Nationwide Longitudinal Study of Psychological Responses to September 11

To examine the degree to which demographic factors, mental and physical health history, lifetime exposure to stressful events, September 11-related experiences, and coping strategies used shortly after the attacks predict psychological outcomes over time. DESIGN, SETTING, AND PARTICIPANTS: A national probability sample of 3496 adults received a Web-based survey; 2729 individuals (78% participation rate) completed it between 9 and 23 days (75% within 9 to 14 days) after the terrorist attacks. A random sample of 1069 panelists residing outside New York, NY, were drawn from the wave 1 sample (n = 2729) and received a second survey; 933 (87% participation rate) completed it approximately 2 months following the attacks. A third survey (n = 787) was completed approximately 6 months after the attacks. MAIN OUTCOME MEASURES: September 11-related symptoms of acute stress, posttraumatic stress, and global distress.

Seventeen percent of the US population outside of New York City reported symptoms of September 11-related posttraumatic stress 2 months after the attacks; 5.8% did so at 6 months. High levels of posttraumatic stress symptoms were associated with female sex (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.17-2.31), marital separation (OR, 2.55; 95% CI, 1.06-6.14), pre-September 11 physician-diagnosed depression or anxiety disorder (OR, 1.84; 95% CI, 1.33-2.56) or physical illness (OR, 0.93; 95% CI, 0.88-0.99), severity of exposure to the attacks (OR, 1.31; 95% CI, 1.11-1.55), and early disengagement from coping efforts (eg, giving up: OR, 1.68; 95% CI, 1.27-2.20; denial: OR, 1.33; 95% CI, 1.07-1.64; and self-distraction: OR, 1.31; 95% CI, 1.07-1.59). In addition to demographic and pre-September 11 health variables, global distress was associated with severity of loss due to the attacks (beta =.07; P =.008) and early coping strategies (eg, increased with denial: beta =.08; P =.005; and giving up: beta =.05; P =.04; and decreased with active coping: beta = -.08; P =.002).