Immediate and evolving emotions among directly exposed survivors 7 years after the Oklahoma City bombing.

The Oklahoma City bombing in 1995 was one of the most devastating incidents of terrorism in America at that time. Existing research has not examined changes in emotional responses outside of psychopathology to disaster over time. The sample for this study consisted of adult participants randomly selected from a state registry of survivors who were directly exposed to the 1995 bombing in Oklahoma City. The Disaster Supplement to the Diagnostic Interview Schedule was used to collect participants' demographic information and qualitative details of their disaster experience, perceptions, and feelings. A total of 315 items resulted from the coding of responses pertaining to emotions (125 immediately after the disaster event, 140 in the following week, and 50 at approximately seven years postdisaster). The most common emotions in the immediate postdisaster period were shock, fear, and anxiety. In the following week, the most common were sorrow and anger. At seven years, sorrow was the most frequently expressed of all emotions. Understanding the progression of these feelings across time enhances the ability to anticipate responses at different postdisaster timeframes and to intervene in a timely manner.

A longitudinal follow-up study of rescue and recovery narratives of Oklahoma City bombing responders nearly a quarter century later.

BACKGROUND: Most research examining first responders of terrorist incidents has been conducted in early post-disaster periods, utilized quantitative research methods, and focused on psychopathology such as post-traumatic stress. METHODS: Longitudinal follow-up assessments of 124 workers from 181 baseline volunteer rescue and recovery workers originally studied were completed nearly a quarter century after the terrorist bombing of the Murrah Federal Building in Oklahoma City. Open-ended qualitative interviews were used in the follow-up study. RESULTS: The rescue and recovery work, vividly described decades later, was gruesome. These workers' descriptions captured their mental toughness and their professional missions, as well as the emotional and mental health (MH) toll on their lives. CONCLUSIONS: The extreme nature of rescue and recovery work in the aftermath of terrorism suggests potential utility for MH interventions to address the psychological toll that can be expected of human beings under the most extraordinary circumstances.

A longitudinal follow-up study of Oklahoma City bombing survivors in the first quarter century after the disaster.

BACKGROUND: This study is one of the longest postdisaster prospective longitudinal studies of disaster-related psychopathology, completed nearly a quarter century after a terrorist bombing, and the longest follow-up study ever conducted using full diagnostic assessment in highly exposed disaster survivors. METHODS: Oklahoma City bombing survivors (87% injured) were randomly selected from a state survivor registry and interviewed approximately 6 months postdisaster (N = 182; 71% participation) and again nearly 25 years later (N = 103; 72% participation). Interviews were conducted using the Diagnostic Interview Schedule (a structured interview assessing full diagnostic criteria) for panic disorder, generalized anxiety disorder, and substance use disorder at baseline and also for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) at follow-up. The Disaster Supplement assessed disaster trauma exposure and subjective experience. RESULTS: At follow-up, 37% of participants exhibited bombing-related PTSD (34% at baseline) and 36% had MDD (23% at baseline). More new cases of PTSD than MDD developed over time. Nonremission rates were 51% for bombing-related PTSD and 33% for MDD. One-third of participants reported long-term nonemployability. CONCLUSIONS: The presence of long-term medical problems among survivors parallels the persistence of psychopathology. Ongoing medical problems might have contributed to psychiatric morbidity. Because no major variables predicted remission from bombing-related PTSD and MDD, all survivors with postdisaster psychopathology likely need access to long-term evaluation and care.

A longitudinal study of Oklahoma City bombing rescue and recovery responders providing qualitative introspections of their experience nearly a quarter century later.

BACKGROUND: The 1995 terrorist bombing in Oklahoma City provided a particularly useful research opportunity. It was the most severe incident of terrorism on American soil at the time. Prior research on rescue and recovery workers responding to such events has been largely limited to early post-disaster periods, most focusing on psychopathology such as post-traumatic stress disorder. This incident provided a unique unrealized opportunity to examine long-term psychosocial effects on first responders studied longitudinally over decades after the event, using qualitative methods to yield rich, in-depth observations. METHODS: A volunteer sample of 181 volunteer first responders for the Oklahoma City bombing was initially assessed 3 years after the bombing, and 124 (70 percent of those documented to still be alive) participated in longitudinal follow-up interviews an average of 23-24 years after the incident. The follow-up study included open-ended, nondirected qualitative interviews of the workers' personal disaster narratives. RESULTS: The experience of providing rescue and recovery efforts after the Oklahoma City bombing had lasting effects on these first responders' personal and professional relationships. It taxed their coping skills, elicited an enduring resilience, and permanently altered their outlook on life. Unlike the directly exposed survivors, these first responders found meaning and affirmation in their professional service, reaffirming their original motivations to be part of a helping profession that in today's world now requires recovery and rescue work in major terrorist incidents. Even though the work was very gruesome and taxing, more than two decades later, these workers expressed pride in their participation and had no regrets about it. CONCLUSIONS: The Oklahoma City bombing experience was life-changing for first responders, setting a standard for those who will follow in their footsteps. Continuing to conduct this line of work in the decades to follow reflected a conviction that their continued service honored both survivors and members of their profession. Despite the positive aspects of their perspectives on their experience, the attention they received to their emotional and psychological processing and recovery was limited, implying the importance of additional development and research on assistance to these needs.

A Prospective Post-disaster Longitudinal Follow-up Study of Emotional and Psychosocial Outcomes of the Oklahoma City Bombing Rescue and Recovery Workers During the First Quarter Century Afterward.

OBJECTIVE: Little prospectively assessed post-disaster longitudinal research has been done on mental health (MH) outcomes of disaster rescue and recovery workers. This longitudinal prospective study, which is examining first responders to a terrorist bombing in Oklahoma City after nearly a quarter century, was conducted to investigate their long-term MH outcomes using full diagnostic assessments. This will most accurately inform planning for longitudinal MH care needs. METHODS: Longitudinal follow-up interviews of 124 rescue and recovery workers, from an original volunteer sample of 181 volunteer workers, were completed 3 years after the bombing, and reassessed 23 years after using consistent research methods. Structured diagnostic interviews were conducted at both assessments, but these were limited to posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) with additional questions about alcohol use, problems, and major psychosocial problems of life at follow up. RESULTS: Initially, the rescue and recovery workers had a lower prevalence of post-disaster PTSD and MDD than directly exposed survivors. They also showed higher rates of PTSD than MDD. However, over time, PTSD increased a little while MDD increased 4-fold though fewer than 50% of the cases were remitted. CONCLUSION: Low remission and increasing MDD provide incentives for surveillance and availability of treatment for decades after disaster, regardless of whether they were pre-existing conditions or disaster related.

Making Meaning of Surviving the Oklahoma City Bombing Seven Years Later.

Objective: No previous studies examined how survivors made meaning (i.e. interpreted the personal significance) of a disaster experience after seven years. This qualitative study follows up on a previously published analysis of 182 directly-exposed survivors of the Oklahoma City bombing, assessed after six months had elapsed for bombing-related psychopathology and meaning-making processes. The current study examines how 113 survivors (62% follow-up rate) made meaning of their bombing experience after seven years. Method: Survivors answered questions about the effects of the bombing on their beliefs and perspectives. Their responses were hand recorded by interviewers and transcribed. Content was coded into themes, allowing codes of multiple themes. Excellent interrater reliability was obtained (Cohen's kappa≥.8). Results: The survivors were 50% (57/113) male, 93% (105/113) Caucasian, 34% (38/113) college educated, and 71% (80/113) married with a mean (SD) age of 42.5 (10.6) (range = 19-69) years at the time of the bombing. Eight themes emerged and indicated that survivors matured in personal goals and character, interpersonal relationships, and philosophical thought (e.g., reconsideration of human nature and religion). More than one third of the comments included negative remarks about personal harm, especially psychological effects. Conclusions: Nearly two thirds of the material was positive in tone and consistent between six months and seven years. Negative content was entirely new relative to six-month baseline interview responses, suggesting many survivors incorporate greater reflection on negative outcomes in meaning-making processes over time. After several years, clinicians could encourage survivors to integrate positive and negative consequences as meaning. Longer-term studies are needed.

A Prospective Longitudinal Study of Qualitative Disaster Narratives of Highly Trauma-Exposed Survivors of the Oklahoma City Bombing Nearly a Quarter Century Later.

Objective: To examine highly trauma-exposed survivors of the 1995 Oklahoma City Murrah Federal Building bombing nearly a quarter century later, focusing on survivors' immediate personal experiences of it through open-ended narratives. Methods: An original sample of 182 bombing survivors, studied approximately 6 months post bombing, was randomly selected from a state registry of 1,092 bombing survivors, with 71% participation. Of the original 182 bombing survivors, 103 completed the longitudinal follow-up, conducted at a median of 23 years post bombing. Qualitative data for the follow-up study were collected using an expanded version of the Disaster Supplement to the Diagnostic Interview Schedule. Of the original sample, 39 were known to be deceased, 25 could not be located, and 15 declined participation. Results: In all, 12 themes were identified, but just 3 (Locations, Bombing experience, and Initial actions) are detailed here. All survivors were in heavily damaged buildings (about one-half in the Murrah Federal building) or directly outside, and the majority (84%) were injured. They described intense and gruesome experiences of the bombing, difficult efforts to escape to safety and help other survivors, and continuing postbombing experiences once outside. Conclusions: A striking finding was the intensity of the survivors' memories almost a quarter century after the bombing. Their sensory recollections remained vivid, generally as bright and intense as in earlier reporting periods. It may be that the salience of this extreme event stabilized memories of it yielding such vivid descriptions nearly a quarter century later.

A Qualitative Longitudinal Study of Injuries and Medical Care, Assistance, and Losses Recounted by Oklahoma City Bombing Survivors after Nearly a Quarter Century.

INTRODUCTION: Terrorist incidents occur with alarming frequency. Much is known about acute injuries and psychopathology arising from terrorism, as well as medical care and functional status assessed in early post-disaster periods. Survivors' memories of these experiences may change over subsequent decades, and their perspectives may evolve. Little information is available on how survivors describe these experiences decades later. STUDY OBJECTIVE: This longitudinal qualitative study of directly-exposed survivors of the 1995 Oklahoma City bombing was conducted nearly a quarter century after the disaster. It collected systematic, open-ended descriptions of survivors' injuries and medical care, assistance received and given, and disaster-associated losses. It sought to illuminate whether survivors recall long-term consequences of disaster exposure so long after the event, providing important details with great clarity and associated emotion, or alternatively lose memory and sharpness of recollection for these aspects of their bombing experience. METHODS: A sample of 182 bombing survivors was randomly recruited from a state registry of 1,092 bombing survivors and interviewed at approximately six months after the bombing (71% participation). The sample was re-interviewed an average of 23 years after the disaster (72% follow-up participation) using an open-ended interview with survivors describing in their own words their personal experience of the bombing and its effects on their lives. The interviews were audio recorded and professionally transcribed. Themes were identified in the text of the interviews, and passages were coded using qualitative software, achieving excellent inter-rater reliability for each theme. This article covers three of twelve total themes identified. RESULTS: Nearly a quarter century after the bombing, this highly trauma-exposed Oklahoma City bombing survivor sample had memories that were still vivid, graphic, and evocative. They described injuries and medical care, assistance given and received, and losses with great detail and intensity. Despite the continuing strong emotions expressed by these survivors in relation to the bombing, the qualitative content suggested that lasting psychopathology was not a central concern. CONCLUSION: This is one of the longest prospective longitudinal, qualitative studies ever conducted with highly trauma-exposed survivors of a terrorist bombing. These findings are critical to disaster emergency response and effective management of the disaster response and early care for the survivors, as the effects of the disaster may shape the rest of their lives.

A Qualitative Longitudinal Study of Workplace Issues, Authorities and Media, and Relationships Recounted by Oklahoma City Bombing Survivors After Nearly a Quarter Century.

OBJECTIVE: The aim of the study is to examine the long-term course of disaster-related experience among survivors of a terrorist bombing and the long-term recollection of initial workplace effects across nearly a quarter century. METHODS: From an initial randomly selected sample of highly trauma-exposed survivors of the 1995 Oklahoma City bombing, 103 participated in qualitative open-ended interviews about their bombing experience approximately 23 years after disaster. RESULTS: The survivors described their bombing experience clearly with extensive detail and expression of persistent strong emotion. Their discussions reflected findings from earlier assessments and also continued over the course of the next decades to complete their stories of the course of their occupational and interpersonal postdisaster journeys. CONCLUSIONS: Long-term psychosocial ramifications in these survivors' lives continue to warrant psychosocial interventions, such as occupational and interpersonal counseling.

Prevalence of Tardive Dyskinesia in an Electronic Medical Record Study at a Large Community Mental Health Treatment Center.

Objective: To determine the prevalence of tardive dyskinesia (TD) identified by clinicians in naturalistic data in a real-world treatment setting.Methods: Electronic medical record data were analyzed from a single large community mental health treatment center for all psychiatric provider encounters of 120,431 unique adult and child patients during a 5-year period from January 2013 through December 2017, focusing on clinician-identified TD in patients prescribed antipsychotic medication.Results: Only half of the antipsychotic-prescribed patients had Abnormal Involuntary Movement Scale (AIMS) information recorded in their medical records, and only 1% of those with AIMS data had a positive AIMS identifying TD. AIMS testing represented the largest source of all identified TD in these patients, but only one-third of the patients with a positive AIMS in the record had a clinical diagnosis of TD recorded in the prescriber's diagnostic impression list from billing code data. The clinical identification of only 1% of antipsychotic-prescribed patients with TD in this study is far below generally established TD prevalence estimates of previous research. An important methodological contributor to this discrepancy is generation of the data by treating clinicians in this study who greatly under identified TD relative to systematic research methodology.Conclusions: Given the recent availability of US Food and Drug Administration-approved pharmaceutical agents for treatment of TD, it is now more important than ever to identify and intervene in TD. Agency-wide policies and procedures can be established to ensure that TD assessments are systematically conducted with regularity and accuracy among all antipsychotic-prescribed patients.