Factors Affecting Mental Health Outcome 2-3 Years after the 9/11 Attack Among Asian Americans

Background and Purpose:  Due to the proximity of Chinatown to the disaster site of the World Trade Center (WTC) attack on 9/11, and a large number of South Asians working in the WTC and nearby buildings, Asian Americans constituted a sizeable proportion of those exposed to the attack. The aftermath created major challenges for mental health professionals.  While dozens of studies have investigated its impact on the survivors, few have included Asians.  Due to cultural factors and the immigrant status, Asians’ reaction to such traumatic experience could differ from other racial groups.  Using data from the World Trade Center Health Registry (WTCHR), the only dataset with a sizeable Asian sample (4,705 at baseline), this study aims to examine the mental health impact of the attack and related risk/protective factors among Asians compared to the Whites.  Results will enable targeting subgroups for future prevention and follow-up treatment for Asians who have a pattern of service underutilization. 

Method:

Recruitment: WTCHR, funded by FEMA, provides data to evaluate the long-term health effects of the WTC attack.   We used baseline data collected 2-3 years after 9/11, which provided the largest sample.  Participants included rescue/recovery workers, workers in WTC/nearby buildings, street passersby, and nearby residents.  They were recruited through media campaigns and contacts from lists provided by employers, government agencies, and tenant organizations.  Data were collected by telephone and personal interviewing.

Measures:

PTSD was measured by the PTSD Checklist, Civilian Version (PCL-C), a self- measure inquiring about symptomology in the past month based on DSM-IV. We used 44 as the cutoff point.

Serious Psychological Distress was measured by the Kessler 6 scale, a non-specific screening tool for depression, anxiety, schizophrenia, etc.

Exposure to 9/11 tapped into participants’ location in the collapsed/damaged building, dust cloud exposure, witnessing horrific events, injury, being rescue/recovery worker, and evacuation.

Analyses: In addition to descriptive and bivariate analyses, logistic regressions were used to examine the associations between PTSD and the demographics and 9/11 exposures for each race.  Wald tests were then used to detect racial difference.

Results: Asians compared to the Whites were more likely to have probable PTSD and serious psychological distress.  Racial contrasts were especially noted in that education and employment status had no effect on PTSD for Asians while these were protective factors for the Whites.  For both races, participants who were younger and much older had protective effect relative to those in their prime years (25-44).  However, Asians who are slightly older (45-64) fared worse.  Women had higher risk for PTSD for both races.  While exposure highly increased the risk for PTSD, no racial difference was detected.

Implications: As a contrast to previous findings, Asians were found to be at a higher risk for PTSD after the WTC attack, and risk and protective factors had some significant differences between the races.  Given the striking underutilization of mental health services among Asians and the lasting effects of PTSD for years, more aggressive effort needs to be made to target this population to offer service.