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Disaster Media Coverage and Psychological Outcomes: Descriptive Findings in the Extant Research
Open accessAbstract
This review of the literature on disaster media coverage describes the events, samples, and forms of media coverage (television, newspapers, radio, internet) studied and examines the association between media consumption and psychological outcomes. A total of 36 studies representing both man-made and natural events met criteria for review in this analysis. Most studies examined disaster television viewing in the context of terrorism and explored a range of outcomes including posttraumatic stress disorder (PTSD) caseness and posttraumatic stress (PTS), depression, anxiety, stress reactions, and substance use. There is good evidence establishing a relationship between disaster television viewing and various psychological outcomes, especially PTSD caseness and PTS, but studies are too few to draw definitive conclusions about the other forms of media coverage that have been examined. As media technology continues to advance, future research is needed to investigate these additional media forms especially newer forms such as social media.
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“Recent research provided extensive evidence that indirect exposure is associated with stress symptoms and other psychopathologies comparable to those linked to direct exposure [13,16,23-27].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [16]
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In the citing paper
“A large body of previous research has convincingly established the association between media exposure and symptoms of posttraumatic stress related to various life-threatening stressors, such as war conflicts [9,10], terrorism and other acts of mass violence [11-15], natural disasters [16,17], and recently also the COVID-19 pandemic”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [16]
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Pfefferbaum, B. J., Palka, J. M., & North, C. S. (2021) · Behavioral Sciences · doi:10.3390/bs11030029 · Cited by 9
“In particular, media coverage of the 11 September) attacks generated extensive research on media contact and posttraumatic stress [1,2] with fewer studies focused on depression [2].”
BackgroundInfluentialSelf-citationMapping the Mental Health of Residents After the 2013 Boston Marathon Bombings
Jose, R. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22312 · Cited by 9
Link, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 11
Rosenfield, S., Kato, K., & Smith, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.017 · Cited by 9
Gökçen, O., Karataş, K. S., Akkuş, M., Dönmez, F., Aydoğan, Ç., & Aydoğan, E. (2024) · Turkish Journal of Psychiatry · doi:10.5080/u27483 · Cited by 14
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BackgroundResultInfluentialHorwitz, A. V. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.004 · Cited by 8
Keith, V. M., & Brown, D. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.019 · Cited by 9
Zhang, S., Liu, T., Liu, X., & Chao, M. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00738-1 · Cited by 8
“Moreover, inconsistent with other studies, media content had no direct correlations with depression (e.g., Busso et al., 2014; Pfefferbaum et al., 2014), anxiety (e.”
ResultWell-Being across the Life Course
Mirowsky, J., & Ross, C. E. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.021 · Cited by 8
Gesesew, H. A., Tesfamicael, K., Mwanri, L., Atey, T. M., Gebremedhin, A. T., Gebremariam, K. T., Tesema, A. G., Hailu, S. G., Tesfay, F. H., Mruts, K. B., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.10.075 · Cited by 7
Cho, H., Lee, W., Urban, A. C., Huang, L., & Long, Y. (2021) · Proceedings of the Association for Information Science and Technology · doi:10.1002/pra2.471 · Cited by 7
“Psychological Strain, Media Consumption, and Fiction’s Power Psychological strain may be present in people who are not directly exposed to distressing events, and event-related media consumption may predict traumatic symptoms (Monfort & Afzali, 2017; Pfefferbaum et al., 2014).”
Backgroundvan Antwerpen, N., Turnbull, D. A., & Searston, R. A. (2021) · Psychology Health & Medicine · doi:10.1080/13548506.2021.2008994 · Cited by 7
“Given findings on disaster-related media and mental health, including anxiety and post-traumatic stress (Pfefferbaum et al., 2014), and relationships between information CONTACT Natasha van Antwerpen natasha.vanantwerpen@adelaide.edu.au The University of Adelaide, Hughes North Terrace, Adelaide SA…”
BackgroundPosttraumatic Stress Related to Orlando Nightclub Shooting: LGBTQ Identity and Media Use
First, J. M., Shin, H., Figueroa-Caballero, A., Okker-Edging, K., Spialek, M. L., & Houston, J. B. (2022) · Journal of Loss and Trauma · doi:10.1080/15325024.2022.2116823 · Cited by 7
“…to media coverage of collective traumatic events (such as disasters resulting from natural hazards or human causes) have been found to result in posttraumatic stress reactions for individuals who do and do not experience those events directly (Houston et al., 2018; Pfefferbaum et al., 2014).”
BackgroundInfluentialShould I Help? Prosocial Behaviour during the COVID-19 Pandemic
Wider, W., Lim, M. X., Wong, L. S., Chan, C. K., & Maidin, S. S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192316084 · Cited by 14
“There are several factors that contribute to a community’s resilience; nevertheless, two of them are likely to be substantial benefits of prosocial behaviour [62].”
BackgroundDefining Mental Disorders: Sociological Investigations into the Classification of Mental Disorders
Whooley, O. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.006 · Cited by 7
Orui, M., Nakayama, C., Moriyama, N., Tsubokura, M., Watanabe, K., Nakayama, T., Sugita, M., & Yasumura, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182212048 · Cited by 7
Pfefferbaum, B., Palka, J., & North, C. S. (2022) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2020.227 · Cited by 6
Self-citationSharif, S. P., Naghavi, N., Esmaeelinezhad, O., She, L., Allen, K., Nia, H. S., & Rahmatpour, P. (2025) · BMC Psychology · doi:10.1186/s40359-025-02769-y · Cited by 7
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Terrorist attacks sharpen the binary perception of “Us” vs. “Them”
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Wolfers, L. N., Lüpken, L. M., Schimmel, M., Utz, S., Nabi, R. L., & Gaiser, F. (2024) · Communication Studies · doi:10.1080/10510974.2024.2365068 · Cited by 6
“Conversely, the literature on the effects of viewing television programming about a crisis suggests the opposite (for an overview see Pfefferbaum et al., 2014).”
Terrorism Media Effects in Youth Exposed to Chronic Threat and Conflict in Israel
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Self-citationThe Measurement of Mental Disorder
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Fatah, N. K. A. E., El‐Ashry, A. M., Khedr, M. A., & Ali, S. M. (2025) · International Journal of Mental Health Nursing · doi:10.1111/inm.70082 · Cited by 5
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An Existential Analysis of Responses to the 2020 Coronavirus Outbreak
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Occurrence of the Mass Casualty Incident at a Mass Gathering Event
Peters, G. A., & Goralnick, E. (2024) · Cambridge University Press eBooks · doi:10.1017/9781009105156.024 · Cited by 4
Adolescent’s Mental Health in Context of Indirect Exposure to Terrorism: A Qualitative Study
Younis, S., Jami, H., Riaz, F., & Saleh, W. (2024) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-024-00675-w · Cited by 3
“This was true for not only Post traumatic stress disorder (PTSD) and Post traumatic stress symptoms (PTSS), but also for depression, stress reactions, anger, substance use, negative emotion, and complicated grief (Comer et al., 2016; Pfefferbaum et al., 2014, 2018; Yeung et al., 2018).”
Chan, B. M. C., Schouten, B. C., Boukes, M., Mansueto, A. C., & van Weert, J. C. M. (2024) · Journal of Health Communication · doi:10.1080/10810730.2024.2428973 · Cited by 5
“Using fear appeals may thus be associated with negative consequences on vulnerable populations’ mental health (Ali et al., 2019; Pfefferbaum et al., 2014; Vasterman & Ruigrok, 2013).”
Development and Multinational Validation of the War-related Media Exposure Scale (WarMES)
Fekih‐Romdhane, F., Helmy, M. S., Alhuwailah, A., Shuwiekh, H. A. M., Maalej, E., Naser, A. Y., Obeïd, S., Cheour, M., & Hallit, S. R. (2025) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2025.10149 · Cited by 9
“There is sufficient evidence that war-related media contact carries the potential for negative and long-lasting psychological impacts, 7 – 9 hence the strong need for simple, effective, and economic measurement instruments for specifically measuring this factor.”
Stickley, A., Oh, H. Y., Sumiyoshi, T., Narita, Z. C., Shirama, A., Shin, J. I., & Waldman, K. E. (2020) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13115 · Cited by 4
“It also supports the conclusion of an earlier literature review that there is a relation between disaster media coverage and worse psychological health.(3) Increased media coverage was linked to PE even after controlling for the presence of concurrent mental illness.”
BackgroundResultThe Effects of Exposure to Factors Related to Death in Mental Health
Bolaséll, L. T., Oliveira, V. C. D. C., & Kristensen, C. H. (2021) · Journal of Loss and Trauma · doi:10.1080/15325024.2021.1959854 · Cited by 4
“Previous studies have explored the effects of exposure to media cover of traumatic events, such as disasters and terrorist attacks, pointing to the association between exposure and PTSD, depression and CG (Pfefferbaum et al., 2014).”
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“, 2011); however, previous studies indicate that anxiety is the most recurring psychological problem (Laugharne et al., 2011; Pfefferbaum et al., 2014).”
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Li, H., He, X., Hu, T.-Y., & Xie, X. (2022) · Journal of Health Psychology · doi:10.1177/13591053221105349 · Cited by 4
“…radio) and social media (e.g. Micro-blog, Facebook, WeChat) have been found to be associated with individuals’ behavioral responses during disasters (Asghar et al., 2021, 2022; Pfefferbaum et al., 2014; Seo, 2021), the pathway to which information is delivered may vary (Ren et al., 2021).”
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Carlton, S., Nissen, S., & Wong, J. H. K. (2022) · Media Culture & Society · doi:10.1177/01634437221117502 · Cited by 4
“Media coverage has the potential to have wide-reaching effects for people’s recovery (Pfefferbaum et al., 2014), with positive framing said to provide media audiences with a sense of hope and efficacy in a time of anxiety and despair (Hatfield, 2021; Puente et al., 2019).”
BackgroundWilliams, D. R., Costa, M., & Leavell, J. P. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.018 · Cited by 4
Work and Unemployment as Stressors
Limonic, L., & Lennon, M. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.015 · Cited by 4
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Etterlattes opplevelser av medienes rapportering etter Utøya-terroren
Dyregrov, K., Kristensen, P., & Dyregrov, A. (2016) · Norsk medietidsskrift · doi:10.18261/issn.0805-9535-2016-03-03 · Cited by 4
“Internasjonale og norske studier har vist sammenheng mellom medieeksponering etter terrorangrep og akutte stressreaksjoner, post-traumatiske stressymptomer, komplisert sorg, depresjon, angst, sinne, frykt og fysisk sykdom (Pfefferbaum et al., 2014; Silver et al., 2013).”
BackgroundCultural Diversity and Mental Health Treatment
Woo, B., Walton, E. C., & Takeuchi, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.029 · Cited by 4
Unseen repercussions of war: psychological effects on Jordanians during the Israeli Palestinian war
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“…the vast majority of research proves that the mere exposure to traumatic scenes of the war, whether through news or other social media platforms, is associated with stress, anxiety and depression (Garfin et al., 2022; Kellerman et al., 2022; Malecki et al., 2023; Pfefferbaum et al., 2014).”
Sociological Approaches to Mental Illness
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“…those that take place around the event, such as the severity of trauma exposure, personal loss of beloved ones or material losses, being at the event site, witnessing the destruction and death, or seeing images on the media (Goldmann & Galea, 2014; Pfefferbaum et al., 2014; Pietrzak et al., 2013).”
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“…as anxiety and post-traumatic stress disorder in individuals who have directly experienced disasters, and one review article explaining the relationship between disaster news on the media and posttraumatic stress, depression and anxiety was also found (Kar & Bastia, 2006; Pfefferbaum et al., 2014).”
BackgroundMethodInfluentialWhat Outcomes Should the Study of Mental Health Try to Explain?
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“Increased contact with media coverage 29 and graphic exposure 4 have been identified as predictors of post-traumatic psychological distress.”
BackgroundMarital Status and Mental Health
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Social media smartphone app and psychopathology – A case report
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“”[1] It includes websites such as Facebook, WhatsApp, Twitter, and MySpace, online gaming, virtual worlds like YouTube, blogs, Sims, and so on, which allows repeated and constant interaction mostly among younger generation.”
Mental Illness and the Criminal Justice System
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Begic, P., Greenglass, E. R., Hintsa, T., Karkkola, P., & Buchwald, P. (2023) · Journal of Health Psychology · doi:10.1177/13591053231184065 · Cited by 3
“Previous research has shown that constant thoughts and worries can lead to depression or cognitive interference with one’s work or studies (Pfefferbaum et al., 2014).”
Mental Health in Cross-Cultural Context
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Anxious: Using the Brain to Understand and Treat Fear and Anxiety by Joseph LeDoux
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“Current research associates the development of anxiety symptoms in response to media exposures of disaster and terrorism (Pfefferbaum et al., 2014).”
BackgroundDevelopment and Multinational Validation of the War-related Media Exposure Scale (WarMES)Preprint
Fekih‐Romdhane, F., Helmy, M. S., Alhuwailah, A., Shuwiekh, H. A. M., Maalej, E., Naser, A. Y., Obeïd, S., Cheour, M., & Hallit, S. R. (2023) · Research Square · doi:10.21203/rs.3.rs-3691171/v1 · Cited by 3
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“Furthermore, involvement in especially risky or dangerous social media use, such as being the victim or perpetrator of cyberbullying [24] or cyberstalking [25], or witnessing repeated trauma-based imagery [26], can cause negative mental health consequences.”
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Epilogue: The Three Solitudes of the Sociology of Mental Health
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Trauma-informed group work in social work academia: responding to students’ indirect trauma
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“For example, in their review of 36 studies, Pfefferbaum et al. (2014) examined the association among media exposure from terrorist events and natural disasters and psychological outcomes, finding evidence that disaster television viewing was significantly associated with PTSD caseness and…”
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“These traumas affect a large part of society and constitute an important mental health problem (Pfefferbaum et al., 2014).”
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“…shown that indirect exposure through media to mass violence and traumatic images can also lead to increased risk for mental health morbidity [27], we could find only one study, which examined the relationship between mass violence and PEs among a nationally representative sample of US…”
The HIV-Mental Health Challenge
Walkup, J. T., & Crystal, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.032 · Cited by 2
Mental Health Effects of Media Exposure Following a Natural Disaster
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Building resilience in CTLs: Reflections on practice
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Keeping Employees Safe During Health Crises: The Effects of Media Exposure, HR Practices, and Age
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“Our study assumes such anxiety and other negative psychological outcomes (Houston, 2009; Pfefferbaum et al., 2014) as the given mechanisms and did not directly test for their presence.”
BackgroundCOVID-19 related information seeking: The impact of media on parental concerns
Arnaud, Y., Drouin, O., & Silva, R. B. D. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.977634 · Cited by 3
Zhang, S., Zhang, Y., Xue, D., Zhang, H., Chao, M., & Liu, T. (2023) · Psychiatry Investigation · doi:10.30773/pi.2022.0146 · Cited by 2
Wu, F., Yang, T., Zhang, C., Yu, Y., & Xu, D. (2024) · Journalism Practice · doi:10.1080/17512786.2024.2308524 · Cited by 2
“Previous studies found that media use generally increases negative emotions, such as anxiety and depression in risk situations (Pfefferbaum et al. 2014).”
van Antwerpen, N., Searston, R. A., & Turnbull, D. A. (2021) · doi:10.31234/osf.io/pb9jm · Cited by 2
Pasamón, S. Y. (2024) · Universitat de València eBooks · doi:10.7203/puv-oa-270-6 · Cited by 1
Cho, H., Lee, W., Huang, L.-M. C., & Urban, A. C. (2024) · The Library Quarterly · doi:10.1086/730461 · Cited by 1
“Previous studies in media suggest that audiences ’ consumption of event-related materials may predict their traumatic symptoms (Pfefferbaum et al. 2014; Monfort and Afzali 2017), and pandemic-related media consumption is no exception (Bendau et al. 2020).”
BackgroundDesastres naturales y seguridad de periodistas: una aproximación al caso español
Echarri, O. D., Mardaras, L. I., & González, M. J. C. (2025) · INDEX COMUNICACIÓN · doi:10.62008/ixc/15/02desast · Cited by 1
Risk and Protective Factors of the Media-Transmitted Traumatization During War in Ukraine
Juríčková, V., Adámek, P., Grygarová, D., Jonáš, J., Havlík, M., Horáček, J., & Kesner, L. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2524606 · Cited by 1
“Individuals who consume emotionally intense news, such as graphic images and catastrophic framing, reported persistent distress and intrusive thoughts even months later (Pfefferbaum et al., 2014).”
InfluentialAging in the shadow of war: indirect trauma and resilience among older adults after October 7th
Schorr, A. V., Sasson, T., Starikov, N., Porat, S. B. B., Bazarnik, A., & Arbely, O. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2559373 · Cited by 4
“This group occupies a unique psychosocial position, physically distant yet emotionally proximate, as they consumed extensive media coverage, formed mental representations of the atrocities, and internalized a sense of national vulnerability (Pfefferbaum et al., 2014).”
Maulidar, I. (2025) · Journalism · doi:10.1177/14648849251384495 · Cited by 1
“Pfefferbaum et al. (2014) review evidence that media exposure to disasters can adversely affect mental health, not only among the audience, but among those producing the coverage, pointing to heightened risk of PTSD, depression, and anxiety.”
Zhang, Y., Dang, J., & Ma, Z. (2025) · BMC Psychology · doi:10.1186/s40359-025-03807-5 · Cited by 2
“Research on the impact of disaster media coverage has documented a relationship between the amount of media exposure and psychological outcomes, particularly PTSD symptoms [39, 47].”
Pescosolido, B. A., & Boyer, C. A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.025 · Cited by 1
Salciunaite-Nikonove, L., Žemaitaitytė, M., & Šmigelskas, K. (2023) · Children · doi:10.3390/children11010032 · Cited by 1
“Platforms like Instagram and TikTok may contribute to heightened anxiety from war-related exposure, echoing past instances where media exposure contributed to increased anxiety [28].”
BackgroundCommunity Mental Health Care Organizations
Dobransky, K. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.026 · Cited by 1
The Mental Health Consumers/Survivors Movement in the US
McLean, A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.031 · Cited by 1
Ashraf, A., Shabir, G., Rashid, H. A., & Ghaznavi, Q. U. Z. (2021) · Journal of Business and Social Review in Emerging Economies · doi:10.26710/jbsee.v7i1.1570 · Cited by 1
“Disasters striking in remote areas of the globe have immediate psychological impact on citizens and defensive response towards the occurrences (Pfefferbaum et al., 2014).”
BackgroundIntegrating Service Delivery Systems for Persons with Severe Mental Illness
Cuddeback, G. S., & MORRISSEY, J. P. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.027 · Cited by 1
Tunç, P. (2021) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.892821 · Cited by 6
(2017) · Cambridge University Press eBooks · doi:10.1017/9781316481424.011
Yejin, K., & Lee, K. (2017) · Korean Journal of Child Studies · doi:10.5723/kjcs.2017.38.6.51
“지진, 해일, 홍수, 태풍과 같은 자연재해 는 그 형태에서는 차이를 보이지만 삶의 터전을 붕괴시킴으로 써 아동에게 물리적, 심리적으로 피해를 준다는 공통점을 가 진다(Bokszczanin, 2007; Giannopoulou et al., 2006; Pfefferbaum et al., 2014; Piyasil et al., 2007).”
Özten, E., & Sayar, G. H. (2014) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.5455/cap.20140911104911
Theoretical Perspectives on Mental Health and Illness: Introduction to Part I
Scheid, T. L., & Wright, E. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.003
Preventing Adolescent Suicidal Behavior: Integrating Sociology and Public Health
Crosby, A. E., & Willis, L. A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.030
Watson, D. P., Adams, E. L., & Jackson, J. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.033
The Social Context of Mental Health and Illness: Introduction to Part II
Scheid, T. L., & Wright, E. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.012
Mental Health Systems and Policy: Introduction to Part III
Scheid, T. L., & Wright, E. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.023
Biological Approaches to Psychiatric Disorders: A Sociological Approach
Schwartz, S., & Corcoran, C. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.009
Frissen, T., Coppens, T., Tobback, L., & d’Haenens, L. (2018) · Lirias · doi:10.5117/2018.046.003.005
Metadata
- Authors
- Pfefferbaum, B., Newman, E., Nelson, S. D., Nitiéma, P., Pfefferbaum, R. L., & Rahman, A.
- Affiliations
- University of Oklahoma Health Sciences Center (US)
- University of Tulsa (US)
- Phoenix College (US)
- Corresponding author
- Pfefferbaum, Betty
- Venue
- Current Psychiatry Reports
- Published
- 2014-07-27
- Volume
- 16
- Issue
- 9
- Pages
- 464-464
- ISSN
- 1523-3812 (ISSN-L)
- 1535-1645
- PMC
- PMC4144190
- OpenAlex
- W2148450146
- Cited by
- 230
- References
- 27
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 21 · 2023: 14 · 2022: 26 · 2021: 31 · 2020: 30 · 2019: 14 · 2018: 9 · 2017: 43 · 2016: 6 · 2015: 3 · 2014: 1
- FWCI
- 20.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Psychiatry Reports (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Oklahoma
- National Institute of Mental Health (R25MH070569)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Communication › Public Relations and Crisis Communication
- Social Sciences › Sociology and Political Science › Disaster Management and Resilience
- Keywords
- post-traumatic stress disorder, post-traumatic stress, psychological outcomes, terrorism, media use, depression, anxiety, substance use, natural disasters, man-made disasters, social media
- MeSH terms
- Anxiety, Mental Disorders, Disasters, Fear, Humans, Mass Media, Stress, Psychological
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