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Posttraumatic Stress Disorder as a Result of Mass Trauma

Arieh Y. Shalev, MD; Rivka Tuval-Mashiach, PhD; and Hilit Hadar, MA

Published: January 1, 2004

Article Abstract

There is a large body of literature on the psychological consequences of trauma experienced byindividuals, but there are few studies of the acute and long-term effects of mass trauma on victimizedcommunities. Acute stress reactions are expected, and overall resilience in the aftermath of major disastersis the rule rather than the exception. However, the available literature on mass trauma suggeststhat certain factors may provide clues to identifying persons at greater risk for posttraumatic stressdisorder (PTSD). The severity of the trauma and the accessibility of support systems may affect longtermoutcome. In industrialized countries, mass violence caused by malicious human intent may be amore virulent precursor to PTSD than other types of mass trauma, such as technological or naturaldisasters. School-aged children, women, persons with existing psychiatric illness, those who experiencedsignificant losses or threat to life, those who have insufficient psychological and social supportsystems, and persons who exhibit symptoms of functional impairment may be at greater risk forPTSD. The findings of a population study of 2 traumatized communities are discussed. Early interventionin communities suffering mass trauma should consist of general support and bolstering of therecovery environment rather than psychological treatment; some forms of early psychological interventionsmay worsen outcome. There is a great unmet need for treatment and intervention guidelinesfor victims of mass trauma, and well-designed studies are warranted.

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