TUESDAY, Sept. 10, 2002 (HealthDayNews) -- The psychological trauma experienced after the September 11 terrorist attacks was by no means limited to New York, Pennsylvania or Washington, D.C., a new study confirms.
About 17 percent of the U.S. population residing outside New York City had symptoms of post traumatic stress disorder even two months after the attacks, according to a study in tomorrow's issue of the Journal of the American Medical Association. Researchers based the estimate on a national random sample of Americans.
"And generally this study was done on people not directly exposed," says lead author Roxane Cohen Silver, a professor of psychology and social behavior at the University of California-Irvine School of Social Ecology. "Ninety-nine percent did not lose anyone [in the attacks]."
In the study, Cohen and her colleagues also found those who recovered from the trauma best were those who kept trying to cope with the emotional fallout. Those who went into a denial mode or distracted themselves from the tragedies tended to have more psychological distress months later, Silver says.
"I would be hesitant to say there is one correct way to respond," Silver says. However, certain strategies are definitely associated with greater distress, she found.
Silver and her co-researchers from UC-Irvine and the University of Denver did an Internet-based survey in three phases. In the first, 2,729 respondents answered questions between nine and 23 days after the attacks. In phase two, 933 of the original respondents answered questions about their psychological state of minds about two months after the attacks. In phase three, 787 of them answered questions six months after.
The psychological effects lingered, they found. Two months after, nearly two-thirds of respondents still had fear of terrorist attacks at least sometimes and nearly 60 percent feared harm to their families. Six months later, fears of terrorism were still felt at least sometimes by more than 37 percent and fear of harm to families by more than 40 percent.
Higher levels of distress were found among women, those who were separated from their marriage partner, those who had previous depression or anxiety disorders, those with physical illness, and those with more exposure to the attacks.
Coping styles made a difference in how well people did. Besides asking respondents about their psychological frame of mind, Silver and her team asked how they reacted early on, giving them a list of 14 strategies such as active coping (reaching out or doing something useful, such as giving blood), seeking emotional support, humor, acceptance, religion, venting, turning to substance use, giving up, distracting themselves and other options.
"It very much surprised me that coping strategies were so potent," Silver says. Those who used denial, self-distraction, self-blame or disengagement had higher levels of distress, she found. But those who engaged in active coping had lower levels of distress.
"One of the things that was really impressive from a statistical standpoint was that these coping strategies were important above and beyond variables like prior mental health history," she says. In other words, even those with a previous mental health problem who actively coped could do well.
The value of the study, Silver says, may be to help mental health professionals better identify those who might be at risk for ongoing psychological problems.
The study makes sense to Stephen Sideroff, a clinical psychologist on staff at Santa Monica-UCLA Medical Center.
"What trauma does is play with our body's survival mechanism," he says. "It shifts the thermostat, so to speak. We all have a cognitive framework about what is dangerous," he says, though it varies from person to person. Then a trauma of the magnitude of the terrorist attacks throws us off and "adds a level of unpredictability."
To recover, he adds, "you need to deal with the emotions, reframe what has happened so you can go on with your life." Those who actively cope are doing just that.
What To Do
The American Psychological Association has more information on coping with both terrorism and stress.
