Acute stress reactions following the assassination of

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Acute stress reactions following the assassination of Mexican presidential candidate Colosio Article in Journal of Traumatic Stress · November 2002 DOI: 10.1023/A:1020137409097 · Source: PubMed

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C 2002) Journal of Traumatic Stress, Vol. 15, No. 5, October 2002, pp. 401–405 (

Acute Stress Reactions Following the Assassination of Mexican Presidential Candidate Colosio1

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José R. Maldonado,2,3 Kathy Page,2 Cheryl Koopman,2 Lisa D. Butler,2 Heather Stein,2 and David Spiegel2

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Considerable evidence suggests that exposure to traumatic events increases the risk of developing anxiety-spectrum disorders in response to later traumatization. We conducted a survey in Guadalajara, Mexico to assess factors associated with acute stress reactions to the assassination of a political figure. Participants included 86 adults who completed the Stanford Acute Stress Reaction Questionnaire (SASRQ) and measures of the perceived impact of the assassination, exhibited emotional behavior following the assassination, and had exposure to a specific prior disaster (a gas pipeline explosion). The results suggest that acute stress reactions can occur in response to an assassination, and that those most susceptible are those most emotionally invested, those who engage in emotional behavioral responses, and those whose lives have been affected by a previous potentially traumatic event.

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KEY WORDS: political assassination; social trauma; acute stress; sensitization to stress; emotional behavior.

idential candidate Luis Donaldo Colosio. On March 23, 1994, Mr. Colosio was shot and killed during a political rally in Tijuana just after he delivered a speech in a poor neighborhood. Mr. Colosio stepped down from the platform and was walking among the crowd back to his car when he was shot twice. He was pronounced dead 3 hr later. The shock of the assassination was felt throughout the country. In disbelief, people could be heard in the streets of Tijuana crying “it is not possible” for days after the incident (Asesinan a Colosio, 1994; Guillermoprieto, 1994). Similar to President John F. Kennedy, Colosio was eulogized in the aftermath of his assassination. Several polls showed that a majority of Mexicans believed Colosio’s assassination was part of a conspiracy, probably orchestrated by a faction within his own political party. At the time this study was conducted, the case had not been solved. We examined three hypotheses in this study:

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Considerable evidence suggests that exposure to traumatic events increases the risk of developing anxietyspectrum disorders in response to later traumatization (Archibald & Tuddenham, 1956; Bremner, Southwick, Johnson, Yehuda, & Charney, 1993; Breslau, Davis, & Andreski, 1995; Briere, 1988; Cole & Putnam, 1992; Feinstein & Dolan, 1991; Foa & Rothbaum, 1989; Foa, Steketee, & Rothbaum, 1989; Herman, 1992; Kardiner, 1941; Laufer, Brett, & Gallops, 1985; McFarlane, 1988; Perry, Difede, Musngi, Frances, & Jacobsberg, 1992; Putnam, 1992; van der Kolk & Fisler, 1994). In this study, we examined acute stress reactions within the context of a specific event, that of the assassination of Mexican pres1 Previous versions of this paper have been presented at the annual meet-

ing of the American Psychiatric Association, San Diego, CA, May 1997 and at the annual meeting of the International Society of Traumatic Stress Studies, Montreal, Canada, November 1997. 2 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. 3 To whom correspondence should be addressed at Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, MC 5718, Stanford University School of Medicine, Stanford, California 943055718; e-mail: [email protected].

1. The perceived impact of the stressful event would be positively associated with the intensity of acute stress symptoms experienced. Thus, we would expect that those individuals who saw Mr. Colosio 401 C 2002 International Society for Traumatic Stress Studies 0894-9867/02/1000-0401/1


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Maldonado, Page, Koopman, Butler, Stein, and Spiegel as a significant political figure, and who placed hope and trust in him, would suffer a greater degree of distress than people to whom the candidate represented just another politician with no major personal relevance. 2. The display of assassination-related emotional behaviors (e.g., marching in processions and praying) would be positively associated with the intensity of acute stress symptoms. Such behaviors are not currently part of the symptom criteria for Acute Stress Disorder (ASD; American Psychiatric Association, 1994); however, such behaviors in response to a stressful event may indicate a high level of distress, and little research has been done to examine overt behavior associated with acute stress symptoms. Therefore, we wanted to investigate the relationship of event-related behaviors immediately following the assassination of the presidential candidate to acute stress symptoms. 3. Persons who have had previous exposure to a (societal) traumatic event will experience more acute stress symptoms upon exposure to an unrelated (societal) stressful or traumatic event. The experience of traumatic events may make people more sensitive to later stressful or traumatic events, as suggested by a number of studies on sensitization and PTSD (Bremner et al., 1993; Yehuda, Boisoneau, Lowy, & Giller, 1995). In this study, we examine the possible sensitizing effect of exposure to a prior gas pipeline explosion on acute stress symptoms experienced after the assassination of Colosio.

Table 1. Descriptive Statistics Summarizing the Demographic Characteristics of the Sample (N = 86) Demographic characteristic Gender Male Female Nationality Mexican Other Marital status Single Married Separated Divorced Age in years Number of children

Percentage of respondents

Mean

SD

Range

27.9 1.1

9.7 1.8

18–71 0–10

65.6% 34.4% 97.6% 2.4% 67.1% 30.6% 1.2% 1.2%

graphic characteristics of this sample are summarized in Table 1. Recruitment Respondents were recruited during the 4th week after the assassination by a Spanish-speaking, American researcher (KP) present in Guadalajara, a city about 1,500 miles from Tijuana. The researcher, who spoke Spanish, recruited respondents by randomly stopping people on a major city street and interviewing Red Cross rescue workers and students at a local college. All forms and instruments had been translated by a native Spanish-speaking member of our team (JRM). Measures

Method Participants Ninety-seven individuals volunteered to participate in this study. Eighty-six participants (30 women, 56 men) provided complete data. Eleven respondents were excluded from analysis because their data were incomplete. All respondents were 18 years of age or older (M = 27.9, SD = 9.7, range = 18–71), spoke Spanish, were recruited in the city of Guadalajara, and provided written consent. Approximately 90% (86/96) of those approached completed and returned the survey instrument. Of these, 28 were pedestrians (32.6% of the sample), 3 were Red Cross workers (3.5%), and 55 were college students (64.0%). College students were recruited during one of their regular class sessions. Virtually all respondents were Mexican (97.6%, 2.4% other); 67.1% were single, 30.6% were married, and 2.4% were separated or divorced. The demo-

Stanford Acute Stress Reaction Questionnaire (SASRQ; Cardeña, Koopman, Classen, Waelde, & Spiegel, 2000) This instrument is designed to measure peritraumatic anxiety, dissociation, and acute stress disorder. Respondents were asked to indicate the extent to which each of 30 items described their experiences during and shortly after the assassination of the presidential candidate. Items are rated on a 6-point Likert scale, where 0 = have not experienced and 5 = very often experienced. The internal consistency of the items in the SASRQ was excellent in this sample (Cronbach’s alpha = .95), and the measure has been found to have very good reliability and validity. Perceived Impact of the Event Respondents rated four items on a 0–10 visual analog scale to assess the perceived impact of the assassination


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Acute Stress Reactions After Political Assassination of the presidential candidate. The items were: the degree to which respondents liked the candidate; his importance to them; how disturbed they felt about his assassination; and, how likely it was that they would have voted for him for President had he lived. Responses to these items were highly internally consistent (Cronbach’s alpha = .88). The mean of these four items was used as a measure of the perceived impact of the event. Exposure to a Previous Traumatic Event To assess respondents’ exposure to a previous potentially traumatic event, we asked about their exposure to a well-documented event that happened in Guadalajara 2 years prior to this study. On April 22, 1992, a massive sewer line explosion created a 20-foot-deep trench, destroying nearly 20 city blocks. The blast killed at least 200 people, injured more than 1,400, and left over 15,000 homeless (Mexico: Sewer explosion rocks Guadalajara, 1992). Exposure to this previous event was assessed using 10 items (No = 0 or Yes = 1). The first six items (“living in Guadalajara at the time of the explosion”; “heard the explosion”; “saw the damage caused by the explosion”; “had to evacuate your home”; “had damage to your home”; and “suffered physical symptoms or injury as a result of the explosion”) were summed to yield a total score describing the respondent’s own exposure (direct exposure). The next four items (“had a family member or friend who had to evacuate their home”; “had a family or friend who had damage to their home”; “had a family or friend suffer physical symptoms or injury”; and “had a family member or friend die”) were summed to yield a total score describing the exposure of the respondent’s friends and family (vicarious exposure). Assassination-Related Behavior Respondents were asked whether they had (No = 0 or Yes = 1) engaged in each of eight activities in reaction to the assassination (attended Mass or other religious service; prayed individually; marched in a procession; wrote on posters, billboards, or signs; experienced “luto” [mourning]; cryed or wept; suffered an “ataque de nervios” [attack of the nerves]; or ate or drank as a distraction). These items were summed to form a scale of moderate internal consistency (Cronbach’s alpha = .72). Data Analysis A multiple regression analysis was conducted on the SASRQ total score as the dependent variable and using

403 Table 2. Means, Standard Deviations, and Ranges on Measures of Independent and Dependent Variables (N = 86) Variable Perceived impact of traumatic event Emotional behavior Direct exposure to the explosion Vicarious exposure to explosion Acute stress reaction score

M

SD

Range

5.2 1.6 1.9 1.6 14.3

2.8 1.1 0.9 1.3 20.4

0–10 0–8 0–4 0–4 0–125

the simultaneous entry procedure for entering the independent variables (direct exposure to the explosion, vicarious exposure to the explosion, perceived impact of the assassination, and assassination-related emotional behavior). We did not include demographic variables, as we were missing data on most of those variables and they were not of central interest in this study. We included dummy variables for status as a student or member of the street sample to compare the subgroups. Results The descriptive statistics summarizing the independent and dependent variables are presented in Table 2. (Zero-order correlations among the independent and dependent variables are available upon request from the authors.) The results of the multiple regression analyses conducted on the SASRQ total score and the IES subscales. For the SASRQ total score, the final equation accounted for 52% of the variance, adjusted R 2 = .48, F(6, 79) = 13.99, p < .001, with higher SASRQ total scores significantly related to a greater perceived impact of the assassination (β = .21, p < .05), to vicarious exposure to the pipeline explosion (β = .23, p < .01), and to more emotional behavioral responses to the assassination (β = .54, p < .001). For the IES Intrusion Subscale, the final equation accounted for 49% of the variance, showing a significant association with emotional behavior. For the IES Avoidance Subscale, the final equation accounted for 38% of the variance, with a significant relationship found with the perceived impact of the assassination and emotional behavior. None of the other relationships reached statistical significance in the multiple regression analyses. Discussion Over the past few years, we have witnessed an increase in the frequency and intensity of public violence. This study’s results suggest that adverse national events may have far-reaching impact on the lives of those living in the communities where they occur.


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404 The findings of this study suggests that the persons who cared about Colosio as a person and invested hope in him as presidential candidate experienced significantly greater acute stress disorder symptoms than did other persons in the period immediately following his assassination. This confirms the hypothesis that the perception of the impact of the trauma was related to the degree of distress symptoms experienced. These results also confirm the hypothesis suggesting that vicarious exposure to previous traumatic events is associated with greater acute stress disorder symptoms in response to a new unrelated stressor. Respondents whose family or friends had been negatively affected by the earlier unrelated trauma (the Guadalajara explosion) were much more affected by the assassination. We confirmed the hypothesis that respondents who had close friends or family members hurt or killed in a previous event would experience greater acute stress disorder symptoms when exposed to a new, unrelated traumatic event. In this case, a societal event (i.e., the gas line explosion) 2 years later predicted widespread distress upon exposure to a subsequent but unrelated traumatic societal event (i.e., the assassination of a presidential candidate). Finally, we found that people who exhibited overt expressions of distress (e.g., crying, “luto,” marching in processions) were at greater risk for developing acute stress reactions. Interpretation of the findings in this study is limited by the cross-sectional nature of the research design and should be made with caution. The relationship between acute stress reactions and previous vicarious exposure to the explosion may, for example, reflect an exacerbation of residual symptomatology in response to an earlier trauma rather than an acute response to the assassination per se. Similarly, retrospective accounts of how important the candidate was to the individual may have been influenced by postassassination events such as media exposure or recollection of one’s reaction. The study found that people who exhibited overt expressions of distress were at greater risk for developing acute stress reactions. Interpretation of this finding may be limited by the cross-sectional nature of the research design. Therefore, we are unable to interpret the causal direction of this relationship. Perhaps those who engaged in the most emotional behavior were already most upset; as a result, their overt expression of emotions helped to alleviate their distress, which would have otherwise been greater. It is also possible that their overt manifestations of distress represent a culturally sanctioned way of expressing pain for those who are most distressed. If that is true, these acts may not represent a psychopathological reaction but a culturally acceptable way of expressing sorrow. Future research should further examine the value of

Maldonado, Page, Koopman, Butler, Stein, and Spiegel emotional behavior in eliciting more adaptive mechanisms that may result from additional support provided by family, friends, and others. The fact that this study was conducted in Mexico is one of its main strengths as well as a source of methodological and conceptual limitations. The examination of symptoms associated with ASD and PTSD resulting from a traumatic event in Mexico extends the work of previous researchers on acute stress reactions to traumatic events in a Latin American country and sample. At the same time, this study involved the use of methods and instruments designed in the United States for the study of reactions of distress in our society, and therefore may not be sensitive to a range of culture-specific reactions. These instruments, even though translated to the primary language of the population under study, may not have accurately captured the sentiments and cultural idiosyncrasies present. Also, our sample was relatively small and could be biased, for example, in favor of those more interested in or affected by the assassination. Furthermore, the mean responses on the dependent measures (SASRQ) were lower than those reported by populations exposed to more personally life-threatening events (e.g., studies reviewed in Cardeña et al., 2000), suggesting that these results may be more generalizable to understanding reactions to a stressful rather than traumatic event. Future studies should attempt to examine these variables among more fully representative samples of persons exposed to traumatic life events. These results suggest that experiencing previous traumatic events is associated with greater acute stress reactions. In the study, respondents whose close family or friends had been negatively affected by the earlier unrelated trauma (the Guadalajara explosion) were much more affected by the assassination. As already suggested by other studies, people who had been exposed to prior stress had more severe reactions to subsequent trauma (Bremner et al., 1993; Engel et al., 1993; Koopman, Classen, & Spiegel, 1994, 1996; Zaidi & Foy, 1994). In fact, the results of our study suggest that acute stress reactions can occur in response to national events, and that those most susceptible are those most emotionally invested, those who engage in emotional behavioral responses, and those whose lives have been affected by a previous potentially traumatic event. Thus, persons who have had greater previous exposure to a societal traumatic event may be more likely to experience more acute stress symptoms upon future exposure to an unrelated societal stressful or traumatic event. Our study suggests that unrelated, consecutive societal events may have an additive effect on the development of trauma related symptoms.


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Acute Stress Reactions After Political Assassination The study also suggests that physical presence may not be needed for a person to be psychologically affected by the event. This raises the issue of whether distant exposure to vicarious traumatic events (e.g., television and media coverage), which may have personal significance to a given individual, may somehow sensitize individuals to develop acute stress-like reactions when exposed to future traumatic events. This would be an important topic for future research. Acknowledgments This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation. We also appreciated the contributions of Maria Arroyo de Maldonado and Evan Page in the translation of the questionnaires, Xin-Hua Chen for her suggestions for improving an earlier version of the manuscript, Suzanne Sims for her editorial contributions to the final version, and the persons participating in the study. References

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405 Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60, 174–184. Engel, C. C., Engel, A. L., Campbell, S. J., McFall, M. E., Russo, J., & Katon, W. (1993). Posttraumatic stress disorder symptoms and precombat sexual and physical abuse in Desert Storm veterans. Journal of Nervous and Mental Disease, 181, 683–688. Feinstein, A., & Dolan, R. (1991). Predictors of post-traumatic stress disorder following physical trauma: An examination of the stressor criterion. Psychological Medicine, 21, 85–91. Foa, E. B., & Rothbaum, B. O. (1989). Behavioral psychotherapy for posttraumatic stress disorder. International Review of Psychiatry, 1, 219–226. Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualization of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. Guillermoprieto, A. (1994, April 4). Losing the future. The New Yorker, pp. 53–56. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377– 391. Kardiner, A. (1941). The traumatic neuroses of war. New York: Hoeber. Koopman, C., Classen, C., & Spiegel, D. (1994). Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, California, firestorm. American Journal of Psychiatry, 151, 888– 894. Koopman, C., Classen, C., & Spiegel, D. (1996). Dissociative responses in the immediate aftermath of the Oakland/Berkeley Firestorm. Journal of Traumatic Stress, 9, 521–540. Laufer, R. S., Brett, E., & Gallops, M. S. (1985). Dimensions of posttraumatic stress disorder among Vietnam veterans. Journal of Nervous and Mental Disease, 173, 538–545. McFarlane, A. C. (1988). The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors. Journal of Nervous and Mental Disease, 176, 30–39. Mexico: Sewer explosion rocks Guadalajara. (1992). Facts on File [On-line service], 318–319. Perry, S., Difede, J., Musngi, G., Frances, A. J., & Jacobsberg, L. (1992). Predictors of posttraumatic stress disorder after burn injury. American Journal of Psychiatry, 149, 931–935. Putnam, J. J. (1992). On the etiology and pathogenesis of the posttraumatic psychoses and neuroses. Journal of Nervous and Mental Disease, 25, 769–799. van der Kolk, B. A., & Fisler, R. E. (1994). Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger Clinic, 58, 145–168. Yehuda, R., Boisoneau, D., Lowy, M. T., & Giller, E. L., Jr. (1995). Doseresponse changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Archives of General Psychiatry, 52, 583–593. Zaidi, L. Y., & Foy, D. W. (1994). Childhood abuse experiences and combat-related PTSD. Journal of Traumatic Stress, 7, 33–42.

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