title: Cardiopulmonary and mental health diagnoses surrounding the September 11 terrorist acts in a military population.
abstract: BACKGROUND
  In addition to psychological disorders, emotional stress can trigger a chain of neurohumoral imbalances that can manifest as cardiopulmonary complaints. No studies were identified that used objective clinical data on complaints after the terrorist attacks of September 11, 2001. The purpose of this descriptive study was to identify all cardiopulmonary and psychological diagnoses among active duty personnel seeking care at a military treatment facility and/or its ancillary facilities before and after September 11, 2001.
  
  
  METHODS
  The study population included 40,981 active duty military personnel between August 13, 2001 and October 9, 2001 (4 weeks before and 4 weeks after September 11, 2001). Demographic and diagnostic data were obtained from the Composite Health Care System for each visit during the study period. The outcomes of interest were psychological and cardiopulmonary diagnoses.
  
  
  RESULTS
  There were 19,595 clinic visits before September 11, 2001 compared to 19,207 clinic visits in the 4 weeks after September 11. There was no increase in total psychological diagnoses in the postexposure period, compared with the preexposure period (risk ratio (RR), 0.97; 95% confidence interval (CI), 0.84-1.11). The only statistically significant finding was a decrease in diagnoses of psychoses (RR, 0.62; 95% confidence interval, 0.42-0.91). However, diagnoses of depressive disorders were increased in the postexposure period (RR, 1.61; 95% CI, 0.89-2.90; p = 0.11). Total cardiopulmonary diagnoses did not increase in the postexposure period, compared with the preexposure period (RR, 0.96; 95% CI, 0.91-1.02).
  
  
  CONCLUSIONS
  This descriptive study failed to identify evidence that any changes in cardiopulmonary or mental health diagnoses were attributable to September 11 terrorist attacks. In the unfortunate event of another national tragedy, it is recommended that health care professionals administer a questionnaire to determine why patients are seeking care after the tragedy. These data could be linked to International Classification of Diseases data to determine the effects of the tragedy on the health of personnel and their utilization of health care services.
authors.affiliation: Cardiology Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA. RobertEckart@amedd.army.mil
authors.forename: Robert E
authors.initials: RE
authors.lastname: Eckart
authors.forename: Eric A
authors.initials: EA
authors.lastname: Shry
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Scoville
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Thompson
authors.forename: Karl C
authors.initials: KC
authors.lastname: Stajduhar
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D023481:Terrorism / Q000523:psychology*; D013781:Texas / Q000453:epidemiology