title: Regional prevalence of fatiguing illnesses in the United States before and after the terrorist attacks of September 11, 2001.
abstract: OBJECTIVE
  Stress or emotional traumas are considered risk factors for unexplained fatiguing illnesses. From July to December 2001, the Centers for Disease Control and Prevention conducted a multigeographical pilot study to test the feasibility of a survey to estimate the prevalence of fatiguing illnesses in the United States. We used data obtained during this survey to estimate the effect of the coincidentally occurring terrorist attacks of September 11, 2001, on the regional prevalence of fatiguing illnesses.
  
  
  METHODS
  Identified by random-digit dialing, 2,728 households in eight regional strata were interviewed, and 7,317 respondents were screened for severe fatigue of at least 1 month duration. Identified fatigued people of age 18 to 69 years (N = 440) and a sample of nonfatigued people of the same age range (N = 444) were interviewed in detail concerning fatigue, other symptoms, and medical and psychiatric histories.
  
  
  RESULTS
  Weighted prevalence estimates based on interviews performed after the attacks were significantly lower compared with estimates based on interviews performed before the attacks (prolonged fatigue: 5,450 vs. 1,530/100,000, p =.010; chronic fatigue: 18,510 vs. 10,070/100,000, p =.002; chronic fatigue syndrome-like illness: 2,510 vs. 960/100,000, p =.014).
  
  
  CONCLUSIONS
  Our findings suggest decreased regional prevalence of fatiguing illnesses in the aftermath of the terrorist attacks. The causes of this effect are unknown but might involve acute psychological and physiological adaptations that modify the perception or manifestation of fatigue. Future studies should be specifically designed to scrutinize the relationship between stress and fatiguing illnesses and the mediating mechanisms of such a relationship.
authors.affiliation: Division of Viral and Rickettsial Diseases, Viral Exanthems and Herpesvirus Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. cmheim@emory.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Heim
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bierl
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.forename: Dieter
authors.initials: D
authors.lastname: Wagner
authors.forename: William C
authors.initials: WC
authors.lastname: Reeves
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S. / Q000706:statistics & numerical data; D002908:Chronic Disease; D005221:Fatigue / Q000453:epidemiology*; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014481:United States / Q000453:epidemiology