Carol North

University of Texas Southwestern Medical Center | UT Southwestern · Department of Psychiatry

Introduction Terrorism and trauma survivors often experience changes in biomarkers of autonomic, inflammatory and hypothalamic-pituitary-adrenal (HPA) axis assessed at various times. Research suggests interactions of these systems in chronic stress. Study Objective This unprecedented retrospective study explores long-term stress biomarkers in thre...

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences...

The Oklahoma City bombing in 1995 was one of the most devastating incidents of terrorism in America at that time. Existing research has not examined changes in emotional responses outside of psychopathology to disaster over time. The sample for this study consisted of adult participants randomly selected from a state registry of survivors who were...

Healthcare workers were substantially impacted by the COVID-19 pandemic. Front-line workers continue to suffer higher rates of distress and burnout than they had before the pandemic. In order to heal the front-line workforce and plan for the next disaster in healthcare, it is necessary to carefully reflect on the COVID-19 pandemic and integrate tha...

While the pandemic adversely affected healthcare workers (HCWs) regardless of gender, recent studies suggest that female front-line HCWs experienced substantially more deleterious effects of the pandemic compared to their male counterparts, with higher rates of burnout and psychiatric illness. As a result, turnover and decreased productivity have i...

Many veterans returning to civilian life face medical and mental health issues. As there is a stigma of using mental health services, equine-assisted activities and therapy (EAAT) has been considered a nonconventional intervention to support the mental health and well-being of veterans. In this qualitative study, 14 focus groups with 67 participant...

Objective Much of disaster mental health research uses quantitative methods, focusing on numerical prevalence, services, and outcomes. Methods Qualitative methods can provide more detailed, rich, and spontaneous insights into personal disaster experiences, yielding important insights beyond deductive methods. This large-scale qualitative narrative...

Background: Most research examining first responders of terrorist incidents has been conducted in early post-disaster periods, utilized quantitative research methods, and focused on psychopathology such as post-traumatic stress. Methods: Longitudinal follow-up assessments of 124 workers from 181 baseline volunteer rescue and recovery workers ori...

Introduction: Virtually nothing is known about how thoughts and feelings, coping, and processing of terrorism by survivors of terrorism evolve as decades pass. Qualitative longitudinal studies conducted in future decades of the lives of terrorism survivors through detailed individual narratives can deliver new knowledge about cognitive and emotiona...

Background: After disasters, mental health professionals might be called upon to help address the emotional consequences of the disaster among survivors and other affected groups, but the clinicians themselves could be affected. This exploratory study examined the experiences of 60 mental health professionals, most of whom provided mental health c...

Objective: This study assessed the incidence of and risk factors for prolonged seizures (>180 sec) in electroconvulsive therapy (ECT). Method: In 611 adult patients undergoing 6697 ECT treatments administered over a 2.5-year study period, 29 individuals experienced 42 prolonged seizures. A comparison sample (n = 29) was matched on sex, age, and...

Front-line workers during the Covid-19 pandemic faced inordinate stress levels, as historically high volume and acuity in our hospitals was accompanied by concerns about our safety. We suggest that supporting front-line workers is an essential part of the pandemic response plan. We propose strategies to address the emotional and mental health (MH)...

Background: This study is one of the longest postdisaster prospective longitudinal studies of disaster-related psychopathology, completed nearly a quarter century after a terrorist bombing, and the longest follow-up study ever conducted using full diagnostic assessment in highly exposed disaster survivors. Methods: Oklahoma City bombing survivor...

Background: There is little systematic information about intelligence and academic achievement among sheltered homeless adults. This study adds descriptive data on intelligence and academic achievement, examines discrepancies across these concepts, and explores the associations among demographic and psychosocial characteristics in the context of i...

Objective: Little prospectively assessed post-disaster longitudinal research has been done on mental health (MH) outcomes of disaster rescue and recovery workers. This longitudinal prospective study, which is examining first responders to a terrorist bombing in Oklahoma City after nearly a quarter century, was conducted to investigate their long-t...

Background: Excessive alcohol use and alcohol use disorders (AUDs) are serious medical problems in general populations. Alcohol use is associated with stressful events. Thus it is possible that problems with alcohol use increase in association with disasters. It is important to know the extent to which disasters contribute to these problems in exp...

This study's purpose was to learn about survivors' raw personal experiences of the Oklahoma City bombing in terms of reported actions, thoughts, and feelings, and to examine the evolution of their feelings with the passage of time, post-disaster. A randomly selected sample of 182 directly-exposed survivors of the 1995 Oklahoma City bombing were int...

Background: The 1995 terrorist bombing in Oklahoma City provided a particularly useful research opportunity. It was the most severe incident of terrorism on American soil at the time. Prior research on rescue and recovery workers responding to such events has been largely limited to early post-disaster periods, most focusing on psychopathology suc...

To assess the elements necessary to be a successful learning community (ClinCalc) mentor to medical students from the mentee’s perspective. Few such studies have utilized the in-depth and richness of detail obtained in qualitative studies. This qualitative study analyzed four focus group discussions lasting 45–90 min conducted at the University of...

Little is known about how Coronavirus Disease-2019 (COVID-19) infection is associated with stressful events (SEs) and stress-related psychological symptoms. This study examined the prevalence of SEs and incidence of stress-related symptoms accompanying COVID-19 infection. The association between these stress-related symptoms and psychosocial functi...

Objective: No previous studies examined how survivors made meaning (i.e. interpreted the personal significance) of a disaster experience after seven years. This qualitative study follows up on a previously published analysis of 182 directly-exposed survivors of the Oklahoma City bombing, assessed after six months had elapsed for bombing-related psy...

Recent findings Cocaine use plays a large role in initiating and maintaining homelessness. Purpose of review The present review systematically studied the existing literature on prevalence of cocaine use, cocaine use problems, and cocaine use disorders in the lives of homeless populations. Summary A total of 57 articles with 55 unique studies wer...

Objective: To examine highly trauma-exposed survivors of the 1995 Oklahoma City Murrah Federal Building bombing nearly a quarter century later, focusing on survivors’ immediate personal experiences of it through open-ended narratives. Methods: An original sample of 182 bombing survivors, studied approximately 6 months post bombing, was randomly sel...

Objective: To examine the long-term course of disaster-related experience among survivors of a terrorist bombing and the long-term recollection of initial workplace effects across nearly a quarter century. Methods: From an initial randomly-selected sample of highly trauma-exposed survivors of the 1995 Oklahoma City bombing, 103 participated in q...

Introduction Terrorist incidents occur with alarming frequency. Much is known about acute injuries and psychopathology arising from terrorism, as well as medical care and functional status assessed in early post-disaster periods. Survivors’ memories of these experiences may change over subsequent decades, and their perspectives may evolve. Little i...

Background: Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology. Methods: A sample of 278 disaster-affected Kenyans was assessed...

Background: A systematic diagnostic mental health assessment was conducted with first-year students at Paul Quinn College, a small historically Black college/university (HBCU) in Dallas, Texas. Methods: A sample of 128 students was assessed with the Mini-International Neuropsychiatric Interview for DSM-5 and the Childhood Trauma Questionnaire....

Background: Little is known about smoking habits and disorders among homeless populations. Previous research has not generally differentiated tobacco use from tobacco use disorders in this population. Known associations of tobacco use and morbidity and mortality in general populations may also apply to homeless populations. Methods: A 2-year lon...

Objectives Chronic obstructive pulmonary disease (COPD) is a common and severe respiratory illness. Prior research suggests that COPD may be associated with depression as well as cognitive impairment and increased risk of dementia. Many studies to date have been relatively small, have largely relied on global screening measures to identify cognitiv...

Objective: Individuals commonly present to the emergency department (ED) for care after violence and many are also at risk for subsequent self or other-directed violence. Screening for violence risk represents an important part of ED care, but is challenging to implement effectively. Feedback from ED providers is needed to characterize differences...

Objective: To determine the prevalence of tardive dyskinesia (TD) identified by clinicians in naturalistic data in a real-world treatment setting. Methods: Electronic medical record data were analyzed from a single large community mental health treatment center for all psychiatric provider encounters of 120,431 unique adult and child patients duri...

This chapter addresses psychiatric issues in the care of patients with traumatic injuries. Psychiatric illness is the proverbial “elephant in the room” for the care of these patients, as the prevalence of psychopathology in this patient population is highly prevalent, and its effects on medical outcomes and treatment are substantive. Research from...

Objective: Some IBS patients possess detailed memories of the events surrounding their bowel symptom onset ("episodic memories"). In this exploratory study we sought to: (1) examine memory relationship with gastrointestinal (GI) symptom severity, extraintestinal symptoms, and mood; (2) qualitatively explore memory valence and content in IBS patien...

Objective: Despite the ongoing growing interest and established benefits of mental health recovery and peer support services, little is known about the effects of mental health recovery and peer support services specifically in community education programs. Seeking to further expand this scope, this article details the development, implementation,...

Disaster mental health is a consequential topic in today’s world in which disasters are increasing in both numbers and magnitude and inflicting deep psychological wounds across wide populations [...]

Disaster mental health (MH) research has documented substantial MH consequences warranting targeted interventions. Little research has been conducted on MH assistance for employees in the postdisaster workplace. Conducted about 3 years after the September 11, 2001 (9/11), terrorist attacks, this study examined the services provided to and used by a...

Background: Antisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups...

Background: Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined...

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that is more prevalent in women than men and has been linked to an elevated risk of developing cardiovascular disease. Although the physiological mechanisms are unclear, it is thought that exaggerated neuro-cardiovascular reactivity is partially responsible. Indeed, women w...

Background: Posttraumatic stress disorder (PTSD) is more prevalent in women than men and is associated with an increased risk for dementia. Indeed, we previously showed that cognitive function is impaired in women with PTSD, but the underlying mechanisms remain unknown. In patients with mild cognitive impairment, the cardiovascular response during...

Objective: Posttraumatic stress disorder (PTSD) is prevalent and sometimes severely disabling. Providing effective treatment for PTSD and addressing its social consequences require accurate diagnosis. PTSD criteria have changed in all editions of the American Diagnostic Criteria since introduction of the diagnosis in DSM-III in 1980. The DSM-5 Fiel...

Muscle sympathetic nerve activity (MSNA) increases during isometric exercise via increased firing of low-threshold action potentials (AP), recruitment of larger, higher-threshold APs, and synaptic delay modifications. Recent work found that women with post-traumatic stress disorder (PTSD) demonstrate exaggerated early-onset MSNA responses to exerci...

Background The use of older data and references is becoming increasingly disfavored for publication. A myopic focus on newer research risks losing sight of important research questions already addressed by now-invisible older studies. This creates a ‘Groundhog Day’ effect as illustrated by the 1993 movie of this name in which the protagonist has to...

This study compared perspectives of highly trauma-exposed Oklahoma City bombing survivors (N=141) with and without PTSD. Survivors' responses to questions about the effects of the bombing on their perspectives were hand-recorded and transcribed, six themes identified, and interrater reliability established. Both diagnostic groups (with and without...

Previous research on suicide risk in relation to disasters has yielded varying findings, likely resulting at least in part from inconsistencies in definitions of disaster exposure and assessment of psychiatric disorders. This study examined suicidal thoughts and behaviour in a sample of 379 adults affected by the 9/11 attacks on New York City, usin...

Most women in homeless populations are mothers, the majority being single mothers. Retaining child custody is challenging in homeless circumstances. Prospective longitudinal studies are needed to follow the moving pieces of housing and child custody in the context of carefully-assessed psychiatric and substance use disorders over time. A 2-year pro...

Objective Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disa...

Survivors of disasters can be expected to form meaningful perspectives on their experiences that shape their trajectories of recovery; thus, these perspectives are important to study. If humans are naturally compelled to create meaning from traumatic experiences, the creation of meaning should be evident in survivors' discussion of the effects of t...

Objective: Research is needed on disaster-affected workplaces, particularly on employee job satisfaction and performance, to inform workplace responses promoting employee postdisaster adjustment and wellbeing. Methods: Quantitative and qualitative data were collected from a volunteer sample of 255 employees of eight workplaces affected by the 9/...

Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic. Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May a...

Objective Little research has been conducted on the timing of the onset and course of suicidality relative to the timing of the onset and temporal status of homelessness. Therefore, this longitudinal study investigated suicidal ideation and plans and suicide attempts in a homeless population in relation to housing attainment, psychiatric disorders,...

Objective: The objective of this study was to use quantitative and qualitative data to gather information about emergency medicine and psychiatric provider perspectives regarding the evolution of a violence risk screening process including the simultaneous implementation of a universal suicide screening program. Methods: A retrospective review o...

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8-10 months after the bombing, 17...

Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or...

Purpose This study examined how exposure to events during the Coronavirus Disease-19 (COVID-19) era is linked to symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), COVID-19 era-related stress (CS), alcohol use disorder (AUD), and suicidal ideation (SI) in low and middle-income U.S adults. Methods A national sample of...

The growing disaster psychiatry research literature has focused on posttraumatic stress disorder, producing little insight into subjective disaster experience. Qualitative research, especially narrative analysis, may provide in‐depth exploration of individual disaster experience and efforts to make meaning of it. Disaster narratives were collected...

The objectives of this study were to assess the prevalence of personality disorders and to examine personality as a predictor of psychosocial characteristics and behaviors of HCV patients. HCV patients (n = 259) from three infectious disease and liver clinics who completed Cloninger’s Temperament and Character Inventory (TCI), an inventory for pers...

Background Suicidal behavior is increasing among US youths. Contact with the health care system is common in the months before suicide. Objective: To assess the characteristics of suicide risk among youths presenting for health care, universal screening results from a large hospital system were analyzed. Methods A retrospective analysis of the Ask...

Research has examined the association between contact with media coverage of mass trauma events and various psychological outcomes, including depression. Disaster-related depression research is complicated by the relatively high prevalence of the major depressive disorder in general populations even without trauma exposure. The extant research is i...

Major depressive disorder is associated with pro-inflammatory markers, such as cytokines TNF-alpha, IL-6, IL-1ß, and C-reactive protein. Galectin-3 is a novel emerging biomarker with pro-inflammatory properties. It is a saccharide binding protein distributed throughout many tissues with varying functions and is a predictor of poor outcomes in patie...

Background: Delirium is a major source of morbidity in the inpatient hospital setting. This study examined differences between patients with delirium present prior to hospital admission and those with hospitalacquired delirium in several health outcomes. Methods: A total of 12,529 patients on 2 inpatient units were included in this retrospective...

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full...

The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumati...

This study investigated psychosocial functioning and employment status in association with postdisaster major depression and its course in survivors of 11 different disasters in a sample of 808 directly-exposed survivors of 10 disasters and 373 survivors of the 11 September 2001 (9/11), terrorist attacks on New York City’s World Trade Center (total...

This study examined positive and negative post-9/11 perceptions and attitudes toward oneself and others, using categorical and open-text responses to 6 research questions about perceptions of self and others after the disaster. Nearly 3 years after the 9/11 terrorist attacks on average, a volunteer sample of 379 employees from 8 New York City compa...

Background: Disaster studies establishing an association between parent and child disaster reactions usually discuss results in terms of the influence of parents on their children. This study explores a complementary interpretation of this association by focusing on the potential influence of children on their parents. Methods: Investigations of...

Mental health research on the 9/11 attacks has primarily focused on posttraumatic stress disorder among survivors. Fewer studies have examined mental health effects on workers who provided postdisaster mental health care for the local population in the aftermath of the attacks. A focus group of New York City-based mental health workers was conducte...

Psychoeducation is a well-established approach to patient care for individuals coping with severe mental illness. Psychoeducation is an umbrella term for a group of intervention models designed to provide information, guidance, and support to individuals with severe mental illness and their families. Originally developed to help families and patien...

This study examined associations of individual characteristics on perceived workplace conditions and safety in a volunteer sample of 254 employees from businesses in New York City’s World Trade Center (WTC) towers and other area workplaces who completed structured diagnostic and disaster-specific interviews an average of 35 months after the Septemb...

This study investigated gaps in existing knowledge on justice, desire for revenge, and associated factors in disaster research through data collected nearly three years post disaster on justice and revenge from survivors of the September 11, 2001 (9/11) attacks. A volunteer sample of 379 employees of eight affected businesses completed interviews a...

Objective: The objective of this study was to examine associations between media contact and posttraumatic stress in a sample with a large number of individuals who were directly exposed to the September 11, 2001 (9/11) attacks and to compare outcomes in exposed and unexposed participants. Methods: Structured interviews and questionnaires were a...

Galectin-3 (Gal3) is expressed by microglia and performs functions including adhesion; activation of macrophages and fibroblasts, and mediates inflammatory responses in the hippocampus. The present study examined whether serum Gal3 levels predict hippocampal volume in a multi-ethnic, community-based sample. Results of a multiple linear regression (...

Educational programs for hepatitis C (HCV) have been created by professionals. There has not been a focus on whether what clients want to know about HCV differs from what providers want patients to know. This study addresses this gap by examining topics selected by participants in an education/support group model. Data were collected as part of a r...

Background Individuals with alcohol use disorder (AUD) and those who have experienced traumas or chronic stress exhibit dysregulated hypothalamic–pituitary–adrenal (HPA) axis reactivity. Whether and how trauma and stress histories interact with AUD to affect HPA axis reactivity has not been assessed. Methods In the present study, 26 healthy male c...

Objective: Mental health care in the growing US Muslim population is a relevant topic given ongoing discrimination and self-stigma similar to that seen in other racial and religious communities. Data concerning efforts to integrate religious practice or spiritual concepts into mental health education are limited. Therefore, the objective of this s...

Absence of formal and systematic screening for mood and anxiety disorders among patients with sickle cell disease (SCD) can result in under-recognized psychological problems. This study examined the prevalence of psychological symptoms using a systematic screening process. Patients with SCD completed four self-report screening tools for measurement...

Objective: Dissociation and trauma have a well-documented relationship, and dissociation is assumed to result from trauma exposure. If trauma generates dissociative psychopathology, it should be observed after exposure to disaster and be associated with disaster-related psychopathology. Few studies have focused specifically on dissociation as an ou...

Secondary data obtained through the 2015 point-in-time homelessness count and an administrative health care utilization database was used to identify differences in demographic characteristics, health service use, and predictors of health service use among people experiencing unsheltered and sheltered homelessness. Compared to sheltered participant...

Objectives: The increasing frequency of visits to the pediatric psychiatric emergency department in the United States signals a need for a better understanding of factors contributing to more frequent utilization. This study examined characteristics of patients associated with higher utilization of the pediatric psychiatric emergency department to...

Objectives: The relationship of adult antisocial behavior to the diagnosis of ASPD has not been investigated in homeless populations. This study examined ASPD and adult-only antisocial behavior in a 2-year prospective longitudinal study of literally homeless individuals in St. Louis, Missouri in 1999-2001. Methods: A subsample of 241 provided compl...

Background: This study examined the prevalence of somatization disorder in Urological Chronic Pelvic Pain Syndrome (UCPPS) and the utility of two self-report symptom screening tools for assessment of somatization in patients with UCPPS. Methods: The study sample included 65 patients with UCPPS who enrolled in the Multidisciplinary Approach to th...

Post-traumatic stress disorder (PTSD) is a psychiatric illness that is more prevalent in women and accumulating evidence suggests a link between PTSD and future development of cardiovascular disease. The underlying mechanisms are unclear but augmented sympathetic reactivity to daily stressors may be involved. We measured muscle sympathetic nerve ac...

Background: The increase in terrorism worldwide has stimulated research on directly and indirectly exposed survivors, but there have been few investigations of the children of highly exposed survivors. This study examined the relationship between parental psychopathology and outcomes in their children who were exposed indirectly to a terrorist inc...

BACKGROUND Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outc...