We obtained scientific articles for this review using a multistep procedure within the time frame of September 2001 (following the 9/11 attacks) to April 2011. First, we performed a search of the peer-reviewed literature published between September 2001 and April 2011 using the MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO, and PILOTS (Published International Literature on Traumatic Stress) databases. Articles were included for initial review if they included (a) September 11, 2001 either as literal text in the body of an article or as a MeSH (Medical Subject Headings) term (these included entry terms World Trade Center Attack, 2001, 9-11-2001 Attack, and September 11 Terrorist Attacks, 2001) and (b) keywords for PTSD, including posttraumatic stress disorder and PTSD. Studies assessing the impact of post-9/11 stressors such as the wars in Iraq and Afghanistan were not included in this review. Studies that focused on other psychiatric disorders (e.g., depression, generalized anxiety disorder, complicated grief, and substance abuse) were not included in this review but are presented briefly in the discussion. This initial search resulted in a generation of 761 articles.
We next limited the articles to epidemiologic studies that focused predominantly on highly exposed groups defined as those living or working within close proximity to the WTC and the Pentagon, first responders, and recovery workers. To date, no studies have been published on reactions among the local population or recovery workers from Shanksville, Pennsylvania, where one plane crashed after hijackers redirected it from Washington, DC. We excluded articles that did not satisfy our selection criteria or were predominantly secondary analyses of previously published epidemiological studies of PTSD among highly exposed populations, unless the findings provided new insight into risk factors. Articles reporting an incomplete assessment of PTSD (e.g., two or three posttraumatic stress symptoms) or focusing on the biology of PTSD were excluded, as were review articles, editorials, commentaries, and case reports. We compared our sample with those studied in previous review articles (i.e., Galea et al., 2005
; Neria et al., 2008
) to verify that its results were comprehensive.
Our search identified 34 peer-reviewed articles on PTSD among groups highly exposed to the 9/11 attacks that have been published since 2001. We classified these studies as either (a) community studies (n = 6) or (b) studies of specific populations (n = 28), including rescue and recovery workers (n = 9), Pentagon staff (n = 4), WTC evacuees (n = 1), NYC workers (n = 2), primary care patients (n = 3), and children and adolescents (n = 7). Also, because two studies reported findings from a variety of specific populations (e.g., survivors, rescue workers), we grouped them separately from the other studies of specific populations.
The results of this search are presented in . The table is sectioned according to the classification described above and provides a summary of each article, including lead author and year of publication, specific sample type, study design (i.e., cross-sectional or longitudinal), sample size (including information on sample attrition in longitudinal studies), sampling method (i.e., random, systematic, convenience, or mixed), survey type (i.e., face-to-face interview, in-person questionnaire, computer-assisted telephone interview, online questionnaire, or mailed questionnaire), time frame of data collection, PTSD instrument used (e.g., Structured Clinical Interview for DSM–IV
[SCID; First, Spitzer, Gibbon, & Williams, 1995
], Clinician-Administered PTSD Scale [CAPS; Blake et al., 1995
], PTSD Symptom Checklist [PCL; Weathers, Litz, Herman, Huska, & Keane, 1993
]), PTSD prevalence estimate, and a listing of the correlates of PTSD found for each study.
Journal Articles Focusing on Posttraumatic Stress Disorder (PTSD) Among Populations Highly Exposed to the Events of September 11, 2001 (9/11)