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New Yorkers Bore Brunt of PTSD After Sept. 11

Rates of disorder much higher in most affected area than in rest of nation

TUESDAY, Aug. 6, 2002 (HealthDayNews) -- New Yorkers were far more likely than other Americans to report symptoms of post traumatic stress disorder (PTSD) in the first two months after the Sept. 11 terrorist attacks that felled the World Trade Center, a new study has found.

The rate of probable PTSD among New York adults on that day topped 11 percent, compared with 4 percent in the nation as a whole. That translates into more than half a million New Yorkers with trauma symptoms related to the events, which disproportionately affected their city and killed more than 2,800 there alone.

"Many or most Americans were distressed in some way or another by the attacks. They were angry, afraid, bereaved -- they were a lot of other things," said William Schlenger, a mental health expert at the Research Triangle Institute in Research Triangle Park, N.C., and lead author of the study.

"But much of that distress has been shown to be self-limiting. It goes away by itself, and probably -- though it was uncomfortable for them -- its clinical significance was limited," said Schlenger, whose findings appear in tomorrow's issue of the Journal of the American Medical Association.

While the attack on the Pentagon occurred just across the Potomac River from Washington, D.C., only 2.7 percent of people surveyed in that city reported symptoms of PTSD. Schlenger said that may be because people considered the Pentagon a military target as opposed to a civilian symbol like the Twin Towers. Or it may reflect the fact that the building lies outside the city, whereas the New York assault struck at the heart of its business district.

Post traumatic stress disorder is emotional distress linked to a trauma that is relived repeatedly though nightmares and flashbacks. The condition is also marked by physical ailments, such as insomnia, chest pain and stomach ailments. Studies in Vietnam veterans have found that perhaps half of those who suffered PTSD developed chronic cases. The rest either got better on their own or improved with treatment.

Schlenger and his colleagues surveyed nearly 2,300 people nationwide. About one in eight said they had a relative, friend, or co-worker killed or injured in the attacks. A quarter said they had family or friends in the military. Overall, the researchers estimate that 10 million Americans had one degree of separation from the events.

Proximity to the attacks was the strongest predictor of PTSD. After adjusting for factors like sex, age and education, people in New York on the day of the disaster were nearly three times more likely than those elsewhere in the country to report symptoms of the condition. The risk of PTSD was also elevated among women and people who watched a lot of television coverage of the events.

In the first two months after the attacks, 11.6 percent of Americans reported clinically significant distress that wasn't PTSD. Yet that level fell within the expected range, the researchers said. Again, television coverage was associated with these symptoms.

Why that's true is not clear, Schlenger said, though it probably reflects the use of TV as a coping mechanism.

"The findings are more consistent with the interpretation that people watched more TV as a way of coping with distress rather than that they became distressed with what they saw," Schlenger said.

More than 60 percent of New York parents reported that at least one of their children suffered sleeping trouble, irritability and other problems after the attacks. That appeared to be a higher proportion than elsewhere in the country, but the differences weren't statistically significant, Schlenger said.

"The impact on children across the nation is not fully understood yet, and it warrants further exploration," added study co-author Juesta Caddell, also of the Research Triangle Institute.

Terence Keane, director of the VA National Center for PTSD in Boston, called the findings good news.

"The possibility that the impact would have been felt more broadly is real, but these data are reassuring to us. Only the most directly affected by the assault are suffering psychologically," said Keane, who is also a professor of psychiatry at Boston University School of Medicine.

Dr. Eric Braverman, director of PATH Medical, a New York City clinic, said the results of the study aren't surprising. The psychological impact of a traumatic event is always felt strongest in the immediate area where the incident occurred and by those whose connection with victims is most direct. As the physical and emotional distance from the event widen, its ripples are fainter, he said.

Trauma acts like a lever, prying loose depression, anxiety and even physical ailments that might be lying beneath the surface, Braverman said. "It exacerbates your normal vulnerability," he added, showing up as insomnia for some, sinus infections or heartburn for others.

And that makes diagnosing PTSD difficult. After all, Braverman said, a quarter of Americans complain of anxiety, a quarter have the blues sometimes, as many as half are stressed. The key to dealing with PTSD, Braverman added, is to treat these underlying conditions individually.

What To Do

Learn about PTSD from the National Center for PTSD or the PTSD Alliance.

SOURCES: William Schlenger, Ph.D., and Juesta Caddell, Ph.D., Research Triangle Institute, Research Triangle Park, N.C.; Terence M. Keane, Ph.D., director, VA National Center for PTSD, and professor of psychiatry, Boston University School of Medicine; Eric Braverman, M.D., director, PATH Medical Center, New York City; Aug. 7, 2002, Journal of the American Medical Association
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