Lessons from past wars, terrorist attacks, and wartime hostage experiences regarding risk of subsequent psychiatric...

Review mental health disorders following exposure to war or terrorist related traumas.

Review of studies of the mental health consequences of war, terrorist attacks, and imprisonment for civilians and soldiers.

Following terrorist attacks, those directly exposed or who lost loved ones were at the highest risk for mental disorders. In both military and civilians in war zones, high psychopathology rates were seen, mostly PTSD and major depression, and the latter strikingly persisted for many years after the war. War refugees also show psychopathology developing during and persisting after war. Civilian hostages captured by terrorists and abused military prisoners of war commonly manifest anxiety, depression, and PTSD that persist for many years. Duration of exposure appeared related to rates of depression and PTSD. Suicidal ideation is related to both PTSD and depression and seemed to increase over time in those directly exposed or who have lost loved ones.

The findings show the importance of assessment targeting not only PTSD but also depression more broadly in exposed populations. Assessments and treatment remain required for many years after war or terrorist attack exposure. Given the evolving nature of war and its impact on civilians, future studies should include assessments of traumatic brain injury, nutritional state, infectious diseases, environmental toxins, and other psychiatric disorders, and examine long-term sequelae.