title: Communal bereavement and resilience in the aftermath of a terrorist event: Evidence from a natural experiment.
abstract: BACKGROUND
  Sociological analyses of the psychological distress experienced by persons indirectly exposed to traumatic stressors have been conceptualized as a form of communal bereavement, defined by Catalano and Hartig (2001) as the experience of distress among persons not attached to the deceased. Their theory predicts communal bereavement responses particularly in the setting of loss of essential state, religious, or economic institutions.
  
  
  OBJECTIVE
  To estimate the extent to which the September 11, 2001 attacks on the U.S. World Trade Center had a causal effect on psychological distress nationwide.
  
  
  METHODS
  We used a difference-in-differences framework applied to repeated cross-sectional data from more than 300,000 participants in the 2000 and 2001 Behavioral Risk Factor Surveillance System surveys. Psychological distress was measured using three questions eliciting days of poor mental health-related quality of life. The September 11 attacks served as our exposure of interest.
  
  
  RESULTS
  The September 11 attacks had a statistically significant, adverse, causal effect on psychological distress nationally. Both the magnitude and statistical significance of the estimated effects were larger in the New York City region compared to the rest of the country. Our estimates were robust to probes of the parallel trends assumption and potential sources of selection bias, as well as to falsification tests. However, these effects had largely resolved within four weeks.
  
  
  CONCLUSIONS
  Contrary to findings from the medical and public health literature, we conclude that the September 11 attacks did not have lasting effects on communal bereavement.
authors.affiliation: Massachusetts General Hospital, MGH Global Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA; Mbarara University of Science and Technology, Mbarara, Uganda. Electronic address: actsai@partners.org.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.affiliation: Massachusetts General Hospital, MGH Global Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Atheendar S
authors.initials: AS
authors.lastname: Venkataramani
mesh_terms: D000328:Adult; D001601:Bereavement; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009519:New York City; D055500:Resilience, Psychological; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*
keywords: Disasters; Post-traumatic; September 11 terrorist attacks; Stress disorders; Terrorism