People who 'gave up' after 9/11 more likely to remain distressed

September 10, 2002

The Sept. 11 attacks of 2001 left a lingering psychological impact on the nation according to new research published in the Sept. 11 issue of the Journal of the American Medical Association (JAMA). While 17 percent of the U.S. population living outside New York City reported symptoms of posttraumatic stress two months following the attacks, 6 percent continued to report symptoms six months afterward.

A National Science Foundation (NSF)-funded study led by Roxane Cohen Silver, professor of psychology and social behavior at the University of California, Irvine, was unusual because it followed people who were already taking part in an Internet survey panel when the Sept. 11 attacks occurred. Therefore, their mental and physical health histories were known prior to the tragedy. The study, Silver explains, provides new insights into how mental health workers can help people who have experienced trauma, and dispels a number of myths about who might be most affected by such an event.

"This investigation demonstrates that the effects of a major national trauma are not limited to those directly affected by it, and the degree of response cannot be predicted simply by objective measures of exposure to, or loss from, the trauma," Silver said. "It shows that early disengagement from coping efforts (such as 'giving up,' distracting oneself, or refusing to believe what happened) predicts poor psychological outcomes over time." Her paper for JAMA, "A Nationwide Longitudinal Study of Psychological Responses to September 11," was co-authored by researchers in her department, E. Alison Holman, Michael Poulin, and Virginia Gil-Rivas, as well as Daniel McIntosh, a psychology professor at the University of Denver.

"Overall, our data show that six months after the events of 9/11, the effects continued throughout the country among individuals who were, for the most part, not directly affected by the attacks," Silver said. The paper was based on a national random sample of Americans participating in an Internet-based survey. Respondents were questioned about distress and posttraumatic stress symptoms during the first two weeks, two months and six months after the attacks. A total of 933 people participated in the first and second rounds of the survey, and 787 of those participated in the third round.

"Posttraumatic stress symptoms, while declining over the six months, still remained elevated. Moreover, individuals continued to have substantial anxiety about future terrorist attacks personally affecting themselves or those close to them," the authors write. Those individuals who had preexisting mental or physical health difficulties or had greater exposure to the attacks (including watching them on "live" TV) were more likely to show continued stress symptoms over time. "We believe it is important for health care professionals to recognize that potentially disturbing levels of trauma-related symptoms can be present in a substantial portion of individuals who are not directly exposed to a trauma, particularly when the trauma is a massive national tragedy such as the 9/11 attacks," Silver added. "However, rather than considering these symptoms as evidence of psychiatric 'disorders' per se, their presence is likely to represent a normal response to an abnormal event."
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