Acute psychological responses to the September 11 terrorist
attacks—even among people who were not at the World Trade Center or the
Pentagon—predicted greater incidence of heart ailments over the next
three years, according to a study that surveyed respondents' health before and
after the events.
The percentage of diagnosed cardiovascular problems increased among
individuals with acute stress responses to the 9/11 attacks in the three years
following the attacks, from 18.7 percent to 27.3 percent. This was true even
after adjustment for cardiac risk factors, exposure to the attacks, and
pre-9/11 mental health, reported E. Alison Holman, F.N.P., Ph.D., an assistant
professor of nursing science at the University of California, Irvine, and
colleagues in the January Archives of General Psychiatry.
"Acute stress responses may have value beyond their potential for
predicting PTSD," they wrote.
Public health officials should consider the potential impact of indirect
exposure to extreme stress, given that only 3.6 percent of the respondents
reported direct exposure.
The data came from a nationally representative sample of 2,592 people
surveyed before and after the attacks by Knowledge Networks Inc., a firm that
conducts anonymous, Web-based surveys.
The participants were first surveyed beginning in June 2000. They were
later asked about their psychosocial status just after the attacks and again
at 12, 18, 24, and 36 months afterward. Physical health assessments were
conducted at 12 and 24 months after the attacks. The surveys also asked if the
respondents worried that an act of terrorism would affect them or their family
in the future.
About 12 percent of respondents reported high levels of DSM-IV
criteria B, C, D, and E acute stress symptoms related to the attacks. Since
most were not directly exposed to the attacks, they did not meet criterion A
and so were not assumed to have acute stress disorder.
These respondents were twice as likely to report being diagnosed with high
blood pressure and three times more likely to have heart problems in the first
or second years afterward than the rest of the sample. Pre-9/11 cardiac
ailments predicted later ones, but didn't predict acute stress responses.
Among the physiological effects of short- and long-term stress are higher
blood pressure, more arrhythmias, increased atherosclerosis, and greater
neurohormonal arousal, said the researchers.
Early spotting of stress symptoms after similar events might help identify
people at higher risk for future cardiovascular problems, suggested Holman and
"Terrorism, Acute Stress, and Cardiovascular Health" is