No Evidence of Suicide Increase Following Terrorist Attacks in the United States: An Interrupted Time‐Series Analysis of September 11 and Oklahoma City

There is substantial evidence of detrimental psychological sequelae following disasters, including terrorist attacks. The effect of these events on extreme responses such as suicide, however, is unclear. We tested competing hypotheses about such effects by employing autoregressive integrated moving average techniques to model the impact of September 11 and the Oklahoma City bombing on monthly suicide counts at the local, state, and national level. Unlike prior studies that provided conflicting evidence, rigorous time series techniques revealed no support for an increase or decrease in suicides following these events. We conclude that while terrorist attacks produce subsequent psychological morbidity and may affect self and collective efficacy well beyond their immediate impact, these effects are not strong enough to influence levels of suicide mortality.     

Coping Self‐Efficacy and Psychological Distress Following the Oklahoma City Bombing1

Findings from a study of 27 victims of the Oklahoma City bombing are reported. This research focused on the importance of subjective appraisals of coping self‐efficacy in predicting psychological distress following this tragedy. Results supported the hypothesis that judgments of coping self‐eficacy taken 2 months after the bombing added significantly to the explanation of general and trauma‐related distress after controlling for income, social support, threat of death, and loss of resources. Coping self‐eficacy judgments taken I year later were also important in explaining psychological distress after controlling for loss of resources and social‐support perceptions. Although coping self‐efficacy perceptions taken at 2 months were related to distress levels 1 year later, they did not remain significant in a regression analysis controlling for loss of resources and income. Implications of these findings for post‐terrorist bombing interventions are discussed.     

Psychological Impact of Terrorism on Children and Families in the United States

Summary

This article reviews the literature on the psychological impact of terrorism on children and families in the United States. It includes studies of the 1993 World Trade Center bombing in New York City and the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, as well as the September 11 attacks. These studies explore the impact of various forms and degrees of exposure to terrorism on children across the development spectrum and on the relationships between parental and child reactions. The article concludes with a framework for future research on children's adaptation following mass trauma.     

Disaster mental health services following the 1995 Oklahoma City bombing: modifying approaches to address terrorism

How did the 1995 Oklahoma City bombing differ from prior disasters and what implications did it have for disaster mental health services and service delivery? The federal disaster mental health approach in this country developed largely out of experiences with natural disasters. The 1995 Oklahoma City bombing differed in several important ways, including the large number of human casualties, higher rates of psychopathology, and an extended period of concern due to the criminal investigation and trials, which suggested the need to consider modifications in the program. Outreach was extensive, but psychiatric morbidity of direct victims was greater than that of victims of natural disasters, emphasizing the need for attention to the triage and referral process. Other concerns that warrant consideration include practices related to record keeping and program evaluation.     

Spectral Decompositions of Multiple Time Series: A Bayesian Non-parametric Approach

We consider spectral decompositions of multiple time series that arise in studies where the interest lies in assessing the influence of two or more factors. We write the spectral density of each time series as a sum of the spectral densities associated to the different levels of the factors. We then use Whittle’s approximation to the likelihood function and follow a Bayesian non-parametric approach to obtain posterior inference on the spectral densities based on Bernstein–Dirichlet prior distributions. The prior is strategically important as it carries identifiability conditions for the models and allows us to quantify our degree of confidence in such conditions. A Markov chain Monte Carlo (MCMC) algorithm for posterior inference within this class of frequency-domain models is presented. We illustrate the approach by analyzing simulated and real data via spectral one-way and two-way models. In particular, we present an analysis of functional magnetic resonance imaging (fMRI) brain responses measured in individuals who participated in a designed experiment to study pain perception in humans.     

Structure and organization of research efforts following the bombing of the murrah building

Abstract

In the days and weeks following the Oklahoma City bombing on April 19,1995, Oklahoma state authorities, university faculty and staff, and leading experts from across the nation formed a coalition to address issues of clinical service delivery, educational intervention, and research. This article focuses on the centralized approach applied to the administration of research endeavors. This centralization was designed to minimize revictimization of both survivors and affected families, enhance the quality of data collected, and facilitate cooperation between participating investigators. The resultant set of projects includes a variety of research methodologies and study populations and will serve to significantly enhance understanding of the mental health sequelae of such disasters.     

Provider Perspectives on Disaster Mental Health Services in Oklahoma City

Abstract

Seven years after the bombing of the Murrah Federal Building in Oklahoma City, 34 individuals affiliated with various organizations were interviewed about their experiences in providing disaster mental health services to victims and the community. Their perspectives elucidated the importance of preparedness, training and education, local control, interagency cooperation, and psychosocial support for providers. Significant conflicts emerged among providers about credentials, referrals, the quality of services provided, and the appropriateness, in this context, of basing services solely on a crisis counseling model. The lack of ongoing needs assessment or evaluation data further fueled the debates. On the basis of the findings, the authors outline several recommendations for planning mental health responses to future terrorist attacks.     

Vicarious stress: patterns of disturbance and use of mental health services by those indirectly affected by the Oklahoma City bombing.

This study explored the intermediate psychological effects of terrorism on adults not directly affected by the Oklahoma City bombing by examining the course of PTSD and subthreshold PTSD symptoms over time and whether treatment affected this course. The respondents were interviewed at 3-mo. intervals for 18 mo. following an initial 6-mo. survey. Analysis suggested avoidance, re-experiencing, and increased arousal symptoms in this population were limited over time, declining with or without treatment between 6 and 9 mo. Conversely, victimization symptoms remained high without mental health intervention for the first year after the disaster. The study also examined the nature and occurrence of comorbidity in groups seeking and not seeking treatment.     

The Effects of Values on Worries Associated With Acute Disaster: A Naturally Occurring Quasi‐Experiment1

On April 12, 1995, a bomb exploded in Oklahoma City, Oklahoma, destroying a federal office building, killing 168 people, and upending American notions of safety and security in the heartland. Using data collected before, immediately after, and 1 year after the bombing from 3 samples living within 25 miles of the explosion in a naturally occurring quasi‐experiment, research examined effects of values on people's worries in the context of a macrolevel traumatic event. High self‐transcendence and conservation values correlated with higher macro‐worries immediately after vs. before the explosion, but these worries were lower 1 year later. Findings indicate that values emphasizing broader social perspectives were associated with higher macrolevel worries, while values emphasizing one's own life and welfare were not.     

Mass traumatic terror in Oklahoma City and the phases of adaptational coping,part I: Possible effects of intentional injury/harm on victims' post-traumatic responses

The bombing in Oklahoma City shook the entire nation from “sea to shining sea.” This tremendous collective sensation was made even worse when available evidence revealed that this act of terrorism had not been committed by some terrorist from the Middle East but one from Middle America. The blast stunned the nation's sense of collective safety, while it raised serious questions about our ability as a nation to manage violence, and the profound feelings of discontent and narcissistic injuries among distressed Americans. Was it this failure to address chronic discontents that led to this tragedy of mass violence? These larger sociocultural and political issues are being debated in public and private forums throughout the nation, an activity that is likely to continue for some time to come. As these issues are debated in the public arena, victims' levels of psychological distress are expected to rise, as they attempt to process the traumatic shock in their minds and bodies. Specifically, this article has two parts and focuses on acute and post-acute psychophysiological traumatic stress responses in victims, as well as issues pertaining to assessment, prevention, and treatment. Part I addresses the nature of disasters, with a special emphasis on the victim's subjective evaluation (meaning) of the reality of a catastrophe caused by intentional human strategy. The article, additionally, discusses issues of epidemiology of stress reactions, post-traumatic stress disorder, co-morbidity, risk factors, and assessment and diagnostic considerations. Part II, to be published in the next of issue of the Journal, will focus on issues of prevention as well as post-disaster intervention. Prevention of chronic post-traumatic stress disorder after the Oklahoma City bombing is a critical objective by debriefers and mental health professionals. A proposed four-phase model called “self-efficacy adaptational coping” will be presented in Phase II as well. The present article is probably the first major discussion on the traumatic effects of the blast on individuals, families, and the communities of Oklahoma City, and the first to offer some broad guidelines to intervention. Since it predates future empirical studies, the author relies on his almost 20 years of experience in the field of traumatic stress, and on a review and integration of pertinent disaster outcome studies in the national and international literature.     

On Time and Deepening in Psychoanalysis

The metaphor of depth has most often been used in analytic thinking to denote extension in space or time. Depth, and its companion term deepening, may also be used to describe quality rather than distance; something is deep when it is serious or important. The deepening of analysis is linked to temporality but not in a linear way. Analysis deepens as it sets in motion a series of changes in the experience of time: The past comes alive and is worked through. Past and present come into a new relation with one another. The analytic frame and the rhythm of the exchange between patient and analyst also bring to life past experiences and fantasies to do with time. Both patient and analyst must enter a fluid time-state in order for deepening to occur. Clinical examples illustrate these dimensions of temporal experience and the way they emerge in the deepening analytic process.     

Comparison of Nomothetic Versus Idiographic-Oriented Methods for Making Predictions About Distal Outcomes From Time Series Data

We illustrate the idiographic/nomothetic debate by comparing 3 approaches to using daily self-report data on affect for predicting relationship quality and breakup. The 3 approaches included (a) the first day in the series of daily data; (b) the mean and variability of the daily series; and (c) parameters from dynamic factor analysis, a statistical model that uses all measurement occasions to estimate the structure and dynamics of the data. Our results indicated that data from the first measurement occasion does not provide information about the couples' relationship quality or breakup 1 to 2 years later. The mean and variability of the time series, however, were more informative: females' average positive and negative affect across time was related to relationship quality, whereas males' variability in negative affect across time was predictive of breakup. The dynamic factor analysis, in turn, allowed us to extract information central to the dyadic dynamics. This information proved useful to predict relationship quality but not breakup. The importance of examining intraindividual variability and couple dynamics is highlighted.     

Ethical and methodological issues in academic mental health research in populations affected by disasters: the Oklahoma City experience relevant to September 11, 2001

Empirical data from research studies are vital to guiding mental health interventions following disasters. However, few data are available for this purpose. Important advances in policy and procedures for the conduct of organized research emerged from the Oklahoma City bombing, yielding cooperative working relationships among researchers and culminating in the ethical attainment of informative research data. However, the academic community was again caught off guard after the September 11, 2001, terrorist attacks. Suggestions to surmount these obstacles include incorporating research infrastructures into disaster preparedness plans in advance; organizing the community of researchers; and working closely with major funding organizations. Methodological issues pertaining to measurement of psychopathology include the importance of obtaining diagnostic data; interpreting the meaning of symptoms in the absence of a psychiatric disorder; differentiating preexisting symptoms from those that emerged after the disaster, and optimal timing of postdisaster assessment.     

A graphical representation of the mediated effect

Mediation analysis is widely used in the social sciences. Despite the popularity of mediation models, few researchers have used graphical methods, other than structural path diagrams, to represent their models. Plots of the mediated effect can help a researcher better understand the results of the analysis and convey these results to others. This article presents a method for creating and interpreting plots of the mediated effect for a variety of mediation models, including models with (1) a dichotomous independent variable, (2) a continuous independent variable, and (3) an interaction between an independent variable and the mediating variable. An empirical example is then presented to illustrate these plots. Sample code for creating plots of the mediated effect in R and SAS is also included, and may be downloaded from www.psychonomic.org/archive.     

Development and Preliminary Feasibility Testing of a Decision Support Tool for Childhood Anxiety Treatment

In this practical application, we describe the steps to build a decision-support tool using GeNIe 2.1 software. The method incorporates principles of decision analyses and allows for a systematic strategy to balance treatment efficacy data with patient preferences. We illustrate the utility for helping clinicians and patients choose between two or more efficacious treatment options (CBT, medication, or their combination). Preliminary pilot data from families (n = 5) seeking services at a specialty clinic for childhood anxiety disorders support the usability of the tool and high patient satisfaction. We use case examples and sample graphical output to illustrate how the decision-support system can be used to integrate data on (a) baseline symptom severity, (b) the relative effectiveness of two or more treatment options, and (c) patient preferences and values, to arrive at a personalized treatment recommendation. The decision-support tool enabled child and parent preferences to be explicitly stated and facilitated discussions about how best to incorporate their preferences into an evidence-based treatment strategy.     

A Latent Growth Curve Modeling Approach to Pooled Interrupted Time Series Analyses

This paper presents a latent variable approach for the estimation of treatment effects within a pooled interrupted time series (ITS) design. Although considered quasi-experimental, the ITS design has been noted as representing one of the strongest alternatives to the randomized experiment, making it highly appropriate for use in documenting the presence of effects that might warrant further evaluation in a large-scale randomized study. Results suggest that the latent variable growth modeling (LGM) is capable of detecting simultaneous differences in both level and slope, and provides tests of significance for these two necessary indicators of an ITS intervention effect. As shown in the analyses, the LGM framework provides a comprehensive and flexible approach to research design and data analysis, making available to a wide audience of researchers an analytical framework for a variety of analyses of growth and developmental processes.     

Time Series Analysis in Historiometry: A Comment on Simonton

Time series analysis (TSA) is one of a number of new methods of data analysis appropriate for longitudinal data. Simonton (1998) applied TSA to an analysis of the causal relationship between two types of stress and both the physical and mental health of George III. This innovative application demonstrates both the strengths and weaknesses of time series analysis. Time series is applicable to a unique class of problems, can use information about temporal ordering to make statements about causation, and focuses on patterns of change over time, all strengths of the Simonton study. Time series analysis also suffers from a number of weaknesses, including problems with generalization from a single study, difficulty in obtaining appropriate measures, and problems with accurately identifying the correct model to represent the data. While careful attempts are made to minimize these problems, each is present in the Simonton study, although sometimes in a subtle manner. Changes in how the data could be gathered are suggested that might help to solve some of these problems in future studies. Finally, the advantages and disadvantages of employing alternative methods for analyzing multivariate time series data, including dynamic factor analysis, are discussed.     

Detecting nonlinearity in psychological data: Techniques and applications

Modern graphical and computational techniques for detecting nonlinearity in psychological data sets are presented. These procedures allow researchers to determine the information complexity of temporal data, using physiological and psychological measurements, and to provide evidence for chaos in time series contaminated by measurement noise. Problems with noise reduction and appropriate experimental control, using surrogate time series, are discussed, and applications of the technology are illustrated, using response time, handwriting, and typing data sets. In an experimental application of appropriate nonlinear analysis procedures, the results of a time series prediction experiment confirm that some subjects are sensitive to chaos. In contrast to previous attempts demonstrating sensitivity to chaos, the experiment reported here employs surrogate series to control for linear stochastic aspects of the stimulus sequences, such as autocorrelation. Recommendations for the selection of appropriate software for performing nonlinear analyses are presented, including a comprehensive list of World-Wide Web sites offering such software.