Psychological and behavioural reactions to the bombings in London on 7
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《英国医生杂志》
1 King's College London, Institute of Psychiatry, Department of Psychological Medicine, Weston Education Centre (PO62), London SE5 9RJ, 2 University College London, Subdepartment of Clinical Health Psychology, London WC1E 6BT, 3 Health Protection Agency, Centre for Emergency Preparedness and Response, Porton Down, Salisbury, Wiltshire SP4 0JG
Correspondence to: G James Rubin g.rubin@iop.kcl.ac.uk
Objectives To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population.
Design A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions.
Setting Interviews took place between 18 and 20 July.
Participants 1010 participants (10% of the eligible people we contacted) completed the interviews.
Main outcome measures Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal.
Results 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks.
Conclusions Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.
The terrorist attacks on central London's transport network on 7 July 2005 caused 52 fatalities and some 700 injuries. The psychological effects of the attacks remain unknown. Shortly after the attacks in the United States on 11 September 2001, about 90% of the residents of New York City and Washington DC reported symptoms of stress, with 44% reporting substantial symptoms.1 High levels of distress have also been seen among school students after the 1995 bombing of the Murrah Building in Oklahoma City2 and in the Israeli population as a consequence of the ongoing intifada.3 Not surprisingly, those most exposed to an attack show the highest levels of distress, but after 11 September emotional reactions were noted across the US and as far away as Italy.4 5
Emotional reactions to terrorist incidents vary. Some people develop well recognised psychiatric disorders such as depression or post-traumatic stress disorder. Others, while not meeting the criteria for a formal psychiatric diagnosis, still report higher levels of general anxiety or stress related symptoms. Still others report no psychiatric symptoms but show considerable changes in their behaviour6 or their feelings about the future.3
After the attacks on 7 July, many commentators said that terrorism would have a reduced emotional impact on Londoners because of the city's history of dealing with IRA terrorism and the Blitz.7 It has also been argued that Londoners were not unprepared for these attacks: British politicians and security officials have warned on many occasions that acts of terrorism in London were probable, if not inevitable, and British preparations for terrorism have extended to sending a leaflet to every household in the country in August 2004, providing advice about what to do in the event of a major incident.8 Whether these experiences and preparations served to minimise the short term psychological effects of the recent attacks remains to be seen.
We surveyed a representative sample of Londoners to assess levels of distress and altered travel intentions after the terrorist attacks on 7 July. This survey will also serve as a baseline for a planned follow-up of this sample in six months' time. We also investigated several potential correlates of distress, including demographic variables, level of exposure, previous experience of terrorism, and uncertainty about the safety of others.
Methods
Market and Opinion Research International (MORI) conducted a telephone survey by using a random digit dialling method for all London telephone numbers. The survey used proportional quota sampling, a standard method for opinion polls that entails setting quotas for participants on a range of demographic factors and ensures that the sample interviewed is representative of the population of interest. In this survey, we set quotas with regard to sex, age, working status, residential location, housing tenure, and ethnicity to make our sample representative of the demographic distribution of London as shown in the most recent census data.
We invited people aged 18 or over and who spoke English to participate in an interview about "issues facing Londoners." The 20 minute interviews took place in the evenings from Monday 18 July to Wednesday 20 July 2005 and were completed before a second failed attack on London's transport network on Thursday 21 July.
A power calculation showed that a sample size of 1000 would provide us with a 95% confidence interval of –3% to 3% for our data.
Primary outcomes
We measured two primary outcomes. Firstly, we assessed whether "as a result of the London bombings," participants had experienced substantial stress, defined as responding "quite a bit" or "extremely" to one or more of five symptoms (see table 1 for wording). Other possible responses were "not at all," "a little bit," and "moderately." This measure was identical to that used in a similar study of the impact of the 11 September attacks on the adult US population.1 Secondly, we assessed whether, once the transport system had returned to normal, the participant intended to travel "more often," "less often," or "no difference" with regard to tubes, trains, buses, or travelling into central London. We excluded people who did not normally travel by these means for the relevant items. For comparison, we also asked about travel intentions concerning cars and travel elsewhere in the UK.
Table 1 Prevalence of stress among a representative sample of Londoners after the bombings on 7 July 2005. Values are numbers (percentages) of respondents unless otherwise indicated
Secondary outcomes
Secondary outcomes included sense of safety for self and friends or relatives, which we measured by using items identical to those used in a survey of reactions to terrorism in Israel,3 perceived likelihood of another attack on London in "the near future," current sense of safety on a four point scale from "very safe" to "very unsafe" when travelling by tube, train, bus, car, into central London, or elsewhere in the UK, and self efficacy for coping with terrorism.3 Participants were also asked whether they had talked to someone about their thoughts and feelings regarding the bombings on a four point scale from "a great deal" to "not at all," whether they had spoken to any mental health specialist since the bombings, whether they felt they needed to speak to a mental health specialist, and whether they had spoken to a religious leader or adviser.
Respondents with children in a London school on 7 July were asked whether they had attempted to check on their children's safety and whether they went to the school earlier than usual to see or collect their children. All participants were asked whether they had attempted to check the safety of immediate friends and family on the day.
Predictor measures
Demographic predictor variables consisted of all variables used to define the sampling quotas, together with having children under 18, religion, household income, and social class.9 A single item measured whether the participant was in central London when he or she first heard about the explosions. We also measured exposure by using four items assessing whether the participant felt he or she might have been injured or killed, a friend or relative might have been injured or killed, they saw someone who was injured or killed, or a close friend or family member was injured or killed. These categories were not mutually exclusive.
Two items, which we combined for the analyses, inquired whether participants had previously been involved in a real terrorist incident or a false alarm about terrorism. We also asked whether the participant had received and read the government leaflet concerning emergency preparedness.
We asked "how sure or unsure were you about the safety or whereabouts of any close friends or relatives who might have been in central London" to assess uncertainty over the safety of others on a four point scale from "very sure" to "very unsure." We also asked participants whether they had attempted to contact anybody by mobile phone and, if they had attempted to contact two or more people, how easy that had been on a four point scale from "very difficult" to "very easy."
Analysis
Because quota sampling rarely achieves a sample that is exactly representative of the target population, we first weighted our data in order to improve its representativeness. We calculated weights on the basis of the disparity between the demographic distribution achieved and the known demographic distribution of London and applied these to individual participants according to their demographic profile. In practice, because our quota sampling worked well, the effects of this weighting were small. Weighted and unweighted data are available from the authors on request.
We calculated univariate odds ratios to assess the association between each predictor variable and substantial stress or reduced travel intentions. We used logistic regressions to calculate a second set of odds ratios controlling for the role of age, sex, and social class—common confounders for psychological distress. We also calculated odds ratios to assess the association of reduced sense of safety while travelling and presence of substantial stress with travel intentions. We calculated all odds ratios separately for each variable. As such they are not independent of each other.
Results
We contacted 11 072 people, of whom 1059 were ineligible or over quota with regard to their demographics. Of the 10 013 eligible respondents, 1207 agreed to participate and 1010 completed the interview (10.1%). This response rate is not unusually low for a telephone survey using quota sampling. Furthermore, given that response rates are not as valid an indication of non-participation in quota surveys as they are in random probability surveys, this figure should be taken as indicative only. We did not record reasons for non-participation. However, of the 197 people who started an interview but withdrew before completion, 21 were unhappy discussing the bombings, 8 did not believe the survey was relevant, 64 did not have time to continue, 36 refused to supply a reason, and 68 were dropped for technical or other reasons.
Responses to the primary outcomes are given in tables 1 and 2. Thirty one per cent of the sample reported substantial stress, and 32% reported that once the London transport system had returned to normal they intended to travel less by at least one of the methods asked about. Tables 3 and 4 show data for the secondary outcomes.
Table 2 Alterations in travel intentions after the bombings on 7 July among a representative sample of Londoners.* Values are numbers (percentages) of respondents
Table 3 Immediate responses to the 7 July bombings among a representative sample of Londoners
Table 4 Perceived sense of safety, self efficacy, and need to talk to someone about emotions among a representative sample of Londoners after the bombings on 7 July 2005
When we controlled for age, sex, and social class where applicable, the following were significant correlates of substantial stress (see table 5 for comparison groups): being female; being from social class D or E; not owning your own home; being nonwhite, Muslim, or from another faith; having a household income of less than ￡30 000; believing that you or a close friend or relative might have been injured or killed; having a close friend or relative who was injured or killed; having no previous experience of terrorism; being unsure about the safety of others; and having had difficulty reaching people by mobile phone. In addition, Muslims reported significantly more stress than people of other faiths.
Table 5 Predictors of the presence of substantial distress after the bombings in London on 7 July 2005
Similarly, the following showed significant associations with reduced intention to travel by either tube, train, bus or into central London (see table 6 for comparison groups): being female, being younger, being non-white, being religious, having a household income of less than ￡30 000, believing that you or a close friend or relative might have been injured or killed, having a close friend or relative who was injured or killed, not having read the government advice leaflet, having been unsure about the safety of others, having substantial stress, and feeling unsafe while travelling.
Table 6 Predictors of altered travel intentions after the bombings in London on 7 July 2005
Discussion
Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med 2001;345: 1507-12.
Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, et al. Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing. Am J Psychiatry 1999;156: 1069-74.
Bleich A, Gelkopf M, Solomon Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 2003;2003: 612-20.
Silver RC, Holman EA, McIntosh DN, Poulin M, Gil-Rivas V. Nationwide longitudinal study of psychological responses to September 11. JAMA 2002;288: 1235-44.
Apolone G, Mosconi P, La Vecchia C. Post-traumatic stress disorder. N Engl J Med 2002;346: 1495-8.
Grieger TA, Fullerton CS, Ursano RJ, Reeves JJ. Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks. Psychiatr Serv 2003;54: 1383-7.
London under attack. Economist 2005 July 9; 9.
HM Government. Preparing for emergencies. What you need to know. www.preparingforemergencies.gov.uk (accessed 19 Aug 2005).
Market and Opinion Research International (MORI). How to use surveys in management decision. www.mori.com/pubinfo/pfh/how-to-use-surveys-in-management-decision.shtml (accessed 22 Aug 2005).
Wessely S. Don't panic! Short and long term psychological reactions to the new terrorism: the role of information and the authorities. J Mental Health 2005;14: 1-6.
Meltzer H, Gill B, Petticrew M, Hinds K. The prevalence of psychiatric morbidity among adults living in private households. London: HMSO, 1995.
Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B, et al. Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med 2004;34: 1543-51.
North CS, Nixon SJ, Shariat W, Mallonee S, McMillen JC, Spitznagel EL, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA 1999;282: 755-62.
Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, et al. Psychological reactions to terrorist attacks. Findings from the national study of Americans' reactions to September 11. JAMA 2002;288: 581-8.
Greenberg N, Thomas SL, Iversen A, Unwin C, Hull L, Wessely S. Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment. J Mental Health 2003;12: 565-73.
Rose S, Bisson J, Wessely S. A systematic review of single-session psychological interventions (`debriefing') following trauma. Psychother Psychosom 2003;72: 176-84.(G James Rubin, research fellow1, Chris R)
Correspondence to: G James Rubin g.rubin@iop.kcl.ac.uk
Objectives To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population.
Design A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions.
Setting Interviews took place between 18 and 20 July.
Participants 1010 participants (10% of the eligible people we contacted) completed the interviews.
Main outcome measures Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal.
Results 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks.
Conclusions Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners.
The terrorist attacks on central London's transport network on 7 July 2005 caused 52 fatalities and some 700 injuries. The psychological effects of the attacks remain unknown. Shortly after the attacks in the United States on 11 September 2001, about 90% of the residents of New York City and Washington DC reported symptoms of stress, with 44% reporting substantial symptoms.1 High levels of distress have also been seen among school students after the 1995 bombing of the Murrah Building in Oklahoma City2 and in the Israeli population as a consequence of the ongoing intifada.3 Not surprisingly, those most exposed to an attack show the highest levels of distress, but after 11 September emotional reactions were noted across the US and as far away as Italy.4 5
Emotional reactions to terrorist incidents vary. Some people develop well recognised psychiatric disorders such as depression or post-traumatic stress disorder. Others, while not meeting the criteria for a formal psychiatric diagnosis, still report higher levels of general anxiety or stress related symptoms. Still others report no psychiatric symptoms but show considerable changes in their behaviour6 or their feelings about the future.3
After the attacks on 7 July, many commentators said that terrorism would have a reduced emotional impact on Londoners because of the city's history of dealing with IRA terrorism and the Blitz.7 It has also been argued that Londoners were not unprepared for these attacks: British politicians and security officials have warned on many occasions that acts of terrorism in London were probable, if not inevitable, and British preparations for terrorism have extended to sending a leaflet to every household in the country in August 2004, providing advice about what to do in the event of a major incident.8 Whether these experiences and preparations served to minimise the short term psychological effects of the recent attacks remains to be seen.
We surveyed a representative sample of Londoners to assess levels of distress and altered travel intentions after the terrorist attacks on 7 July. This survey will also serve as a baseline for a planned follow-up of this sample in six months' time. We also investigated several potential correlates of distress, including demographic variables, level of exposure, previous experience of terrorism, and uncertainty about the safety of others.
Methods
Market and Opinion Research International (MORI) conducted a telephone survey by using a random digit dialling method for all London telephone numbers. The survey used proportional quota sampling, a standard method for opinion polls that entails setting quotas for participants on a range of demographic factors and ensures that the sample interviewed is representative of the population of interest. In this survey, we set quotas with regard to sex, age, working status, residential location, housing tenure, and ethnicity to make our sample representative of the demographic distribution of London as shown in the most recent census data.
We invited people aged 18 or over and who spoke English to participate in an interview about "issues facing Londoners." The 20 minute interviews took place in the evenings from Monday 18 July to Wednesday 20 July 2005 and were completed before a second failed attack on London's transport network on Thursday 21 July.
A power calculation showed that a sample size of 1000 would provide us with a 95% confidence interval of –3% to 3% for our data.
Primary outcomes
We measured two primary outcomes. Firstly, we assessed whether "as a result of the London bombings," participants had experienced substantial stress, defined as responding "quite a bit" or "extremely" to one or more of five symptoms (see table 1 for wording). Other possible responses were "not at all," "a little bit," and "moderately." This measure was identical to that used in a similar study of the impact of the 11 September attacks on the adult US population.1 Secondly, we assessed whether, once the transport system had returned to normal, the participant intended to travel "more often," "less often," or "no difference" with regard to tubes, trains, buses, or travelling into central London. We excluded people who did not normally travel by these means for the relevant items. For comparison, we also asked about travel intentions concerning cars and travel elsewhere in the UK.
Table 1 Prevalence of stress among a representative sample of Londoners after the bombings on 7 July 2005. Values are numbers (percentages) of respondents unless otherwise indicated
Secondary outcomes
Secondary outcomes included sense of safety for self and friends or relatives, which we measured by using items identical to those used in a survey of reactions to terrorism in Israel,3 perceived likelihood of another attack on London in "the near future," current sense of safety on a four point scale from "very safe" to "very unsafe" when travelling by tube, train, bus, car, into central London, or elsewhere in the UK, and self efficacy for coping with terrorism.3 Participants were also asked whether they had talked to someone about their thoughts and feelings regarding the bombings on a four point scale from "a great deal" to "not at all," whether they had spoken to any mental health specialist since the bombings, whether they felt they needed to speak to a mental health specialist, and whether they had spoken to a religious leader or adviser.
Respondents with children in a London school on 7 July were asked whether they had attempted to check on their children's safety and whether they went to the school earlier than usual to see or collect their children. All participants were asked whether they had attempted to check the safety of immediate friends and family on the day.
Predictor measures
Demographic predictor variables consisted of all variables used to define the sampling quotas, together with having children under 18, religion, household income, and social class.9 A single item measured whether the participant was in central London when he or she first heard about the explosions. We also measured exposure by using four items assessing whether the participant felt he or she might have been injured or killed, a friend or relative might have been injured or killed, they saw someone who was injured or killed, or a close friend or family member was injured or killed. These categories were not mutually exclusive.
Two items, which we combined for the analyses, inquired whether participants had previously been involved in a real terrorist incident or a false alarm about terrorism. We also asked whether the participant had received and read the government leaflet concerning emergency preparedness.
We asked "how sure or unsure were you about the safety or whereabouts of any close friends or relatives who might have been in central London" to assess uncertainty over the safety of others on a four point scale from "very sure" to "very unsure." We also asked participants whether they had attempted to contact anybody by mobile phone and, if they had attempted to contact two or more people, how easy that had been on a four point scale from "very difficult" to "very easy."
Analysis
Because quota sampling rarely achieves a sample that is exactly representative of the target population, we first weighted our data in order to improve its representativeness. We calculated weights on the basis of the disparity between the demographic distribution achieved and the known demographic distribution of London and applied these to individual participants according to their demographic profile. In practice, because our quota sampling worked well, the effects of this weighting were small. Weighted and unweighted data are available from the authors on request.
We calculated univariate odds ratios to assess the association between each predictor variable and substantial stress or reduced travel intentions. We used logistic regressions to calculate a second set of odds ratios controlling for the role of age, sex, and social class—common confounders for psychological distress. We also calculated odds ratios to assess the association of reduced sense of safety while travelling and presence of substantial stress with travel intentions. We calculated all odds ratios separately for each variable. As such they are not independent of each other.
Results
We contacted 11 072 people, of whom 1059 were ineligible or over quota with regard to their demographics. Of the 10 013 eligible respondents, 1207 agreed to participate and 1010 completed the interview (10.1%). This response rate is not unusually low for a telephone survey using quota sampling. Furthermore, given that response rates are not as valid an indication of non-participation in quota surveys as they are in random probability surveys, this figure should be taken as indicative only. We did not record reasons for non-participation. However, of the 197 people who started an interview but withdrew before completion, 21 were unhappy discussing the bombings, 8 did not believe the survey was relevant, 64 did not have time to continue, 36 refused to supply a reason, and 68 were dropped for technical or other reasons.
Responses to the primary outcomes are given in tables 1 and 2. Thirty one per cent of the sample reported substantial stress, and 32% reported that once the London transport system had returned to normal they intended to travel less by at least one of the methods asked about. Tables 3 and 4 show data for the secondary outcomes.
Table 2 Alterations in travel intentions after the bombings on 7 July among a representative sample of Londoners.* Values are numbers (percentages) of respondents
Table 3 Immediate responses to the 7 July bombings among a representative sample of Londoners
Table 4 Perceived sense of safety, self efficacy, and need to talk to someone about emotions among a representative sample of Londoners after the bombings on 7 July 2005
When we controlled for age, sex, and social class where applicable, the following were significant correlates of substantial stress (see table 5 for comparison groups): being female; being from social class D or E; not owning your own home; being nonwhite, Muslim, or from another faith; having a household income of less than ￡30 000; believing that you or a close friend or relative might have been injured or killed; having a close friend or relative who was injured or killed; having no previous experience of terrorism; being unsure about the safety of others; and having had difficulty reaching people by mobile phone. In addition, Muslims reported significantly more stress than people of other faiths.
Table 5 Predictors of the presence of substantial distress after the bombings in London on 7 July 2005
Similarly, the following showed significant associations with reduced intention to travel by either tube, train, bus or into central London (see table 6 for comparison groups): being female, being younger, being non-white, being religious, having a household income of less than ￡30 000, believing that you or a close friend or relative might have been injured or killed, having a close friend or relative who was injured or killed, not having read the government advice leaflet, having been unsure about the safety of others, having substantial stress, and feeling unsafe while travelling.
Table 6 Predictors of altered travel intentions after the bombings in London on 7 July 2005
Discussion
Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med 2001;345: 1507-12.
Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, et al. Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing. Am J Psychiatry 1999;156: 1069-74.
Bleich A, Gelkopf M, Solomon Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 2003;2003: 612-20.
Silver RC, Holman EA, McIntosh DN, Poulin M, Gil-Rivas V. Nationwide longitudinal study of psychological responses to September 11. JAMA 2002;288: 1235-44.
Apolone G, Mosconi P, La Vecchia C. Post-traumatic stress disorder. N Engl J Med 2002;346: 1495-8.
Grieger TA, Fullerton CS, Ursano RJ, Reeves JJ. Acute stress disorder, alcohol use, and perception of safety among hospital staff after the sniper attacks. Psychiatr Serv 2003;54: 1383-7.
London under attack. Economist 2005 July 9; 9.
HM Government. Preparing for emergencies. What you need to know. www.preparingforemergencies.gov.uk (accessed 19 Aug 2005).
Market and Opinion Research International (MORI). How to use surveys in management decision. www.mori.com/pubinfo/pfh/how-to-use-surveys-in-management-decision.shtml (accessed 22 Aug 2005).
Wessely S. Don't panic! Short and long term psychological reactions to the new terrorism: the role of information and the authorities. J Mental Health 2005;14: 1-6.
Meltzer H, Gill B, Petticrew M, Hinds K. The prevalence of psychiatric morbidity among adults living in private households. London: HMSO, 1995.
Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B, et al. Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med 2004;34: 1543-51.
North CS, Nixon SJ, Shariat W, Mallonee S, McMillen JC, Spitznagel EL, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA 1999;282: 755-62.
Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, et al. Psychological reactions to terrorist attacks. Findings from the national study of Americans' reactions to September 11. JAMA 2002;288: 581-8.
Greenberg N, Thomas SL, Iversen A, Unwin C, Hull L, Wessely S. Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment. J Mental Health 2003;12: 565-73.
Rose S, Bisson J, Wessely S. A systematic review of single-session psychological interventions (`debriefing') following trauma. Psychother Psychosom 2003;72: 176-84.(G James Rubin, research fellow1, Chris R)