Although the resilience of children growing up in adverse circumstances is
well documented, relatively little has been known about adults' ability to"
tough it out" when the going gets rough.
However, that may be changing. Recently, California investigators found
that resilience among college students constituted not just recovery from
adversity, but a personal growth from it that may strengthen them against more
of life's insults (Psychiatric News, September 2).
And now New York City investigators have found that the majority of New
Yorkers were resilient in the aftermath of the September 11, 2001, terrorist
attack on the World Trade Center.
The study was headed by George Bonanno, Ph.D., an associate professor of
clinical psychology at Columbia University. Results are in press with
Most adults are exposed to at least one potentially traumatic event, such
as a physical or sexual assault or a life-threatening accident, in their
lifetime, past studies have found. But to what extent are adults resilient
after such events? Bonanno and his team decided to find out by examining the
prevalence of resilience among New Yorkers during the six months following the
September 11 attack.
Adults in New York City and nearby areas in New York, New Jersey, and
Connecticut were contacted by random-digit dial about six months after
September 11 to see if they would agree to a phone interview. Thirty-four
percent did. The final sample of 2,800 represented the broader New York
population, as evidenced by comparison with the most recent census data.
During the phone interview, participants were assessed for the presence of
the 17 symptoms that constitute posttraumatic stress disorder (PTSD). Here,
the National Women's Study PTSD module was used, which has a sensitivity of 99
percent and a specificity of 79 percent when compared with PTSD diagnosed by
the Structured Clinical Interview for DSM-III-R. Participants were
also asked how close they had been to the September 11 attack, whether they
had been physically injured by it, and whether they had lost loved ones in
Bonanno and his colleagues then analyzed the interview results to determine
how many of the participants had displayed resilience to the attack, and
particularly resilience under specific exposure conditions. They defined
resilience as one or no PTSD symptoms, since studies of sub-threshold
depression have typically set this as a criterion for the absence of
Sixty-five percent of participants were resilient, the investigators found.
Of particular interest to the researchers were the two small groups most
directly endangered by the attack: the 22 individuals who were in the World
Trade Center buildings at the time of the attack and the 59 individuals who
were injured because they were near the attack site. Even though 25 percent of
the 22 individuals who were in the buildings had probable PTSD, more than half
met resilience criteria. And even though 26 percent of the 59 injured
individuals had probable PTSD, about one-third showed resilience.
In fact, even in instances where people experienced multiple traumas, they
often exhibited resilience. For example, a third of the 142 individuals who
both experienced the death of a loved one through the attack and witnessed the
attack were found to be resilient.
The researchers also explored using either a more stringent or more liberal
definition of resilience. Even here, the results did not change to any
substantial degree. For example, because some respondents may have been
depressed even in the absence of PTSD symptoms, the investigators tried
further narrowing the definition of resilience to include the absence of
depression. However, this restriction did not appreciably lower the
proportions of people showing resilience across exposure categories.
"On the whole, these findings demonstrate widespread resilience in
the New York City area during the six months after the September 11th
attack," Bonanno and his team concluded. "Even among the groups
with the most pernicious levels of exposure and highest probable PTSD, the
proportion that were resilient never dropped below one-third."
"This investigation is an exemplary attempt to study the poorly
understood concept of resilience using an existing database to capture the
opposite—that is, the presence of serious mental health consequences of
9/11," Randall Marshall, M.D., director of trauma studies and services
at Columbia University, told Psychiatric News. "Dr. Bonanno is
right about the need to take resilience seriously as a subject of scientific
investigation, meaning future studies have to be designed to capture and
understand resilience as an outcome and a process that is much more than the
`absence of psychopathology.'
"That said, I cannot agree with the conclusion [that since 65 percent
of New Yorkers showed resilient reactions, it demonstrates] high levels of
resilience in the general population.... If we were discussing medical illness
after exposure to an environmental pathogen, no one would be reassured that
only 65 percent of persons did not experience any symptoms of illness
at all.... Resilience should have been in the 90th percentile....
"[In short] large numbers of people did not demonstrate resilience
after 9/11, and therefore we should devote much more attention to ways to
enhance resilience and promote recovery."
The study was funded by the National Institute of Mental Health.
"Psychological Resilience After Disaster: New York City in the
Aftermath of the September 11th Terrorist Attack" will be posted at<www.ingenta.com/journals/browse/bpl/psci>
once it is published. ▪