A total of 268 physicians participated in service provision for first encounters, 32 of whom also provided follow-up contacts; an additional 13 physicians participated only in follow-up contacts, for a total of 281 psychiatrists. The DPO psychiatrists averaged 3 first encounter contacts and 15 follow-up contacts. Two physicians had 52 contacts, and one physician had 63 contacts; the maximum was 98. Overall, the psychiatrists had a mean of 4.5 (SD = 9.7, n = 280) contacts each, and the median was 2.
Descriptive information on specialties was available for 274 DPO psychiatrists, only 9 of whom (3%) described themselves as psychiatric trauma specialists. Based on information provided by the psychiatrist volunteers, 34 (12%) specialized in pediatric psychiatry and 240 (88%) were adult psychiatrists. Of the 203 psychiatrists from whom data on home state were available, the vast majority (187, 92%) were from the state of New York, while 7 hailed from New Jersey, 4 from Pennsylvania, and one each from Connecticut, Florida, Maine, Ohio, and South Carolina. Of the 186 New York City physicians, 68% (127) were from Manhattan and 10% were from Brooklyn (12) or the Bronx (6). About half (51%) of the volunteer physicians were women.
Individuals Who Were Evaluated
The database contains entries on 848 unique individuals who underwent 923 full encounters with DPO psychiatrists from September 15, 2001 to November 20, 2001. The follow-up database contains data on 311 individuals who were contacted between September 17, 2001 and October 7, 2002. These 311 individuals received a total of 697 follow-up contacts (a mean of 2.2 follow-up contacts per person), for a total of 1,620 DPO-recorded contacts.
Of the 840 evaluated individuals affected by the disaster for whom gender was recorded, 478 (57%) were women and 362 (43%) were men. The mean age of the 802 individuals for whom age was recorded was 39.1 (SD = 12.5) years, with ages ranging from 3 to 78 years, with a median of 39 years. Few children under age 18 were given full evaluations (n = 31, 4% of the sample). Child psychiatrists saw 19 children and adult psychiatrists saw 10 children (data on specialty missing for 2 of the psychiatrists who evaluated children).
Data were available on ethnicity for 118 (14%) of the individuals seen, of whom 49 (42%) were Hispanic/Latin American, 36 (31%) were African/ African-American, 26 (22%) were Caucasian, 5 (4%) were Asian, and 2 (2%) were from the Indian subcontinent. Evaluations noted a total of 45 different ethnicities from Albanian to Uzbek.
Clinical Diagnostic Impressions
Data on clinicians’ impressions of psychiatric diagnoses were available for 693 initial encounters. Most of the individuals (92%, n = 640) seen were assigned a post-9/11 psychiatric diagnosis. The most prevalent diagnosis was acute stress disorder, which was assigned in 38% (n = 260). Posttraumatic stress disorder (PTSD) was diagnosed in 14% (n = 99), another anxiety disorder in 9% (n = 59), and adjustment disorder in 20% (n = 137). Major depression was diagnosed in 11% (n = 76). Bereavement was identified in 12% (n = 84). Less prevalent diagnoses included bipolar I disorder in 1% (n = 9), bipolar II disorder in 1% (n = 6), alcohol abuse/dependence in 1% (n = 7), drug abuse/dependence in < 1% (n = 3), and personality or somatoform disorder in 1% (n = 9). Two percent (n = 12) were diagnosed with “normal” reactions. No one was diagnosed with schizophrenia. Other psychosis was observed in 4 individuals, while possible psychosis was suspected in another 3. Five individuals reported contemplating suicide after 9/11.
During the first month after 9/11, 6% (n = 30) of the 526 patients seen by DPO psychiatrists were diagnosed with PTSD, which notably is too short a duration of symptoms for the diagnosis to be made according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).3
In the second month, 23% (n = 62) of the 275 patients first seen during that month received a PTSD diagnosis. In the third month, 13% (n = 5) of the 39 patients first seen in that month were diagnosed with PTSD. Overall, of 99 PTSD diagnoses given by the DPO psychiatrists after the 9/11 terrorist attacks, 30 (30%) were made before October 11, 2001 (i.e., within 1 month of the event) so that these individuals did not meet the duration criterion in the DSM-IV-TR PTSD criteria.
Eight individuals were diagnosed with the following medical problems: fracture, post concussion syndrome, hypertension, hypothyroidism, breast lump, migraine, history of seizure disorder, history of herniated disk, and sexual dysfunction.
Pre-9/11 psychiatric diagnoses were recorded in only 9 individuals: major depression (n = 4), PTSD (n = 2), bipolar I disorder (n = 2), alcohol abuse (n = 1), generalized anxiety disorder (n = 1), unspecified anxiety disorder (n = 1), and attention-deficit/hyperactivity disorder (n = 1).
The 848 individuals who were evaluated described a total of 5,438 symptoms (mean = 6.4, SD 15.0, symptoms per person). More than half of these individuals described insomnia and anhedonia, and 20% or more reported problems with mood, anxiety, dreams, and appetite. The most commonly reported symptoms are shown in . Uncommon symptoms (<1% of reported symptoms) included panic attacks, shortness of breath, palpitations, physiological reactions to reminders, numbness/emotional distance, social isolation/withdrawal, feeling distant from one’s normal self, feeling things are unreal, trying not to think or talk about the event, and psychogenic amnesia for important parts of the event. Rarely reported symptoms (<0.1% of reported symptoms) included delusions, visual hallucinations, other hallucinations, ideas of reference, disorganized or catatonic behavior, extreme upset with reminders, sense of foreshortened future, increased alcohol use, and somatic complaints. Substance abuse issues were noted in 9% (n = 78) of individuals. Specific substances of abuse identified included alcohol (6%), cocaine (1%), cannabis (2%), hallucinogens (<1%), opiates (1%), sedatives (<1%), and others (1%).
Symptom prevalence N = 848 patients
Virtually all symptoms were reported as starting on 9/11, with only 20 of the 5,438 symptoms having started later (all started within 2 months).
Of the 848 individuals evaluated, 401 (47%) received psychotropic medications (a total of 549 prescriptions). A nonbenzodiazepine sleep aid was prescribed to 29% (n = 250) of those evaluated, and 23% (n = 199) received a benzodiazepine. Antidepressant prescriptions were provided to 27 individuals (3% of those evaluated.) Four people received prescriptions for risperidone, and two received prescriptions for narcotics.
The mean number of pills in each prescription was 5.7 (SD = 3.9) pills for benzodiazepines, 5.0 (SD = 2.8) pills for nonbenzodiazepine hypnotics, and 16.5 (SD = 11.3) pills for antidepressants. The number of pills prescribed was significantly higher for benzodiazepine than for nonbenzodiazepine hypnotic prescriptions (Satterthwaite unequal variance t = 2.05, df = 297, p = 0.041).
Medication by Diagnosis and Symptoms
As noted above, data on clinicians’ impressions of psychiatric diagnoses were available for 693 individuals. Psychotropic medication was more likely to have been prescribed for the 640 individuals who received a post 9/11 diagnosis than for the 53 individuals without a post 9/11 diagnosis (52% [n = 332] vs. 23% [n = 12]; chi2 = 16.73, df = 1, p < 0.001). Only 4% (n = 2) of those with no diagnosis received a benzodiazepine, while 19% (n = 122) of people with a diagnosis received a benzodiazepine (chi2 = 7.79, df = 1, p = 0.005). The 260 patients with a diagnosis of acute stress disorder were more likely to be prescribed a nonbenzodiazepine hypnotic agent than the 433 patients without this diagnosis (35% [n = 91] vs. 22% [n = 96]; chi2 = 13.57, df = 1, p < 0.001).
Data on symptomatology were recorded for all 848 individuals who were evaluated. The 519 individuals with complaints of insomnia were more likely than the 329 patients without such complaints to be prescribed a benzodiazepine (19% [n = 99] vs. 12% [n = 41]; chi2 = 6.57, df = 1, p = 0.010) and to receive a nonbenzodiazepine hypnotic (35% [n = 183] vs. 10% [n = 32]; chi2 = 70.05, df = 1, p < 0.001).
Initial follow-up contacts consisted of individuals returning to see psychiatrists at the FAC. However, as fewer and fewer individuals had other reasons to seek a variety of services at the FAC, psychiatric contacts dwindled and formal psychiatric operations were terminated in late November, 2001. Between April and October, 2002, psychiatrists made telephone contacts to obtain information about follow-up psychiatric status. Of the 174 individuals with follow-up records, 21% (n = 37) said they did not recall their initial contact with a DPO psychiatrist, 76% (n =132) said they felt better since their contact with DPO, and 41% (n = 72) said they had followed recommendations from their original contact with DPO psychiatrists. Medication was described as helpful by 53 persons (30% of those followed up).