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Schlenger WE, Caddell JM, Ebert L, et al. Psychological Reactions to Terrorist Attacks: Findings From the National Study of Americans' Reactions to September 11. JAMA. 2002;288(5):581–588. doi:10.1001/jama.288.5.581
Author Affiliations: Research Triangle Institute, Research Triangle Park, NC (Drs Schlenger, Caddell, Ebert, Jordan, and Kulka, Mss Rourke and Thalji, and Mr Wilson); Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (Drs Schlenger, Caddell, Jordan, and Fairbank); and Knowledge Networks, Menlo Park, Calif (Dr Dennis).
Context The terrorist attacks of September 11, 2001, represent an unprecedented
exposure to trauma in the United States.
Objectives To assess psychological symptom levels in the United States following
the events of September 11 and to examine the association between postattack
symptoms and a variety of indices of exposure to the events.
Design Web-based epidemiological survey of a nationally representative cross-sectional
sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief
Symptom Inventory, administered 1 to 2 months following the attacks.
Setting and Participants Sample of 2273 adults, including oversamples of the New York, NY, and
Washington, DC, metropolitan areas.
Main Outcome Measures Self-reports of the symptoms of PTSD and of clinically significant nonspecific
psychological distress; adult reports of symptoms of distress among children
living in their households.
Results The prevalence of probable PTSD was significantly higher in the New
York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major
metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure
of clinically significant psychological distress suggests that overall distress
levels across the country, however, were within expected ranges for a general
community sample. In multivariate models, sex, age, direct exposure to the
attacks, and the amount of time spent viewing TV coverage of the attacks on
September 11 and the few days afterward were associated with PTSD symptom
levels; sex, the number of hours of television coverage viewed, and an index
of the content of that coverage were associated with the broader distress
measure. More than 60% of adults in New York City households with children
reported that 1 or more children were upset by the attacks.
Conclusions One to 2 months following the events of September 11, probable PTSD
was associated with direct exposure to the terrorist attacks among adults,
and the prevalence in the New York City metropolitan area was substantially
higher than elsewhere in the country. However, overall distress levels in
the country were within normal ranges. Further research should document the
course of symptoms and recovery among adults following exposure to the events
of September 11 and further specify the types and severity of distress in
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