Did 9/11 Make us Sicker as a Nation?

Doctor visits have increased 18 percent

/ Author:  / Reviewed by: Joseph V. Madia, MD

A ten-year anniversary is a seminal thing, especially when it marks something as momentous and life-changing as 9/11. Something that we experienced collectively, as Americans, that forever changed us.

But it appears that more than our psyche and internal feelings about our country, and the way we view and travel the world, have been affected. The events of that devastating day may have also made us less healthy, and created an enduring mental trauma in many.

Since September 11, 2001 the number of doctor visits and physician-diagnosed illnesses have increased across the United States. In the first three years alone after the terrorist attacks, illnesses rose by 18 percent among American adults.

While the spike was higher among people with pre-existing health conditions, even previously healthy individuals showed an increase in accessing health care and in doctor-diagnosed ailments.

Enduring Mental Health Tolls

In 2007, studies at New York–Presbyterian Hospital/Weill Cornell Medical College and New York University revealed the long-term psychological repercussions of people who were directly affected by the attacks. Researchers compared brain scans of adults who witnessed the attacks on the World Trade Center with people who were farther away and didn't directly see the events.

Even six years later, people within two miles of Ground Zero had hyperactive activity in the amygdala, the part of the brain that processes emotional intensity and creates emotional memories - even when those people had consciously recovered from the trauma and showed no mental disorder.

In a separate study, researchers followed 45 children who had lost a parent on 9/11. Even though most had received therapy, psychiatric illnesses had doubled in those children during the years afterward. The kids also had increased amounts of cortisol, a stress hormone, in their saliva - to the point of chronic elevations. This suggested to researchers that the "fight or flight" mechanism had remained switched on in these children, which could lead to greater stress, cognitive impairment, weak bones and insulin resistance later in life.

"The terrorist attacks were attacks on the entire country, and there is still an urgent need for a long-term federal commitment to address their health impacts," said New York Mayor Michael Bloomberg. According to a 2009 report on 9/11 health by the WTC Medical Working Group, it remained unknown whether there is a relationship between WTC exposure and longer-term illnesses, including cancer, and the need to continue to actively study these links was addressed.

All of these studies demonstrate the ongoing toll that such traumatic events have on all of us.

Ten Years Later, and Doctor Visits are Increased

The University of California at Irvine conducted a study to look at the effects of what researchers call "collective trauma." Presidential assassinations and natural disasters fall into this category, along with terrorism. E. Alison Holman, co-author of the study and a health psychologist, says that watching the terrorist attacks unfold on live television seems to have contributed to our stress-related illnesses as a nation.

“We cannot underestimate the impact of collective stress on health,” Holman said, adding that people who work in health professions need to be trained to recognize symptoms of extreme stress, even if it's through indirect exposure.

Holman and her co-author, Roxane Cohen Silver, looked at surveys of almost 2,000 adults who completed Internet surveys in the days, months and years after 9/11. The survey asked the number of times participants had seen a doctor and whether they had been diagnosed with any of 35 illnesses. Information was also obtained about their exposure to the events of September 11 - whether a participant had been directly exposed (4.5 percent), had viewed everything live on TV (63 percent), or had watched the events only after they happened.

Those who had watched the attacks unfold live, as it happened, experienced a rise in physical ailments over the next three years, by 28 percent, and visits to medical providers increased. Doctor-diagnosed illnesses also increased in the first three years after 9/11, from 79.2 percent to 89.5 percent.

The researchers say that these increases are above what would be expected solely from an aging population. “Large-scale collective traumas such as 9/11 often set in motion a series of events, such as personal loss, economic hardship and fears about the future,” Holman said.

Understanding and Coping with 9/11 Trauma for the Future

A decade after 9/11, it's apparent that both psychological trauma, such as post-traumatic stress disorder (PTSD) or depression, and physical ailments will be long-term effects of the nation's worst terrorist attack. These effects spread far beyond Ground Zero to encompass our country as a whole in collective trauma.

The journal American Psychologist has released a special issue, "9/11: Ten Years Later" to examine the social and psychological impacts of that day. A team of psychologists examined these lasting effects and outline strategies for understanding and coping with long-term fall-out in a dozen articles.

"We are different now," wrote Roxane Cohen Silver. The long-term psychological consequences are no longer thought to be restricted to those who lost a loved one or were directly affected. "The psychological impact 'spilled over' beyond those directly exposed, affecting those who merely witnessed the attacks indirectly. Indeed, this spillover went far beyond posttraumatic stress responses. Of course, millions of young people today also grew up in the shadow of 9/11, and [these articles] discuss how this collective trauma may have influenced their coping, their sociopolitical attitudes, and their overall beliefs about the world."

Review Date: 
August 24, 2011