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August 4, 2004

Posttraumatic Stress Among Survivors of Bioterrorism—Reply

Author Affiliations

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

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

In Reply: Drs Gross and Neria seek more information about PTSD among the participants in our study.We point out that the purpose of our study was to assess the physiological relationship between bioterrorism-related anthrax infection and residual health complaints.1 While we did not find evidence to link the persisting health complaints with the anthrax infection or its toxins, the results do indicate that traumatic stress symptoms are prominent and need to be addressed within each survivor's medical, psychiatric, and social system of care. The anthrax survivors most frequently reported high levels of depressive, anxious, obsessive-compulsive, and hostile symptoms. These findings are consistent with those obtained from survivors of criminal assault.2 The 9 survivors (60%) with clinically relevant distress scores on the Symptom Checklist 90-Revised (transformed global severity index scores ≥63) also met screening criteria for possible PTSD derived from the same instrument.3,4 However, this PTSD index was created and validated for use with female survivors of sexual assault. Accordingly, we did not examine this index further because it has unknown validity for participants in our study. We agree that it is important to assess for psychiatric comorbidity in those exposed to traumatic events, including posttraumatic stress, other anxiety, and depressive disorders.