Spike in Depression, PTSD Found in Post-Sept. 11 Manhattan

Survey finds psychological impact deepened the closer people were to Ground Zero

WEDNESDAY, March 27, 2002 (HealthDayNews) -- The Sept. 11 terrorist attack on the World Trade Center had a devastating psychological effect on Manhattan residents, a survey finds, and the worst may be yet to come -- not only in New York City but all across the nation.

Random telephone calls to almost 1,000 Manhattan residents living below 110th Street a month or two after the attack found 7.5 percent of them with the cluster of psychiatric symptoms called post-traumatic stress disorder (PTSD) and 9.7 percent suffering depression, says a report in tomorrow's New England Journal of Medicine. The report, by a New York Academy of Medicine group led by Dr. Sandro Galea, says the New York City borough suffered "a substantial burden" of both trauma and depression.

"Given the scope of the event, these results are not surprising," says Galea, an epidemiologist with the academy's Center for Urban Epidemiological Studies. "Both findings confirm what a lot of people had expected. They give us a benchmark for planning after such events in the future."

And although the 9/11 event was unprecedented, studies of the psychological impact after the 1995 Oklahoma City bombing indicate that "what we will probably see is an increase in the number of people reporting these symptoms," adds Esther Giller, executive director of the Sidran Institute, a Baltimore-based nonprofit organization devoted to helping people understand the effect of PTSD.

"The number of people presenting for treatment peaked at the anniversary of the bombing," Giller says. "Then it dropped to the level found immediately after the bombing and continued at that level for six months. So there was an 18-month life cycle in Oklahoma City."

Galea's telephone survey was done in October and November, "pretty early in the scheme of things," Giller notes. "My interpretation is that this is pretty early in the life cycle of PTSD and depression."

The New York researchers assessed PTSD by asking about symptoms that fall into three different clusters: reliving the event, (through recurrent or persistent thoughts, for example); avoiding reminders of the event, (going out of the way to avoid the scene or not watching television, for example); and hyper-arousal, ( a constant feeling of being unsafe).

Overall, 13.6 percent of the people surveyed met the criteria for PTSD or depression and 3.7 percent had symptoms consistent with both disorders, the researchers say. The incidence was highest for people living below Canal Street, those who were closest to the disaster.

"The finding that the closer you get, the greater the likelihood of symptoms is consistent of what has been known for a long time," says Dr. Matthew Friedman, executive director of the Department of Veterans Affairs National Center for PTSD.

But the World Trade Center attack was unusual because it had a national impact, Giller says. Because New York City is the nation's financial center, there was both an emotional and monetary impact felt across the country, she adds.

PTSD can be insidious, she says. "People often don't realize what is happening, in part because they try to avoid thinking about it, and so they don't do anything about it," she says.

"Seeing the family doctor may be the first line of defense," she advises. "The doctor can do an assessment, determine what is going on, and help with seeking therapy if it is needed."

What To Do

For people who have had a stressful experience, Friedman says, "The important thing is to educate yourself and family members in what the symptoms look like. If those symptoms might be interfering with the quality of life, seek an expert to figure out what it is and what to do."

For an overview of PTSD, symptoms and treatment, consult the National Center for Post-Traumatic Stress Disorder or the Sidran Institute.

SOURCES: Sandro Galea, M.D., epidemiologist, Center for Urban Epidemiological Studies, New York Academy of Medicine, New York; Esther Giller, executive director, Sidran Institute, Baltimore; Matthew Friedman, M.D., Ph.D., executive director, National Center for Posttraumatic Stress Disorder, White River Junction, Vt.; March 28, 2002, New England Journal of Medicine
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