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Findings From the National Study of Americans' Reactions to September 11

William E. Schlenger, PhD; Juesta M. Caddell, PhD; Lori Ebert, PhD; B. Kathleen Jordan, PhD; Kathryn M. Rourke, MPE; David Wilson, MS; Lisa Thalji, MA; J. Michael Dennis, PhD; John A. Fairbank, PhD; Richard A. Kulka, PhD

JAMA. 2002;288:581-588.

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 children.

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).

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