depression and 9/11I remember exactly where I was when the first plane his the tower. I had never experienced anything like that and even though I was more than 1,000 miles away, the attacks deeply disturbed me. Eleven years later, I am still overcome with sorrow and horror when I watch the towers fall. Today, the 11th anniversary, we will watch them fall over and over.

I have tried to imagine what I would have done had I been there. How I would have felt seeing, smelling, hearing, and touching that much devastation. What I spend little time thinking about is how those people who really were there are doing today. Much has been said, written, and studied regarding the physical effects of being at ground zero. Much also has been written about post-traumatic-stress disorder and 911 survivors and responders.

But, as you will see below, not nearly as much as been done to study other mental health side effects of 911 – especially when it comes to depression and substance abuse. Every year The World Trade Center Medical Working Group of New York City puts out its annual report. In the 2011 report, the most recent available, depression is mentioned 16 times – two of those in footnotes.

Below you will find each reference to depression in the 25-page report:

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Expand research on the impact of 9/11 on mental health and substance use by:
•collecting additional data on the prevalence of WTC-related depression, suicide and substance use among WTC-exposed populations.
•assessing the impact of chronic WTC-related physical health conditions on long-term mental health.
•studying the impact of tobacco use on WTC-related respiratory conditions.

Increase research on mental and physical health effects on vulnerable populations who were exposed to the WTC collapse including children who went to school or who lived in the area, had first responder parents, or lost family members on 9/11… This includes research estimating the burden of WTC-related illness to help policymakers allocate resources rationally; research about the persistence of both mental and physical conditions; research into co-occurring mental health conditions such as depression and substance use; research about the impact of tobacco use on WTC-related illness; and research about cancer and mortality risk among WTC-exposed populations. In addition, researchers not affiliated with the MWG have published studies on post-9/11 suicide rates.

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Depression, anxiety and substance use disorders have not been as well studied as PTSD among WTC-exposed people. The studies to date, however, suggest that the prevalence of these conditions increased shortly after 9/11 and there is significant co-morbidity with PTSD in WTC-exposed populations.

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Researchers at the NY/NJ WTC Clinical Consortium report that workers, excluding police responders, continued to screen positive at high rates for PTSD (19.2%), depression (17.9%) and panic disorder (12.3%). Police responders had much lower rates of these conditions: PTSD (5%), depression (4.5%) and panic disorder (4.8%).18

The FDNY WTC Medical Monitoring and Treatment Program screened nearly 2,000 retired firefighters, the majority of whom were disabled, for depression, PTSD, and alcohol problems four to six years after 9/11. Among those at elevated risk for depression (23%) or PTSD (22%), 70% were at elevated risk for both conditions.  Problem alcohol use and early arrival at the WTC site were identified as unique risk factors for depression and PTSD, respectively.

Two studies conducted by Weil-Cornell Medical College researchers based on more than 3,000 mostly male utility workers who were screened for mental health conditions at their place of employment offer new insights about traumatic stress among WTC recovery workers:
Ten to 22 months after 9/11, eight percent of 2,960 workers had symptoms consistent with full PTSD, 6% with depression, 3.5% with anxiety and 2.5% with panic disorder.

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Among a sample of 455, mostly female patients who were screened for mental health conditions when they sought primary care at a general medicine clinic in New York City, the PTSD rate decreased significantly from 9.6% one year after 9/11 to 4.1% three years later. Patients who reported pre-9/11 depression, the only significant predictor of PTSD trajectory, were 10 times more likely to have PTSD four years after the WTC attacks than those who didn’t.

Substantial co-morbidity across physical and mental health conditions exists among firefighters. In a study of nearly 11,000 firefighters seven to nine years after 9/11, FDNY researchers found that 41.8% of those reporting symptoms of probable PTSD also self-reported a physician diagnosis of obstructive airways disease (OAD), which includes asthma, bronchitis or COPD/emphysema; 33.3% with probable PTSD or depression also self-reported a physician diagnosis of OAD. Among those with depression alone, 28.5% self-reported OAD. The researchers found similar results when they used medical records instead of self-reports for the analysis.

Rescue and recovery workers who sought treatment at the NY/NJ WTC Clinical Consortium from 2002 – 2010 also reported substantial co-morbidity: in a clinical population of more than 27,000 workers, nearly half with asthma (1,459 workers) also reported at least one mental health condition, as did more than a third of workers with either sinusitis (2,006 workers) or gastroesophageal reflux disease (2,348 workers). Similarly, around 70% of workers who reported PTSD (2,806 workers), depression (2,153 workers),or panic disorder (1,129 workers) also reported a physician diagnosis of at least one physical disorder.

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It is difficult to determine the incidence and prevalence rates for many potentially WTC- related conditions, including persistent cough, dyspnea, sinusitis, gastrointestinal symptoms, PTSD and depression because confirmatory laboratory or diagnostic testing is either not available or because an acknowledged “gold standard” does not exist for diagnosing a condition.
World Trade Center photo available from Shutterstock