9/11's Psychological Scars Slowly Healing

THURSDAY Sept. 11, 2008 -- New Yorkers may be starting to heal psychologically -- as much as it is possible to heal at all -- from the terrorist attacks on the World Trade Center towers on Sept. 11, 2001, experts now say.

"There is a thing called natural recovery and, for some people, it happens quickly, and for others, it takes a long time. What's happened over the past seven years is we're seeing more and more people reaching natural recovery," said Katherine L. Muller, director of psychology training and director of the Cognitive Behavior Therapy Program at Montefiore Medical Center in New York City.

Muller has also been involved in Project Liberty, created in 2001 to provide crisis counseling to people affected by the Twin Towers attack. The project has recently phased down operations.

"We monitor how many folks come requesting treatments, and those numbers have certainly gone done on a very predictable curve," Muller said. "In 2008, we had very few inquiries directly related to 9/11."

Still, it's impossible to discern what is happening right now, since most studies have only looked at results four to five years after planes crashed into the towers, as well as the Pentagon and a Pennsylvania field, killing almost 3,000 people.

"We are anticipating to present preliminary findings on mental health ramifications six to seven years after the attack in a few months, but it takes time to collect this information," said Lorna Thorpe, deputy commissioner for the New York City Department of Health & Mental Hygiene. "What we can say for certain is that many, many people who were directly affected by 9/11 -- meaning survivors, first responders, lower Manhattan residents -- had traumatic symptoms. Most of the indirectly affected people have resolved those symptoms pretty quickly and healed."

But rescue workers and others directly affected may have triple the rate of post-traumatic stress disorder (PTSD) than background levels, she added.

"If symptoms proceed past six months, then it tends to be chronic if not treated well," Thorpe said. "So, we anticipate today that many people are still suffering from PTSD, in part because perhaps they're not seeking care. One characteristic of PTSD is avoidance of the issue. People often take a year to step forward and really seek care."

And every year, as the anniversary of the disaster approaches, health-care workers often see a spike in anxiety disorders and other mental health issues among survivors.

Some 12 percent to 15 percent of people report persistent mental health problems, said Dr. Philip J. Landrigan, who oversees The World Trade Center Medical Monitoring and Treatment Program at the Mount Sinai School of Medicine in New York City. That, he added, is "amazingly similar to being in combat."

"People who didn't normally drink were drinking alcohol, people who didn't usually take drugs were taking drugs," Landrigan said. "A lot of that was a short-term phenomenon that has faded now after seven years, but there are still persistent mental health problems in a substantial proportion."

A new report from the World Trade Center (WTC) Health Registry, just published in the Journal of Public Health this week, finds that in the two to three years following the catastrophe, 16 percent of adults enrolled in the registry reported that they probably had PTSD, while 8 percent had severe psychological distress.

"The most common things we saw were anxiety disorders, PTSD and depression," Muller said.

According to the report, the PTSD rate was highest among people who were injured during the attacks (35 percent), low-income people (31 percent) and Hispanics (30 percent). Overall, minorities, low-income individuals and women experienced higher rates of both mental and physical problems.

"There are a couple of factors that seem to predispose people to having persistent symptoms," Landrigan said. "One is having directly witnessed the trauma like people jumping out of buildings, which seems to have been worst of all. Second is having preexisting mental health problems, people who are already anxious."

Children who had experienced previous trauma were also at heightened risk as were people who did not have specific training, the so-called "naive volunteers."

"These would be people like construction workers, thousands of constructions workers who jumped into bulldozers and rushed to the site on the afternoon of 9/11 to help with rescue and recovery," Landrigan said. "It made a huge difference, but they're not used to dealing with death and destruction, and most have been devastated."

Preschool children exposed to "high-intensity WTC attack-related events" are at increased risk for sleep problems and anxious/depressed behavioral symptoms, reported a study in the Feb. 2008 issue of the Archives of Pediatric & Adolescent Medicine.

The 9/11 attacks also altered, literally, the dreams of Americans, with dreams after the disaster showing more intense images.

And all of this is in the context of lingering physical health problems. Studies have documented that people with no history of heart problems who felt extremely stressed following the 9/11 terrorist attacks were prone to heart problems in the three years following the attacks.

The recent WTC Health Registry report found that 3 percent of adult residents in lower Manhattan and workers had developed asthma two to three years after the attack.

"Most of the firefighting department [including emergency medical technicians] were present at the World Trade Center the first couple of days," said Dr. Thomas Aldrich, a professor of medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. "A tremendous number of people were exposed and virtually everyone had a cough. Most got better, but a percentage had persistent symptoms. Approximately 800 firefighters and EMTs have retired because of respiratory disabilities, which is unprecedented."

More information

There's more on health issues following the 9/11 attacks at the World Trade Center Health Registry.

Posted: September 2008


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