title: The mental health impact of 9/11 on inner-city high school students 20 miles north of Ground Zero.
abstract: OBJECTIVE
  To determine the rate of post-traumatic stress disorder (PTSD) after 9/11 in a sample of New York City high school students and associations among personal exposure, loss of psychosocial resources, prior mental health treatment, and PTSD.
  
  
  METHODS
  A total of 1214 students (grades 9 through 12) attending a large community high school in Bronx County, 20 miles north of "Ground Zero," completed a 45-item questionnaire during gym class on one day eight months after 9/11. Students were primarily Hispanic (62%) and African American (29%) and lived in the surrounding neighborhood. The questionnaire included the PCL-T, a 17-item PTSD checklist supplied by the Office of Behavioral and Social Science Research of the National Institutes of Health (NIH). The PCL-T was scored following the DSM-IV criteria for PTSD requiring endorsement of at least one repeating symptom, two hyperarousal symptoms, and three avoidance symptoms. Bivariate analysis comparing PTSD with personal exposure, loss of psychosocial resources, and mental health variables was done and multiple logistic regression was used to identify significant associations.
  
  
  RESULTS
  There were 7.4 % of students with the PTSD symptom cluster. Bivariate analysis showed a trend for females to have higher rates of PTSD (males [6%] vs. females [9%], p = .06] with no overall ethnic differences. Five of the six personal exposure variables, and both of the loss of psychosocial resources and mental health variables were significantly associated with PTSD symptom cluster. Multiple logistic regression analysis found one personal exposure variable (having financial difficulties after 9/11, odds ratio [OR] = 5.27; 95% confidence interval [CI] 2.9-9.7); both the loss of psychosocial resources variables (currently feeling less safe, OR = 3.58; 95% CI 1.9-6.8) and currently feeling less protected by the government, (OR = 4.04; 95% CI 2.1-7.7); and one mental health variable (use of psychotropic medication before 9/11, OR = 3.95; 95% CI 1.2-13.0) were significantly associated with PTSD symptom cluster.
  
  
  CONCLUSIONS
  We found a rate of PTSD in Bronx students after 9/11 that was much higher than other large studies of PTSD in adolescents done before 9/11. Adolescents living in inner cities with high poverty and violence rates may be at high risk for PTSD after a terrorist attack. Students who still felt vulnerable and less safe eight months later and those with prior mental health treatment were four times more likely to have PTSD than those without such characteristics, highlighting the influence of personality and mental health on development of PTSD after a traumatic event.
authors.affiliation: Section of Adolescent Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA. mecalderoni@hotmail.com
authors.forename: Michele E
authors.initials: ME
authors.lastname: Calderoni
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Alderman
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Silver
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Bauman
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology*; D013334:Students / Q000523:psychology; D014505:Urban Population