Women who survived Tuesday's shooting at the LA Fitness athletic club in Collier now are likely to face a struggle to heal emotionally from their traumatic close encounter with a gunman.
Post-traumatic stress disorder following a harrowing event is twice more likely to affect women than men, said Dr. Carol S. North, a Texas psychiatrist and leading researcher on the mental health impact of disasters.
Women also are more likely to suffer longer from the anxiety disorder, which can develop after an ordeal in which grave physical harm occurred or was threatened, she said.
"In the general population, [PTSD] is twice as common in women as men," she said. "Why, we don't know."
As many as 40 women were participating in an aerobics class Tuesday night at the fitness club when George Sodini, 48, of Scott -- who in a blog had expressed his hatred of women -- walked in, turned off the lights and began shooting. Mr. Sodini killed three women and wounded nine others before fatally shooting himself.
Two of the women who died -- Heidi Overmier, 46, of Carnegie, and Elizabeth Gannon, 49, of Green Tree -- were buried yesterday after separate services. Visitation for the third, Jody Billingsley, 37, of Mt. Lebanon, begins tonight at Beinhauer's in Peters.
A candlelight vigil to mourn the shooting victims will be held at 8:15 p.m. Tuesday, one week from the shootings, in front of the fitness center in the Great Southern shopping center off Route 50.
Mental health concerns may arise for those who were wounded in or witnessed such a horrific event, according to Dr. North, a professor and director of the program in trauma and disaster at the Dallas VA Medical Center and a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas.
"It's the exposure of the women [in the exercise class,]" Dr. North said, that may lead to problems. "The two most common disorders are first, post-traumatic stress disorder, and second, major depression."
Dr. North and her research team have studied nearly 3,000 survivors of major disasters, including the bombings in Oklahoma City and the U.S. embassy in Nairobi, the Capitol Hill anthrax attacks, the Sept. 11 terrorist attacks, and Hurricane Katrina.
She is also the lead author of a series of studies assessing effects of a mass shooting in October 1991 in which a gunman killed 23 people before fatally shooting himself in a restaurant in Killeen, Texas.
Emotional distress immediately after a trauma can't be diagnosed immediately as a psychiatric disorder, Dr. North said. Almost everyone exposed to a traumatic event experiences some symptom that is associated with PTSD.
Those symptoms may include feeling jumpy or keyed-up, having trouble sleeping or concentrating, or experiencing vivid, unwanted images of the event.
"That doesn't necessarily mean someone has or will develop post-traumatic stress disorder. Most people will get better," she said. "Most people do not develop post-traumatic stress disorder or a psychiatric disorder."
That's due to human resilience, she said.
"Don't confuse distress with psychiatric illness," she said. "Resilience has to do with strength, personality, the psyche. People who do well are people without previous psychiatric illness."
But people who have suffered from major depression before a highly traumatic event are more likely to have a depressive episode after an event, she said. Any psychiatric illness is of note, including panic or generalized anxiety disorders, she said.
"If they've had major depression in the past, their chance of having another episode is about 50 to 100 percent," she said.
Dr. North's team of researchers does not study the effectiveness of counseling after traumatic events, only psychiatric issues that develop. But she advised people who show symptoms of illness to seek help.
"The onset of symptoms starts very quickly. [In the Oklahoma City bombing], the large majority of people developed symptoms the same day as the event," she said.
Some people may seek help right away, while others may wait as long as a year.
"We particularly find that going to church for help is very common," she said. "This was the case in the Nairobi embassy bombing."
The amount of time a person may be affected by PTSD varies, Dr. North said. While studies indicate that more women are affected by longterm PTSD, men seem to have more substance-use disorders after traumatic events, she said.
What can people do to help themselves? Dr. North suggests:
1. Try to get back to regular routines as soon as reasonably possible.
2. Avoid isolation from others. "That's a sign of real concern. We recommend people seek the comfort of loved and trusted people in their lives.
3. Take care of yourself. Don't smoke, don't drink, get good nutrition, get exercise, get sleep. Set aside time and a comfortable space for sleep.
4. Practice "good sleep hygiene," Dr. North said. Keep the sleeping space dark, quiet and comfortable. Avoid stimulating activities and drinks with caffeine or alcohol before bed.
What can others do to help those who were affected by the traumatic event?
"Be there for them," Dr. North said. "Be willing to listen, let people talk. Sometimes people just want to tell their stories. Oftentimes people have told us, 'People are getting tired of hearing about it, but I need to talk about it.' "
Jill Daly can be reached at firstname.lastname@example.org or 412-263-1596.