The psychological impact of terrorist attacks: examining a dose-response relationship between exposure to 9/11 and Axis I mental disorders.
BACKGROUND
Previous research has suggested a dose-response relationship between exposure to the 9/11 terrorist attacks and posttraumatic stress disorder (PTSD) and depression. However, this relationship has not been examined with other Axis I mental disorders. This study examined whether the incidence of Axis I mental disorders was associated with level of exposure to the 9/11 terrorist attacks.


METHODS
Data came from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-2; N=34,653, ages 20+) collected between 2004 and 2005. This survey utilized a fully structured face-to-face interview to assess the presence of DSM-IV Axis I disorders since Wave 1 of the NESARC, collected between 2001 and 2002. Multiple logistic regression analyses were employed to examine the relationship between the level of exposure to 9/11 and the prevalence of Axis I disorders since Wave 1.


RESULTS
In adjusted models, higher levels of exposure increased the odds of having new onset PTSD, any anxiety disorder, and any mental disorder. Compared to participants who were not exposed to 9/11, those who directly experienced 9/11 had six times the odds of having PTSD, 2.5 times the odds of having any anxiety disorder, and nearly twice the odds of having any mental disorder.


CONCLUSIONS
Results suggest that there is a dose-response relationship between level of exposure to the 9/11 attacks and PTSD. Furthermore, higher levels of exposure increase the odds of having any anxiety disorder and any Axis I mental disorder.
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
Christine A
CA
Henriksen
James M
JM
Bolton
Jitender
J
Sareen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004781:Environmental Exposure / Q000009:adverse effects* / Q000145:classification / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology; D005260:Female; D033062:Friends / Q000523:psychology; D006117:Grief; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult