The study found about 17 percent of the U.S. population living outside New York City reported symptoms of posttraumatic stress around Thanksgiving, and 6 percent reported symptoms at six months after the terrorist attacks. The study appears in the Sept. 11 issue of the Journal of the American Medical Association.
Roxane Cohen Silver, professor of psychology and social behavior, led the nationwide study showing that those who disengaged from coping efforts within the first week or two after the attacks -- such as "giving up," distracting themselves, or refusing to believe what happened -- were more likely to have poor psychological outcomes over time. This finding is significant because it may assist mental health workers in identifying those individuals who could be at risk for long-term psychological problems following a traumatic event.
"Overall, our data show that six months after the events of 9-11, the effects continued throughout the country among individuals who were, for the most part, not directly affected by the attacks," Silver said. She found that many individuals across the United States continued to have substantial anxiety about future terrorist attacks personally affecting themselves or those close to them.
Using an anonymous Web-based survey method, Silver and her colleagues collected information about distress and posttraumatic stress symptoms from a national random sample of Americans -- at two weeks, two months and six months after Sept. 11. The study is unique among most trauma research because it follows people who were already part of an Internet panel when the attacks occurred, so their mental and physical health history was known prior to the tragedy. Those individuals who had pre-existing mental or physical health difficulties or had greater exposure to the attacks (including watching them on "live" TV) were more likely to show continued stress symptoms over time.
"This research dispels a number of myths," Silver said. "The effects of a major national trauma are not limited to those directly affected by it, and the degree of response cannot be predicted simply by objective measures of exposure to or loss from the trauma. This fact has not been adequately acknowledged by some mental health professionals.
"We believe it is important to recognize that potentially disturbing levels of trauma-related symptoms can be present in individuals who are not directly exposed to a trauma, particularly when it is a massive national tragedy such as the 9-11 attacks," she added. "Rather than seeing these symptoms as evidence as psychiatric disorders, however, their presence is likely to represent a normal response to an abnormal event."
The JAMA article, "A Nationwide Longitudinal Study of Psychological Responses to September 11," was co-authored by E. Alison Holman, Michael Poulin and Virginia Gil-Rivas of UCI and Daniel McIntosh, a University of Denver professor of psychology.
Silver has spent more than 20 years conducting research on how individuals cope with stressful life events. The National Science Foundation funds the ongoing study, and the researchers will continue to collect data at the one-year mark and during the next four years.
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