Wanting to do something to help New Yorkers in the wake of last year's attack on the World Trade Center, Sandro Galea, M.D., M.P.H, and colleagues at the New York Academy of Medicine's Center for Urban Epidemiologic Studies realized that reliable estimates of the disaster's psychological effects would be useful to city planners in forming a response. Just one month after September 11, the first survey to assess the mental health effects on New Yorkers was fielded by a team led by Dr. Galea and David Vlahov, Ph.D., the Center's director. The Commonwealth Fund provided funding for a mental health needs assessment four months later, and an additional survey was conducted six to nine months after the attack.We asked Dr. Galea what he learned from the studies.
A substantial number of people who were not directly affected by the 9/11 attack experienced symptoms of posttraumatic stress disorder or depression, or both. How did the effects of the attack ripple throughout the city?
Sandro Galea: In three ways, I think. First, while the attacks were happening, it was unclear what their scope was; many people felt that their own lives were endangered even if they were not at the World Trade Center site. Second, the number of people able to see the towers collapse was almost certainly large—about a quarter of New Yorkers by our estimates. Third, the effects of the attacks on the city included disruptions to transportation, communication, and a substantial economic downturn—all of which affected hundreds of thousands of New Yorkers. What we learned is that large-scale disasters in densely populated urban environments can have public health implications well beyond the people directly affected by the attacks.
Now that you have data from one to two months, four to five months, and six to nine months after the attacks, what have you found about the progression and persistence of 9/11-related psychological effects?
Galea: Our early analysis of these data is showing relatively rapid resolution of most of the probable full-blown post-traumatic stress disorder that developed after September 11. However, our most recent data suggest that a large number of people continue to have psychological symptoms. This is the first time we've been able to follow the course of traumatic stress symptoms in the general population after a disaster, and what we learn could be critical in guiding public mental health response in the future.
How did New York use the survey data?
Galea: Our preliminary and subsequent data contributed to the state's effort to obtain FEMA [Federal Emergency Management Agency] funding for mental health interventions. Also, the State Office of Mental Health has implemented Project Liberty, which provides services for those who've demonstrated symptoms of psychological illnesses as well as outreach to the general population through education and counseling.
In the event of another terrorist attack, how do you think the public health research community might play a role in the response?
Galea: Well, first we need mechanisms in place for rapid, reliable assessments of the scope of need in the general population. I think it's fair to say that we were unprepared for an attack that would have mental health consequences both for people who were directly affected and for the general population. Rapid assessments would help us establish estimates of the scope of the problem and of the public health resources that should be implemented after a disaster. Second, we need to think about creative efforts that have a reasonable chance of minimizing the incidence of post-traumatic stress disorder and other psychological distress.We're now working on a project to evaluate the potential benefit of an early educational intervention. It's plausible that efforts like this can be implemented quickly after a disaster and have a tremendous positive effect.