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RB4546|RAND

OJCTIVANALYI.
FFCTIVOLUTION.

RAND> PublishedResearch> ResearchBriefs> RB4546>

After9/11:treandCoping
AcroAmerica
Aurvivorofnaturaldiater,violentcrime,andwarattet,peoplewhoarevictimor
witneeofatraumaticeventoftenexperiencemptomoftre,ometimeforear
after.uteventinrecentearhavetaughtuthatindividualneednotepreentata
catatrophiceventtoexperiencetremptom.
TheterroritattackthathooktheUnitedtateoneptemer11,2001wereimmediatel
roadcatonTVcreenacrothenation.Remarkalevideofootagethathowedthe
eventandtheiraftermathingraphicdetailwarepeatedlairedaftertheattack.Man
Americanmahaveidentifiedwiththevictimorperceivedtheunprecedentedattacka
directedatthemelveawell.Thu,evenpeoplewhowerenowherenearthelocationof
theattackmighthaveexperiencedutantialtrerepone.
omeQuetionWeAked
Adult

utantialtre
(%)

inceTueda,haveoueenothered:
Feelingverupetwhenomethingremindouofwhathappened? 30
Repeateddituringmemorie,thought,ordreamaoutwhat
happened?

16

Havingdifficultconcentrating?

14

Troulefallingortaingaleep?

11

Feelingirritaleorhavingangrouturt?

Atleatoneoftheaove?

44

(Poilereponewere"notatall,""alittleit,""moderatel,""quiteait,"and
"extremel."utantialtrewadefinedaananwerof"quiteait"or"extremel.")
Children
inceTueda,haourchildeen:
Avoidingtalkingorhearingaoutwhathappened?

18

Havingtroulekeepinghiorhermindonthingand
concentrating?

12

Havingtroulefallingortaingaleep?

10

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Loinghiorhertemperoreingirritale?

10

Havingnightmare?

Atleatoneoftheaove?

35

Worriedaouthiorherafetortheafetofalovedone?

47

(Forchildren,trewadefinedaareponeof"e"onatwo-pointcale["e,""no"]).

Oururve
Weaemledateamofreearcherwhodeignedandconductedatelephoneurveofa
nationallrepreentativeampleofU..houeholdthreetofivedaaftertheattack.
Thepurpoeoftheurvewatodeterminetheimmediatereactionofadulttothe
eventandtheirperceptionoftheirchildren'reaction.Ourprimargoalwatolearn
whetherpeoplearoundthecountrexperiencedmptomoftreatrateanwhere
nearthoeofpeoplewholivedwithincloeproximit.Inaddition,wehopedtolearn
omethingaouthowpeoplecopedwiththeirreaction.
MotAdultandManChildrenhowedignoftre
Ninetpercentoftheadulturveedreportedexperiencing,toatleatomedegree,one
ormoremptom,and44percentoftheadultreportedautantiallevelofatleatone
mptomoftre(eeox,"omeQuetionWeAked").Whilethoecloettotheiteof
attackhadthemotutantialtre,repondentthroughoutthecountr,fromlarge
citietomallcommunitie,reportedtremptom:36percentofrepondentover
1,000milefromtheWorldTradeCenterreportedutantialtrereaction,compared
with60percentofthoewithin100mileoftheite.
tudiehavehownthatchildrenwhowereexpoedolelthroughteleviiontouch
horrifingeventatheChallengerdiater,theOklahomaCitoming,andtheGulfWar
experiencedtrauma-relatedtrereaction.Wefoundthatchildrenwerealoprofoundl
affectedtheeventofeptemer11.Thirt-fivepercentofparentreportedthattheir
childrenhowedoneormoreignoftre,and47percentreportedthattheirchildren
wereworriedaouttheirownafetortheafetofalovedone.
TheContriutionofTeleviion
AdultwatchedanaverageofeighthourofTVcoverageoftheattackoneptemer11,
withnearlafifthoftheurverepondentreportingthatthewatched13houror
more.Thoewhowatchedthemotteleviionreportedthemottre.
Accordingtoparentalreport,childrenwatchedanaverageofthreehourofTVcoverage
aouttheattack,witholderchildrenwatchingignificantlmorethanoungerone.
Amongchildrenwhoeparentdidnottrtolimittheirteleviionviewing,watchingmore
televiionwaaociatedwithhavingmoremptomoftre.
WecannotawhethermoreTVviewingprecipitatedhighertrelevel.Foromepeople,
televiionmahaveeenaourceofinformationaouttheituationandwhattodo,and
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thereforemahaveprovidedapoitivemeanofcopingwithtre.Other,epeciall
children,mahavereactedtotherepeatedviewingofterrifingimagewithheightened
anxiet.
OtherWaofCoping
Wefoundthatpeoplerepondedtothetragiceventofeptemer11inavarietofwa
(eethefigure).Motpeopleturnedtootherforocialupport,andmanturnedtotheir
religionoranotherourceofpiritualguidance.Morethan30percentdonatedmoneor
lood,aout20percentaidtheegantotockpilethinglikefoodorga,and60percent
reportedparticipatingingroupactivitielikememorialorvigil,whichcanprovidea
eneofcommunit.
Aout40percentofpeoplereportedavoidingactivitie(likewatchingteleviion)that
remindedthemoftheevent.Healthprofeionalhavetendedtoregardavoidanceaan
impedimenttotheemotionalproceingneededforrecoverfromtrauma.However,under
theeunuualcircumtanceandinthefaceofcontinuouTVcoverage,avoidancema
notnecearilhaveeenanunhealthrepone.
Profeionalorganizationlikethe
AmericanAcademofPediatric
recommendthatduringcrie,
parentconiderlimitingtheir
children'televiionviewingofthe
criiandpeakwiththemaoutit.
Nearlallparentweurveedpoke
withtheirchildrenaouttheattack.
Morethan80percentofparent
reportedtalkingwiththeirchildren
foranhourormore,and14percent
pokewiththeirchildrenforatotal
ofmorethanninehouraoutthe
attack.Aoutathirdofparent
triedtolimittheamountofTVnewtheirchildrenwatched:Parentofoungerchildren
andofchildrenwhohadmoretremptomweremorelikeltolimittheirchildren'TV
viewing.
WhatNext?
tudieofreactiontopriorcriehavehownthatformotpeoplewithindirectexpoure,
trereactionwanewithtime.However,theunprecedentednatureoftheeventof
eptemer11,coupledwiththecontinuedTVcoverageandtheongoingthreatthathave
followed,leadutopeculatethatthepchologicalimpactmanotdiminiharapidlfor
omepeople.Reminderoftheeventmatriggerarecurrenceoftremptomfor
ome.Wearenowperformingafollow-upurvetoaehowpeople'initialrepone
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havechangedwithtimeandtowhatextentindividual'immediatereponepredictlater
mptom.
ecaueinterventionaremoteffectivewhenegunoonaftertheprecipitatingevent,
wehopetoidentifearlignthatchildren--oradult--needhelpandwatorepondto
theirneed.Wealohopetoidentifactivitiethatprovedtoepoitivecopingrepone.
Providingclinician,clergandotherpiritualleader,emploer,teacher,chool
counelor,andotherwiththikindofinformationhouldenalethemtorepond
quickl,aoonamptomappear,andguidepeopletomorepoitivewaofcopingin
theeventoffurtherdiaterofthimagnitude.
ThiHighlightummarizeRANDreearchreportedinthefollowingpulication:
chuter,M.A.,.D.tein,L.H.Jacox,R.L.Collin,G.N.Marhall,M.N.lliott,A.J.Zhou,D..
Kanoue,J.L.Morrion,.H.err."ANationalurveoftreReactionAftertheeptemer11,2001,
TerroritAttack,"NewnglandJournalofMedicine,Vol.345,No.20,Novemer15,2001,pp.1507-1512.

R-4546(2001)
AtractofallRANDHealthpulicationandfulltextofmanreearchdocumentcan
efoundontheRANDHealthweiteatwww.rand.org/health.
RANDpulicationareditriutedtothetradeNN.RANDiaregiteredtrademark.
RANDianonprofitintitutionthathelpimprovepolicanddeciionmakingthrough
reearchandanali;itpulicationdonotnecearilreflecttheopinionorpolicieof
itreearchponor.
Copright2001RAND
Allrightreerved.Permiionigiventoduplicatethion-linedocumentforperonalue
onl,alongaitiunalteredandcomplete.Copiemanoteduplicatedforcommercial
purpoe.
Pulihed2001RAND
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