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A Legacy of 9/11: Years of Increased Illness

A large-scale study suggests 9/11-related stress led to a major increase in health problems across the U.S.
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To most Americans, the 9/11 terrorist attacks were shocking, frightening, enraging.

Newly published research suggests they were also, quite literally, sickening.

Two University of California, Irvine, researchers report the tragedy triggered a large and lingering rise in self-reported health problems, as well as visits to medical professionals, across the nation.

Among a nationally representative sample of about 2,000 American adults, reports of physical ailments increased 18 percent over the three years following the attacks of Sept. 11, 2001.

This story originally posted on July 21, 2011.

“Those who watched the attacks live on TV were most likely to report an increase in physical health ailments over time,” E. Alison Holman and Roxane Cohen Silver write in the journal Social Science and Medicine. “This finding was most pronounced for individuals who experienced high levels of pre-9/11 health problems.”

The foundation of this longitudinal study was a health survey administered between June 2000 and Sept. 9, 2001. A panel of 2,592 Americans was chosen “using traditional probability methods for creating national survey samples,” the researchers write. “Items from this survey provided the baseline assessments for our respondents.”

Participants reported whether they had ever been diagnosed by a physician with one or more of 35 illnesses, including diabetes, heart problems and depression. They also revealed the number of times they had seen a doctor in the past year for each ailment.

Follow-up surveys were conducted in the fall of 2002, 2003 and 2004, asking a similar set of questions. These surveys, which featured an impressively large percentage of the original sample (1,950 of the original 2,592 participants took part in the year three follow-up), “also included questions about respondents’ smoking status, as well as height and weight,” the researchers write.

The results are quite striking. “The proportion of the sample reporting at least one physician-diagnosed physical ailment over the three-year period rose from 79.2 percent to 89.5 percent,” Holman and Silver report. “After adjusting for demographics, pre-9/11 ailments, health risk factors (and other relevant variables), the overall incidence of physical health ailments increased 18 percent over the three years post-9/11.”

“We are confident that the increases in health ailments reported over time by our sample reflect more than merely health changes expected to be seen in an aging sample,” they write.

The researchers further found that “Rates of health care utilization increased significantly over the two years following 9/11.” (That specific question was not asked in the survey on the third anniversary.)

A second set of follow-up surveys assessed their level of exposure to the 9/11 attacks. Participants were placed in one of three categories: Those who either saw one of the attacks in person, or had a close relationship with someone in the buildings or airplanes involved (4.5 percent of the sample); those who watched the attacks live on television (62.9 percent); and those who learned of them only after the fact (32.6 percent).

It turns out watching them in real time had huge health consequences. “When compared to individuals who learned about the attacks only after they happened, those who watched the attacks live on TV reported a 28 percent increased incidence of physical ailments over three years post-9/11,” Holman and Silver write.

The researchers note there is a well-established connection between stress and illness. But while studies suggest ongoing psychological trauma for those directly affected by the tragedy, it isn’t clear how long-lasting the psychological impact of the attacks was on the rest of the nation.

A study of university students in San Diego found that while many experienced at least one PTSD symptom in the days immediately following the attacks, long-term depression and anxiety levels remained largely unchanged. “9/11-related stress responses among distant witnesses were very mild, focused and transitory in scope,” psychologist Georg Matt concluded.

But it’s important to note that most people in California were still asleep when the attacks occurred. They didn’t watch the tragedy unfold in real time on television — a factor this paper cites as an apparent catalyst for later health problems.

These results “highlight the importance of not underestimating the health and societal impact of collective stress,” Holman and Silver conclude. They also point out higher rates of health care utilization lead to higher health care costs.

That’s something to keep in mind the next time you hear politicians or pundits debate whether our budgetary priority should be funding health care or combating terrorism. This study suggests the two concerns are, in fact, complementary.

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