Boston Marathon Bombings: High Impact on Kids' Mental Health

Deborah Brauser

June 05, 2014

One year after the bombing at the 2013 Boston Marathon, about 11% of children who attended the 2013 Boston Marathon have likely developed posttraumatic stress disorder (PTSD), new research shows.

A survey of 460 of these young people showed that 10.6% of those who attended the event reported symptoms of PTSD 6 months later, a figure that is comparable with the incidence of PTSD in New York City schoolchildren 6 months after the events of September 11, 2001.

The incidence of PTSD in kids who attended the event was approximately 6 times higher than for children who did not attend the event but who watched television coverage of the attack and subsequent manhunt for the suspected bombers.

Still, children who watched more than 3 hours of televised coverage were more likely to have conduct problems, PTSD symptoms, and total difficulties than those who watched less coverage.

"Clinical efforts must maintain a broadened focus beyond simply youth present at the blasts," write the investigators, led by Jonathan S. Comer, PhD, from the Department of Psychology at Florida International University in Miami.

They add that "it is critical" to monitor and understand how young people adjust after such serious events.

"The study demonstrates that the community responses that follow an attack can also have considerable impact on children's psychological well-being," they note in a release.

The study was published online June 2 in Pediatrics.

Limited Research

"Research has documented the psychosocial toll of terrorism on young people, but most of that work has focused on large-scale attacks, like September 11," report the researchers in a release.

They add that studies on children's reactions to attacks at family events such as the Boston Marathon bombing have been limited.

"Furthermore, the extraordinary postattack interagency manhunt and shelter-in-place warning made for a truly unprecedented experience in its own right for families," they write.

"Understanding the psychological adjustment of Boston-area youth in the aftermath of these events is critical for informing clinical efforts."

For this study, the investigators surveyed 460 parents/caretakers of children between the ages of 4 and 19 years (mean age, 11.8 years) who lived within 25 miles of the attack site or Watertown, Massachusetts. For those with more than 1 child, parents reported on their eldest child's experience.

Demographics showed that 46.7% of the parents reported household incomes of less than $100,000 per year. In addition, 18.3% lived within 5 miles of the attack, and 35% lived within 5 miles of Watertown.

All filled out their 45-minute online surveys during the first 6 months postattack and then received $30 compensation.

The UCLA Reaction Index, Parent-Report Scale was used to measure youth posttraumatic stress, with scores over 37 indicating "likely PTSD." In addition, the Strengths and Difficulties Questionnaire (SDQ) was used to report emotional symptoms, and survey questions were used to determine a total attack exposures tally and a total manhunt exposures tally.

Results shows that 71 of the children attended the marathon and that 51.7% were under the shelter-in-place warning.

Parents of marathon-attending children reported significantly greater posttraumatic stress (P < .001), conduct problems (P = .001), peer problems (P = .04), and total difficulties (P = .03) than parents of those who did not attend the event.

In addition, PTSD was 5.7 times higher for attending vs nonattending young people.

On attack day, 21% of all surveyed children watched more than 3 hours of television coverage. The overall mean average was 1.5 hours of watched coverage.

Only 31% of the surveyed parents reported trying to restrict their children's viewing of attack coverage on event day; 37.7% attempted to restrict television exposure to the manhunt.

Watching televised coverage of the attack was significantly associated with PTSD symptoms (P < .001), as well as conduct problems and total difficulties (both, P < .01).

Prosocial behaviors and positive peer functioning (as shown on SDQ scales) moderated the impact of attack exposure on PTSD symptoms

Manhunt Experiences

Common experiences during the manhunt included being under the shelter-in-place warning, seeing a heavier police presence in the neighborhood than usual, and seeing uniformed service personnel in the neighborhood.

The more extreme experiences significantly associated with PTSD symptoms included hearing manhunt-related gunshots, having an officer enter and search the home, and knowing the slain officer (all, P < .01).

Manhunt and attack exposures each predicted 9% of PTSD symptom variance.

However, exposure to manhunt experiences was "more robustly associated than attack-related exposures" with emotional problems, conduct and peer problems, and hyperactivity/inattention.

"The current study suggests that in the first 6 months after the 2013 Boston Marathon attack and manhunt, there was considerable heterogeneity in attack- and manhunt-related exposures and clinical outcomes," summarize the investigators.

"Although children, on average, showed normative functioning, marathon attendance and many specific…exposures were associated with greater psychopathology across youth," they write.

The researchers note that the results show "how destabilizing terrorism-related experiences" can stretch beyond immediate attack exposure.

"These findings underscore the urgency of connecting affected youth with mental health care," they write.

"Continued research is [now] needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities."

The study authors have reported no relevant financial relationships.

Pediatrics. Published online June 2, 2014. Abstract

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