1、http:/Hispanic Journal of Behavioral Sciences DOI: 10.1177/0739986303251695 2003; 25; 56 Hispanic Journal of Behavioral SciencesHilda M. Pantin, Seth J. Schwartz, Guillermo Prado, Daniel J. Feaster and Jos Szapocznik Severity and Relationship to Previous Traumatic ExposurePosttraumatic Stress Disord
2、er Symptoms in Hispanic Immigrants After the September 11th Attacks:http:/ online version of this article can be found at:Published by:http:/can be found at:Hispanic Journal of Behavioral Sciences Additional services and information for http:/ Email Alerts:http:/ Subscriptions:http:/ http:/ http:/ C
3、itationsat Curtin University Library on January 12, 2009 http:/Downloaded from 10.1177/0739986303251695ARTICLEHispanic Journal of Behavioral SciencePantin et al. / September 11th PTSD SymptomsPosttraumatic Stress Disorder Symptomsin Hispanic Immigrants Afterthe September 11th Attacks: Severityand Re
4、lationship to PreviousTraumatic ExposureHilda M. PantinSeth J. SchwartzGuillermo PradoDaniel J. FeasterJos SzapocznikUniversity of MiamiThis study examined posttraumatic stress disorder (PTSD) symptom severity in Hispanicimmigrants exposed to September 11th attacks through television, ascertained th
5、e rela-tionship between previous traumatic exposure and September 11threlated symptoms,and investigated the effect of television exposure of the attacks on symptoms. A total of110 Hispanic immigrant adults (22 males, 88 females) living more than 1,000 miles fromthe attacks completed measures of natu
6、ral disaster exposure, war violence exposure, andSeptember 11threlated PTSD symptoms. Of the sample, 14% self-reported September11threlated PTSD symptoms consistent with a Diagnostic and Statistical Manual ofMental Disorders (DSM-IV) diagnosis. Previous exposure to natural disasters and warviolence
7、was significantly related to September 11threlated PTSD symptomatology.Individuals with symptoms consistent with a DSM-IV PTSD diagnosis reported twice asmuch war violence exposure and one-and-a-half times as much natural disaster expo-sure as those not meeting criteria. Results are discussed regard
8、ing potential publichealth implications.Keywords: PTSD; September 11th; terrorism; Hispanic immigrants; previous traumaticexposureThe September 11th, 2001, terrorist attacks on the World Trade Centerand the Pentagon comprised one of the most hostile, devastating, and far-reaching acts of aggression
9、ever committed on American soil. Both WorldHispanic Journal of Behavioral Sciences, Vol. 25 No. 1, February 2003 56-72DOI: 10.1177/0739986303251695 2003 Sage Publications56at Curtin University Library on January 12, 2009 http:/Downloaded from Trade Center towers were completely destroyed, and the Pe
10、ntagon receivedsignificant damage. The known death toll in New York, Washington, andrural Pennsylvania amounted to more than 3,000 people (the AssociatedPress, 2002). The attacks caused property damage estimated to be in excessof $50 billion (New York State Insurance Department, 2001).The most compa
11、rable previous terrorist attack in the United States was thebombing of the Alfred P. Murrah Federal Building in Oklahoma City on April19, 1995. The death toll from that attack was 167 people, with property dam-age estimated at $625 million (North et al., 1999). Of direct witnesses to theblast who we
12、re surveyed, 34.3% were diagnosed with posttraumatic stressdisorder (PTSD; North et al., 1999).Given the elevated rates of PTSD symptomatology endorsed by individu-als who witnessed the Oklahoma City bombing, the degree of PTSD symp-toms endorsed after September 11th may have been even greater becau
13、se ofboth the severity of the attacks and the widespread and continuous media cov-erage. Individuals with PTSD symptoms may experience distress andincreased health risks (e.g., depression, anxiety, substance abuse, hyperten-sion, infectious diseases) for up to 20 years after the event, and most do n
14、otseek treatment for PTSD (Davidson, 2001). Although PTSD symptomatologyis generally limited to individuals in direct proximity to the traumatic event,in the case of September 11th, individuals living thousands of miles from theepicenter of the attacks may have been sufficiently exposed to repeatedb
15、roadcasts of the events to develop PTSD symptoms (Schuster et al., 2001;cf. DeJong et al., 2001). There is evidence that in children, degree of televi-sion exposure to traumatic events contributes significantly to PTSD symp-toms (Pfefferbaum et al., 2001), although the extent to which the resultsrep
16、orted by Pfefferbaum et al. (2001) generalize to adult populations isunknown. However, given that the majority of the American public wasexposed to the September 11th attacks through television, PTSD may repre-sent a significant public health problem if adults exposed to the attacks ontelevision wer
17、e at risk for developing PTSD symptoms.Whereas the extent of PTSD symptomatology related to September 11this expected to be high for the American population as a whole, population-Pantin et al. / September 11th PTSD Symptoms 57AUTHORS NOTE: Preparation of this article was supported by National Insti
18、tute on MentalHealth Grant No. MH63042 to Dr. Jos Szapocznik. We thank Dr. Thomas A. Mellman for hiscritical feedback on the article, Dr. Victoria Bustamante for her guidance in validating our mea-sure, Ms. Maria Tapia for coordinating the assessment battery, and Mr. Omar Cardentey for hisclerical a
19、nd administrative support. Correspondence and reprint requests should be addressed toDr. Hilda M. Pantin, Center for Family Studies, Department of Psychiatry and Behavioral Sci-ences, University of Miami School of Medicine, 1425 N.W. 10th Ave., Miami, FL 33136; phone:305-243-4592; fax: 305-243-5577;
20、 e-mail: hpantinmed.miami.edu.at Curtin University Library on January 12, 2009 http:/Downloaded from based surveys have found significantly higher September 11threlated PTSDrates among minorities (Schuster et al., 2001) and among Hispanics, specifi-cally (Galea et al., 2002), in the United States. M
21、oreover, the incidence andseverity of PTSD may be even higher for individuals who have immigratedfrom homelands ravaged by traumatic events such as wars and natural disas-ters (Zea, Diehl, Guzman,2000).Past traumatic exposure is related to greater levels of mental health prob-lems, including PTSD (Z
22、ea et al., 1996). The greater the number and severityof prior traumatic events experienced, the more severe prior PTSD symptomsare likely to have been (Thabet American Psychiatric Association APA,1994) PTSD diagnosis and the relationship of this symptomatology to previ-ous traumatic exposure. Fourth
23、, we sought to ascertain the relationship58 Hispanic Journal of Behavioral Sciencesat Curtin University Library on January 12, 2009 http:/Downloaded from between television exposure to the attacks and September 11threlatedPTSD symptoms. We administered measures of prior war exposure, priornatural di
24、saster exposure, amount of television exposure to the September11th attacks, and September 11threlated PTSD symptoms to a nonclinicalsample of Hispanic immigrant parents who were participating in a parent-centered prevention trial at the time of the attacks.MethodParticipantsThe sample for this stud
25、y consisted of 110 Hispanic immigrant parents orparent figures participating in a larger, parent-centered adolescent HIV-prevention trial in Miami. All participants were community volunteers andwere not selected for clinical symptomatology. Participants were primarilyCuban (34.5%) or Nicaraguan (29.
26、1%), with smaller numbers of participantsoriginating from Colombia (8.2%) and Honduras (6.4%). Of participants,50% had resided in the United States for more than 10 years, 24.5% for 3 to10 years, and 25.5% for less than 3 years (see Table 1 for demographic infor-mation on the sample used in this stu
27、dy).As per the inclusion criteria for the larger trial, all the parents had aneighth-grade Hispanic adolescent and resided in the city of Miami and noneof the parents or their adolescents had been previously hospitalized for psy-chiatric reasons. None of the participants reported being in New York o
28、rWashington during the attacks (they were all in the Miami area or in LatinAmerica at that time), and only three participants reported knowing anyonewho was hurt or killed. Consistent with the gender roles in traditional His-panic culture, the majority of the parents participating in the trial (i.e.
29、, pri-mary caregivers) were mothers or mother figures (Gomez see the appendix). We modeled our scale after existingPTSD measures that have been validated against clinical diagnostic inter-views (e.g., Davidson et al., 1997; Pynoos et al., 1987), simplifying the word-ing of items for Hispanic immigra
30、nts with low reading levels. In a validationsample, we established convergent validity between the September 11thTraumatic Distress Inventory and the Davidson Trauma Scale (Davidsonet al., 1997), a self-report PTSD measure that has been shown to be concor-dant with the DSM-IV diagnostic criteria for
31、 PTSD. The correlation betweenthe severity scores for the two measures was .87 (p .001). The September11th Traumatic Distress Inventory also demonstrated acceptable convergentvalidity with the Davidson Trauma Scale in terms of classifying symptom-atology consistent with a DSM-IV PTSD diagnosis, Fish
32、ers exact p .02.The September 11th Traumatic Distress Inventory demonstrated high test-retest reliability during a 2-day period, r = .92, p .001 (Pantin et al., 2002).The September 11th Traumatic Distress Inventory includes 22 self-reported items modeled after DSM-IV (APA, 1994) PTSD criteria. Two i
33、temsreflect Criterion Cluster A (exposure). Five items reflect Criterion Cluster B(intrusive reexperiencing). Seven items reflect Criterion Cluster C (avoid-ance or numbing). Five items reflect Criterion Cluster D (hyperarousal). Oneitem reflects Criterion E (duration of symptoms). One item reflects
34、 CriterionF (functional impairment). (See the appendix.)September 11th PTSD was indexed in three ways. First, a continuous Sep-tember 11th PTSD severity score was created by summing each participantsresponses to items reflecting DSM-IV (APA, 1994) Criterion Clusters B, C,D, and F. These are the clus
35、ters that indicate the severity of the symptomsexperienced. Possible scores on this severity index range from 0 to 36. TheCronbachs alpha coefficient for the severity index was .89.Second, participants were classified according to whether they endorseditems consistent with the criteria for each of t
36、he six DSM-IV (APA, 1994)PTSD criterion clusters (A through F). For items within Criterion Clusters B,C, D, and F, only “often true” responses were used as indicative of endorse-ment. For Cluster A, participants had to indicate exposure either in person orthrough television (none of the participants
37、 reported exposure in person). ForCluster B, participants had to endorse one of the five items consistent withintrusive reexperiencing. For Cluster C, participants had to endorse three ofthe seven items consistent with avoidance and numbing. For Cluster D, par-ticipants had to endorse two of the fiv
38、e items consistent with hyperarousal.For Cluster E, participants had to indicate the symptoms had persisted for 1month or more. For Cluster F, participants had to report that thoughts of thePantin et al. / September 11th PTSD Symptoms 61at Curtin University Library on January 12, 2009 http:/Download
39、ed from September 11th attacks significantly interfered with their daily functioning.A criterion cluster endorsement count was created to reflect the number ofDSM-IV PTSD diagnostic criterion clusters with which the participantsresponses were consistent. For this criterion cluster endorsement count,
40、 eachparticipant was assigned a score between 0 and 6. A score of 0 indicates thatthe participants self-reports were not consistent with any of the diagnosticcriterion clusters, whereas a score of 6 indicates symptomatology consistentwith a PTSD diagnosis.Third, participants were categorized based o
41、n whether their self-reportedsymptoms were consistent with a DSM-IV (APA, 1994) PTSD diagnosis.Participants were placed into the “yes” category only if their symptom-atology was consistent with all of the DSM-IV diagnostic criterion clusters.That is, they had to have a score of 6 on the criterion cl
42、uster endorsementcount.ProceduresAll measures were translated into Spanish using established back-translationand committee evaluation procedures (Kurtines Criterion Cluster B, 2(1) =0.92, not significant; Criterion Cluster C, 2(1) = 0.11, not significant; Crite-rion Cluster D, 2(1) = 2.29, not signi
43、ficant; Criterion Cluster E, 2(1) = 3.08,not significant; Criterion Cluster F, 2(1) = 0.55, not significant; symptomsconsistent with a full PTSD diagnosis, 2(1) = 0.04, not significant.1Therewere also no significant gender differences in previous war violence expo-Pantin et al. / September 11th PTSD
44、 Symptoms 65at Curtin University Library on January 12, 2009 http:/Downloaded from sure, F(1, 108) = 0.97, not significant, or in previous natural disaster expo-sure, F(1, 108) = 0.01, not significant.DiscussionThis study was conducted to determine the extent and severity of PTSDsymptoms in a noncli
45、nical sample of Hispanic immigrants who lived morethan 1,000 miles from the epicenter of the September 11th terrorist attacks.We also sought to ascertain the extent to which traumatic experiences in par-ticipants native countries affected and exacerbated the degree of PTSDsymptoms reported after the
46、 attacks. Based on previous research with chil-dren (Pfefferbaum et al., 2001), we also expected that the amount of televi-sion exposure to the attacks would be predictive of PTSD symptom severity.This study was noteworthy in that we obtained reports of considerableSeptember 11threlated PTSD symptom
47、atology and of levels of PTSD con-sistent with a DSM-IV (APA, 1994) diagnosis in a sample of participants who(except for three who knew someone who had been hurt or killed) had nodirect connection to the attacks and who were all more than 1,000 miles fromthe epicenter of the events. This finding sta
48、nds in stark contrast to prior stud-ies of PTSD following wars, terrorist attacks, or natural disasters in which thevast majority of individuals evidencing PTSD symptoms were those directlyexposed to or in the vicinity of the traumatic events (DeJong et al., 2001;C. Garrison et al., 1995; North et al., 1999). This finding also speaks to themassive scope and impact of the September 11th attacks in contrast with themore localized nature of traumatic events that have been previously studie
