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Trauma Exposure and Posttraumatic Stress Disorder Among Employees of New York City Companies Affected by the September 11, 2001 Attacks on the World Trade Center

Published online by Cambridge University Press:  08 April 2013

Carol S. North ,
David E. Pollio ,
Rebecca P. Smith ,
Richard V. King ,
Anand Pandya ,
Alina M. Surís ,
Barry A. Hong ,
Denis J. Dean ,
Nancy E. Wallace  and
Daniel B. Herman
...Show all authors
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Abstract

Objective: Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD.

Methods: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11–related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision.

Results: The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate’s direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness.

Conclusions: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

(Disaster Med Public Health Preparedness. 2011;5:S205-S213)

Keywords

posttraumatic stress disordertrauma exposuredisasterdisaster mental health servicestraumadtress disorders, post-traumaticSeptember 11 terrorist attacksterrorismdisaster responseNew York City
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 5 , Issue S2 , September 2011 , pp. S205 - S213
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2011

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References

REFERENCES

1.Silver, RC, Holman, A, McIntosh, DNCoping with a national trauma: a nationwide longitudinal study of responses to the terrorist attacks of September 11.In: Neria Y, Gross R, Marshall RD et al, eds. 9/11: Mental Health in the Wake of Terrorist Attacks. New York: Cambridge University Press; 2006: 45-70.Google Scholar
2.Galea, S, Ahern, J, Resnick, H.Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346 (13):982–987.CrossRefGoogle ScholarPubMed
3.Galea, S, Resnick, H, Ahern, J.Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks. J Urban Health. 2002;79 (3):340–353.CrossRefGoogle ScholarPubMed
4.Galea, S, Vlahov, D, Resnick, H.Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol. 2003;158 (6):514–524.Google Scholar
5.Schuster, MA, Stein, BD, Jaycox, L.A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med. 2001;345 (20):1507–1512.CrossRefGoogle ScholarPubMed
6.Silver, RC, Holman, EA, McIntosh, DN, Poulin, M, Gil-Rivas, V.Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002;288 (10):1235–1244.CrossRefGoogle ScholarPubMed
7.Schlenger, WE, Caddell, JM, Ebert, L.Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA. 2002;288 (5):581–588.Google Scholar
8.Brackbill, RM, Hadler, JL, DiGrande, L.Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009;302 (5):502–516.Google Scholar
9.Farfel, M, DiGrande, L, Brackbill, R.An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health. 2008;85 (6):880–909.Google Scholar
10.DiGrande, L, Perrin, MA, Thorpe, LE.Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008;21 (3):264–273.CrossRefGoogle ScholarPubMed
11.DiGrande, L, Neria, Y, Brackbill, RM, Pulliam, P, Galea, S.Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. Am J Epidemiol. 2011;173 (3):271–281.CrossRefGoogle Scholar
12.North, CS, McCutcheon, V, Spitznagel, EL, Smith, EM.Three-year follow-up of survivors of a mass shooting episode. J Urban Health. 2002;79 (3):383–391.CrossRefGoogle ScholarPubMed
13.North, CS, Nixon, SJ, Shariat, S.Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282 (8):755–762.CrossRefGoogle ScholarPubMed
14.Grace, MC, Green, BL, Lindy, JLThe Buffalo Creek disaster: a 14-year follow-up.In: Wilson JP, Raphael B, eds. International Handbook of Traumatic Stress Syndromes. New York: Plenum; 1993:441-449.Google Scholar
15. McFarlane, AC.Posttraumatic stress disorder: a model of the longitudinal course and the role of risk factors. J Clin Psychiatry. 2000;61(Suppl 5)15–20, discussion 21-23.Google Scholar
16.North, CS, Smith, EM, Spitznagel, EL.Posttraumatic stress disorder in survivors of a mass shooting. Am J Psychiatry. 1994;151 (1):82–88.Google Scholar
17.Breslau, N.Outcomes of posttraumatic stress disorder. J Clin Psychiatry. 2001;62(Suppl 17)55–59.Google ScholarPubMed
18.Ehlers, A, Mayou, RA, Bryant, B.Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol. 1998;107 (3):508–519.Google Scholar
19.Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB.Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52 (12):1048–1060.Google Scholar
20.Galea, S, Ahern, J, Resnick, HPost-traumatic stress symptoms in the general population after a disaster: implications for public health.In: Neria Y, Gross R, Marshall RD et al, eds. 9/11: Mental Health in the Wake of Terrorist Attacks. New York: Cambridge University Press; 2006: 19-44.Google Scholar
21.Robins, LN, Cottler, LB, Compton, WM, Bucholz, K, North, CS, Rourke , KMDiagnostic Interview Schedule for the DSM-IV.DIS-IV; 2000. St Louis, Mo: Washington University School of Medicine.Google Scholar
22.Ross, HE, Swinson, R, Doumani, S, Larkin, EJ.Diagnosing comorbidity in substance abusers: a comparison of the test-retest reliability of two interviews. Am J Drug Alcohol Abuse. 1995;21 (2):167–185.Google Scholar
23.Erdman, HP, Klein, MH, Greist, JH, Bass, SM, Bires, JK, Machtinger, PE.A comparison of the Diagnostic Interview Schedule and clinical diagnosis. Am J Psychiatry. 1987;144 (11):1477–1480.Google Scholar
24.Goethe, JW, Ahmadi, KS.Comparison of Diagnostic Interview Schedule to psychiatrist diagnoses of alcohol use disorder in psychiatric inpatients. Am J Drug Alcohol Abuse. 1991;17 (1):61–69.Google Scholar
25.Wittchen, HU, Semler, G, von Zerssen, D.A comparison of two diagnostic methods. Clinical ICD diagnoses vs DSM-III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (version 2). Arch Gen Psychiatry. 1985;42 (7):677–684.CrossRefGoogle ScholarPubMed
26.Helzer, JE, Spitznagel, EL, McEvoy, L.The predictive validity of lay Diagnostic Interview Schedule diagnoses in the general population. A comparison with physician examiners. Arch Gen Psychiatry. 1987;44 (12):1069–1077.CrossRefGoogle ScholarPubMed
27.North, CS, Pfefferbaum, B, Narayanan, P.Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005;186:487–493.Google Scholar
28.North, CS, Ringwalt, CL, Downs, D, Derzon, J, Galvin, D.Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Arch Gen Psychiatry. 2011;68 (2):173–180.CrossRefGoogle ScholarPubMed
29.Canino, G, Bravo, M, Rubio-Stipec, M.The impact of disaster on mental health: prospective and retrospective analyses. Int J Ment Health. 1990;19:51–69.Google Scholar
30.Robins, LN, Fishbach, RL, Smith, EMImpact of disaster on previously assessed mental health.In: Shore JH, ed. Disaster Stress Studies: New Methods and Findings. Washington, DC: American Psychiatric Association; 1986:22-48.Google Scholar
31.North, CS, Pfefferbaum, B, Vythilingam, M.Exposure to bioterrorism and mental health response among staff on Capitol Hill. Biosecur Bioterror. 2009;7 (4):379–388.CrossRefGoogle ScholarPubMed
32.Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS.National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38 (4):381–389.Google Scholar
33.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
34.North, CS, Pfefferbaum, B, Robins, LN, Smith, EMThe Diagnostic Interview Schedule/Disaster Supplement (DIS-IV/DS),.2001. St Louis, Mo: Washington University School of Medicine.Google Scholar
35.North, CS.Approaching disaster mental health research after the 9/11 World Trade Center terrorist attacks. Psychiatr Clin North Am. 2004;27 (3):589–602.Google Scholar
36.North, CS, Surís, AM, Davis, M.Toward validation of the diagnosis of posttraumatic stress disorder. Am J Psychiatry. 2009;166:1–8.Google Scholar
37. McDonald, SD, Calhoun, PS.The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev. 2010;30 (8):976–987.Google Scholar
38.Dolan, M, Murphy, J, Thalji, L, Pulliam, PWorld Trade Center Health Registry: sample building and denominator estimation. http://www.nyc.gov/html/doh/downloads/pdf/wtc/wtc-building-denominator.pdf. Published January 2006. Accessed April 10, 2011.Google Scholar
39.North, CS, Pfefferbaum, B, Hong, BHistorical perspective and future directions in research on psychiatric consequences of terrorism and other disasters.In: Yuval N, Gross R, Marshall R, eds, et al. September 11, 2001: Treatment, Research and Public Mental Health in the Wake of a Terrorist Attack. New York: Cambridge University Press; 2006:95-113.Google Scholar
40.North, CS, Hong, BA, Pfefferbaum, B.P-FLASH: Development of an empirically-based post-9/11 disaster mental health training program. Mo Med. 2008;105 (1):62–66.Google Scholar
41.Dohrenwend, BP, Turner, JB, Turse, NA.The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313 (5789):979–982.Google Scholar