Exposure to a community trauma, perievent panic attacks, and psychological well-being: A longitudinal analysis of the World Trade Center disaster

Objective: This study examines the association between exposure to the World Trade Center disaster (WTCD), perievent panic, and psychological well-being for New York City (NYC) residents one and two years after the attacks. Methods: The data come from a two-wave longitudinal study. Using random-digit dialing, all English or Spanish-speaking NYC residents who have been living in NYC on September 11, 2001 were eligible. Wave 1 (W1) interviews occurred between October and December, 2002, and Wave 2 (W2) interviews occurred between October, 2003, and January, 2004. Measures: Mental health outcomes included posttraumatic stress disorder (PTSD) and major depression measured in both W1 and W2 surveys. Predictor variables from W1 included demographic variables (gender, ethnicity, and income), WTCD exposure, perievent panic attack related to the WTCD, stressful events not related to the WTCD, and psychological resources (self-esteem and social support). In addition, the analyses included lifetime depression and lifetime panic attack prior to the WTCD measured retrospectively at W1. Results: Using structural equation modeling and controlling for the independent variables, the more exposure respondents had to the WTCD the more likely they experienced a perievent panic attack and meet criteria for W1 and W2 PTSD. Perievent panic was directly related to both W1 and W2 PTSD, even after controlling for prior psychological difficulties. A similar pattern held for depression. Conclusion: Exposure to the WTCD continues affect the mental health of survivors and perievent panic attack appears to be a marker for both current and future psychological problems.