{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:09:39Z","timestamp":1787008179385,"version":"build-2736575974"},"reference-count":53,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T00:00:00Z","timestamp":1259625600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science"],"published-print":{"date-parts":[[2009,12,1]]},"abstract":"<jats:p>The October 2001 anthrax attacks heralded a new era of bioterrorism threat in the U.S. At the time, little systematic data on mental health effects were available to guide authorities' response. For this study, which was conducted 7 months after the anthrax attacks, structured diagnostic interviews were conducted with 137 Capitol Hill staff workers, including 56 who had been directly exposed to areas independently determined to have been contaminated. Postdisaster psychopathology was associated with exposure; of those with positive nasal swab tests, PTSD was diagnosed in 27% and any post-anthrax psychiatric disorder in 55%. Fewer than half of those who were prescribed antibiotics completed the entire course, and only one-fourth had flawless antibiotic adherence. Thirty percent of those not exposed believed they had been exposed; 18% of all study participants had symptoms they suspected were symptoms of anthrax infection, and most of them sought medical care. Extrapolation of raw numbers to large future disasters from proportions with incorrect belief in exposure in this limited study indicates a potential for important public health consequences, to the degree that people alter their healthcare behavior based on incorrect exposure beliefs. Incorrect belief in exposure was associated with being very upset, losing trust in health authorities, having concerns about mortality, taking antibiotics, and being male. Those who incorrectly believe they were exposed may warrant concern and potential interventions as well as those exposed. Treatment adherence and maintenance of trust for public health authorities may be areas of special concern, warranting further study to inform authorities in future disasters involving biological, chemical, and radiological agents.<\/jats:p>","DOI":"10.1089\/bsp.2009.0031","type":"journal-article","created":{"date-parts":[[2010,7,27]],"date-time":"2010-07-27T09:57:08Z","timestamp":1280224628000},"page":"379-388","source":"Crossref","is-referenced-by-count":28,"title":["Exposure to Bioterrorism and Mental Health Response among Staff on Capitol Hill"],"prefix":"10.1177","volume":"7","author":[{"given":"Carol S.","family":"North","sequence":"first","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Pfefferbaum","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena","family":"Vythilingam","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Schorr","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela S.","family":"Boudreaux","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward L.","family":"Spitznagel","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. Schorr, PhD, is Professor of Sociology,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry A.","family":"Hong","sequence":"additional","affiliation":[{"name":"Carol S. North, MD, MPE, holds the Nancy and Ray L. Hunt Chair in Crisis Psychiatry; is Director of the Program in Trauma and Disaster, Dallas VAMC; and is Professor of Psychiatry and Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas. Betty Pfefferbaum, MD, JD, is the George Lynn Cross Research Professor and holds the Paul and Ruth Jonas Chair, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center; she is also the Director of the Terrorism and Disaster Center of the National Child Traumatic Stress Network, Oklahoma City, Oklahoma. Meena Vythilingam, MD, is Deputy Director, Psychological Health Strategic Operations, Force Health Protection &amp; Readiness, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, Virginia. Gregory J. Martin, MD, is Director, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland. John K. 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