Q&A: How 9/11 Kids Coped With Their Loss

An estimated 3,000 children lost a parent in the 2001 World Trade Center attack, instilling in them a legacy of anguish. The full psychological impact on those children may never be known, but a new study—the first empirical investigation of the youngsters who lost a parent on September 11—provides some significant pointers. The findings, released today by researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center, will appear in the April issue of the journal Biological Psychiatry. The investigation compared 45 kids who lost a parent in the WTC attack to 34 children who had not lost a parent, and found that in the years following the attack, the rate of psychiatric illness among children who lost a parent reached nearly 73 percent. Bereaved children showed double the rate of anxiety disorders seen in their non-bereaved counterparts and 10 times the rate of post-traumatic stress disorder. NEWSWEEK's Julie Scelfo spoke with Dr. Cynthia Pfeffer, professor of psychiatry at Weill Cornell Medical College and lead author of the study, to find out more. Excerpts:

NEWSWEEK: How many kids were in your study?
Cynthia Pfeffer:
There were 45 bereaved children who lost parents on September 11 in the towers and 34 who were not bereaved, all around 9 years on average.

Was it difficult to enroll children in your study?
It was. While these families were getting a lot of support, the fact that they had a spotlight on them made some of the children feel very different than other kids in their community. They didn't want to be singled out, so to speak.

What did you find?
We found that before 9/11 these were normal children living in the community. However, after 9/11, after losing a parent, they seemed to have developed psychiatric disorders, especially PTSD (Post Traumatic Stress Disorder). Their rate of PTSD after 9/11 was about 30 percent—as compared to 3 percent [in the non-bereaved control group]. So it's 10 times higher. And that was a significant difference.

My understanding is that you also looked to see whether the children had physical symptoms of stress. Is that right?
When a person is severely stressed, cortisol levels often go up for a period of time. We were interested in whether this occurred in these children, and if so, for how long? Indeed, we found their cortisol levels did go up and tended to stay significantly higher than the non-bereaved children throughout the entire period of our study. Over time, their levels were decreasing. But bereaved children still had consistently higher levels than the non-bereaved.

What effects are associated with elevated cortisol levels?
We don't know what happens in children yet. In adults with significantly higher cortisol levels chronically, they can experience bone loss, cognitive problems, development of diabetes. Our findings suggest the possibility that severe stress over loss on 9/11 may have altered these children's responses to future stresses. In other words, after 9/11, when they encountered other stress, their bodies may have reacted [differently].

Did you find that many of the kids were depressed?
We actually expected that there would be a higher rate of [depression] than we found because people often talk about how bereavement manifests in depression. But what we found in the study is that anxiety disorders are very much involved in bereavement.

How many of the children in your study suffered from some sort of anxiety disorder?
Nearly three in 10 bereaved children had some type of anxiety disorder. 27.3 percent of bereaved youngsters suffered from separation anxiety and 25 percent experienced generalized anxiety, double the rate seen in non-bereaved youngsters. The rate of simple phobias in bereaved children was also double that of non-bereaved children [13.6 percent vs. 5.9 percent.]

How do anxiety disorders affect the lives of children who lost a parent on September 11?
Some were more withdrawn, some were hampered by nightmares, others were hampered by thoughts about how the parent died. The thoughts would suddenly pop into their mind, intrude on whatever they were doing, and they would get nervous and anxious.

The death of a parent is always traumatic for a child. How does bereavement change when the loss occurs in such a devastating way?
I think this kind of loss, which was very traumatic, sudden, unexpected, creates intense responses, perhaps similar to other kinds of highly traumatic losses like by suicide, car accidents, murder. These are very stressful losses, and we're still figuring out how the bereavement process may be experienced differently than losing a parent from illness, for example.