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Sandro Galea

Publications and source records attributed to Sandro Galea.

At least 37 records · Page 2Linked to original sources
PubMed2006

PTSD and depression after the Madrid March 11 train bombings.

The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.

Adolescent↗
PubMed2006

Panic reactions to terrorist attacks and probable posttraumatic stress disorder in adolescents.

A number of factors, including subjective reactions and appraisal of danger, influence one's reaction to a traumatic event. This study used telephone survey methodology to examine adolescent and parent reactions to the 2001 World Trade Center attacks 6 to 9 months after they occurred. The prevalence of probable posttraumatic stress disorder (PTSD) in adolescents was 12.6%; 26.2% met study criteria for probable subthreshold PTSD. A probable peri-event panic attack in adolescents was strongly associated with subsequent probable PTSD and probable subthreshold PTSD. This study suggests that the early identification of peri-event panic attacks following mass traumatic events may provide an important gateway to intervention in the subsequent development of PTSD. Future studies should use longitudinal designs to examine the course and pathogenic pathways for the development of panic, PTSD, and other anxiety disorders after exposure to disasters.

Adolescent↗
PubMed2006

Comparison of two widely used PTSD-screening instruments: implications for public mental health planning.

Epidemiological research serves a critical role in public mental health planning in the aftermath of disasters, particularly via estimation of the mental health burden and potential needs of affected communities. However, different measures are used across studies to assess mental health response, making cross-study comparison difficult. The National Women's Study Posttraumatic Stress Disorder module (NWS-PTSD) and PTSD Checklist (PCL) have been among the most widely used measures of PTSD in postdisaster research. Here, the authors used a sample of 233 New York City-area residents who were administered both the NWS-PTSD and PCL 4 months after the September 11, 2001 terrorist attacks. The PCL yielded higher prevalence estimates at the symptom, cluster, and diagnostic levels. Implications for the interpretation of epidemiological data are discussed.

Adult↗
PubMed2006

The impact of resource loss and traumatic growth on probable PTSD and depression following terrorist attacks.

The authors interviewed by phone 2,752 randomly selected individuals in New York City within 6 to 9 months after the attacks of September 11, 2001 on the World Trade Center, and 1,939 of these were reinterviewed at a 12- to 16-month follow-up. It was hypothesized that resource loss would significantly predict probable posttraumatic stress disorder (PTSD) and probable depression since September 11, and that resource loss's impact would be independent of previously identified predictors relating to individuals' demographic characteristics, history of stressful event exposure, prior trauma history, peritraumatic experience, and social support. Second, it was predicted that reported traumatic growth would be related to greater, not lesser, psychological distress. The authors' findings supported their hypotheses for resource loss, but traumatic growth was unrelated to psychological outcomes when other predictors were controlled.

Adolescent↗
PubMed2006

Gender differences in sexual behaviors, sexual partnerships, and HIV among drug users in New York City.

We compared sexual behaviors/partnerships and determined sexual risk correlates associated with HIV by gender among street-recruited drug users using chi-square tests and logistic regression. Men reported higher risk sexual behaviors, yet fewer high-risk sexual partners than women. After adjustment, HIV seropositive men were more likely than seronegatives to be older, MSM, use condoms, and have an HIV-infected partner. HIV seropositive women were more likely to be older, have an HIV-infected partner, and not use non-injected heroin. IDU was not associated with HIV. Prospective studies are needed to determine how gender-specific sexual behaviors/partnerships among drug users affect HIV acquisition.

Adult↗
PubMed2006

The urban environment and sexual risk behavior among men who have sex with men.

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Homosexuality, Male↗
PubMed2006

Community reentry: perceptions of people with substance use problems returning home from New York City jails.

Each year about 100,000 people return to New York City communities from municipal jails. Although about four-fifths report drug or alcohol problems, few have received any formal drug treatment while in jail. Researchers and practitioners have identified a number of policies related to corrections, income, housing, and drug treatment that may be harmful to the successful reintegration of people leaving jail. In order to explore the challenges to successful community reentry, six focus groups and one in-depth interview were conducted with 37 men and women who had been released from jail or prison in the last 12 months. Participants were asked to describe their experiences prior to and immediately following release from jail. Findings suggest that many people leaving jail are not prepared for release and, upon release, face a myriad of obstacles to becoming healthy, productive members of their communities. We discuss the implications of these findings for programs and policies that promote community reintegration of individuals returning from correctional facilities.

Deinstitutionalization↗
PubMed2006

The epidemiology of nonspecific psychological distress in New York City, 2002 and 2003.

The 30-day prevalence of nonspecific psychological distress (NPD) is 3%, nationwide. Little is known about the prevalence and correlates of NPD in urban areas. This study documents the prevalence of NPD among adults in New York City (NYC) using population-based data from the 2002 and 2003 NYC Community Health Surveys (CHS) and identifies correlates of NPD in this population. We examined two cross-sectional random-digit-dialed telephone surveys of NYC adults (2002: N = 9,764; 2003: N = 9,802). Kessler's K6 scale was used to measure NPD. Age-adjusted 30-day prevalence of NPD declined from 6.4% [95% Confidence Interval (CI): 5.8-7.0] in 2002 to 5.1% [95% CI: 4.5-5.6] in 2003. New Yorkers who were poor, in poor health, chronically unemployed, uninsured, and formerly married had the highest prevalence of NPD. Declines occurred among those who were married, white, recently unemployed, and female. NPD prevalence in NYC is higher than national estimates. A stronger economy and recovery from September 11th attacks may have contributed to the 2003 decline observed among selected subgroups. The excess prevalence of NPD may be associated with substantial economic and societal burden. Research to understand the etiology of this high prevalence and interventions to promote mental health in NYC are indicated.

Adolescent↗
PubMed2006

Gender disparities in posttraumatic stress disorder after mass trauma.

BACKGROUND: Although several studies have shown that rates of posttraumatic stress disorder (PTSD) are higher in women than in men, less is known about whether women are more vulnerable to PTSD after a major community-wide traumatic event. OBJECTIVE: The aim of this study was to examine gender disparities in the prevalence of probable lifetime PTSD and probable PTSD after a mass traumatic event. METHODS: A representative sample of men and women living in the New York City metropolitan area was selected using random-digit dialing, and subjects were interviewed by telephone 6 to 9 months after the September 11, 2001 (9/11) terrorist attacks. We assessed probable lifetime PTSD and probable PTSD related to the 9/11 attacks using a brief screening instrument and potential correlates. RESULTS: A total of 2752 individuals (1479 women, 1273 men) were interviewed. The lifetime prevalence of probable PTSD was significantly higher for women than for men (17.2% vs 12.1%; P = 0.005). Experiences of sexual assault (P < 0.001), preexisting mental health problems (P = 0.04), race/ethnicity (P = 0.01), marital status (P < 0.001), and having had probable peri-event panic in the first few hours after the 9/11 attacks (P < 0.001) were all significantly related to women's greater susceptibility to probable lifetime PTSD. However, the prevalence of probable PTSD related to 9/11 was not significantly different between women and men (6.5% vs 5.4%), although women were significantly more likely to report re-experiencing (P < 0.001) and hyperarousal (P < 0.001) symptoms than were men. Women were more likely than men to experience probable peri-event panic during the 9/11 attacks (P < 0.001); this explained, in part, the greater subsequent likelihood of re-experiencing and hyperarousal symptoms among women compared with men. CONCLUSIONS: More factors explain the risk of PTSD among women and men after interpersonal trauma than after a disaster. Using peri-event panic symptomatology after a traumatic event to determine the risk of posttraumatic symptoms may suggest avenues for intervention that can decrease the burden of PTSD in women.

Adult↗
PubMed2006

Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City.

Over the past 30 years, studies have shown that survivors of community-wide disasters suffer from a variety of physical and mental health problems. Researchers also have documented increased substance use in the aftermath of these disasters. In the present study, we examined the relationship between alcohol use and mental health status within the context of the terrorist attacks on the World Trade Center in New York City (NYC). The data for the present report come from a 2-wave panel study of adults living in NYC on the day of the attacks. Wave 1 (W1) and Wave 2 (W2) interviews occurred one year and two years after the attacks, respectively. Overall, 2,368 individuals completed the W1 survey (cooperation rate, 63%) and 1,681 completed the W2 survey (re-interview rate, 71%). The alcohol use variables examined were binge drinking, alcohol dependence, increased days drinking, and increased drinks per day. The outcomes examined included measures of posttraumatic stress disorder (PTSD), major depression, BSI-18-Global Severity and measures of SF12-mental and physical health status. After controlling for demographic, stress, and resource factors, multivariate logistic regressions indicated that all alcohol measures were related to one or more of these outcomes. In particular, binge drinking was related to partial PTSD, while alcohol dependence was associated subsyndromal PTSD, severity of PTSD, depression, BSI-18 global severity, and SF-12 poor mental health status. Increased post-disaster drinking was positively associated with subsyndromal PTSD and negatively associated with SF-12 physical health. We discuss reasons for these results and the negative consequences that heavy alcohol use may have on the postdisaster recovery process.

Adolescent↗
PubMed2006

Antidepressants and youth suicide in New York City, 1999-2002.

OBJECTIVE: To determine the proportion of youth suicides in New York City from 1999 to 2002 in which antidepressants were detected at autopsy. METHOD: This is a medical examiner surveillance study of suicides in New York City among those younger than 18 years of age. The outcome measure is serum toxicology for antidepressants. RESULTS: From 1999 through 2002, there were 41 individuals younger than 18 years of age among residents of New York City who committed suicide. Thirty-six (87.8%) had a serum toxicological analysis and an injury death interval of 3 days or less. There was one (2.8%) suicide in which both bupropion and sertraline were detected at the time of autopsy. Antidepressants were not detected in any of the other youth suicides. CONCLUSIONS: The detection of antidepressants at autopsy was quite rare in youth suicides in New York City from 1999 to 2002.

Adolescent↗
PubMed2006

Risk factors for depression after a disaster.

Environmental stressors such as mass disasters may contribute to an increased prevalence of depression within the population affected. We examined the prevalence of probable major depression and risk factors for depression in the 6-month period after the September 11, 2001, attacks on the World Trade Center among New York City (NYC) metropolitan residents. A total of 2700 persons who were representative of the NYC metropolitan area were included in this cross-sectional telephone survey. The prevalence of probable major depression in the 6 months after the attacks was 9.4%. Multivariate logistic regression covariates associated with the likelihood of probable major depression included being directly affected by the attacks, having a perievent panic attack, experiencing multiple life stressors, and having been exposed to previous traumatic events. Mass traumatic event exposure appears to be an independent environmental risk factor for depression in the postdisaster context; specific reactions such as perievent panic attacks may have prognostic value.

Adolescent↗
PubMed2006

Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack.

Research on adult reactions to potentially traumatic events has focused almost exclusively on posttraumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n= 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.

Adaptation, Psychological↗
PubMed2006

Social context and depression after a disaster: the role of income inequality.

STUDY OBJECTIVE: To examine the association between neighbourhood income inequality and depression, both overall and among those with different levels of income, in the post-disaster context. DESIGN: A representative cross sectional random digit dial telephone survey was conducted. SETTING: New York City (NYC) six months after September 11, 2001. PARTICIPANTS: 1570 respondents were interviewed, of whom 1355 provided residence information permitting their inclusion in this analysis. Past six month depression was assessed using a lay administered instrument consistent with DSM-IV criteria. Income inequality was measured with the Gini coefficient. MAIN RESULTS: The sample was demographically representative of NYC (56.2% female, 35.7% white, 6.3% Asian 24.2% African American, 29.7% Hispanic, and 4.2% other race or ethnicity) and the prevalence of past six month depression was 12.4%. In a final adjusted model, neighbourhood level income inequality was positively associated with depression but this association was not significant (beta = 7.58, p = 0.1). However, among those with low individual income (< 20,000 US dollars) there was a strong significant association between income inequality and depression (beta = 35.02, p<0.01), while there was no association among those with higher income. CONCLUSIONS: In the post-disaster context, neighbourhood level income inequality was associated with depression among persons with lower income; this group may be more socially or economically marginalized and dependent on local resources. Future research should examine potential mechanisms through which income inequality and other features of the social context may affect mental health in the post-disaster context.

Adolescent↗
PubMed2006

Social context and the psychobiology of posttraumatic stress.

A growing body of research is identifying the molecular and genetic correlates of psychopathology and holds tremendous promise in suggesting the biologic mechanisms that may explain emergent posttraumatic stress disorder (PTSD) phenotypes. Another body of research has begun to consider how elements of the social context may influence the risk of PTSD. It is likely that the social context and molecular/genetic factors jointly determine the risk of PTSD and as such scientific inquiry that considers the interrelationship of these factors stands to advance the field. However, there are particular conceptual and methodologic challenges to conducting and designing studies that adequately assess both the social context and the biologic determinants of PTSD. Much of the current research exploring the biology of PTSD is conducted with highly selective samples that were recruited on the basis of strict phenotypic or medical history criteria. In contrast, population-based sampling represents an opportunity to obtain heterogeneous samples that better represent the population distribution of relevant molecular, genotypic, and phenotypic parameters of interest. These sampling strategies also allow researchers to consider the role of the social context and in turn, how the social context influences the molecular determinants of PTSD. An example of our own work illustrates the feasibility of the population-based sampling approach.

Health↗
PubMed2006

Heroin and cocaine dependence and the risk of accidental non-fatal drug overdose.

The relation between illicit drug dependence and the likelihood of drug overdose is unclear. We recruited 1,066 habitual drug users for this analysis through street-based outreach in New York City. In this sample, 99.3% of respondents used heroin in the past year and 87.1% of respondents used cocaine; 819 (77.5%) heroin users and 735 (79.2%) cocaine users were severely dependent on either drug respectively. In multivariable models, among heroin users, persons who were severely heroin dependent were less likely (OR = 0.6; 95% CI = 0.4-0.9) to have overdosed on any drug in the past year; among cocaine users, those who were severely cocaine dependent were more likely (OR = 1.6; 95% CI = 1.0-2.6) to have overdosed in the past year. The relation between illicit drug dependence and risk of overdose may vary for different patterns of drug dependence. These observations suggest that overdose prevention interventions, perhaps even those specifically targeting opiate overdose, may be more efficiently directed at individuals exhibiting cocaine dependence.

Adolescent↗
PubMed2006

Predictors of peritraumatic reactions and PTSD following the September 11th terrorist attacks.

In this study the authors characterize peritraumatic reactions of residents of New York City during and immediately following the September 11th terrorist attacks, identify predictors of those reactions, and identify predictors of PTSD 4 months later. A cross-sectional sample of New York residents (n = 2,001) responded to questions about sociodemographics, historical factors, event-related exposure; acute cognitive, emotional, and physiological reactions to the September 11th terrorist attacks; and current (past month) PTSD symptoms. Factor analyses of peritraumatic reactions yielded three related, but distinct, peritraumatic response patterns - dissociation, emotional reactions, and panic/physiological arousal. Several demographic, historical, and exposure-related variables predicted one or more peritraumatic reaction patterns. After controlling for demographic, historical, and exposure factors, each of the peritraumatic reactions factors, one historical factor and one event-related exposure factor remained as significant predictors of PTSD. These results support a growing literature concerning the predictive value of peritraumatic reactions in relation to PTSD. Implications for preventive efforts and suggestions for future research are discussed.

Acute Disease↗