Mental health effects of 9-11 attacks studied

School of Medicine researchers have received a five-year, $2.5 million grant from the National Institutes of Health to lead a study of the persistent mental health impact of the September 11 terrorist attacks on people who were in the World Trade Center towers when the planes struck.

“Previous studies have looked more at the general mental health effects on the population in Manhattan, but no studies to date have looked systematically at the psychiatric effects on people who were employed in the towers,” said principal investigator Carol S. North, M.D., professor of psychiatry. “It’s important to understand long-term mental health effects, to appreciate the mental health problems and the needs of the people involved so services and interventions can be designed.”

Carol North
Carol North

North and co-investigators Barry Hong, Ph.D., professor of psychiatry, associate professor of medicine and adjunct associate professor of psychology in Arts & Sciences, and Edward L. Spitznagel Jr., Ph.D., professor of mathematics in Arts & Sciences, will team with researchers from New York and Oklahoma City in the new study.

Investigators will conduct diagnostic psychiatric assessments on 400 survivors, including the most exposed workers from businesses on the highest floors of the World Trade Center towers and their spouses or partners. The goal is to follow the course of psychiatric disorders — especially post-traumatic stress disorder (PTSD) — in the years following a major disaster to assess the treatment needs and to develop and implement interventions that might restore individuals to more productive functioning in the post-disaster workplace.

By studying survivors of the Oklahoma City bombing — the deadliest terrorist attack in the United States prior to September 11 — North and her colleagues found that although most survivors did not develop psychiatric illness, more than one-third did experience PTSD in the months and years after the bombing. Pre-existing psychiatric conditions increased the risk of PTSD.

Survivors who were more seriously injured in the blast were at greater risk for PTSD, as were those who experienced the injury or death of a family member or close friend.

By studying World Trade Center survivors, the team expects to find many of the same influences on psychiatric health. Even more than two years after the attacks, North expects many survivors will still be suffering.

“In Oklahoma City, healing was not always rapid,” she said. “Many people healed quite slowly, and we would anticipate that with a disaster of an even larger scope and magnitude, healing might take even longer for many survivors.”

Over the years, North and her colleagues have done extensive disaster research with survivors. They have studied earthquakes and floods, industrial and technological accidents such as plane crashes, and man-made disasters such as the Oklahoma City bombing and a mass shooting at a cafeteria in Killeen, Texas.

Although North believes the scope of the World Trade Center attack makes it difficult to compare with those disasters, she believes the knowledge gained from survivors of those events will guide the researchers in this study.

Past studies — particularly from survivors in Oklahoma City — suggest most people need time to process grief and anger before moving on.

Others survivors, particularly those who develop a class of symptoms known as avoidance and numbing symptoms, are at high risk for developing PTSD. Avoidance and numbing symptoms include not wanting to think about the disaster, feeling distant or isolated from others and avoiding reminders of the event.

In Oklahoma City, those with at least three avoidance and numbing symptoms went on to develop PTSD 94 percent of the time.

But this study will differ from North’s past disaster work because it will focus on the workplace.

“The workplace has been largely neglected in disaster studies,” North said. “We hope this study will help us learn specific ways companies might be able to help their employees get better and return to productive functioning after these sorts of events.”

The study will examine questions about how soon survivors should return to work and whether companies should hold events — such as memorial services — or offer counseling services to workers.

“What about emergency communication plans that could allow people to check on the well-being of their co-workers?” North said. “A lot of anecdotal evidence suggests stress and worry over the well-being of others is a major problem for survivors in the days after a disaster.

“Might businesses put procedures in place to help their employees avoid that type of stress in the future? We hope this study will provide some answers.”