Acute stress disorder in victims after terror attacks in Mumbai, India

In November 2008, 164 people were killed and at least 308 were physically injured in terror attacks on Mumbai, India. ¹ One of the common psychiatric disorders in victims of terror is acute stress disorder. Out of 74 victims admitted to a public hospital, 70 were assessed by a senior psychiatrist (V.P.B.) for the presence of acute stress disorder in the week following hospitalisation. Four patients who were too severely injured were excluded. Victims were directly brought to the hospital because of its proximity to the terror sites or were transferred from other hospitals owing to space, facility and staff (medical/non-medical) constraints.

After obtaining informed consent, patients were individually interviewed and their demographic data (gender, age, address, socioeconomic status (as per B.G. Prasad classification), ² religion, education, marital status and occupation), and details of the injuries sustained (initial gravity score) ³ were recorded. Patients were specifically evaluated for the presence of acute stress disorder using DSM–IV–TR criteria. ⁴ Details of past psychiatric history and family history of psychiatric disorders were also collected. The collected data were then tabulated and analysed using the chi-squared test.

The mean (s.d.) age of the victims was 33.5 (12.95) years. There were 52 males and 18 females. Acute stress disorder was found in 21 (30%) of the 70 victims assessed. Other similar studies on victims of terror attacks have found a prevalence of acute stress disorder varying from 12.5 to 47%. ^5–7 According to Bryant, ⁵ human-caused trauma has higher rates of acute stress disorder. According to Stern ⁸ and Janoff-Bulman, ⁹ this is because the usually indiscriminate and random nature of terrorist attacks create extreme anxiety and helplessness, and destroy individuals' beliefs in their own invulnerability and in the justness of the world.

There were some interesting observations and differences between the patients with and without acute stress disorder on various demographic and clinical variables, although none of the differences reached the level of statistical significance. Acute stress disorder was more common in: females (female, 44.4% v. male, 25.0%); younger victims (<33.5 years, 34.9% v. >33.5 years, 22.2%); victims who were following the Muslim religion (Muslim, 33.3% v. Hindus, 29.6%); residents of Mumbai (residents, 36.6% v. immigrants, 20.7%); divorcees and single victims (divorcees and single, 50.0% and 46.7% v. married and widows, 25.5% and 0%); unemployed (unemployed, 37.5% v. employed, 28.0%); those of low socioeconomic status (low socioeconomic status, 31.7% v. middle socioeconomic status, 20.0%); patients with more than 6.5 years of education (>6.5 years, 39.1% v. ≤6.5 years, 25.5%); and those with severe injury (severe injury, 31.0% v. moderate injury, 25.0%). None of the victims had any past history or family history of any psychiatric disorders.