Community disaster, perievent panic attack, and depression: A structural equation model analysis of the terrorists attacks on the World Trade Center in New York City

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: Using random-digit dialing, all English or Spanish-speaking current NYC residents who were 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: Our main mental health outcome was W1 and W2 major depression. Predictor variables from W1 included demographic variables (gender and income), WTCD exposure, perievent panic attack related to the WTCD, and pre-WTCD psychological problems. Variables from W2 included stressful events not related to the WTCD and psychological resources (self-esteem and social support). Results: Using structural equation modeling and controlling for the predictor 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 depression. Perievent panic was directly related to W1 depression, but had no direct association with W2 depression, after controlling for other variables. Panic attack was related to increases in W2 stressful events and decreases in W2 psychological resources. Conclusion: Exposure to the WTCD continued to affect the interpersonal functioning and mental health of survivors two years the World Trade Center terrorist attacks. Perievent panic attack affects future stressful events and psychological resources, but adds little additional information to our understanding of long-term depression.