Introduction

Post-traumatic stress after disasters and after September 11, 2001

Major disasters are associated with increased rates of psychological distress and morbidity among survivors (Norris et al., 2002a, b; Galea et al., 2005). The vast majority of post-disaster research has focused on the groups that are typically considered to be most affected by disasters and a substantial literature has documented the burden of psychopathology faced by survivors of disasters (North et al., 1999; Salcioglu et al., 2003) persons who are involved in the post-disaster recovery efforts (North et al., 2002), and family and friends of persons who are killed or seriously injured in disasters (Stoppelbein & Greening, 2000). Post-traumatic stress disorder (PTSD) is the most commonly studied, and likely the most prevalent mental health problem in these groups after disasters (Green & Lindy, 1994; Galea et al., 2005), although other mental health problems including depression (Kuo et al., 2003), generalized anxiety disorder (Smith et al., 1990), and non-specific psychological stress (Carr et al., 1997) have been studied.

In the aftermath of the September 11 attacks there was every reason to believe that the impact of the attacks among the survivors of the attacks would be comparable to that among survivors of other major disasters. For example, in the aftermath of the bombing of the Murrah Federal Building in Oklahoma City, North and colleagues reported that 34.3% of adult survivors of the bombing who were either in the building at the time of the bombing or in close proximity had symptoms consistent with a diagnosis of PTSD in the first 6 months after the bombing (North et al., 1999). Official estimates of the number of persons who were survivors of the September 11 attacks vary.