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J Urban Health. 2002 September; 79(3): 383–391.
PMCID: PMC3456787

Three-year follow-up of survivors of a mass shooting episode


This report describes a 3-year follow-up study of survivors of a mass shooting incident. Acute-phase and 1-year follow-up data from this incident have been previously reported. The Diagnostic Interview Schedule/Disaster Supplement was used to assess 116 survivors at 1–2 months and again 1 and 3 years later, with an 85% reinterview rate. Examining the course of postdisaster posttraumatic stress disorder (PTSD) and major depression in individuals allowed detailed consideration of remissions and delayed detection of disorders not possible from data presenting overall rates across different time frames. Only about one half of the PTSD cases identified at any time over 3 years were in remission at the 3-year follow-up. Those who did not recover from PTSD diverged from those who recovered at 3 years by reporting increased numbers of symptoms over time, especially avoidance and numbing symptoms. Although women and people with preexisting disorders were at greater risk for the development of PTSD, these variables did not predict chronicity. Chronicity of PTSD was predicted by functional impairment and seeking mental health treatment at baseline. Chronicity of major depression was predicted by report of family history of depression and treatment for paternal alcohol problems. No delayed cases of PTSD were identified. Studies are needed to compare these characteristics of the course of PTSD with other populations, using consistent methodology to allow valid comparison.

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Selected References

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1. Steinglass P, Gerrity E. Natural disasters and posttraumatic stress disorder: short-term versus long-term recovery in two disaster-affected communities. J Appl Soc Psychol. 1990;20:1746–1765. doi: 10.1111/j.1559-1816.1990.tb01509.x. [Cross Ref]
2. Epstein R, Fullerton C, Ursano R. Posttraumatic stress disorder following an air disaster: a prospective study. Am J Psychiatry. 1998;155:934–938. [PubMed]
3. Wang XW, Gao L, Shinfuku N, Zhang H, Zhao C, Shen Y. Longitudinal study of earthquake-related PTSD in a randomly selected community sample in North China. Am J Psychiatry. 2000;157:1260–1266. doi: 10.1176/appi.ajp.157.8.1260. [PubMed] [Cross Ref]
4. Groenjian AK, Steinberg AM, Najarian LM, Fairbanks LA, Tashjian M, Pynoos RS. Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. Am J Psychiatry. 2000;157:911–916. doi: 10.1176/appi.ajp.157.6.911. [PubMed] [Cross Ref]
5. North CS, Smith EM, Spitznagel EL. One-year follow-up of survivors of a mass shooting. Am J Psychiatry. 1997;154:1696–1702. [PubMed]
6. Grace MC, Green BL, Lindy JL, Leonard AC. The Buffalo Creek Disaster: a 14-year follow-up. In: Wilson JP, Raphael B, editors. International Handbook of Traumatic Stress Syndromes. New York: Plenum Press; 1993. pp. 441–449.
7. McFarlane A. The longitudinal course of posttraumatic morbidity: the range of outcomes and their predictors. J Nerv Ment Dis. 1988;176:30–39. doi: 10.1097/00005053-198801000-00004. [PubMed] [Cross Ref]
8. Weisæth L. Post-traumatic stress disorder after an industrial disaster. In: Pichot P, Berner P, Wolf R, Thau K, editors. Psychiatry—the State of the Art. New York: Plenum Press; 1985. pp. 299–307.
9. Green BL, Lindy JD, Grace MC, et al. Buffalo Creek survivors in the second decade: stability of stress symptoms. Am J Orthopsychiatr. 1990;60:43–54. doi: 10.1037/h0079168. [Cross Ref]
10. Johnson SD, North CS, Smith EM. Psychiatric disorders among victims of a courthouse shooting spree: a three-year follow-up study. Commun Ment Health J. 2002;38:181–194. doi: 10.1023/A:1015269521969. [Cross Ref]
11. Robins LN, Helzer JE, Cottler L, Goldring E. NIMH Diagnostic Interview Schedule, Version 3—Revised. St. Louis, MO: Washington University; 1989.
12. North CS, Smith EM, Spitznagel EL. Posttraumatic stress disorder in survivors of a mass shooting. Am J Psychiatry. 1994;151:82–88. [PubMed]
13. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., revised. Washington, DC: APA; 1987.
14. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970;126:983–987. [PubMed]
15. North CS, Nixon SJ, Shariat S, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282:755–762. doi: 10.1001/jama.282.8.755. [PubMed] [Cross Ref]
16. McMillen JC, North CS, Smith EM. What parts of PTSD are normal: intrusion, avoidance, or arousal? Data from the Northridge, California earthquake. J Trauma Stress. 2000;13:57–75. doi: 10.1023/A:1007768830246. [PubMed] [Cross Ref]
17. Ursano RJ, Fullerton CS, Kao T, Bhartiya VR. Longitudinal assessment of posttraumatic stress disorder and depression after exposure to traumatic death. J Nerv Ment Dis. 1995;183:36–42. doi: 10.1097/00005053-199501000-00007. [PubMed] [Cross Ref]

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