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August 4, 2004

Posttraumatic Stress Among Survivors of Bioterrorism

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(5):566. doi:10.1001/jama.292.5.566-a

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.