How Are We Doing?

We all know that the nation's psyche was badly battered on September 11. But how badly? And for how long? Now researchers have quantified the scope of the problem. Among the findings published last week in the Journal of the American Medical Association: one to two months after the attacks, 11 percent of New Yorkers had symptoms of posttraumatic stress disorder--almost three times the national average. The condition, which can last a lifetime at its worst, "has the potential of creating a substantial public-health problem," says lead author William Schlenger.

The Web-based survey of 2,273 Americans is the latest in a new and growing field: the psychological aftermath of 9-11. The study of posttraumatic stress increased with Vietnam vets, but the disorder did not became a medical diagnosis until 1980. Since then research has been conducted after all kinds of trauma, from rapes to earthquakes to Oklahoma City. But within days of 9-11 it became clear that while prior findings could offer clues, nobody could predict the country's response to an event of such magnitude. Researchers began surveying the country, first by phone, then by Internet, which allowed them faster and broader access to respondents than they'd had in the past. They also had a new category of potential victims: not just disaster survivors--the focus of prior research--but those who witnessed the events on TV. The findings "will advance the field so we have a much better understanding of reactions to trauma," says Dr. Mark Schuster, a Rand Corp. health-policy researcher.

As the data accumulates, researchers are developing a picture of the country's mental health over time. One early study reported high levels of stress nationwide in the days after the attacks, confirming that all Americans were affected, not just those in New York and Washington. It also found that nearly everybody discussed their feelings, something other disaster victims may not have done. Schuster, the study's lead author, says the size and impact of the attacks "gave people permission to open up." The JAMA study is the first to document possible rates of PTSD in New York and Washington as compared to other parts of the country. One surprising finding: D.C. rates were about the same as the rest of the nation's, perhaps because the target was military and the devastation less severe. The study also found that the most significant distinguishing factor among people with probable PTSD--even more so than having a family member, friend or co-worker killed or injured--was how many hours of television they watched. Schlenger says the people who were most distressed may have sought out TV as a coping mechanism.

More research will be out in the weeks and months to come, including one report on the psychological impact of the anthrax scare on Capitol Hill. Next week at the American Psychological Association's annual meeting, Stanford researchers will present early data from an Internet survey of 7,500 Americans. It turns out that the survey itself may have had a therapeutic effect. In unsolicited e-mails, some respondents thanked researchers for helping them process their feelings.

So far, the science is backing up what is already clear--the country's resilience. Last week's study found that while half a million New Yorkers had PTSD symptoms, most likely because of their proximity to Ground Zero, most Americans were doing OK. Another study will report that rates of probable PTSD and depression in Manhattan fell by about two thirds between October and January.

The next big test: the 9-11 anniversary. Attack footage could exacerbate symptoms in people who already have PTSD. And children might not realize the crashing planes took place in the past, says Schuster. "Parents may find kids getting scared and needing support." But the anniversary may also offer a catharsis, an end to a year of grieving. Perhaps then our national psyche can really begin to heal.

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