Judith P. Andersen

Terrorism, Acute Stress, and Cardiovascular Health: A 3-Year National Study Following the September 11th Attacks

CONTEXT The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample. OBJECTIVE To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years. DESIGN, SETTING, AND PARTICIPANTS A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks. MAIN OUTCOME MEASURES Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks. RESULTS Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years). CONCLUSION Using health data collected before 9/11 as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks.

Mental- and Physical-Health Effects of Acute Exposure to Media Images of the September 11, 2001, Attacks and the Iraq War

Millions of people witnessed early, repeated television coverage of the September 11 (9/11), 2001, terrorist attacks and were subsequently exposed to graphic media images of the Iraq War. In the present study, we examined psychological- and physical-health impacts of exposure to these collective traumas. A U.S. national sample (N = 2,189) completed Web-based surveys 1 to 3 weeks after 9/11; a subsample (n = 1,322) also completed surveys at the initiation of the Iraq War. These surveys measured media exposure and acute stress responses. Posttraumatic stress symptoms related to 9/11 and physician-diagnosed health ailments were assessed annually for 3 years. Early 9/11- and Iraq War–related television exposure and frequency of exposure to war images predicted increased posttraumatic stress symptoms 2 to 3 years after 9/11. Exposure to 4 or more hr daily of early 9/11-related television and cumulative acute stress predicted increased incidence of health ailments 2 to 3 years later. These findings suggest that exposure to graphic media images may result in physical and psychological effects previously assumed to require direct trauma exposure.

Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample

Background Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences. Purpose To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults. Methods Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071). Results Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers. Conclusions Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.

Applying Resilience Promotion Training Among Special Forces Police Officers.

Police Special Forces (a.k.a. special weapons and tactics [SWAT]) officers are tasked with responding to the most critical situations, including incidents that require specialized skills and equipment beyond typical policing activities. In this study, we tested the feasibility of applying Arnetz and colleagues’ resilience promotion training that was developed for patrol officers to SWAT team officers (n = 18). The resilience promotion training program included psychoeducation focused on police stress and resilience, and the practice of resilience promotion techniques (controlled breathing and imagery) while listening to audio-recorded critical incident scenarios. The aims of this study were to (a) examine if a resilience training program was relevant and accepted by SWAT team officers and (b) assess participants’ physiological stress responses (heart rate, respiration) during the resilience training sessions to note if there were improvements in stress responding over time. Our findings revealed that participants were able to significantly reduce their average heart rate and improve their ability to engage in controlled respiration (i.e., breathing) during simulated critical incidents over the course of the 5-day training. Improvements in stress responding were observed even when the critical incident scenarios became more graphic. Results suggest that an intervention to reduce stress responses of SWAT officers to critical incident scenarios works in a simulated training setting. Translation of these findings to real-world occupational hazards is a recommended next step.

Lifetime victimization and physical health outcomes among lesbian and heterosexual women.

Background Lifetime victimization experiences, including child sexual abuse (CSA), child physical abuse (CPA), adult sexual assault (ASA), and adult physical assault (APA), are associated with health problems. Purpose To examine relationships between cumulative victimization and physical health among heterosexual and lesbian women and determine whether these relationships differ by sexual identity. Methods Large samples of heterosexual (n = 482) and lesbian women (n = 394) were interviewed. Questions included lifetime victimization experiences and physical health problems. Results Compared to women who reported no childhood victimization, those who reported experiencing both CSA and CPA were 44% more likely to report health problems and women who experienced all four types of victimization (CSA, CPA, APA, ASA) were nearly 240% as likely to report physical health problems. Interaction analyses revealed the association between victimization and physical health did not differ by sexual identity. Conclusions Although lesbians were more likely to report all types of victimization, results suggest that victimization conferred increased physical health risks regardless of sexual identity.

The Association Between Bullying and Physical Health Among Gay, Lesbian, and Bisexual Individuals

Background: Research suggests that lesbian, gay, and bisexual (LGB) populations experience higher prevalence of school bullying than heterosexuals. Objectives: We examined if (a) verbal versus physical bullying were differentially associated with physical health among sexual minorities and (b) if sexual identity (i.e., homosexual [i.e., lesbian/gay] vs. bisexual) moderated the association of bullying on physical health. Design: LGB adults aged 18 to 66 years (n = 463) were recruited online. Participants reported high school experiences of verbal and physical bullying and physician-diagnosed health conditions. Results: Physical and verbal bullying were related to physical health conditions (ps < .01). Physical bullying had a significant negative impact on physical health for bisexual persons (p < .001) but not for gay/lesbian persons. Conclusions: Experiencing bullying in high school was associated with physical health problems in adulthood. Bullying had a different relationship with health problems for bisexually identified individuals compared to lesbian/gay individuals. Future research should strive to disentangle potential differences in the relationship between bullying and health within sexual minority groups.

Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual.

Few studies have examined the rates of childhood victimization among individuals who identify as “mostly heterosexual” (MH) in comparison to other sexual orientation groups. For the present study, we utilized a more comprehensive assessment of adverse childhood experiences to extend prior literature by examining if MH individuals’ experience of victimization more closely mirrors that of sexual minority individuals or heterosexuals. Heterosexual (n = 422) and LGB (n = 561) and MH (n = 120) participants were recruited online. Respondents completed surveys about their adverse childhood experiences, both maltreatment by adults (e.g., childhood physical, emotional, and sexual abuse and childhood household dysfunction) and peer victimization (i.e., verbal and physical bullying). Specifically, MH individuals were 1.47 times more likely than heterosexuals to report childhood victimization experiences perpetrated by adults. These elevated rates were similar to LGB individuals. Results suggest that rates of victimization of MH groups are more similar to the rates found among LGBs, and are significantly higher than heterosexual groups. Our results support prior research that indicates that an MH identity falls within the umbrella of a sexual minority, yet little is known about unique challenges that this group may face in comparison to other sexual minority groups.

A Training Method to Improve Police Use of Force Decision Making

Police safety and use of force decisions during critical incidents are an ongoing source of concern for both police practitioners and the public. Prior research in the area of police performance reveals that psychological and physiological stress responses during critical incidents can shape the outcome of the incident, either positively or negatively. The goal of this study was to test a training method to improve use of force decision making among police. This randomized controlled pilot study consisted of training officers to apply techniques to enhance psychological and physiological control during stressful critical incidents. Of a pool of 80 police officers, potential participants were invited based on equivalent age, years of experience, physiological characteristics (i.e., body mass index [BMI] and cardiovascular reactivity), and expertise. Results revealed that the intervention group displayed significantly better physiological control, situational awareness, and overall performance, and made a greater number of correct use of force decisions than officers in the control group (all ps < .01). The relevant improvements in use of force decision-making found in this pilot study indicate that this training method warrants further investigation. Improved use of force decision making directly translates into potential lifesaving decisions for police and the civilians they are working with.

Mental Preparedness as a Pathway to Police Resilience and Optimal Functioning in the Line of Duty

The idea of fostering ‘resilience’ among police and military personnel is a topic of growing interest (Andersen et al., 2015a; Cornum, Matthews, & Seligman, 2011; Reivich, Seligman, & McBride, 2011). This topic is particularly timely in light of recent media depictions of questionable use-of-force actions by police and the subsequent public retaliations against the police

Psychological and Physiological Responses following Repeated Peer Death

Objective Undergraduates at a university in the United States were exposed – directly and indirectly – to 14 peer deaths during one academic year. We examined how individual and social factors were associated with psychological (e.g., anxiety, depression, somatization) and physiological (i.e., cortisol) distress responses following this unexpected and repeated experience with loss. Method Two to three months after the final peer death, respondents (N = 122, 61% female, 18–23 years, M = 20.13, SD = 1.14) reported prior adverse experiences, degree of closeness with the deceased, acute responses to the peer deaths, ongoing distress responses, social support, support seeking, and media viewing. A subset (n = 24) returned hair samples for evaluation of cortisol responses during the previous 3 months. Results Ongoing psychological distress was associated with a) prior interpersonal trauma, b) fewer social supports, and c) media exposure to news of the deaths (ps<.05). Participants who had no prior bereavements showed, on average, high cortisol (>25 p/mg) compared to individuals with one or two prior bereavement experiences (who were, on average, within the normal range, 10 to 25 p/mg) (p<.05). Only 8% of the sample utilized available university psychological or physical health resources and support groups. Conclusions Limited research has examined the psychological and physiological impact of exposure to chronic, repeated peer loss, despite the fact that there are groups of individuals (e.g., police, military soldiers) that routinely face such exposures. Prior adversity appears to play a role in shaping psychological and physiological responses to repeated loss. This topic warrants further research given the health implications of repeated loss for individuals in high-risk occupations and university settings.