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. 2011 Sep;5 Suppl 2(0 2):S205-13.
doi: 10.1001/dmp.2011.50. Epub 2011 Sep 7.

Trauma exposure and posttraumatic stress disorder among employees of New York City companies affected by the September 11, 2001 attacks on the World Trade Center

Carol S North  1 , David E Pollio, Rebecca P Smith, Richard V King, Anand Pandya, Alina M Surís, Barry A Hong, Denis J Dean, Nancy E Wallace, Daniel B Herman, Sarah Conover, Ezra Susser, Betty Pfefferbaum
Affiliations

Trauma exposure and posttraumatic stress disorder among employees of New York City companies affected by the September 11, 2001 attacks on the World Trade Center

Carol S North et al. Disaster Med Public Health Prep. 2011 Sep.

Abstract

Objective: Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD.

Methods: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision.

Results: The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness.

Conclusions: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

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Conflict of interest statement

Author Disclosures: The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Exposures to the attacks by geographic location relative to World Trade Center towers. aCompared with those in towers, P ≤.05.bCompared with all of those within 0.1 mi (both inside and not inside towers), P ≤.001.
Figure 2
Figure 2
Nearest geographic locations to World Trade Center (WTC) towers during the attacks among those who met and who did not meet posttraumatic stress disorder (PTSD) symptom criteria, by exposure group hierarchy.
See this image and copyright information in PMC

Comment in

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