Nationwide longitudinal study of psychological responses to September 11.

By R. Silver, E. Alison Holman, D. McIntosh, Michael Poulin, V. Gil-Rivas. Journal of the American Medical Association (JAMA), 2002

1,213 citations recorded by the source corpus.

CONTEXT The September 11, 2001, attacks against the United States provide a unique opportunity to examine longitudinally the process of adjustment to a traumatic event on a national scale. OBJECTIVE To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time. DESIGN, SETTING, AND PARTICIPANTS A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks. MAIN OUTCOME MEASURES September 11-related symptoms of acute stress, posttraumatic stress, and global distress. RESULTS Seventeen percent of the US population outside of New York City reported symptoms of September 11-related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11-1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre-September 11 health variables, global distress was associated with severity of loss due to the attacks (beta =.07; P =.008) and early coping strategies (eg, increased with denial: beta =.08; P =.005; and giving up: beta =.05; P =.04; and decreased with active coping: beta = -.08; P =.002). CONCLUSIONS The psychological effects of a major national trauma are not limited to those who experience it directly, and the degree of response is not predicted simply by objective measures of exposure to or loss from the trauma. Instead, use of specific coping strategies shortly after an event is associated with symptoms over time. In particular, disengaging from coping efforts can signal the likelihood of psychological difficulties up to 6 months after a trauma.

Subfields: Clinical Psychology, Epidemiology

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Citations in the corpus

Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness (2008, background): “And, in extreme cases, such as the September 11th terrorist attacks, the stress may be felt by an the entire nation (Silver et al. 2002).”
Post-traumatic stress disorder following disasters: a systematic review (2007, background): “2006b), other studies conducted in national samples after the same attacks (Schlenger et al. 2002 ; Silver et al. 2002) and in distant areas after the Oklahoma City bombing (Pfefferbaum et al.”
Destruction and Distress: Using a Quasi-Experiment to Show the Effects of the September 11 Attacks on Mental Well-Being in the United Kingdom (2011, background): “For example, PTSD was not limited to those who experienced the 9 ⁄ 11 attacks directly (Silver et al., 2002), although the actual levels of stress outside of New York are disputed (Schlenger et al., 2002).”
The epidemiology of post-traumatic stress disorder after disasters. (2005, background): “3% nationally September 11 terrorist attacks; (32) IES-R 2 months 17% 6 months 5.”
Nightmare frequency as a function of age, gender, and September 11, 2001: Findings from an Internet questionnaire. (2006, background): “The finding that 9/11 affected particularly the 10 –29 years old male group is unexpected because females consistently reported more PTSD symptoms post-9/11 than did males (Grieger, Fullerton, & Ursano, 2003; Hoven et al., 2005; Sciancalepore & Motta, 2004; Silver et al., 2002; Torabi & Seo, 2004)”
The internet as psychological laboratory. (2006, background): “…consumption habits (e.g., Iacobucci 2003), adult attachment (e.g., Wei et al. 2004), job satisfaction (e.g., Judge & Ilies 2004), organizational behavior (e.g., Eaton & Struthers 2002), coping with psychological trauma (Silver et al. 2002), and medical decision making (e.g., Waters et al. 2005).”