Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: Dr Reissman and colleagues1 found that adult survivors of Bacillus anthracis infection had significantly more psychological symptoms
and reduced quality of life after 6 months than did a comparison group of
patients with sepsis and chronic illness.
We have 2 concerns about this study. First, the authors did not assess
for confounding by posttraumatic stress disorder (PTSD), which is a common
psychological consequence of serious medical conditions, especially life-threatening
illness.2,3 Moreover, PTSD
is a risk factor for physical symptoms following trauma.4 Indeed
Reissman et al stated that PTSD may mediate the poor health outcomes and unresolved
health conditions after traumatic exposures. Second, the authors stated that
they used published studies of long-term sequelae of infectious disease and
chronic conditions to provide a context with which to interpret their findings.1 However, patients exposed to B anthracis not only had an infectious disease, but were also exposed
to bioterrorism, an act of mass violence. Individuals exposed to trauma due
to malicious human intent are more likely to be severely impaired compared
with those exposed to naturally or accidentally occurring disasters.5 We believe that studies of the sequelae of terrorism
would provide a more appropriate context.
Gross R, Neria Y. Posttraumatic Stress Among Survivors of Bioterrorism. JAMA. 2004;292(5):566. doi:10.1001/jama.292.5.566-a