title: Health status and health care utilization following collective trauma: a 3-year national study of the 9/11 terrorist attacks in the United States.
abstract: The September 11, 2001 terrorist attacks (9/11) presented a unique opportunity to assess the physical health impact of collective stress in the United States. This study prospectively examined rates of physical ailments and predictors of health care utilization in a U.S. nationally representative sample over three years following the attacks. A sample of adults (N = 2592) completed a survey before 9/11/01 that assessed MD-diagnosed physical and mental health ailments. Follow-up surveys were administered at one (N = 1923), two (N = 1576), and three (N = 1950) years post-9/11 to assess MD-diagnosed physical health ailments (e.g., cardiovascular, endocrine) and health care utilization. Reports of physical ailments increased 18% over three years following 9/11. 9/11-related exposure, lifetime and post-9/11 stress, MD-diagnosed depression/anxiety, smoking status, age, and female gender predicted increased incidence of post-9/11 ailments, after controlling for pre-9/11 health. After adjusting for covariates (demographics, somatization, smoking status, pre-9/11 mental and physical health, lifetime and post-9/11 stress, and degree of 9/11-related exposure), increases in MD-diagnosed cardiovascular, endocrine, gastrointestinal, and hematology-oncology ailments predicted greater utilization of health care services over two years. After the collective stress of 9/11, rates of physical ailments increased and predicted greater health care utilization in a U.S. national sample.
authors.affiliation: Program in Nursing Science, Room 100E Berk Hall, University of California, Irvine, CA 92697-3959, USA. Electronic address: aholman@uci.edu.
authors.forename: E Alison
authors.initials: EA
authors.lastname: Holman
authors.affiliation: Dept of Psychology & Social Behavior, 4201 Social & Behavioral Sciences Gateway, University of California, Irvine, CA 92697-7085, USA.
authors.forename: Roxane Cohen
authors.initials: RC
authors.lastname: Silver
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis*; D013997:Time Factors; D014481:United States / Q000453:epidemiology