New study proves 9/11-related anxiety can linger for years

BY Aline Reynolds

Almost ten years have passed since the 9/11 attacks and a new study shows many survivors and first responders relive the horrors of that day for months or even years.

Conducted by the New York City Department of Health and Mental Hygiene, the study reveals that 95 percent of 9/11 survivors report exhibiting at least one syptom attributable to posttraumatic stress disorder, as a result of the attacks.

Based on survivor interviews performed in 2003 and 2004, approximately 15 percent – or about 355 – of the 3,271 people surveyed likely have a chronic case of posttraumatic stress disorder two-to-three years following 9/11, according to the study.

The survivors that participated in the study are among the more-than 71,000 individuals that belong to the World Trade Center Health Registry, which allows health experts to track and investigate illnesses and recovery tied to 9/11. All of the participants reported to be in one of the World Trade Center towers during the period between the first plane’s impact and the subsequent collapsing of the other WTC buildings later that morning.

The study is the first of its kind to document the long-term stress reactions of civilians that were inside the towers during the attacks, according to Laura DiGrande, the principal author of the study, and co-director of the Injury Surveillance and Prevention program at the D.O.H M.H.

Many people recover from acute stress experienced immediately after the event, DiGrande explained. “It seems like PTSD… but it’s sort of like a natural response, and many people recover from that,” she said. Other studies have tracked a high prevalance of these PTSD-like symptoms within six weeks of the attacks, and a dwindling of the symptoms five months thereafter.

“This is the first time that survivors who are under direct attack were looked at very closely,” said DiGrande, making it “truly a civilian sample” of the emotional after-effects survivors of the attacks have since endured.

Chronic PTSD is an extremely debilitating disorder, and is commonly linked to suicidal thoughts, medical problems and functional impairment, according to Yuval Neria, director of the Trauma and PTSD Program at Columbia University and a co-author of the study.

The study indicated that low-income participants were by far at highest risk of developing post-traumatic stress from the 9/11 events — almost half of them were screened PTSD-positive. “There are lots of different theories why income and socioeconomic status is related to PTSD,” said DiGrande, such as shortages in mental health resources available to them to help overcome the trauma of 9/11.

“It’s something researchers are continuing to try to understand more fully.”

The implication of the findings, according to the study, “is that the impact of terrorism on survivors, particularly those in low socioeconomic positions, could be substantial,” since PTSD is tied to other disorders and harmful behaviors that effect daily functioning, wellness, and relationships.

The study’s participants were asked questions about whether or not they’ve repeatedly had disturbing thoughts or dreams of 9/11 events; physical reactions, such as heart pounding and sweating, when being reminded of 9/11; and difficulty remembering significant events of the day. These questions, DiGrande said, are ones that psychiatrists typically use to diagnose PTSD.

None of the participants were available for an interview, since their names and contact information are not publicly disclosed due to confidentiality agreements with the D.O.H.M.H.

Nearly one in six participants tested positive for probable PTSD, lower than the rate discovered among other terrorist attack survivors, such as those from the Oklahoma City bombings. Researchers speculate that the 9/11 survivors have lower rates of PTSD because they didn’t know their lives were threatened while they were evacuating the towers.

Evacuee accounts described a “calm descent” from the upper floors of the towers. Many of them did not predict the towers’ collapse, according to the study, and therefore did not understand the level of danger they were in until after they exited the building.

The key drivers of PTSD, the study showed, was late evacuation; being on a high floor in World Trade Center 1 or 2 when the evacuation began; being caught in the dust cloud caused by the falling of the towers; or witnessing horrific events, such as the buildings’ collapse or people jumping or falling out of them. Those that sustained an injury were also at a higher risk of developing PTSD, according to DiGrande.

“When you added one or more of these exposures,” she said, “the risk for the person doubled.”

One out of every three African Americans and Hispanics, and one out of every five women, were found to have chronic PTSD – an alarmingly high proportion, according to Neria. These rates, he said, “should signal an acute need for treatment.”

Researchers attribute the high PTSD rates among these groups to increased health exposure or mental problems before 9/11, immigrant status, lack of social supports and emotional reaction around the time of the attacks.

Patients with PTSD are not entitled to financial compensation from the Victim Compensation Fund of the James R. Zadroga 9/11 Health and Compensation Act, or for any other mental health problem, for that matter. The FealGood Foundation, a nonprofit that helped spearhead the bill, is trying to change that.

The Zadroga bill couldn’t be amended to add mental illness, explained Sean Riordan of the FealGood Foundation. The special master, though, who will serve as an arbitration the claims process, could include mental illness as a factor in the amount of reimbursement granted to someone with a physical injury.

“We hope the regulations that are forthcoming will allow this to be considered as a factor for compensable loss,” said Riordan.

Gleaning the results of the study, the authors recommended that, during disaster preparation training, civilians should be informed of potential experiences that heighten one’s risk of acquiring PTSD, such as evacuation, physical injury, and personally witnessing death, destruction and other traumatic events.

The study, DiGrande said, can help plan for future disasters and guide follow-up work of the WTC Health Registry.

PTSD patients can receive mental health treatment for free at Columbia University Medical Center through Neria’s Trauma and PTSD Program. For more information, visit 212-543-5520 or call www.columbiatrauma.org.