first at the closest hospital80-95% of casualties are not admitted to the hospital and most need treatment for non-traumatic injuryI understand that there are a few misconceptions as to what usually happens at the scene, in terms of dealing with victims and the need for acute care – can you share with us some facts?Aud der Heide, 2002 / Quarenteli 1983
24 Loss of Access to Routine Medical Care and Home Care Hurricane Andrew: 1000 Physician Offices, 4 Mental Health Facilities, 11 pharmacies, 7 Convalescent Homes, 2 Dialysis Units, 38 Assisted-living FacilitiesHome health care: Nursing, Oxygen, suction, IV antibiotics, medication, ventilation, chemotherapyTherefore, chronic medical conditions worsen and care is sought at already overburdened hospitalsWhat happens if medical infrastructure is damaged or destroyed during an event?How might one utilize other agencies when medical facilities are down?Aud der Heide, 2002 / Sabatino JAHA 1992
25 Post-Traumatic Stress Disorder (PTSD) PTSD not uncommon after many types of traumatic eventsExamples: Motor vehicle accidents and industrial explosionsNearly all have the acute form at some pointCan develop in people without psychiatric historyRapid recovery is the normDoes everyone involved in such an event exhibit stress effects?
26 Other Trauma-Related Disorders Traumatic griefUnexplained somatic symptomsDepressionSleep disturbancesIncreased use of alcohol and cigarettesIncreased family violence and conflictCan you share other types of problems we might expect to see as a result of a disaster or terrorist event?
27 Oklahoma City Terrorist Attack (at 6 months) 34% PTSD25% Depression40% Never experienced psychiatric problems in the pastLet’s talk about the attack in Oklahoma City… Do the figures on the next slide represent actual victims, families, first responders, people who live in the town?North et. al., JAMA 1999
28 Stress Reactions After 9/11 Terrorist Attacks Nationally representative sample N= days after attack44% Report one or more substantialstress symptoms90% Report at least low levels of stressCan one be affected by television coverage?Schuster et. al., 2001
29 Stress Reactions After 9/11 Terrorist Attacks (2) Nationally representative sample N= days after attackSubstantial Stress ReactionFemale (50% relative risk)Less than 100 mi. (61% > 1000 mi.)TV viewing 9/11 greater than 12 hrs.(58% > 0 to 3 hrs.)Can you explain the statistics revealed on this slide?Schuster et. al., 2001
30 Those With No Previous Psychiatric Illness Are At Risk Oklahoma City near Murah Building(DIS study)USAF POWs returning from VietnamTwin studies of Vietnam Combat VeteransNorth et al Jama 1999 / Ursano et al AJP 1981 / Goldberg et al Arch Gen Psych 1984
31 Somatic Symptoms Frequently increased following disasters Can be an expression of anxiety or depression and leads to the seeking of health careMUPS or MIPS(Multiple Unexplained or Idiopathic Physical Symptoms)Ursano, Fullerton et al 1995/ McCarroll, Ursano, Fullerton et al Psychosomatics 2000
32 Estimated Mental Health Needs in NY State after Sept 11 Expos Group (pop) %PTSD #Case %Seek TreatmentWTC area (162,715) % , % ,615Manhattan (919,000) % , % ,586All 5 NYC Burs. (6.92 mil) 5% , % ,577Nearby counties(4.8mil) 1% , % ,752________________________________TOTAL % 527, % 129,530What do we know about the 9/11/01 World Trade Center Event with regard to PTSD?Herman et al JUH 2002
33 National Study of Reactions to Terrorist Attack 1-2 months post 9/11 (N=2273) Probable PTSDNew York City %Washington DC %Other Metro Areas %Rest of USA %Again, do the figures reflected on this slide represent actual victims, families, first responders, people who live in the town?Schlinger et. al., JAMA 2002
34 PTSD & Increased Alcohol Use in Pentagon Attack Survivors 7 Months (N=77) Exposure70.1% Saw, heard, felt, or smelled the aircraft, explosion, or fire32.5% Feared death13% Experience difficulty with evacuation10% Saw someone dieYou mentioned earlier that increased substance abuse is one result of exposure to a disaster or terrorist event – can you expand on this?Grieger, Fullerton, & Ursano 2003
35 Longitudinal National Study of Reactions to Terrorist Attack 2 weeks (N=2,729), 2 months (N=933) 6 months (N=787)Outside of NYC mos mos.Fears of Future Terrorism % %Fear of Harm to Family % %What happens over time to people affected in these ways?Silver et. al., JAMA 2002
36 Longitudinal National Study of Reactions to Terrorist Attack 2 weeks (N=2,729), 2 months (N=933) 6 months (N=787)Outside of NYC mos mos.9/11 Posttraumatic Stress % %Silver et. al., JAMA 2002
37 Perceived safety Confidence in government Stigmatization Terrorism EffectsTerrorism potentially has profound psychological effects. How is a community affected vs. an individual?
38 DepressionMay be a primary factor in traumatized patients who are reclusive or difficult to treatRequires evaluation and treatmentIf individuals trauma of any sort, does it effect others around them?Anything we should know about prognosis?
39 Traumatic Grief / Bereavement Not uncommon following traumatic eventsOften overlooked in some groups(e.g., parents of adult children who die unexpectedly)May adversely affect social interactionCan you give us an example of how traumatic grief can adversely affect social interaction?
40 Family Conflict Common following a traumatic event Triggered by fear of new threats(e.g., loss of safety, economic impacts, potential loss of job)How does post traumatic stress affect the family? Do different families react differently?
41 Intervention After Disasters Assure Basic NeedsPsychological First AidNeeds AssessmentMonitor the Recovery EnvironmentOutreach/Information DisseminationFostering Resiliency/RecoveryConsultation/Technical AssistanceTriageTreatmentHow can we help with recovery after a disaster? Do you have any messages for our local health audience as to specific role or roles they can play in emergency response?
42 Workplace Needs Distress management Shelter in place Support for continuity of operations centers/leaders (“Site R”)Grief leadershipEvacuation leadershipCentralized locator offsiteTravel policiesCan you expand on each of the ‘Workplace Needs’? For instance, what is ‘Distress Management’?
43 Media Can serve to supply disturbing information & propagate distress Can be a tool for:EducationRecoveryProviding empathy with victimsDo you have any suggestions for us as to how we can properly use the media?
44 Leaders Working with the Media Decrease exposureLess disturbing pictures and storiesInformation may carry different meaningsPerhaps you could comment on the challenges that Public Health leaders should consider when dealing with the media?
45 Preventive Mental Health Drink lots of OJEat your bread crustsBe kind to your neighborsThink cool thoughtsJangle gently as you goAvoid vexatious and disputatious folkFinally, what can we do BEFORE a disaster to improve the public’s mental well-being and perhaps prevent some of the damage a terrorist event might evoke?[I suggest that one of you quote “If you are able to keep your wits about you while others are in panic…” rather than putting on slide]
46 Uniformed Services University Center for the Study of Traumatic StressUniformed Services UniversityResources: Center for the Study of Traumatic Stress web-site:
47 Resources continued:Terrorism and Disaster Ursano, RJ, Fullerton CS, Norwood, AE Cambridge University Press, 2003Preparing for the PsychologicalConsequences of Terrorism:A Public Health Strategy The National Academies Press, 2003
48 Evaluations Please submit your evaluations on-line: or send hardcopy version provided by your site coordinator to theUniversity at Albany School of Public HealthCenter for Public Health Preparedness.Thank you!CLOSE: (at 9:57 precisely)Dr. Ursano, thank you very much for joining us and sharing your expertise on Pscyhological Effects of Terrorism. We really appreciate your presentation.(Show slide)Before we close, I’d like to remind all of you to please take a moment to fill out your evaluations either on line, or send a printed copy back to us at the Center for Public Health Preparedness. Your feedback is invaluable to the development of our future programs.This program will be available on videotape or web-streaming within the next few weeks. Please check our website for more details. We hope you’ll tune in on April 15th for our joint program with T2B2 on Emergency and Risk Communication with special guest from the CDC, Barbara Reynolds.I’m Peter Slocum. Thank you for joining us for the University at Albany’s Center for Public Health Preparedness Grand Rounds Series.
49 Center for Public Health Preparedness University at Albany School of Public Health