Children with mass trauma exposure more likely to develop panic disorder

Children exposed to mass trauma were at increased risk for developing panic disorder, according to results of a study that assessed psychiatric effects of the Sept. 11 terrorist attacks on youths.

“While studies of adults have linked individual trauma exposure, including retrospective reports of childhood trauma exposure, to risk [for] panic disorder, few studies have examined whether and to what degree exposure to mass disaster may increase the risk [for] panic disorder among children and adolescents,” Renee D. Goodwin, PhD, MPH, of the department of epidemiology at Columbia University’s Mailman School of Public Health, and colleagues wrote in Journal of Psychiatric Research. “Among adolescents in China, direct witnessing of ‘tragic scenes’ related to an earthquake was associated with panic disorder. Other than witnessing, little is known about different types of trauma exposure, including indirect exposure, and their association with panic disorder.”

In the current study, the researchers aimed to evaluate whether mass trauma event exposure, specifically the World Trade Center terrorist attack on Sept. 11, 2001, was linked to risk for panic disorder among children, variations in panic disorder according to severity of exposure and sociodemographic characteristics and potential interactions of individual and mass trauma exposure in the risk for panic disorder. They analyzed data from 6,991 students in grades six through 12 who participated in a New York City Board of Education post-Sept. 11 needs assessment study, which was an epidemiologic survey study of probable mental disorders among New York City schoolchildren with exposure to the attack. Participants completed the surveys 6 months after the attack. A three-level variable of severe, moderate and mild served as the primary measure of exposure. Goodwin and colleagues defined direct exposure as experiences including having personally witnessed the attack, been hurt in the attack, been in or near the cloud of dust and smoke, been evacuated to safety or been extremely worried about a loved one’s safety. Indirect exposure included experiences such as having a family member killed or injured in the attack or having a family member witness the attack but escaping unharmed. The researchers used the Diagnostic Interview Schedule for Children Predictive Scales to assess past-month probable panic disorder. Further, they used the University of California, Los Angeles Adolescent Trauma Exposure Schedule to assess prior individual trauma exposure, and they included history of severe injury in violent circumstance, having lived through war and additional items specific to then-recent events in New York City.

Results showed an association between severe exposure (adjusted OR = 2; 95% CI, 1.1-3.7) to the Sept. 11 attack and increased risk for probable panic disorder compared with mild exposure. Higher level of exposure to the attack appeared to increase panic disorder prevalence among all sociodemographic strata. Goodwin and colleagues noted an association between prior individual trauma exposure and increased risk for panic disorder (aOR = 2.4; 95% CI, 1.6-2.5); however, they observed no evidence of a link between prior individual trauma exposure and exposure to the Sept. 11 attack.

“From a clinical perspective, these data suggest that children exposed to mass trauma are at increased risk for development of panic disorder, and those with a history of trauma are particularly vulnerable,” the researchers wrote. “Since there are effective treatments for panic disorder, it may be clinically appropriate to focus on panic disorder among children in psychological evaluations and care in the aftermath of a massive traumatic event. Given the increase in both direct and indirect exposure to mass traumas (eg, media exposure) and the association of panic disorder with subsequent psychiatric problems among youth, successful intervention may have long-term implications.”