A study of survivors of the Oklahoma City bombing has found that nearly half developed post-traumatic stress disorder or had other psychiatric illnesses, such as depression or problems with drugs and alcohol.
The researchers said they were surprised by the degree of suffering and hope the results help mental health professionals focus their efforts after disasters.
The study, published in Wednesday's Journal of the American Medical Assn., looked at 182 adults who were inside or just outside the federal building when the bomb went off in 1995, killing 168 people and injuring nearly 700. The survivors were interviewed six months after the blast.
Forty-five percent of those studied were found to suffer illnesses that included chronic depression and drug and alcohol problems.
The biggest single group of survivors--one out of three--had post-traumatic stress disorder, a condition often seen in Vietnam veterans. Its symptoms include flashbacks, angry outbursts and sleep and concentration problems.
The study was conducted by researchers at Washington University, the Oklahoma State Department of Health and the University of Oklahoma Health Sciences.
Bombing survivors have described nightmares, a fear of entering tall buildings, loss of trust, and flashbacks triggered by loud noises.
"I can still smell the smoke," said Martin Cash, a former benefits counselor with the Veterans Administration who lost an eye in the bombing. Once, when his wife was moving furniture at their home, she bumped the wall.
"That big thud, I came unglued," he said.
"Nobody was untouched by this disaster, but different people were touched differently," said Dr. Carol North, a psychiatrist at Washington University's School of Medicine in St. Louis and one of the study's authors. "Human distress is understandable after horrendous events such as this. We should not necessarily equate that with mental illness."
Those with more serious injuries were more prone to develop a disorder, as were those who had a family member seriously injured or killed. Survivors most at risk were those who refused to think about the event and had feelings of isolation and loss of interest in their surroundings.
Recognizing those symptoms immediately after a disaster could help identify those who need the most help, the researchers said.