Across-cultural study finds that Africans and Americans are affected
similarly by terrorism. A study of this topic, reported in the June
British Journal of Psychiatry, was headed by two disaster psychiatry
experts, Carol North, M.D., a professor of psychiatry at Washington University
in St. Louis, and Betty Pfefferbaum, M.D., chair of psychiatry at the
University of Oklahoma.
The study included some 400 subjects—about half American and about
half Kenyan. The Americans had been impacted by the bombing of a federal
office building in Oklahoma City in 1995, the Kenyans by the bombing of the
U.S. Embassy in Nairobi in 1998.
Six to 10 months after these terrorist incidents, the subjects were
evaluated to learn how the incidents had affected them psychologically and how
they had coped with them. The main instrument the researchers used was the
Disaster Supplement of the Diagnostic Interview Schedule, which has been used
to study more than 2,000 disaster victims in the United States. It provided
information about exposure to the disaster, subjective perceptions, functional
status, coping methods, and treatment. Diagnoses were made using
DSM-IV criteria.
Assessment of the Kenyan subjects was conducted by eight Nairobi mental
health professionals who had been trained in interviewing and in using such
diagnostic instruments. Also, the Kenyans were asked virtually the same
questions that the Americans were asked, except that occasionally words or
phrases were substituted to make the questions more culturally appropriate for
them. For example, they were not asked whether they felt "blue,"
but rather "empty," since empty, not blue, connotes a negative
mood for Kenyans.
When the researchers compared the responses, they found that despite
geographic separation by nearly half a world, the American subjects and the
Kenyan subjects responded quite similarly to being terrorism victims. For
example, posttraumatic functional impairment, defined as interference with
work or relationships with family and friends, occurred among 40 percent of
Kenyan subjects and 39 percent of American ones. Almost a third of male Kenyan
subjects and a little over half of female Kenyan subjects experienced
bombing-related posttraumatic stress disorder (PTSD). By comparison, 19
percent of male American subjects and 38 percent of female American subjects
did. Thus, female subjects in both Kenya and the United States were more
susceptible to bombing-related PTSD than male subjects in the two
countries.
Most Kenyan subjects and most American subjects met DSM-IV PTSD
criteria B and D—that is, a persistent re-experiencing of the traumatic
event and persistent symptoms of increased arousal—but not criterion C,
which is persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness. However, 90 percent of both American and
Kenyan subjects who met criterion C also met full diagnostic criteria for
PTSD.
The means by which the Kenyan and American subjects coped with their trauma
differed somewhat, the investigators learned. For instance, while subjects in
both groups turned to family and friends for support, the Americans were more
likely to use medications and alcohol to cope, while the Kenyans were more
likely to use religion.
"In our study," North told Psychiatric News, "I
was impressed with the similarities in the presentations of psychiatric
disorders after terrorist bombings in survivors of the bombings in Oklahoma
City and in Nairobi, but I was equally impressed with how differently people
in these two cultures coped and sought help for their problems. The specifics
we found pertaining to similarities and differences in these two cultures may
be a first step toward resolving apparently differing evidence about the
expression of disaster mental health effects internationally."
These findings have some practical implications for helping both Americans
and Africans affected by terrorism, the researchers pointed out in their
report. For example, screening both Americans and Africans impacted by
terrorism for PTSD criterion C symptoms might be a good way to identify
individuals with a high likelihood of developing PTSD and thus in need of more
intensive psychiatric care.
The study was funded by the National Institute of Mental Health, National
Memorial Institute for the Prevention of Terrorism and the Office for Domestic
Preparedness, U.S. Department of Homeland Security, and U.S. Agency for
International Development.
An abstract of "Comparison of Post-Disaster Psychiatric
Disorders After Terrorist Bombings in Nairobi and Oklahoma City" is
posted online at<http://bjp.rcpsych.org/cgi/content/abstract/186/6/487>.▪
Br J Psychiatry
2005186487