title: Distress of Routine Activities and Perceived Safety Associated with Post-Traumatic Stress, Depression, and Alcohol Use: 2002 Washington, DC, Sniper Attacks.
abstract: OBJECTIVE
  For over 3 weeks in October 2002, a series of sniper attacks in the Washington, DC, area left 10 people dead and 3 wounded. This study examined the relationship of distress associated with routine activities and perceived safety to psychological and behavioral responses.
  
  
  METHODS
  Participants were 1238 residents of the Washington, DC, metropolitan area (aged 18 to 90 years, mean=41.7 years) who completed an Internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, and items pertaining to distress related to routine activities, perceived safety, and alcohol use. Data were collected at one time point approximately 3 weeks after the first sniper shooting and before apprehension of the suspects. Relationships of distress and perceived safety to post-traumatic stress, depressive symptoms, and increased alcohol use were examined by using linear and logistic regression analyses.
  
  
  RESULTS
  Approximately 8% of the participants met the symptom criteria for probable post-traumatic stress disorder, 22% reported mild to severe depression, and 4% reported increased alcohol use during the attacks. Distress related to routine activities and perceived safety were associated with increased post-traumatic stress and depressive symptoms and alcohol use.
  
  
  CONCLUSIONS
  Distress and perceived safety are associated with specific routine activities and both contribute to psychological and behavioral responses during a terrorist attack. These findings have implications for targeted information dissemination and risk communication by community leaders.
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University of the Health Sciences,Bethesda,Maryland.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Fullerton
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University of the Health Sciences,Bethesda,Maryland.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Herberman Mash
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University of the Health Sciences,Bethesda,Maryland.
authors.forename: K Nikki
authors.initials: KN
authors.lastname: Benevides
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University of the Health Sciences,Bethesda,Maryland.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Morganstein
authors.affiliation: Center for the Study of Traumatic Stress,Department of Psychiatry,Uniformed Services University of the Health Sciences,Bethesda,Maryland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ursano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D012449:Safety; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D023481:Terrorism / Q000523:psychology*
keywords: mental disorders; perceived safety; post-traumatic; stress disorders; terrorism