Context The terrorist attacks of September 11, 2001, represent an unprecedented exposure to trauma in the United States. A study in the Journal of the American Medical Association estimates that more than a half-million people in the New York City metropolitan area may have developed Posttraumatic Stress Disorder (PTSD) in the wake of the September 11 attacks. In contrast, levels of general psychological distress in New York City did not differ from those reported in other parts of the country. Further, in the nation as a whole, general psychological distress was within normal limits. This study (JAMA, 7-August-2002) is the first to report about clinically significant psychological distress and PTSD in the broader New York City metropolitan area, in the Washington, DC, area, and in the nation as a whole.
Objectives To assess psychological symptom levels in the United States following the events of September 11 and to examine the association between postattack symptoms and a variety of indices of exposure to the events.
Design Web-based epidemiological survey of a nationally representative cross-sectional sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom Inventory, administered 1 to 2 months following the attacks.
Setting and Participants Sample of 2273 adults, including oversamples of the New York, NY, and Washington, DC, metropolitan areas.
Main Outcome Measures Self-reports of the symptoms of PTSD and of clinically significant nonspecific psychological distress; adult reports of symptoms of distress among children living in their households.
Results The prevalence of probable PTSD was significantly higher in the New York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure of clinically significant psychological distress suggests that overall distress levels across the country, however, were within expected ranges for a general community sample. In multivariate models, sex, age, direct exposure to the attacks, and the amount of time spent viewing TV coverage of the attacks on September 11 and the few days afterward were associated with PTSD symptom levels; sex, the number of hours of television coverage viewed, and an index of the content of that coverage were associated with the broader distress measure. More than 60% of adults in New York City households with children reported that 1 or more children were upset by the attacks.
Conclusions One to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults, and the prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country. However, overall distress levels in the country were within normal ranges. Further research should document the course of symptoms and recovery among adults following exposure to the events of September 11 and further specify the types and severity of distress in children.
