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The attack on the World Trade Center was unprecedented in New York City's history, so it is not surprising that residents would suffer emotional repercussions. Although media accounts anecdotally described the psychological toll, a scientific measure of the emotional impact of 9/11 remained unknown until several researchers affiliated with Columbia University Health Sciences, the New York Academy of Medicine, and elsewhere surveyed city residents within two months of the attack.

Their results, the first recording of the psychological consequences of a catastrophe so soon after a devastating event, reveal almost 14 percent of New York City dwellers were hit hard, either with depression or post-traumatic stress disorder (PTSD) or both. Their findings, published in the March 28 New England Journal of Medicine, are now helping mental health professionals identify who needs help and to obtain resources to help them.

In their telephone-based survey, performed in English and Spanish between Oct. 16 and Nov. 15, the researchers asked 1,008 Manhattan residents living below 110th Street about their emotional state. The researchers found that 7.5 percent of the residents had PTSD and 9.7 percent depression directly related to the attacks. Overall, the researchers estimate 13.6 percent of New Yorkers were suffering from one or both in the month following the attack.

“These numbers show there is a substantial mental health burden in the general population,” says Dr. Sandro Galea, an epidemiologist at the New York Academy of Medicine, a doctoral student in epidemiology at the Mailman School of Public Health, and the paper's lead author. The researchers expected high levels of distress based on studies of people six months after a human-caused event associated with massive deaths, property damage, and severe economic loss, such as the 1992 Los Angeles riots in which 4 percent of residents near the disturbances had PTSD.

But the NEJM research was unique in sampling the general population so soon after a catastrophe. “We knew that survivors and rescue workers who were actually in the buildings would be affected and there would be a lot of resources directed at the group,” says Dr. Galea. “We wanted to see how everyone else was doing and we wanted results that were useful to the city and state as they were planning resources.”

The data revealed groups disproportionately affected and needing the most help. Not surprisingly, a higher percentage of residents living below Canal Street were affected, but for unknown reasons, Hispanics suffered from PTSD and depression at twice the rate of whites and blacks.

The researchers also found that residents who reported having panic attack symptoms, including shortness of breath, trembling, and a fear of dying, soon after the attack were seven times more likely to have PTSD the following month than residents who didn't have a panic attack.

Dr. David Vlahov, the paper's senior author, director of the academy's Center for Urban Epidemiologic Studies, and professor of clinical epidemiology at the Mailman School, says mental health professionals are trying to come up with inventive ways to protect people after future catastrophes. “One idea is web-based to help people work through the experience,” he says. “It could be made available to a large group of people fairly inexpensively. Otherwise, we’re back to alerting individuals to get counseling.”

Drs. Vlahov and Galea are now analyzing data collected between January and February about the emotional state of residents in all five boroughs and are currently in the midst of collecting data from New York City and nearby counties to monitor any changes in mental health for a six-month follow-up after the event.

“We need reports like this to let people know there's something normal about their pain and suffering,” said Dr. Neal Cohen, former New York City health commissioner, at a press conference announcing the results. “The stigma associated with depression has historically kept people away from help, but we have to talk about it and seek professional care.”