New report finds U.S. unprepared for mental health impact of terrorist acts

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The United States public health and homeland security systems are not adequately prepared for dealing with the psychological effects of terrorism, according to a new report from a task force of the American College of Neuropsychopharmacology (ACNP).

The report asks Congress to take action since current systems ignore mental health planning and do not include science-based approaches for risk communications to the general public.

"The goals of terrorism depend on their psychological impact," said Steven Hyman, Harvard University provost professor of neurobiology at Harvard Medical School, who chaired the ACNP task force. "The pervasive psychological effects of terrorism demand a public health response, and the inclusion of mental health as an integral part of disaster planning is the first step."

The task force report reviewed a wide range of research studies focused on terrorism's effects on children and adults, as well as the effectiveness of current treatments for depressive and traumatic disorders when applied to victims of terrorist activities.

Findings show that when exposed to acts of terrorism, most people recover without intervention, yet many organizations mandated participation in unnecessary treatment. In contrast, a small but significant minority, which includes those most directly affected, experienced long-term psychiatric disorders that were highly disabling, including posttraumatic stress disorder (PTSD) and depression.

The report reviewed the effectiveness of currently available treatments for these psychiatric disorders following disaster-related traumatic events. The task force found that the most widely used intervention - psychological debriefing - is not effective in preventing PTSD and may actually be detrimental.

The findings also suggested that cognitive behavioral therapy (CBT) may have positive effects in treating psychiatric trauma. One controlled clinical trial found that CBT accelerated the rate of recovery, although it did not actually reduce the overall prevalence of PTSD, while another found that 6 months after the event, the prevalence of PTSD was reduced by about two-thirds when victims were treated with CBT. However, the report noted that insufficient numbers of mental health professionals were trained in this technique should an event occur that affected large numbers of the public.

"Interventions have yet to be developed that can help decrease susceptibility to stress and prevent the onset of developing disorders, including posttraumatic stress disorder," said Hyman. "Current treatments need to be refined and new ones developed in order to generate a greater range of treatment options easy to administer around the time of an attack," he emphasized.

In addition, the task force noted currently available treatments are not universally effective, partly because they have not been adapted to terrorism. Most have been developed for other types of trauma such as rape and child abuse, traumas that do not necessarily pose the type of continuing and pervasive societal threat that terrorism poses.

The report also noted the challenges that researchers face in conducting research on effective treatments following a terrorist-related trauma. "Research in this area has been greatly hampered by a lack of immediate access to disaster sites and treatment centers," said Hyman. "While excessive intrusiveness should be avoided, it is important for the research community and the disaster response communities to work together to allow research to proceed - or else it will never be possible to improve our preparedness."

Hyman compared the research needs of the mental health community to those of infectious disease researchers after a biological attack. "Policymakers have a national obligation to be better prepared for the psychological consequences of terrorism and to reduce its impact." This article was prepared by Bioterrorism Week editors from staff and other reports. Copyright 2004, Bioterrorism Week via &

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