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Tip
Sheet: Medical Science & Health Tip sheets highlight timely news and events at Washington University in St. Louis. For more information on any of the stories below or for assistance in arranging interviews, please see the contact information listed with each story. For comments on the Medical Science & Health news tips service, please contact the editor, Jim Dryden at (314) 286-0110 or drydenj@msnotes.wustl.edu. Researchers predict more problems for terrorist attack survivors Media assistance: Jim Dryden - (314) 286-0110 Source: Carol North [St. Louis, Mo., July/August 2002] - As the nation continues to cope with the aftermath of the Sept. 11 terrorist attacks, researchers at Washington University School of Medicine in St. Louis warn that survivors and rescue workers continue to be at increased risk for psychiatric disorders.
North's past research into disasters has shown that subsequent psychiatric disorders tend to cluster most densely at the epicenter of a disaster and then get less frequent as the distance from a disastrous event increases. Those who fled the World Trade Center towers prior to their collapse, who watched the attacks from nearby or who were injured or lost loved ones would be expected to have more difficulty than people whose only experience of the attacks was watching on television from hundreds of miles away. Studying survivors of the 1995 bombing in Oklahoma City, North found that one in three people in the path of the bomb blast developed post-traumatic stress disorder (PTSD). Another 10 percent suffered from one of several other psychiatric disorders, most often from major depression. In Oklahoma City, firefighters who served as rescue workers after the bombing were less likely to be diagnosed with PTSD. Only about 13 percent met the criteria. North says she isn't certain why there was less PTSD among firefighters. It may be that those who choose and are chosen to become firefighters for a living tend to have more psychological resilience. Or it could be that specialized training and experience dealing with disasters may have a protective effect. But while they were less likely to develop PTSD after the bombing, North and colleagues recently found that the Oklahoma City firefighters were very likely to have alcohol problems. In diagnostic interviews, roughly a quarter of the rescue workers were found to have current alcohol abuse and almost half were diagnosed with an alcohol use disorder at some point in their lives. "A lot of people thought that firefighters were so traumatized by the Oklahoma City bombing that they were medicating themselves with alcohol, but we found that virtually all of the drinking problems had been present prior to the bombing," North says. Only 2 percent of the cases of alcohol abuse or dependence were new, so North says it may be important to create programs to identify and manage alcohol problems in populations of rescue workers independent of concerns about what to do for them following a disaster. But North cautions that while the findings from Oklahoma City can be used to guide mental health professionals dealing with rescue workers and survivors in New York City, Washington, D.C., and Pennsylvania, the patterns seen in Oklahoma City won't necessarily be repeated the same way in those who were affected by the events of Sept. 11. "Since last September, we have expected that the terrorist attacks would generate unprecedented mental health consequences," she says. "The 9/11 terrorist attacks were greater both in scope and intensity. More people were killed. More property was damaged, and the 9/11 incidents also attacked the nerve center of our nation and its symbols of our freedom and ideals, so it may have done greater damage to our national sense of security. For those reasons, the 9/11 incidents might yield far greater bereavement among rescue workers who lost 343 of their own when compared to firefighters in Oklahoma City, who rescued the wounded and found the bodies of the dead but did not face the additional burden of losing colleagues as part of the disaster." Even before diagnostic data becomes available about 9/11 survivors and rescue workers, North believes certain things will be true. First, the most common psychiatric problem probably will be post-traumatic stress disorder. It's uncertain how widespread PTSD will turn out to be, but in the weeks immediately following the terrorist attacks, many Americans reported feeling depressed, having trouble concentrating and difficulty sleeping. For most, those symptoms probably have subsided, but for others, flashbacks, hyperarousal and other difficulties associated with PTSD have continued since the attacks. "Post-traumatic stress disorder is a chronic condition," North says. "We do not even diagnose it unless symptoms have persisted for at least a month. The chronic nature of PTSD is such that mental health resources must remain in place in order to manage the long-term consequences and serve those who don't seek treatment right away." North suspects that rescue workers may be among those who did not seek treatment immediately and may not have sought treatment yet. The good news is that past research indicates that most people will not develop psychiatric disorders following the 9/11 attacks. Other positive news is that medication and psychotherapy are highly effective as treatments for many post-disaster psychiatric problems. North also has begun investigating the effects of subsequent bio-terrorism. Anthrax-laced letters put scores of congressional aides, postal workers and others on antibiotics last fall. She hopes to learn about the mental health effects of those incidents and identify the problems created by the possibility of deadly attacks with chemical and biological agents. "Many Americans remain fearful, and frankly, while terrorists threaten us, much of this fear may represent a reasonable response to an actual threat rather than psychiatric illness. Therefore, psychiatric treatment may not eradicate that fear," North says. "We can deal with post-disaster psychiatric problems, however, if we can identify and treat those who need treatment, and frankly, almost a year after the 9/11 attacks, mental health workers are still trying to perform that task." |
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