Before September 11th 2001, we were an epidemiology unit in NYC working on a number of population health issues. Soon after September 11th, in consultation with the department of health commissioner, we geared up to provide an assessment of mental consequences of the events on NYC residents, to provide input into planning for post-event service needs; this subsequently turned into a longitudinal study.

  You and your colleagues reported on the relationship between self-reported asthma and psychological sequelae following 9/11. Was this the only instance in which you examined the link between physical and mental health symptoms, or were there others?

As we were working under an important time pressure, with limited funds and therefore limited space for questions, we did not have the opportunity to study other conditions. 

  What role did television play in the psychological effects of 9/11?

Most disasters in the past have examined those that are directly affected with little attention to those who are more on the periphery.  However, we noted that while rates of PTSD were higher in those who were directly affected (exposure), there were many more people not directly affected, so that the overall proportion of people with new-onset PTSD was not that much higher in those directly affected.  What this suggests is that disasters impact more than those directly affected and that planning of services needs to take this into account.

The other major finding is that persons who experienced panic attacks immediately surrounding the time of the event were the most likely to go on to develop PTSD. This suggests strongly that screening for panic attack in persons after disaster and referral to treatment might reduce the burden of mental health consequences in a population.

  Are your findings from the 9/11 studies at all applicable to the current crisis the country is dealing with in the aftermath of Hurricane Katrina?

While mental health issues are important after all disasters, the circumstances of September 11th and of Katrina are different. September 11th was limited geographically so that impact and the physical availability of services was possible. Katrina involved widespread destruction with considerable gaps created in health service provision. Likewise, difference exists when the event is "man-made" terrorist versus "an act of God" relating to nature. In both circumstances, mental health consequences are anticipated, not only in relation to PTSD and depression, but also, as our studies showed, in terms of substance use. After September 11th, we noted that substance use (cigarettes, alcohol, and marijuana) increased, possibly as a means to self-medicate for anxiety. However, while PTSD subsided considerably in the population over the following 6-9 months, substance use remained elevated.  This suggests that public health needs should be broadly considered.

  Are you still involved with this research? If not, what is your current focus?

We are continuing to follow a representative group of New Yorkers to consider the longer-term consequences of the disaster, including the predictors of persistent PTSD and of delayed-onset PTSD.

David Vlahov, Ph.D.
New York Academy of Medicine
New York, NY, USA