Study Looks At Effects Of National Trauma On Americans' Health

The longitudinal study, "Ethnicity and Gender in the Face of a Terrorist Attack," is one of the first to utilize immediate and long-term post-trauma assessments from a large and diverse national sample to explore gender and ethnic differences in response to a national trauma.

It is published in the December issue of the journal Basic and Applied Social Psychology.

This research may prevent researchers and policy makers from mistakenly assuming that everyone responds the same way to these disasters, say the study's authors. It can justify the design of intervention efforts that target those most vulnerable to terrorist actions over time.

The study was conducted by Thai Q. Chu, a student at UC Irvine; Mark D. Seery, Ph.D., assistant professor, UB Department of Psychology; Whitney A. Ence, a psychology student at University of California, Irvine; E. Alison Holman, FNP, Ph.D., senior research scientist, and Roxane Cohen Silver, Ph.D., professor, both in the Department of Psychology and Social Behavior at UC Irvine.

It was funded by three grants awarded to Silver by the National Science Foundation and an award to Seery from the National Institute of Mental Health.

The study of 1,559 subjects found that during the two years following the attacks, some subjects experienced poorer mental and/or physical health. The affected subjects included:

* Those whose initial reaction to the attacks was sympathy for the victims or sadness

* Those who initially endorsed violent retribution (versus non-violent reprisal or action directed elsewhere)

* Those who endorsed no action at all

The subjects' sex and gender were associated with their initial emotional response, initial endorsement of specific actions and long-term health outcomes.

"We used a panel of study subjects that was in place before 9/11/2001, which made it possible for us to assess and account for pre-trauma mental and physical health, a rarity in trauma research," explained Seery.

"Taken as a whole," he said, "our findings demonstrate that men and whites were more likely to adopt a problem-focused approach to coping with the trauma, while women and those of non-white ethnicity were more likely to adopt an emotion-based approach.

Both approaches, in terms of long-term health, he added, contained "positive and negative aspects."

"Whites and men in this study expressed fewer sad and sympathetic responses to 9/11 than did women and other ethnicities (African American, Hispanic and a third category made up largely of Asian Americans).

"This would predict better long-term health for them," said Seery, "except for the propensity of whites and men to advocate violent retaliation, which was associated with poorer health outcomes over time."

The study employed subjects of various ethnicities and both genders who were presented with open-ended questions about their response to the attacks immediately after 9/11, and self-reported their states of health at two- and six-month intervals over the next two years.

Knowledge Networks Incorporated maintained the Web-enabled survey panel, which was selected through stratified random-digit telephone dialing so that its demographics reflected those of the U.S. Census population. Panel members completed online surveys on a regular basis in exchange for free Internet access.

With regard to ethnicity, the study found that African Americans were twice as likely to respond emotionally after the attacks as were non-Hispanic whites.

"Other ethnicities," a group consisting primarily of Asian Americans, were marginally more likely than were whites to respond emotionally. African Americans were marginally more likely than whites to express sympathy for the victims and significantly more likely to express sadness.

When asked what future action they endorsed, "other ethnicities" were less likely than were whites to endorse taking any action at all, including non-violent reprisal. African Americans were less likely than whites to endorse explicitly violent retaliation and no African-American women endorsed violent retaliation.

In terms of ethnicity and health outcomes, over the period following the attacks, Hispanics reported higher levels of generalized distress than did whites and higher levels of post-traumatic stress (PTS) symptoms from 12 to 14 months post-9/11 than did whites.

Women were more than twice as likely as men to respond with emotion to the attacks. They were marginally less likely than men to respond with anger, more likely than men to respond with sympathy toward the victims and more likely to express sadness due to the events.

Women were less likely than were men to endorse any action, including non-violent reprisal, and much less likely than were men to endorse explicitly violent retaliation. Women more frequently reported generalized distress in the two years after the attacks, higher levels of PTS symptoms from two to 24 months post 9/11 and more health ailments, than did men.

The only significant interaction between gender and ethnicity was for the number of physician-diagnosed ailments. Hispanic men had marginally fewer than did white men and Hispanic women had significantly more than did white women.

Specific early emotional reactions to the events of 9/11 were associated with more negative health effects over time. Those who expressed sadness reported higher levels of PTS symptoms from two to six months after 9/11. Those who expressed sympathy suffered marginally higher PTS symptoms from 12 to 24 months post 9/11. There were no significant effects for expressing anger.

Subjects who endorsed explicitly violent retaliation after the attacks suffered relatively poorer health outcomes than those who endorsed non-violent reprisal, action directed elsewhere or no action. They also experienced more PTS symptoms from two to six months later than did those who endorsed action directed elsewhere.

Respondents who did not endorse any action at all also suffered relatively poorer outcomes: more PTS symptoms from two to 24 months after the attacks than those who endorsed action directed elsewhere, and more PTS symptoms from 12-24 months post attack than those who endorsed non-violent reprisal.

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