Post-traumatic stress grips N.Y. after attack, study says

Depression and post-traumatic stress were strikingly widespread among Manhattan residents in the weeks after Sept. 11, according to the first scientific study designed to measure the psychological toll of terrorism in New York.

A special report published in Thursday’s issue of the New England Journal of Medicine estimates that 20 percent of people living close to the World Trade Center, or one in five, suffered post-traumatic stress disorder.

In the southern two-thirds of Manhattan, 7.5 percent of residents were found to have post-traumatic stress, and 9.7 percent were found to have clinical depression–rates two to three times higher than is estimated in the general population.

The results, researchers said, indicate health officials should consider the mental scars left by terrorist assaults on the public as well as damage suffered by direct victims.

Led by Dr. David Vlahov and Dr. Sandro Galea of the New York Academy of Medicine, the research team, through extrapolation, found that more than 87,000 Manhattan residents suffered bouts of major depression and 67,000 others were afflicted by post-traumatic stress disorder when polled five to eight weeks after the attacks.

Of the study’s 1,008 participants, 3 percent reported the clinical signs of both the stress disorder and depression, which often go together.

“New Yorkers went through a severe trauma,” Galea said. “Keep in mind, the percentages apply only to people who met the formal diagnostic criteria for these disorders. Many, many, thousands of others actually had symptoms. Such high rates mean the general population probably is going to have substantial, long lasting psychological distress.”

The study participants were randomly selected, interviewed by phone and asked questions about their exposure to Sept. 11 events–for example, whether they witnessed the attacks and suffered personal losses–and whether they experienced psychological problems afterward.

They also were asked about their level of emotional support during the six months before the attacks and the number of stressful events they experienced during the previous year.

The survey had a margin of error of plus or minus three percentage points.

Post-traumatic stress disorder symptoms include nightmares, anxiety, irritability and outbursts of anger, and the symptoms must be present for at least a month. Feelings of intense guilt at having survived also are common. Symptoms of depression include a loss of interest in life, loss of appetite, sleeping irregularities, trouble concentrating and feelings of guilt or worthlessness.

Increase in patients seen

The study supports the experience of government mental-health programs and private therapists in New York City, who report that the number of patients seeking help for post-traumatic stress problems has skyrocketed.

Lifenet, a referral service that directs callers to psychologists, reported that call volume doubled in the three months after Sept. 11 and has continued to climb since the six-month mark on March 11.

The service now receives about 350 calls a day, with post-traumatic stress complaints accounting for 26 percent of the calls, compared with less than 1 percent before Sept. 11.

“We do expect to see greater psychological stress the farther we move away from Sept. 11,” said Dr. John Draper, Lifenet director. “People aren’t necessarily as available as they once were when New York was one big support group. Those who cannot go about their business feel very isolated.”

Psychotherapist Laurie Nadel, a specialist in stress and related disorders, is treating about 20 patients for post-traumatic stress. Most of them witnessed the attacks and now report a wide range of phobias, such as fear of elevators, subways and crowds. One patient did not leave her house for a month after Sept. 11.

A survivor’s nightmares

Among the thousands of New Yorkers who have sought psychological help since Sept. 11 is Norma Walewski, 49, in treatment for post-traumatic stress disorder since December. Walewski, an employee of Chicago-based Aon Corp., worked on the 93rd floor of the World Trade Center’s south tower.

For months, she woke up at night in a panic, believing she was still there.

“I’d be in a store and hear people talking about what happened [on Sept. 11], and I would wonder, `Am I really here?'” she said. “You almost dissociate from where you are, like you can’t believe you’re alive.”

The researchers were careful to say they found symptoms “consistent with” the diagnosis for mental disorders. They did not assess post-traumatic stress with in-person interviews, and other experts say assigning personality-disorder scores based on self-reports is problematic.

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“These are the earliest data, and the researchers are to be commended, but there are some technical things I question,” said Dr. Carol S. North, psychiatry professor at Washington University School of Medicine in St. Louis and a leading expert on post-traumatic stress disorder and its relationship to disasters. “How did the researchers make the diagnosis? How did they assess someone’s exposure to the attacks?”

A member of the team behind the new report defended it.

“The method we used has been compared to state-of-the-art methods with trained clinicians interviewing patients, and it produces very similar results,” said Dr. Dean Kilpatrick, professor of psychiatry and behavioral sciences at Medical University of South Carolina, Charleston, and director of the National Crime Victims Research and Treatment Center.

“The information gathered will help mental health professionals respond better when the next attack comes.”