title: Macrolevel stressors, terrorism, and mental health outcomes: broadening the stress paradigm.
abstract: OBJECTIVE
  We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study.
  
  
  METHODS
  Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11.
  
  
  RESULTS
  Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre-September 11 distress and drinking.
  
  
  CONCLUSIONS
  The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm.
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, IL 60612, USA. jrichman@uic.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Richman
authors.forename: Lea
authors.initials: L
authors.lastname: Cloninger
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Rospenda