Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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.
Reissman DB, Arias I, Spotts Whitney EA, Taylor TH. Posttraumatic Stress Among Survivors of Bioterrorism—Reply. JAMA. 2004;292(5):566. doi:10.1001/jama.292.5.566-b
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