PTSD Affected Hispanic Patients in New York for Mo

Low-income, immigrant, primary-care patients in New York City continued to suffer the psychiatric effects of 9/11 long after the original terrorist attack, says a new study.

"Many of these patients, for cultural or economic reasons, shun traditional mental health services, and rely heavily on their primary care doctors for the provision of mental health intervention and treatment," said lead author Yuval Neria, Ph.D., a professor at Columbia University and co-director of the Center for the Study of Trauma and Resilience, New York State Psychiatric Institute.

In another finding, the study negated the notion that post-traumatic stress disorder may develop among those experiencing terrorist events second-hand, such as while watching media coverage of the attacks on television. PTSD did not show up in individuals only indirectly exposed to the 9/11 attacks — unless they were at increased risk for the disorder to begin with.

For the study, published in the latest issue of General Hospital Psychiatry, researchers screened adult primary care patients for PTSD in the months following the 9/11 attacks. The patients — 930 men and women ages 18 to 70 — were seen at the New York Presbyterian Hospital, Columbia University Medical Center. The majority were low-income immigrants — primarily Hispanic.

Neria said that unlike previous community studies that found PTSD rates dropped after six months, his team's study "suggests that a sizable portion of the sample population continues to have PTSD associated with significant functional impairment seven to 16 months after the 9/11 attacks."

"Our findings highlight the specific needs for health care associated with post-disaster psychopathology among low-income Hispanic primary-care patients," he said.

"This study reinforces the idea that early detection and treatment of PTSD in the primary care setting makes perfect sense," said Anthony Ng, M.D., chairman of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disaster.

"Many in the population under study would be reluctant to seek psychiatric help for fear of being stigmatized within their communities, even though they are, in fact, at increased risk for PTSD and its associated illnesses," Ng said.

The study could have particular relevance to the low-income African-American population affected by hurricane Katrina or to any disadvantaged population traumatized by a large-scale disaster or terrorist act, Neria said.

PTSD is often seen in victims of trauma, violence or natural disaster. People with PTSD suffer from intrusive thoughts, nightmares, flashbacks, avoidance of situations that might retrigger traumatic memories, hyper-vigilance and sleep disturbances.

The current prevalence of PTSD in the general population is estimated at five percent to six percent, with higher rates seen in refugees and urban inner city adults. Women are twice as likely to suffer from PTSD as men.

PTSD can be treated with behavioral, cognitive, or EMDR (eye movement desensitization and reprocessing) therapies and medications.

"It is extremely important for the mental health community to work closely with primary care providers in the treatment of PTSD, especially after disasters of the magnitude of the 9/11 attacks," said Ng.

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General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science.

Neria Y, et al. Posttraumatic stress disorder in primary care 1 year after the 9/11 attacks. General Hospital Psychiatry 28 213-222, 2006.