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Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

The effects of the Omagh bomb on adolescent mental health: a school-based study

Authors: Michael Duffy, Maura McDermott, Andrew Percy, Anke Ehlers, David M Clark, Michael Fitzgerald, John Moriarty

Published in: BMC Psychiatry | Issue 1/2015

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Abstract

Background

The main objective of this study was to assess psychiatric morbidity among adolescents following the Omagh car bombing in Northern Ireland in 1998.

Methods

Data was collected within schools from adolescents aged between 14 and 18 years via a self-completion booklet comprised of established predictors of PTSD; type of exposure, initial emotional response, long-term adverse physical problems, predictors derived from Ehlers and Clark’s (2000) cognitive model, a PTSD symptoms measure (PDS) and the General Health Questionnaire (GHQ).

Results

Those with more direct physical exposure were significantly more likely to meet caseness on the GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previous meta-analyses accounted for 20% of the variance in PDS scores but the amount of variance accounted for increased to 56% when the variables highlighted in Ehlers and Clark’s cognitive model for PTSD were added.

Conclusions

High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilst increased exposure was associated with increased psychiatric morbidity, the best predictors of PTSD were specific aspects of the trauma (‘seeing someone you think is dying’), what you are thinking during the event (‘think you are going to die’) and the cognitive mechanisms employed after the trauma. As these variables are in principle amenable to treatment the results have implications for teams planning treatment interventions after future traumas.
Literature
1.
go back to reference National Institute for Clinical Evidence & National Collaborating Centre for Mental Health NICE. The management of PTSD in adults and children in primary and secondary care. London: Guideline 26; 2005. National Institute for Clinical Evidence & National Collaborating Centre for Mental Health NICE. The management of PTSD in adults and children in primary and secondary care. London: Guideline 26; 2005.
2.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th Ed). Washington, DC; 1994. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th Ed). Washington, DC; 1994.
3.
go back to reference Duffy M, Bolton D, Gillespie K, Ehlers A, Clark DM. A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults. PLoS ONE. 2013;8(9):e76618. doi:10.1371/journal.pone.0076618.CrossRefPubMedPubMedCentral Duffy M, Bolton D, Gillespie K, Ehlers A, Clark DM. A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults. PLoS ONE. 2013;8(9):e76618. doi:10.1371/journal.pone.0076618.CrossRefPubMedPubMedCentral
4.
go back to reference McDermott M, Duffy M, Percy A, Fitzgerald M, Cole C. A school-based study of psychological disturbance in children following the Omagh bomb. Child Adolesc Psychiatr Ment Health. 2013;7:36. doi:10.1186/1753-2000-7-36.CrossRef McDermott M, Duffy M, Percy A, Fitzgerald M, Cole C. A school-based study of psychological disturbance in children following the Omagh bomb. Child Adolesc Psychiatr Ment Health. 2013;7:36. doi:10.1186/1753-2000-7-36.CrossRef
5.
go back to reference Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP. A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev. 2012;32:122–38.CrossRefPubMed Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP. A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev. 2012;32:122–38.CrossRefPubMed
6.
go back to reference McNally R. Assessment of posttraumatic stress disorder in children and adolescents. J Sch Psychol. 1996;34:147–61.CrossRef McNally R. Assessment of posttraumatic stress disorder in children and adolescents. J Sch Psychol. 1996;34:147–61.CrossRef
7.
go back to reference Dalgleish T, Meiser-Stedman R, Smith P. Cognitive aspects of posttraumatic stress reactions and their treatment in children and adolescents: an empirical review and some recommendations. Behav Cogn Psychother. 2005;33:459–86.CrossRef Dalgleish T, Meiser-Stedman R, Smith P. Cognitive aspects of posttraumatic stress reactions and their treatment in children and adolescents: an empirical review and some recommendations. Behav Cogn Psychother. 2005;33:459–86.CrossRef
8.
go back to reference Livingston R. Sexually and physically abused children. J Am Acad Child Adolesc Psychiatry. 1987;26:413–5.CrossRefPubMed Livingston R. Sexually and physically abused children. J Am Acad Child Adolesc Psychiatry. 1987;26:413–5.CrossRefPubMed
9.
go back to reference Wang CW, Chan CLW, Ho RT. Prevalence and trajectory of psychopathology among child and adolescent survivors of disastors: a systematic review of epidemiological studies across 1987–2011. Soc Psychiatry Psychiatr Epidemiol. 2013;38:1697–720.CrossRef Wang CW, Chan CLW, Ho RT. Prevalence and trajectory of psychopathology among child and adolescent survivors of disastors: a systematic review of epidemiological studies across 1987–2011. Soc Psychiatry Psychiatr Epidemiol. 2013;38:1697–720.CrossRef
10.
go back to reference Dyregrov A, Yule W. A review of PTSD in children. Child Adolesc Mental Health. 2006;11:176–84.CrossRef Dyregrov A, Yule W. A review of PTSD in children. Child Adolesc Mental Health. 2006;11:176–84.CrossRef
11.
go back to reference Cox CM, Kenardy JA, Hendrikz JK. A meta-analysis of risk factors that predict psychopathology following accidental trauma. J Spec Pediatr Nurs. 2008;13:98–110.CrossRefPubMed Cox CM, Kenardy JA, Hendrikz JK. A meta-analysis of risk factors that predict psychopathology following accidental trauma. J Spec Pediatr Nurs. 2008;13:98–110.CrossRefPubMed
12.
go back to reference Foy DW, Madvig BT, Pynoos RS, Camilleri AJ. Etiologic Factors in the Development of Posttraumatic stress disorder in children and adolescents. J Sch Psychol. 1996;4:133–45.CrossRef Foy DW, Madvig BT, Pynoos RS, Camilleri AJ. Etiologic Factors in the Development of Posttraumatic stress disorder in children and adolescents. J Sch Psychol. 1996;4:133–45.CrossRef
13.
go back to reference Lavi T, Green O, Dekel R. The contribution of personal and exposure characteristics to the adjustment of adolescents following war. J Adolesc. 2013;36:21–30.CrossRefPubMed Lavi T, Green O, Dekel R. The contribution of personal and exposure characteristics to the adjustment of adolescents following war. J Adolesc. 2013;36:21–30.CrossRefPubMed
14.
go back to reference Pine DS, Cohen JA. Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biol Psychiatry. 2002;51:519–31.CrossRefPubMed Pine DS, Cohen JA. Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biol Psychiatry. 2002;51:519–31.CrossRefPubMed
15.
go back to reference Birrer E, Michael T. Rumination in PTSD as well as in traumatized and non-traumatized depressed patients: a cross-sectional clinical study. Behav Cogn Psychother. 2011;39:381–97.CrossRefPubMed Birrer E, Michael T. Rumination in PTSD as well as in traumatized and non-traumatized depressed patients: a cross-sectional clinical study. Behav Cogn Psychother. 2011;39:381–97.CrossRefPubMed
16.
go back to reference Meiser-Stedman R, Shepperd A, Glucksman E, Dalgleish T, Yule W, Smith P. Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single event trauma. J Child Adolesc Psychopharmacol. 2014;24:47–51.CrossRefPubMedPubMedCentral Meiser-Stedman R, Shepperd A, Glucksman E, Dalgleish T, Yule W, Smith P. Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single event trauma. J Child Adolesc Psychopharmacol. 2014;24:47–51.CrossRefPubMedPubMedCentral
17.
go back to reference Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for post-traumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68:748–66.CrossRefPubMed Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for post-traumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68:748–66.CrossRefPubMed
18.
go back to reference Melzer H, Gatward R, Goodman R, Ford T. Mental health of children and adolescents in Great Britain. London: The Stationary Office; 2000. Melzer H, Gatward R, Goodman R, Ford T. Mental health of children and adolescents in Great Britain. London: The Stationary Office; 2000.
19.
go back to reference Hampel P, Peterman F. Age and gender effects on coping in children and adolescents. J Youth Adolesc. 2005;34:73–83.CrossRef Hampel P, Peterman F. Age and gender effects on coping in children and adolescents. J Youth Adolesc. 2005;34:73–83.CrossRef
20.
go back to reference Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45.CrossRefPubMed Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45.CrossRefPubMed
21.
go back to reference Salmon K, Bryant R. Posttraumatic stress disorder in children. The influence of developmental factors. Clin Psychol Rev. 2002;36:21–30. Salmon K, Bryant R. Posttraumatic stress disorder in children. The influence of developmental factors. Clin Psychol Rev. 2002;36:21–30.
22.
go back to reference Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of post-traumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003;129:52–73.CrossRefPubMed Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of post-traumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003;129:52–73.CrossRefPubMed
23.
go back to reference Perrin S, Smith P, Yule W. Practitioner review: The assessment and treatment of post-traumatic stress disorder in children and adolescents. J Child Psychol Psychiatry. 2000;41:277–89.CrossRefPubMed Perrin S, Smith P, Yule W. Practitioner review: The assessment and treatment of post-traumatic stress disorder in children and adolescents. J Child Psychol Psychiatry. 2000;41:277–89.CrossRefPubMed
24.
go back to reference Ehring T, Ehlers A, Glucksman E. Contribution of cognitive factors to the prediction of posttraumatic stress disorder, phobia and depression after road traffic accidents. Behav Res Ther. 2006;44:1699–716.CrossRefPubMed Ehring T, Ehlers A, Glucksman E. Contribution of cognitive factors to the prediction of posttraumatic stress disorder, phobia and depression after road traffic accidents. Behav Res Ther. 2006;44:1699–716.CrossRefPubMed
25.
go back to reference Ehring T, Ehlers A, Glucksman E. Do cognitive models help in predicting the severity of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. A prospective longitudinal study. J Consult Clin Psychol. 2008;76:219–30.CrossRefPubMedPubMedCentral Ehring T, Ehlers A, Glucksman E. Do cognitive models help in predicting the severity of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. A prospective longitudinal study. J Consult Clin Psychol. 2008;76:219–30.CrossRefPubMedPubMedCentral
26.
go back to reference Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychol Assess. 1997;9:445–51.CrossRef Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychol Assess. 1997;9:445–51.CrossRef
27.
go back to reference Goldberg D, Williams PA. User’s guide to the general health questionnaire. Windsor: NFER; 1988. p. 1988. Goldberg D, Williams PA. User’s guide to the general health questionnaire. Windsor: NFER; 1988. p. 1988.
28.
go back to reference Foa EB, Ehlers A, Clark DM, Tolin DM, Orsillo SM. The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychol Assess. 1999;11:303–14.CrossRef Foa EB, Ehlers A, Clark DM, Tolin DM, Orsillo SM. The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychol Assess. 1999;11:303–14.CrossRef
29.
go back to reference Halligan SL, Michael T, Clark DM, Ehlers A. Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. J Consult Clin Psychol. 2003;71:419–31.CrossRefPubMed Halligan SL, Michael T, Clark DM, Ehlers A. Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. J Consult Clin Psychol. 2003;71:419–31.CrossRefPubMed
30.
go back to reference Michael T, Ehlers A, Halligan S, Clark DM. Unwanted memories of assault: What intrusion characteristics predict PTSD? Behav Res Ther. 2005;43:613–28.CrossRefPubMed Michael T, Ehlers A, Halligan S, Clark DM. Unwanted memories of assault: What intrusion characteristics predict PTSD? Behav Res Ther. 2005;43:613–28.CrossRefPubMed
31.
go back to reference Clohessy S, Ehlers A. PTSD symptoms, response to intrusive memories, and coping in ambulance service workers. Br J Clin Psychol. 1999;38:251–65.CrossRefPubMed Clohessy S, Ehlers A. PTSD symptoms, response to intrusive memories, and coping in ambulance service workers. Br J Clin Psychol. 1999;38:251–65.CrossRefPubMed
32.
go back to reference Murray J, Ehlers A, Mayou RA. Dissociation and posttraumatic stress disorder: Two prospective studies of road traffic accident survivors. Br J Psychiatry. 2002;180:363–8.CrossRefPubMed Murray J, Ehlers A, Mayou RA. Dissociation and posttraumatic stress disorder: Two prospective studies of road traffic accident survivors. Br J Psychiatry. 2002;180:363–8.CrossRefPubMed
33.
go back to reference Broderick PC. Early adolescent gender differences in the use of ruminative and distracting coping strategies. J Early Adolescence. 1998;14:173–91.CrossRef Broderick PC. Early adolescent gender differences in the use of ruminative and distracting coping strategies. J Early Adolescence. 1998;14:173–91.CrossRef
34.
go back to reference Fairbrother G, Stuber J, Galeo S, Fleischman AR, Pfefferbaum B. Posttraumatic stress reactions in New York City children after the September 11, 2001 terrorist attacks. Ambul Pediatr. 2003;3:304–11.CrossRefPubMed Fairbrother G, Stuber J, Galeo S, Fleischman AR, Pfefferbaum B. Posttraumatic stress reactions in New York City children after the September 11, 2001 terrorist attacks. Ambul Pediatr. 2003;3:304–11.CrossRefPubMed
35.
go back to reference Pfefferbaum B, Seale TW, McDonald NB, Brandt Jr EN, Rainwater SM, Maynard BT, et al. Posttraumatic stress two years after the Oklahoma City bombing in youth geographically distant from the explosion. Psychiatry. 2000;63:358–70.CrossRefPubMed Pfefferbaum B, Seale TW, McDonald NB, Brandt Jr EN, Rainwater SM, Maynard BT, et al. Posttraumatic stress two years after the Oklahoma City bombing in youth geographically distant from the explosion. Psychiatry. 2000;63:358–70.CrossRefPubMed
36.
go back to reference Cutler SE, Noelen-Hoeksema S. Accounting for sex differences in depression through female victimization: Childhood sexual abuse. Sex Roles. 1991;24:425–38.CrossRef Cutler SE, Noelen-Hoeksema S. Accounting for sex differences in depression through female victimization: Childhood sexual abuse. Sex Roles. 1991;24:425–38.CrossRef
37.
go back to reference Khamis V. Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries. Soc Sci Med. 2008;67:1199–207.CrossRefPubMed Khamis V. Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries. Soc Sci Med. 2008;67:1199–207.CrossRefPubMed
38.
go back to reference Ma X, Liu X, Hu X, Qiu C, Yingcheng W, Huang Y, et al. Risk indicators for post-traumatic stress disorder in adolescents exposed to the Wenchuan earthquake in China. Psychiatry Res. 2011;189:385–91.CrossRefPubMed Ma X, Liu X, Hu X, Qiu C, Yingcheng W, Huang Y, et al. Risk indicators for post-traumatic stress disorder in adolescents exposed to the Wenchuan earthquake in China. Psychiatry Res. 2011;189:385–91.CrossRefPubMed
39.
go back to reference Hizli FG, Taskintuna N, Isikli S, Kilic C, Zileli L. Predictors of posttraumatic stress in children and adolescents. Child Youth Serv Rev. 2009;31:349–54.CrossRef Hizli FG, Taskintuna N, Isikli S, Kilic C, Zileli L. Predictors of posttraumatic stress in children and adolescents. Child Youth Serv Rev. 2009;31:349–54.CrossRef
40.
go back to reference Stallard P, Smith E. Appraisals and cognitive coping styles associated with chronic post-traumatic symptoms in child road traffic accident survivors. J Child Psychol Psychiatry. 2007;48:194–201.CrossRefPubMed Stallard P, Smith E. Appraisals and cognitive coping styles associated with chronic post-traumatic symptoms in child road traffic accident survivors. J Child Psychol Psychiatry. 2007;48:194–201.CrossRefPubMed
42.
go back to reference Ehlers A, Mayou RA, Bryant B. Cognitive predictors of posttraumatic stress disorder in children: results of a prospective longitudinal study. Behav Res Ther. 2003;41:1–10.CrossRefPubMed Ehlers A, Mayou RA, Bryant B. Cognitive predictors of posttraumatic stress disorder in children: results of a prospective longitudinal study. Behav Res Ther. 2003;41:1–10.CrossRefPubMed
43.
go back to reference Gillespie K, Duffy M, Hackmann A, Clark DM. Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behav Res Ther. 2002;40:345–57.CrossRefPubMed Gillespie K, Duffy M, Hackmann A, Clark DM. Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behav Res Ther. 2002;40:345–57.CrossRefPubMed
44.
go back to reference Duffy M, Gillespie K, Clark DM. Posttraumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomized controlled trial. Br Med J. 2007;334:147–50.CrossRef Duffy M, Gillespie K, Clark DM. Posttraumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomized controlled trial. Br Med J. 2007;334:147–50.CrossRef
45.
go back to reference Smith P, Yule W, Perrin S, Tranagh T, Dalgleish T, Clark DM. Cognitive-behavioural therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2007;46:1051–61.CrossRefPubMed Smith P, Yule W, Perrin S, Tranagh T, Dalgleish T, Clark DM. Cognitive-behavioural therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2007;46:1051–61.CrossRefPubMed
46.
go back to reference Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, et al. Clinical needs assessment of middle and high school Students following the 1995 Oklahoma Bombing. Am J Psychiatr. 1999;156:1069–74.PubMed Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, et al. Clinical needs assessment of middle and high school Students following the 1995 Oklahoma Bombing. Am J Psychiatr. 1999;156:1069–74.PubMed
47.
go back to reference Thabet AAM, Vostanis PV. Post traumatic stress disorder reactions in children of war: A longitudinal study. Child Abuse Negl. 2000;24:291–8.CrossRefPubMed Thabet AAM, Vostanis PV. Post traumatic stress disorder reactions in children of war: A longitudinal study. Child Abuse Negl. 2000;24:291–8.CrossRefPubMed
Metadata
Title
The effects of the Omagh bomb on adolescent mental health: a school-based study
Authors
Michael Duffy
Maura McDermott
Andrew Percy
Anke Ehlers
David M Clark
Michael Fitzgerald
John Moriarty
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0398-9

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