MONDAY, Sept. 9, 2002 (HealthDayNews) -- New York City got a one-year checkup today on the health impact of the Sept. 11 attacks, and the examiners found cause for both optimism and concern.
In some respects, New Yorkers have rebounded remarkably from the toppling of the World Trade Center, researchers at an all-day conference said. In other ways, however, they are still reeling from it.
Dr. Jeremiah Barondess, president of the New York Academy of Medicine, which sponsored the conference, said the effects of Sept. 11 on the city's welfare "clearly were not trivial." But, Barondess added, scientists have "learned a lot" since that day about what happened, what might happen after future terrorist attacks, and how to respond better to those events if they occur.
Many of the results relayed today have appeared in previous forums: evidence on rates of post traumatic stress disorder (PTSD) in people directly impacted by the attack on the Twin Towers; respiratory problems from the pollutants spewed across the city when the buildings fell; and the increased use of cigarettes and alcohol in the weeks and months to follow.
But presented together, they offer a clear compendium of the legacy of Sept. 11.
David Vlahov, director of the academy's Center for Urban Epidemiological Studies, estimated that 585,000 New Yorkers had symptoms of PTSD after the event.
Initial rates of PTSD dropped markedly between the fall and the spring, when the most recent surveys were conducted, Vlahov said. But 91,000 people are believed to have chronic cases of the full-blown disorder, which is marked by flashbacks, nightmares, social withdrawal and other signs.
Those with PTSD, his surveys found, were much more likely than others also to have major depression. "Clearly there's overlap" between the two conditions, Vlahov said.
"Fear is disabling," said Dr. Lloyd Sederer, executive deputy commissioner in the division of mental hygiene at the New York City Department of Health and Mental Hygiene. Dealing with it, he said, will take effort.
The good news, Sederer said, is that the events of last year seem to have stimulated a revival of community mental health programs designed to offer all city residents access to emotional care.
A team led by Christina Hoven, a Columbia University public health researcher, surveyed more than 8,200 schoolchildren in New York, a massive epidemiological undertaking. They found that 11 percent of them suffered PTSD related to the attack on the World Trade Center.
Many also had other emotional trouble, including major depression (8 percent), panic (9 percent), anxiety (11 percent), and the fear of public places known as agoraphobia (15 percent).
No previous study had examined the psychological well-being of students in New York. But those numbers were far higher -- between 25 percent and 525 percent -- than rates identified in a prior look at four metropolitan school systems that included a New York suburb, Hoven said.
In all, Hoven said, roughly 200,000 city students, or a sixth of the total enrollment, experienced some emotional distress related to the terrorism attacks and the events that followed (including the October anthrax mailings that killed five people). Girls were more likely than boys to report such problems, and very young children were more likely than their older schoolmates to have signs of PTSD.
Many parents, too, were profoundly affected, said Jennifer Stuber, also of the Center for Urban Epidemiological Studies, who surveyed 475 parents. They were more likely to experience PTSD or depression related to the attacks than childless adults, Stuber said. Single parents were even more likely than married ones to have such problems, and to report increases in their smoking and drinking in the wake of the attacks.
The emotional distress of parents rubbed off on their children. Kids with a parent with PTSD were nearly three times more likely than their classmates to display behavior problems.
Black and Latino children -- who make up the bulk of the city's school system -- and those from one-parent homes were more likely than other children to have received counseling services after Sept. 11, Stuber said. That suggests there may be other children in need of care who are not receiving it, she said.
Dr. Thomas Frieden, commissioner of the New York City Department of Health and Mental Hygiene, cited surveys showing that an estimated 23 percent of adult New Yorkers reported an increase in alcohol use or smoking in the aftermath of the attack.
As many as 75,000 people may have taken up smoking for the first time as a result of Sept. 11.
Given these figures, Frieden said, mental health and substance abuse treatment should be a cornerstone of future disaster planning and response.
Dr. Sandro Galea, a medical epidemiologist at the New York Academy of Medicine who studied trends in tobacco and alcohol use, said the spikes in use of these substances after the attack haven't subsided despite predictions that they would.
One to two months after Sept. 11, roughly 30 percent of people surveyed said they'd increased their intake of tobacco or alcohol. Six to nine months after the event, that number had fallen, but only slightly, to about 26 percent, Galea said. "Contrary to our expectations, the increases in these substances has persisted," he said.
That means 1.5 million New Yorkers are smoking or drinking more than they used to. People with PTSD, depression or both were more likely to report increasing their intake of tobacco and alcohol.
Yet the fact that rates of emotional distress dropped in the months after the terrorist attacks raises a dilemma, Galea said. Perhaps the persistent increase in smoking and drinking is "adaptive," a normal (if unhealthy) reaction to an abnormal event. Or, perhaps it is taking place against the backdrop of psychological trouble that's not severe enough to be diagnosed.
"Where is it going?" Galea asked.
What To Do
Learn more about the response to the disaster from the New York City Department of Health and Mental Hygiene or the Centers for Disease Control and Prevention.
