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    Nucifora, Frederick C. Hall, Ryan C. and Everly, George S. 2011. Reexamining the Role of the Traumatic Stressor and the Trajectory of Posttraumatic Distress in the Wake of Disaster. Disaster Medicine and Public Health Preparedness, Vol. 5, Issue. S2, p. S172.

  • Disaster Medicine and Public Health Preparedness, Volume 5, Issue S2
  • September 2011, pp. S205-S213

Trauma Exposure and Posttraumatic Stress Disorder Among Employees of New York City Companies Affected by the September 11, 2001 Attacks on the World Trade Center


Objective: Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD.

Methods: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11–related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision.

Results: The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate’s direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness.

Conclusions: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

(Disaster Med Public Health Preparedness. 2011;5:S205-S213)

Corresponding author
Correspondence: Address correspondence and reprint requests to Dr Carol S. North, Department of Psychiatry, University of Texas Southwestern Medical Center, 6363 Forest Park Rd, Suite 651, Mail Code 8828, Dallas, TX 75390-8828 (e-mail:
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2.S Galea , J Ahern , H. Resnick Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002;346 (13):982987.

3.S Galea , H Resnick , J. Ahern Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks. J Urban Health. 2002;79 (3):340353.

4.S Galea , D Vlahov , H. Resnick Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol. 2003;158 (6):514524.

5.MA Schuster , BD Stein , L. Jaycox A national survey of stress reactions after the September 11, 2001, terrorist attacks. N Engl J Med. 2001;345 (20):15071512.

6.RC Silver , EA Holman , DN McIntosh , M Poulin , V. Gil-Rivas Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002;288 (10):12351244.

7.WE Schlenger , JM Caddell , L. Ebert Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. JAMA. 2002;288 (5):581588.

8.RM Brackbill , JL Hadler , L. DiGrande Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009;302 (5):502516.

9.M Farfel , L DiGrande , R. Brackbill An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health. 2008;85 (6):880909.

10.L DiGrande , MA Perrin , LE. Thorpe Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008;21 (3):264273.

11.L DiGrande , Y Neria , RM Brackbill , P Pulliam , S. Galea Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. Am J Epidemiol. 2011;173 (3):271281.

12.CS North , V McCutcheon , EL Spitznagel , EM. Smith Three-year follow-up of survivors of a mass shooting episode. J Urban Health. 2002;79 (3):383391.

13.CS North , SJ Nixon , S. Shariat Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA. 1999;282 (8):755762.

18.A Ehlers , RA Mayou , B. Bryant Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol. 1998;107 (3):508519.

19.RC Kessler , A Sonnega , E Bromet , M Hughes , CB. Nelson Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52 (12):10481060.

22.HE Ross , R Swinson , S Doumani , EJ. Larkin Diagnosing comorbidity in substance abusers: a comparison of the test-retest reliability of two interviews. Am J Drug Alcohol Abuse. 1995;21 (2):167185.

24.JW Goethe , KS. Ahmadi Comparison of Diagnostic Interview Schedule to psychiatrist diagnoses of alcohol use disorder in psychiatric inpatients. Am J Drug Alcohol Abuse. 1991;17 (1):6169.

25.HU Wittchen , G Semler , D. von Zerssen A comparison of two diagnostic methods. Clinical ICD diagnoses vs DSM-III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (version 2). Arch Gen Psychiatry. 1985;42 (7):677684.

26.JE Helzer , EL Spitznagel , L. McEvoy The predictive validity of lay Diagnostic Interview Schedule diagnoses in the general population. A comparison with physician examiners. Arch Gen Psychiatry. 1987;44 (12):10691077.

27.CS North , B Pfefferbaum , P. Narayanan Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City. Br J Psychiatry. 2005;186:487493.

28.CS North , CL Ringwalt , D Downs , J Derzon , D. Galvin Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Arch Gen Psychiatry. 2011;68 (2):173180.

29.G Canino , M Bravo , M. Rubio-Stipec The impact of disaster on mental health: prospective and retrospective analyses. Int J Ment Health. 1990;19:5169.

31.CS North , B Pfefferbaum , M. Vythilingam Exposure to bioterrorism and mental health response among staff on Capitol Hill. Biosecur Bioterror. 2009;7 (4):379388.

32.LN Robins , JE Helzer , J Croughan , KS. Ratcliff National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38 (4):381389.

35.CS. North Approaching disaster mental health research after the 9/11 World Trade Center terrorist attacks. Psychiatr Clin North Am. 2004;27 (3):589602.

36.CS North , AM Surís , M. Davis Toward validation of the diagnosis of posttraumatic stress disorder. Am J Psychiatry. 2009;166:18.

37.SD McDonald , PS. Calhoun The diagnostic accuracy of the PTSD checklist: a critical review. Clin Psychol Rev. 2010;30 (8):976987.

41.BP Dohrenwend , JB Turner , NA. Turse The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science. 2006;313 (5789):979982.

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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
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