During a three-week killing spree in October 2002, Washington-area residents sheltered at home, avoided public spaces, missed work and suffered some of the symptoms associated with posttraumatic stress, according to a new study from the Division of Violence Prevention at the Centers for Disease Control and Prevention.

Different from public health investigations following the Oklahoma City bombing or September 11 terrorist attacks, the new work describes community responses after a nearly month-long event “evoking a heightened and sustained sense of vulnerability,” the study said.

More recently, residents of the Phoenix area have been gripped by similar fear. For more than a year, Arizona’s largest city was unsettled by a series of late-night sniper attacks; in early August police arrested two men in connection with those shootings.

The Washington, D.C.-area study, like others before it, documents individual responses to shared traumatic events, pinpoints what proportion of the community is affected and helps us better understand who is at risk for debilitating outcomes such as posttraumatic stress disorder, said psychiatrist and lead study author Jeffrey Schulden. The study also gives mental health professionals clues for helping the community recover after a terror-causing ordeal.

“We’re providing some information to people and primary-care providers around what is the expected range of psychological and behavioral responses and when does that push over the edge to where you might want to involve a mental-health professional specifically, or seek further help,” said Schulden, a medical epidemiologist for the CDC.

The study appears in the October issue of the American Journal of Preventive Medicine. It is based on phone interviews with 1,205 people -  all residents of the district or two nearby Maryland counties. Study participants were interviewed about six months after the sniper spree ended. Two men were arrested and convicted of the 13 attacks that killed 10 people.

“More than a third of residents reported leaving their households less than usual due to concerns about the sniper shootings,” Schulden said. About 16 percent of participants said they stayed home for an entire day.

Forty-five percent of the residents surveyed said they went to public spaces, like parks and shopping centers, less than usual. Among people who worked outside of the home, 5.5 percent reported that they missed at least one day of work due to the sniper shootings.

About 7 percent of residents reported enough symptoms to suggest they were at risk for posttraumatic stress. Women who reported residing within five miles of one of the shootings were more than four times more likely to report elevated traumatic stress symptoms than women living farther from the incidents. Among men, no such association was found.

“This was not a diagnostic interview. It’s purely a screening scale to determine who might be at increased likelihood for having PTSD,” Schulden said. Detecting and diagnosing posttraumatic stress disorder would require a full clinical evaluation, he said.

Rachel Yehuda is director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine and Bronx Veterans Affairs Medical Center. Yehuda said she’s looking for more studies that answer the logical next questions, following Schulden’s work.

“What have we learned about the community needs in the midst, in the wake, of a traumatic event?” Yehuda asks.

U.S. disaster and terrorism response plans need to include mental health programs to facilitate society’s recovery after a community-wide trauma, the study authors conclude. Those plans could include mass-media campaigns which would include not only information on typical or expected reactions, but also information about when to seek the assistance of a mental-health clinician, Schulden said.

But Yehuda said, “For whom should we do that? How do we find the right people to direct our messages toward? That’s what we need to know now.”

Health Behavior News Service