Posttraumatic stress disorder and death anxiety among Iraqi civilians exposed to a suicide car bombing: the role of religious coping and attachment

Abstract

Background Posttraumatic stress disorder (PTSD) as a result of a bombing has been studied in the literature. Limited studies have focused attention on PTSD following a suicide car bombing. However, more research is needed to explore the risk factors for this psychological response. Aims To examine a hypothesised model that death anxiety would be associated with PTSD and psychiatric comorbidity following a suicide car bombing, and that attachment styles and religious coping would influence the impact of this anxiety on distress outcomes. Methods 185 Iraqi civilians exposed to the first suicide car bombing completed questionnaires measuring PTSD, psychiatric comorbidity, death anxiety, religious coping, and attachment experiences. Results 82% met diagnostic criteria for PTSD, the remainder did not. Path analysis showed that death anxiety was significantly correlated with psychiatric comorbidity; it was also correlated with attachment, which was correlated with psychiatric comorbidity. Death anxiety was also significantly correlated with religious coping, which was correlated with both distress outcomes. Conclusions Although Iraqi civilians reported increased death anxiety following a suicide car bombing, those who used religion to cope with the traumatic experience and had functional attachment experiences in the past reported low levels of psychological distress.