Distributed May 20, 2002
For Immediate Release

News Service Contact: Scott Turner

Terror aftermath tough on psychiatric patients, study shows

Findings from a post-Sept. 11, 2001, study by Brown University researchers support the idea that psychiatric patients are at increased risk for experiencing distressing symptoms following national terrorist attacks. The results will be presented May 20, 2002, during the annual meeting of the American Psychiatric Association in Philadelphia.

PROVIDENCE, R.I. — Patients under psychiatric care on Sept. 11, 2001 were particularly distressed after the day’s terrorist attacks on the World Trade Center and Pentagon, a new study finds.

The attacks led to speculation by mental health groups about the vulnerability of psychiatric patients to psychological distress. Studies of people indirectly exposed to traumatic events have shown greater stress-related symptoms in individuals who saw themselves as similar to the victims, saw themselves as potential victims, or viewed the event as highly personal.

Three Brown University researchers surveyed 221 psychiatric patients and 87 medical patients at outpatient facilities at Rhode Island Hospital in Providence, R.I., two to three weeks after Sept. 11. They found that 33 percent of psychiatric patients, compared to 13 percent of medical patients, reported significant symptoms of post-traumatic stress disorder (PTSD). (One symptom – duration of at least one month – was not a factor in this study.) There were no differences between the patient groups in learning about the attacks or in personal involvement with its victims or survivors.

“We needed data to back up the belief that psychiatric patients are more vulnerable,” said lead investigator Laurel Franklin, research fellow in the Department of Psychiatry and Human Behavior. “It is also important to note that medical patients reported some significant psychological reactions and significant stress symptoms. Our suggestion to doctors is to talk with all patients about the Sept. 11 terrorist attacks whether or not those patients say they are experiencing distressing symptoms. In particular [doctors should] be sensitive to the effect of these tragedies on psychiatric patients.”

Franklin will present the findings May 20 during the annual meeting of the American Psychiatric Association in Philadelphia.

Trauma-related symptoms may include thinking and/or dreaming about the attacks, avoiding reminders of them, and irritability following the attacks. Overall, 28 percent of those surveyed reported experiencing such symptoms. The psychiatric patients had a range of diagnoses, including major depression, mood disorders, non-PTSD anxiety and other conditions.

Additional hypotheses as to why psychiatric patients may be at increased risk to developing PTSD symptoms include deficits in coping skills, deficits in social support, poor psychological resiliency, biological vulnerability, or an increased willingness to report psychiatric symptoms, said Franklin.

Forty-four percent of patients in the study first learned of the attacks from television. Thirty percent heard about them from friends, family or coworkers, while 13 percent heard about them over the radio. Four percent lost a loved one, 21 percent had a close friend/loved one who lost someone, and 32 percent knew someone (e.g., a coworker) who lost a loved one.

A small number of patients reported experiencing previous traumatic events similar to the terrorist attacks, including a plane crash (2 percent), terrorist threats (1 percent), military combat (3 percent) or an explosion or fire (13 percent).

Other results showed that psychiatric patients more often wanted to speak to their physician about the Sept. 11 attacks. In addition, patients reporting traumatic-stress symptoms were more likely to want to speak to their physician about the attacks or schedule an appointment to speak with their physician about them and thought that the attacks worsened their pre-Sept. 11 condition.

However, the 23 psychiatric patients in the study with a pre-existing PTSD diagnosis were not more vulnerable to Sept. 11-related “distressing” symptoms compared to the other psychiatric patients surveyed.

The authors conducted a follow-up study to determine which psychiatric patients were more vulnerable to experiencing post- Sept. 11 trauma-related symptoms, which patients continued to live with these symptoms, and potential reasons for the increased vulnerability of psychiatric patients. Those findings are not yet available.

Study co-authors are Diane Young, clinical assistant professor of psychiatry and human behavior, and Mark Zimmerman, M.D., associate professor of psychiatry and human behavior and director of outpatient psychiatry at Rhode Island Hospital.