OBJECTIVE: Posttraumatic stress disorder (PTSD) has been best studied
among combat veterans. Less is known about PTSD among civilian populations
exposed to traumatic events. A recent mass murder spree by a gunman in a
cafeteria in Killeen, Tex., has provided a unique opportunity to study
acute-phase civilian responses to a combat type of experience. METHOD:
Approximately 1 month after the disaster, 136 survivors were interviewed
with the Diagnostic Interview Schedule/Disaster Supplement. RESULTS: In the
acute postdisaster period, 20% of the men and 36% of the women met criteria
for PTSD, which was the most prevalent psychiatric disorder. Most subjects
who developed PTSD had no history of psychiatric illness. Rates of
preexisting PTSD were relatively high and did not predict the presence of
PTSD after the disaster. A history of other predisaster psychiatric
disorders predicted postdisaster PTSD in women but not in men. One-half of
the women and one-fourth of the men with postdisaster PTSD also met
criteria for another postdisaster psychiatric diagnosis, especially major
depression. Psychopathology was infrequent in subjects without PTSD.
CONCLUSIONS: Disaster intervention workers may be able to most effectively
use limited mental health provider resources in the acute postdisaster
period by focusing on screening for acute PTSD, which will identify the
majority of cases with psychiatric disorders following this kind of
disaster. Survivors who have no history of psychiatric disorder should be
screened along with those who do because in the present study, they
represented the majority of the PTSD cases. Subjects with a history of
major depression and women with preexisting psychopathology may be
especially vulnerable to posttraumatic syndromes. Individuals with PTSD
should be further examined for additional psychiatric diagnoses that may
complicate recovery, especially major depression. PTSD among survivors of
civilian combat- like experiences does not appear to present in the same
way that it has been described in Vietnam veterans.Abstract Teaser