Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi

Abstract

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8–10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21–65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.

Additional information

Funding

This work was supported by the National Institute of Mental Health under [Grant MH40025], the US Agency for International Development, and Metrocare Services.

Notes on contributors

Josh M. Raitt

Josh Raitt, MTS, STM, is a MSW student at The University of Texas at Arlington and serves as the Research Study Coordinator at the Altshuler Center for Education & Research at Metrocare Services and the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center, both in Dallas, TX. Samuel Thielman, MD, PhD, is an Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Betty Pfefferbaum, MD, JD, is a George Lynn Cross Research Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center College of Medicine in Oklahoma City, Oklahoma. Pushpa Narayanan, DCH, MA, is an alumna of the College of Public Health at the University of Oklahoma Health Sciences Center. Carol North, MD, MPE, is the Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, TX, and the Director of the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, TX, where she holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is a board-certified Professor with tenure.

Samuel B. Thielman

Josh Raitt, MTS, STM, is a MSW student at The University of Texas at Arlington and serves as the Research Study Coordinator at the Altshuler Center for Education & Research at Metrocare Services and the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center, both in Dallas, TX. Samuel Thielman, MD, PhD, is an Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Betty Pfefferbaum, MD, JD, is a George Lynn Cross Research Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center College of Medicine in Oklahoma City, Oklahoma. Pushpa Narayanan, DCH, MA, is an alumna of the College of Public Health at the University of Oklahoma Health Sciences Center. Carol North, MD, MPE, is the Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, TX, and the Director of the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, TX, where she holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is a board-certified Professor with tenure.

Betty Pfefferbaum

Josh Raitt, MTS, STM, is a MSW student at The University of Texas at Arlington and serves as the Research Study Coordinator at the Altshuler Center for Education & Research at Metrocare Services and the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center, both in Dallas, TX. Samuel Thielman, MD, PhD, is an Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Betty Pfefferbaum, MD, JD, is a George Lynn Cross Research Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center College of Medicine in Oklahoma City, Oklahoma. Pushpa Narayanan, DCH, MA, is an alumna of the College of Public Health at the University of Oklahoma Health Sciences Center. Carol North, MD, MPE, is the Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, TX, and the Director of the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, TX, where she holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is a board-certified Professor with tenure.

Pushpa Narayanan

Josh Raitt, MTS, STM, is a MSW student at The University of Texas at Arlington and serves as the Research Study Coordinator at the Altshuler Center for Education & Research at Metrocare Services and the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center, both in Dallas, TX. Samuel Thielman, MD, PhD, is an Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Betty Pfefferbaum, MD, JD, is a George Lynn Cross Research Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center College of Medicine in Oklahoma City, Oklahoma. Pushpa Narayanan, DCH, MA, is an alumna of the College of Public Health at the University of Oklahoma Health Sciences Center. Carol North, MD, MPE, is the Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, TX, and the Director of the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, TX, where she holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is a board-certified Professor with tenure.

Carol S. North

Josh Raitt, MTS, STM, is a MSW student at The University of Texas at Arlington and serves as the Research Study Coordinator at the Altshuler Center for Education & Research at Metrocare Services and the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center, both in Dallas, TX. Samuel Thielman, MD, PhD, is an Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Betty Pfefferbaum, MD, JD, is a George Lynn Cross Research Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma Health Sciences Center College of Medicine in Oklahoma City, Oklahoma. Pushpa Narayanan, DCH, MA, is an alumna of the College of Public Health at the University of Oklahoma Health Sciences Center. Carol North, MD, MPE, is the Medical Director of the Altshuler Center for Education & Research at Metrocare Services in Dallas, TX, and the Director of the Division of Trauma and Disaster in the Department of Psychiatry at The University of Texas Southwestern Medical Center in Dallas, TX, where she holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is a board-certified Professor with tenure.