title: The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing.
abstract: BACKGROUND
  The course of posttraumatic stress disorder (PTSD) in populations directly exposed to terrorist attacks is of major importance in the post-9/11 era. Because no systematic diagnostic studies of the most highly exposed individuals of the 9/11 terrorist attacks have yet been done, the Oklahoma City bombing remains a unique opportunity to examine PTSD over time in high-exposure terrorist victims.
  
  
  METHODS
  This study assessed 137 survivors in the direct path of the explosion at approximately 6 and 17 months postdisaster, using the Diagnostic Interview Schedule.
  
  
  RESULTS
  Combined index and follow-up data yielded a higher (41%) incidence of PTSD than detected at index (32%) or follow-up (31%). All PTSD was chronic (89% unremitted at 17 months) with no delayed-onset cases. The avoidance and numbing symptom group C, unlike groups B and D alone, was pivotal to current PTSD status and was associated with indicators of functioning at index and follow-up. The findings at index were sustainable.
  
  
  CONCLUSIONS
  This follow-up study confirmed the immediacy of onset of PTSD and its persistence over time, pointing to the need for early interventions that continue over the long term. Group C avoidance and numbing symptoms may aid in early recognition of PTSD and in predicting long-term functioning.
authors.affiliation: Washington University School of Medicine, Department of Psychiatry, St. Louis, MO 63110, USA. NorthC@psychiatry.wustl.edu
authors.forename: Carol S
authors.initials: CS
authors.lastname: North
authors.forename: Betty
authors.initials: B
authors.lastname: Pfefferbaum
authors.forename: Laura
authors.initials: L
authors.lastname: Tivis
authors.forename: Aya
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Chandrashekar
authors.initials: C
authors.lastname: Reddy
authors.forename: Edward L
authors.initials: EL
authors.lastname: Spitznagel
mesh_terms: D000328:Adult; D005107:Explosions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009825:Oklahoma; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D023481:Terrorism / Q000523:psychology*