Subgroups of New York City children at high risk of PTSD after the September 11 attacks: a signal detection analysis.
OBJECTIVE
Case finding is an important challenge in mental health programs responding to large-scale disasters. Most people who experience psychological symptoms after such events return to normal functioning within a few months. Yet a significant minority continues to experience enduring symptoms. This study demonstrated the use of signal detection analyses of community survey data to identify subgroups of children who were at highest risk of posttraumatic stress disorder (PTSD) after the September 11 attacks.


METHODS
This study reanalyzed results of a needs assessment survey conducted six months after the World Trade Center attacks on September 11, 2001, with a representative sample of 7,832 New York City public school students in grades 4 to 12. Receiver operating characteristic (ROC) analyses conducted on half the sample resulted in a decision tree for classifying children into groups at varying levels of risk of PTSD. These decision rules were subsequently retested on the second half of the sample.


RESULTS
We could reliably classify children into groups with varying probabilities of screening positive on a PTSD screen. Nearly two-thirds of children in grades 4 to 12 who screened positive for probable PTSD were concentrated among 4th graders (35%) and among children who had a friend or family member directly exposed to the attacks (28%).


CONCLUSIONS
Signal detection analysis of community needs assessment surveys can identify community subgroups most likely to screen positive for mental health problems after a disaster or terrorist attack. This information can help target screening and outreach efforts to community segments that have the highest need for services.
Rosen
Craig S
CS
National Center for PTSD, Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA. craig.rosen@va.gov
Cohen
Michael
M
D000293:Adolescent; D002648:Child; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D018570:Risk Assessment; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D017603:Signal Detection, Psychological; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*