<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2d1 20170631//EN" "JATS-journalpublishing1.dtd">
      <Volume-Issue>Volume 2, Issue 2</Volume-Issue>
      <Season>Aug-Sep 2021</Season>
      <ArticleTitle>Terrorist Attack: The Psychological Response of the Survivors</ArticleTitle>
          <FirstName>K S</FirstName>
      <Abstract>This study explored the socio-economic and psychological impact of terrorist attacks on the lives of survivors. Although several years may have passed since the incident, it will take time t for respondents to recover from the impact. The survivors still have wounds to remind them of the horrific ordeal. They are plagued with psychological problems, and these problems are often more difficult than the problems and pain caused by physical injuries. Most people often experience stress-related psychological symptoms as well as other related symptoms such as sadness, depression, anxiety, inability to focus on daily activities, nightmares, and flashbacks. In addition, terrorist attacks cause serious long-term socio-economic impacts on survivors, including unemployment, uncertainty in children’s education, and deteriorating health. In addition to the deteriorating socio-economic conditions, the most pressing problems faced by this group of survivors are insufficient government support and lack of follow-up actions in rehabilitation. These problems must be addressed urgently and fully. Months after the attack, the use of primary and secondary health services by young survivors emphasized the importance of allocating resources to meet the growing demand for services over a longer period of time. The results further emphasize the need to address the physical symptoms of disaster survivors receiving mental health services. Thus, it is easier to provide costly evidence-based therapies and treatments to affected people in countries with less fragile health systems than in resource-poor settings. It is important to better understand alternative interventions and mechanisms and social options for providing care in the most vulnerable countries, and to develop strategies to use them effectively.</Abstract>
      <Keywords>Terrorism,Victims,Trauma,Psychiatric help,Mental Health,Physical Symptoms,public health system</Keywords>
        <Abstract>https://ejsss.net.in/ubijournal-v1copy/journals/abstract.php?article_id=13286&amp;title=Terrorist Attack: The Psychological Response of the Survivors</Abstract>
        <References>Abenhaim L, Dab W, Salmi LR. 1992. Study of civilian victims of terrorist attacks       (France, 1982–1987). Journal of Clinical Epidemiology 45(2):103–109.&#13;
	American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (Fifth edition. ed.). Arlington, VA: American Psychiatric Association.&#13;
	Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Hinkov, H. R., Hu, C., Huang, Y., Hwang, I., Jin, R., Karam, E. G., Kovess-Masfety, V., Levinson, D., … Kessler, R. C. (2014). Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological medicine, 44(6), 1303–1317. https://doi.org/10.1017/S0033291713001943&#13;
	Asmundson, G. J. G., and; Katz, J. (2009). “Understanding the Co-occurrence of Anxiety Disorders and Chronic Pain: State-of-the-Art,” Depression and Anxiety, 26(10), pp. 888-901.&#13;
	Beaton, R. and; Murphy, S. (2002). Psychosocial responses to biological and chemical terrorist threats andevents: implications for theworkplace. Journal of the American Association of Occupational HealthNurses, 50,182-189.&#13;
	Bilevicius, E., Sommer, J. L., Asmundson, G. J. G., and; El-Gabalawy, R. (2018). “Posttraumatic Stress Disorder and Chronic Pain are Associated with Opioid Use Disorder: Results from a 2012-2013 American Nationally Representative Survey,” Drug and Alcohol Dependence, 188, pp. 119-125. DOI:10.1016/j.drugalcdep.2018.04.005&#13;
	Bisson JI, Deahl MP. 1994. Psychological debriefing and prevention of post-traumatic stress. British Journal of Psychiatry 165:717–720.&#13;
	Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, K. F., Wickramaratne, P., Speelman, L., Ndogoni, L., and; Weissman, M. (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA, 289(23), 3117–3124. https://doi.org/10.1001/jama.289.23.3117&#13;
	Bonanno, G. A., Brewin, C. R., Kaniasty, K., and; Greca, A. M. (2010). Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities. Psychological science in the public interest : a journal of the American Psychological Society, 11(1), 1–49. https://doi.org/10.1177/1529100610387086&#13;
	Bowler RM, Huel D, Mergler G, Cone JE. 1994. Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster. Journal of Traumatic Stress 7:601–624.&#13;
	Burri, A., and; Maercker, A. (2014). Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation. BMC research notes, 7, 407. https://doi.org/10.1186/1756-0500-7-407&#13;
	Charuvastra, A., and; Cloitre, M. (2008). Social bonds and posttraumatic stress disorder. Annual review of psychology, 59, 301–328. https://doi.org/10.1146/annurev.psych.58.110405.085650&#13;
	Chemtob, C. M., Nomura, Y., Josephson, L., Adams, R. E., and; Sederer, L. (2009). Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks. Disasters, 33(3), 337–352. https://doi.org/10.1111/j.1467-7717.2008.01077.x&#13;
	Comer, J., and; Kendall, P. (2007). Terrorism: The psychological impact on youth. Clinical Psychology: Science And Practice, 14(3), 179-212. doi: 10.1111/j.1468-2850.2007.00078.x&#13;
	Dand;uuml;ckers, M. L., and; Brewin, C. R. (2016). A Paradox in Individual Versus National Mental Health Vulnerability: Are Higher Resource Levels Associated With Higher Disorder Prevalence?. Journal of traumatic stress, 29(6), 572–576. https://doi.org/10.1002/jts.22144&#13;
	Dand;uuml;ckers, M. L., Alisic, E., and; Brewin, C. R. (2016). A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. The British journal of psychiatry : the journal of mental science, 209(4), 300–305. https://doi.org/10.1192/bjp.bp.115.176628&#13;
	Dand;uuml;ckers, M., Reifels, L., De Beurs, D. P., and; Brewin, C. R. (2019). The vulnerability paradox in global mental health and its applicability to suicide. The British journal of psychiatry : the journal of mental science, 1–6. Advance online publication. https://doi.org/10.1192/bjp.2019.41&#13;
	Dand;uuml;ckers, M., Ursano, R., and; Vermetten, E. (2020). A Global Perspective on the Mental Health Response to Terrorism. In E. Vermetten, I. Frankova, L. Carmi, O. Chaban, and; J. Zohar (Eds.), Risk Management of Terrorism Induced Stress: Guidelines for the Golden Hours (Who, What and When) (pp. 10-18). (NATO Science for Peace and Security Series). IOS Press. https://doi.org/10.3233/NHSDP200004&#13;
	Eisenberg, N., and; Silver, R. C. (2011). Growing up in the shadow of terrorism: youth in America after 9/11. The American psychologist, 66(6), 468–481. https://doi.org/10.1037/a0024619&#13;
	Evans-Lacko, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Chiu, W. T., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hu, C., Karam, E. G., Kawakami, N., Lee, S., Lund, C., Kovess-Masfety, V., Levinson, D., Navarro-Mateu, F., … Thornicroft, G. (2018). Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychological medicine, 48(9), 1560–1571. https://doi.org/10.1017/S0033291717003336&#13;
	Fayyad, J., Sampson, N. A., Hwang, I., Adamowski, T., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Borges, G., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Hu, C., Karam, E. G., Lee, S., Navarro-Mateu, F., Oand;#39;Neill, S., Pennell, B. E., Piazza, M., Posada-Villa, J., … WHO World Mental Health Survey Collaborators (2017). The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Attention deficit and hyperactivity disorders, 9(1), 47–65. https://doi.org/10.1007/s12402-016-0208-3&#13;
	Gaibulloev,K.and;Sandler,T. (2009).The impact of terrorism and con?icts on growth in Asia. Economics and Politics, 21, 359-383.&#13;
	Galea, S.,Nandi,A.,and;Vlahov,D. (2005).The epidemiology of Post-Traumatic StressDisorder after disasters. Epidemiologic Review, 27,78-91.&#13;
	Glad, K., Stensland, S., and; Dyb, G. (2021). The Terrorist Attack on Utand;oslash;ya Island: Long-Term Impact on Survivors’ Health and Implications for Policy. Perspectives on Terrorism, 15(3), 60-74. Retrieved August 17, 2021, from https://www.jstor.org/stable/27030882&#13;
	Greenberg, J., Simon, L., Pyszczynski, T., Solomon, S., and; Chatel, D. (1992).Terror management and tolerance: does mortality salience always intensify negative reactions to others who threaten one’s world view? Journal of Personality and Social Psychology, 63, 212-220.&#13;
	Gurwitch, R.H., Sitterle, K. S.,Young, B.H., et al (2002) The aftermath of terrorism. In Helping Children Cope with Disasters: Integrating Research and Practice (eds A.M. La Greca and; W.K. Silverman), pp. 327-357. American Psychological Association.&#13;
	Hussain, D., and; Sarma, R. (2016). Socio-economic and psychological effects of terrorist bomb blasts on the lives of survivors. Intervention, 14(3), 189-199. doi: 10.1097/wtf.0000000000000121&#13;
	Institute for Economics and; Peace, Global Terrorism Index 2018: measuring the impact of terrorism, Sidney. (2021). Retrieved 17 August 2021, from https://www.economicsandpeace.org/wp-content/uploads/2020/08/Global-Terrorism-Index-2018.pdf&#13;
	Kar N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric disease and treatment, 7, 167–181. https://doi.org/10.2147/NDT.S10389&#13;
	Kessler, R. C., and; Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual review of public health, 34, 119–138. https://doi.org/10.1146/annurev-publhealth-031912-114409&#13;
	Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J. P., Levinson, D., Navarro-Mateu, F., … Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European journal of psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080/20008198.2017.1353383&#13;
	Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., Ustand;uuml;n, T. B., and; Wang, P. S. (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiologia e psichiatria sociale, 18(1), 23–33. https://doi.org/10.1017/s1121189x00001421&#13;
	Khan,A.M., Sahandi, I.,Hussain, J., Iqbal, S., and;Rizwan,T. (2012). Impact of Terrorism on Mental Health. AnnalsofPakistanInstituteofMedicalSciences,8, 46-49.&#13;
	Kharash AU.(1996) Humanitarian assessment in extreme situations: Ideology, Methodology, Procedure. In: Introduction to practical social psychology, Moscow: Smisl; , p. 86 129.&#13;
	Kizilhan, J. I., and; Noll-Hussong, M. (2018). “Post-Traumatic Stress Disorder Among Former Islamic State Child Soldiers in Northern Iraq,” British Journal of Psychiatry, 213(1), 425-429. doi:10.1192/bjp.2018.88&#13;
	Lippmann, M., Cohen, M. D., and; Chen, L. C. (2015). “Health Effects of World Trade Center (WTC) Dust: An Unprecedented Disaster’s Inadequate Risk Management,” Critical Reviews in Toxicology, 45(6), pp. 492-530. DOI:10.3109/10408444.2015.10446 01&#13;
	Lucchini, R. G., Hashim, D., Acquilla, S., Basanets, A., Bertazzi, P. A., Bushmanov, A., Todd, A. C. (2017). “A Comparative Assessment of Major International Disasters: The Need for Exposure Assessment, Systematic Emergency Preparedness, and Lifetime Health Care,” BMC Public Health, 17(1), p. 46. DOI:10.1186/s12889-016-3939-3&#13;
	Mitchell J. T. (1983). When disaster strikes...the critical incident stress debriefing process. JEMS : a journal of emergency medical services, 8(1), 36–39.&#13;
	Mokdad, A. H., Forouzanfar, M. H., Daoud, F., Mokdad, A. A., El Bcheraoui, C., Moradi-Lakeh, M.,Murray, C. J. (2016). “Global Burden of Diseases, Injuries, and Risk Factors for Young People’s Health During 1990-2013: A Systematic Analysis for the Global Burden of Disease Study 2013,” Lancet, 387(10036), pp. 2383-2401. DOI:10.1016/s0140-6736(16)00648-6&#13;
	National Academy Press. (1999). Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. Washington, D.C.&#13;
	Neria, Y., DiGrande, L., and; Adams, B. G. (2011). Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. The American psychologist, 66(6), 429–446. https://doi.org/10.1037/a0024791&#13;
	Neria, Y., Wickramaratne, P., Olfson, M., Gameroff, M. J., Pilowsky, D. J., Lantigua, R., Weissman, M. M. (2013). “Mental and Physical Health Consequences of the September 11, 2001 (9/11) Attacks in Primary Care: A Longitudinal Study,” Journal of Traumatic Stress, 26(1), pp. 45-55. DOI:10.1002/jts.21767&#13;
	Norris, F. H. (2001). Fifty thousand disaster victims speak: An empirical review of the empirical literature, 1981^2001. Retrieved from: http://obssr.od.nih. gov/pdf/disaster-impact.pdf&#13;
	North,C. S.,Nixon, S. J., Shariat, S.,Mallonee, S., McMillen, J. C., Spitznagel, E. L. , and; Smith, E. M. (1999). Psychiatric disorders among survivors of the Oklahoma   City bombing.JournaloftheAmericanMedical Association, 282,755-762.&#13;
	Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., De Silva, M. J., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., and; Kirkwood, B. R. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet (London, England), 376(9758), 2086–2095. https://doi.org/10.1016/S0140-6736(10)61508-5&#13;
	Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., Bhat, B., Araya, R., King, M., Simon, G., Verdeli, H., and; Kirkwood, B. R. (2011). Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. The British journal of psychiatry : the journal of mental science, 199(6), 459–466. https://doi.org/10.1192/bjp.bp.111.092155&#13;
	Paz Garcand;iacute;a-Vera, M., Sanz, J., and; Gutiand;eacute;rrez, S. (2016). A Systematic Review of the Literature on Posttraumatic Stress Disorder in Victims of Terrorist Attacks. Psychological reports, 119(1), 328–359. https://doi.org/10.1177/0033294116658243&#13;
	Pfefferbaum, B., Seale,T.W.,McDonald,N. B., et al (2000) Posttraumatic stress two years after the Oklahoma City bombing in youths geographically distant fromthe explosion. Psychiatry, 63, 358-370.&#13;
	Pine, D. S., Costello, J., and; Masten, A. (2005). Trauma, proximity, and developmental psychopathology: the effects of war and terrorism on children. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 30(10), 1781–1792. https://doi.org/10.1038/sj.npp.1300814&#13;
	Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., Cahill, L., and; Orr, S. P. (2002). Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological psychiatry, 51(2), 189–192. https://doi.org/10.1016/s0006-3223(01)01279-3&#13;
	Preventing suicide: A global imperative. (2014). Retrieved 17 August 2021, from https://www.who.int/publications-detail-redirect/9789241564779&#13;
	Rahman, A., Hamdani, S. U., Awan, N. R., Bryant, R. A., Dawson, K. S., Khan, M. F., Azeemi, M. M., Akhtar, P., Nazir, H., Chiumento, A., Sijbrandij, M., Wang, D., Farooq, S., and; van Ommeren, M. (2016). Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological Distress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial. JAMA, 316(24), 2609–2617. https://doi.org/10.1001/jama.2016.17165&#13;
	Raphael, B., and; Maguire, P. (2009). Disaster mental health research:Past, present, and future. In Y. Neria, S. Galea, and; F.H. Norris (Eds.), Mental health and disasters (pp. 7–28). New York: Cambridge University Press.&#13;
	Regens, J. L., Schultheiss, A., and; Mould, N. (2015). Regional Variation in Causes of Injuries among Terrorism Victims for Mass Casualty Events. Frontiers in public health, 3, 198. https://doi.org/10.3389/fpubh.2015.00198&#13;
	Ruscio, A. M., Hallion, L. S., Lim, C., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Borges, G., Bromet, E. J., Bunting, B., Caldas de Almeida, J. M., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hinkov, H., Hu, C., de Jonge, P., … Scott, K. M. (2017). Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA psychiatry, 74(5), 465–475. https://doi.org/10.1001/jamapsychiatry.2017.0056&#13;
	Salguero, J.M., Fernand;aacute;ndez-Berrocal, P., Iruarrizaga, I., et al. (2011). “Major Depressive Disorder Following Terrorist Attacks: A Systematic Review of Prevalence, Course and Correlates,” BMC Psychiatry, 11, p. 96.&#13;
	Sandler, T. and; Enders,W. (2008). Economic consequences of terrorism in developed and developing countries: An overview. In: P. Keefer and; N. Loayza (Eds.) Terrorism, Economic Development and Political Openness ( 17-47). Cambridge, UK: Cambridge University Press.&#13;
	Schelling, G., Kilger, E., Roozendaal, B., de Quervain, D. J., Briegel, J., Dagge, A., Rothenhand;auml;usler, H. B., Krauseneck, T., Nollert, G., and; Kapfhammer, H. P. (2004). Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biological psychiatry, 55(6), 627–633. https://doi.org/10.1016/j.biopsych.2003.09.014&#13;
	Schiff, M., Zweig, H. H., Benbenishty, R., and; Hasin, D. S. (2007). Exposure to terrorism and Israeli youthsand;#39; cigarette, alcohol, and cannabis use. American journal of public health, 97(10), 1852–1858. https://doi.org/10.2105/AJPH.2006.090514&#13;
	Shalev AY. 1992. Posttraumatic stress disorder among injured survivors of a terrorist attack: Predictive value of early intrusion and avoidance symptoms. The Journal of Nervous and Mental Disease 180(8):505–509.&#13;
	Shear, M. K. (2015). “Complicated Grief,” The New England Journal of Medicine, 372(2), pp. 153-160 (citation from p. 154). DOI:10.1056/NEJMcp1315618&#13;
	Soldatova GV, Chaiguerova LA, Shliapnikov VN. (2008) The psychological consequences of terrorism: the experience of Beslan. Psychol; 30 (6): 15 26.&#13;
	Stene, L. E., and; Dyb, G. (2015). Health service utilization after terrorism: a longitudinal study of survivors of the 2011 Utand;oslash;ya attack in Norway. BMC health services research, 15, 158. https://doi.org/10.1186/s12913-015-0811-6&#13;
	Thabet, A. M., Thabet, S. S., and; Vostanis, P. (2016). “The Relationship Between War Trauma, PTSD, Depression, and Anxiety Among Palestinian Children in the Gaza Strip,” Health Science Journal, 10(5), p. 1.&#13;
	The National Consortium for the Study of Terrorism and Responses to Terrorism,. (2018, August 27). About START,  Retrieved August 17, 2021, from http://www.start.umd.edu/about/about-start&#13;
	Wang, C. W., Chan, C. L., and; Ho, R. T. (2013). Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987-2011. Social psychiatry and psychiatric epidemiology, 48(11), 1697–1720. https://doi.org/10.1007/s00127-013-0731-x&#13;
	Waxman,D. (2011).Livingwithterror,not living in terror: The impact of chronic terrorism on Israeli society. Perspectives onTerrorism, 5, 4-26.&#13;
	Whalley, M. G., and; Brewin, C. R. (2007). Mental health following terrorist attacks. The British journal of psychiatry : the journal of mental science, 190, 94–96. https://doi.org/10.1192/bjp.bp.106.026427&#13;
	Wu, P., Duarte, C. S., Mandell, D. J., Fan, B., Liu, X., Fuller, C. J., Musa, G., Cohen, M., Cohen, P., and; Hoven, C. W. (2006). Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students. American journal of public health, 96(5), 804–807. https://doi.org/10.2105/AJPH.2004.058925&#13;
	Yehuda, R., and; Hyman, S. E. (2005). The impact of terrorism on brain, and behavior: what we know and what we need to know. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 30(10), 1773–1780. https://doi.org/10.1038/sj.npp.1300817&#13;
	Zinchenko YP, Karabanova OA.(2012) On the road towards a professional community of psychologists: Results of the V Congress of the Russian Psychological Society. J Voprosy Psikhologii; 3: 158 161.&#13;
	Zinchenko YP.(2008) Psychology of Safety and Resistance to Terrorism. In: Zinchenko YP, Petrenko VF, editors. Psychology in Russia: State of the Art, 1, Moscow: MSU, p.81 101. DOI: 10.11621/pir.2008.0006.</References>