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The course of postdisaster psychiatric disorders in directly exposed civilians after the US Embassy bombing in Nairobi, Kenya: a follow-up study



While disasters are common in Africa, disaster studies in Africa are underrepresented in the published literature. This study prospectively examined the longitudinal course of psychopathology, coping, and functioning among 128 directly exposed Kenyan civilian survivors of the 1998 US Embassy bombing in Nairobi.


The Diagnostic Interview Schedule/Disaster Supplement assessed predisaster and postdisaster psychiatric disorders and variables related to coping, functioning, safety, and religion near the end of the first and third postdisaster years.


Total postdisaster prevalence of posttraumatic stress disorder (PTSD) at the 3-year follow-up was 49; 28 % of the sample still had active PTSD. Delayed-onset PTSD was not observed. Posttraumatic symptoms decayed more slowly in individuals with than those without PTSD. PTSD was more prevalent and chronic than major depression. Those with current PTSD or major depression reported more functioning problems than those without. The length of hospitalization for injuries after the bombing predicted major depression remission, but no predictors of PTSD remission were found.


Despite differences in coping and social variables, longitudinal psychopathology in the Nairobi terrorism survivors appeared broadly similar to results in Western disaster populations. These findings contribute to the understanding of disaster mental health in Africa and may have implications for generalizability of psychiatric effects of terrorist attacks around the globe.

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  1. 1.

    Patel V, Sumathipala A (2001) International representation in psychiatric literature: survey of six leading journals. Br J Psychiatry 178:406–409

  2. 2.

    Norris FH et al (2002) 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65(3):207–239

  3. 3.

    Krueger AB, Maleckova J (2009) Attitudes and action: public opinion and the occurrence of international terrorism. Science 325(5947):1534–1536

  4. 4.

    Kim N (2011) How much more exposed are the poor to natural disasters? Global and regional measurement. Disasters 36:195–211

  5. 5.

    Njenga F (2002) Focus on psychiatry in East Africa. Br J Psychiatry 181:354–359

  6. 6.

    Odejide AO, Oyewunmi LK, Ohaeri JU (1989) Psychiatry in Africa: an overview. Am J Psychiatry 146(6):708–716

  7. 7.

    North CS, Pfefferbaum B (2002) Research on the mental health effects of terrorism. JAMA 288(5):633–636

  8. 8.

    Carlson EB (1996) Trauma research methodology. Lutherville, Md.: Sidran. viii, p291

  9. 9.

    McFarlane AC (1988) The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors. J Nerv Ment Dis 176(1):30–39

  10. 10.

    North CS et al (2005) Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry 186:487–493

  11. 11.

    North CS et al (2011) Psychosocial adjustment of directly exposed survivors 7 years after the Oklahoma City bombing. Compr Psychiatry 52(1):1–8

  12. 12.

    North CS (2010) A tale of two studies of two disasters: comparing psychosocial responses to disaster among Oklahoma City bombing survivors and Hurricane Katrina evacuees. Rehabil Psychol 55(3):241–246

  13. 13.

    Meewisse ML et al (2011) The course of mental health disorders after a disaster: predictors and comorbidity. J Trauma Stress 24(4):405–413

  14. 14.

    Norris FH, Friedman MJ, Watson PJ (2002) 60,000 disaster victims speak: part II. Summary and implications of the disaster mental health research. Psychiatry 65(3):240–260

  15. 15.

    Onder E et al (2006) Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES). Soc Psychiatry Psychiatr Epidemiol 41(11):868–874

  16. 16.

    North CS et al (1999) Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA 282(8):755–762

  17. 17.

    North CS et al (2004) The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing. Ann Clin Psychiatry 16(4):209–215

  18. 18.

    North CS, Smith EM, Spitznagel EL (1994) Posttraumatic stress disorder in survivors of a mass shooting. Am J Psychiatry 151(1):82–88

  19. 19.

    Munyandamutsa N, Mahoro Nkubamugisha P, Gex-Fabry M, Eytan A (2012) Mental and physical health in Rwanda 14 years after the genocide. Soc Psychiatry Psychiatr Epidemiol. Springer, Berlin, pp 1–9. doi:10.1007/s00127-012-0494-9. ISSN: 0933-7954

  20. 20.

    Honig RG et al (1993) Portraits of survival. A twenty-year follow-up of the children of Buffalo Creek. Psychoanal Study Child 48:327–355

  21. 21.

    North CS et al (2009) Toward validation of the diagnosis of posttraumatic stress disorder. Am J Psychiatry 166(1):34–41

  22. 22.

    Nemiah JC (1995) A few intrusive thoughts on posttraumatic stress disorder. Am J Psychiatry 152(4):501–503

  23. 23.

    Yehuda R, McFarlane AC (1995) Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. Am J Psychiatry 152(12):1705–1713

  24. 24.

    Rosen GM, Lilienfeld SO (2008) Posttraumatic stress disorder: an empirical evaluation of core assumptions. Clin Psychol Rev 28(5):837–868

  25. 25.

    North CS, Hong BA, Pfefferbaum B (2008) P-FLASH: development of an empirically-based post-9/11 disaster mental health training program. Mo Med 105(1):62–66

  26. 26.

    Breslau N et al (1997) Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 54(11):1044–1048

  27. 27.

    Kessler RC et al (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52(12):1048–1060

  28. 28.

    Perkonigg A et al (2005) Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. Am J Psychiatry 162(7):1320–1327

  29. 29.

    Galea S et al (2002) Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 346(13):982–987

  30. 30.

    Goenjian AK et al (2000) Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. Am J Psychiatry 157(6):911–916

  31. 31.

    Johnson DR et al (2004) Long-term course of treatment-seeking Vietnam veterans with posttraumatic stress disorder: mortality, clinical condition, and life satisfaction. J Nerv Ment Dis 192(1):35–41

  32. 32.

    Hussain A, Weisaeth L, Heir T (2011) Changes in religious beliefs and the relation of religiosity to posttraumatic stress and life satisfaction after a natural disaster. Soc Psychiatry Psychiatr Epidemiol 46(10):1027–1032

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This research was supported by National Institute of Mental Health (NIMH) Grant MH40025 to Dr. North and under Award Number MIPT106-113-2000-020 to Dr. Pfefferbaum from the National Memorial Institute for the Prevention of Terrorism (MIPT) and the Office for Domestic Preparedness, US Department of Homeland Security. Points of view in this document are those of the author(s) and do not necessarily represent the official position of MIPT, the US Department of Homeland Security, the US Department of Veterans Affairs, or NIMH.

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Correspondence to Gus Zhang.

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Zhang, G., North, C.S., Narayanan, P. et al. The course of postdisaster psychiatric disorders in directly exposed civilians after the US Embassy bombing in Nairobi, Kenya: a follow-up study. Soc Psychiatry Psychiatr Epidemiol 48, 195–203 (2013).

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  • Disaster
  • Mental health
  • Posttraumatic stress disorder
  • Bombing