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This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12).
Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders.
Disasters can lead to widespread property damage, ongoing economic burden, and extensive loss of life. The attacks of September 11 were caused by human design and were instigated to kill civilians and disrupt the American economy. More than 3,000 lives were lost in one day, affecting a large network of individuals who knew the victims. National studies conducted after the 9/11 attacks suggested that between 4% and 11% of the U.S. adult population knew someone who was killed in the attacks of September 11, 2001 (Schlenger et al., 2002; Silver, Holman, Mcintosh, Poulin, & Gil-Rivas, 2002). Although previous reports suggest that unpredictable loss by malicious violence is one of the most psychologically harmful human experiences (Pfefferbaum et al., 2001; Rynearson & McCreery, 1993), only a few investigations have characterized the psychological sequelae of disaster-related loss among those who experienced loss due to the 9/11 attacks (Galea et al., 2002; Neria et al., 2007; Silver et al., 2002).
While emerging findings suggest that most people are able to accommodate to loss and regain functioning (Bonanno et al., 2002), a significant minority develop persistent psychopathology, manifested by enduring bereavement reactions referred to as complicated...