Using health data collected before Sept. 11, 2001, as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks, according to a study published in the January issue of the Archives of General Psychiatry.
E. Alison Holman, FNP, PhD, of the University of California at Irvine, and colleagues believed terrorist attacks of 9/11 present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample. They undertook the study to examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent three years.
A national probability sample of 2,729 adults (78.1 percent participation rate), 95 percent of whom had completed a health survey before 9/11 (final health sample, 2,592), completed a web-based assessment of acute stress responses approximately nine to 14 days after the terrorist attacks. The researchers also examined follow-up health surveys that reassessed physician-diagnosed cardiovascular ailments one year (1,923 subjects, 84.3 percent participation rate), two years (1,576 subjects, 74.2 percent participation rate), and three years (1,950 subjects, 78.9 percent participation rate) following the attacks.
The researchers found that acute stress responses to the 9/11 attacks were associated with a 53 percent increased incidence of cardiovascular ailments over the three subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics.
Participants reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at one year and 1.75 at two years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at two years) over two years, according to the authors. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems two to three years following the attacks (rate ratios, 4.67 at two years and 3.22 at three years).
The other institutions involved in the study were the Center for Behavioral and Decision Sciences in Medicine at University of Michigan in Ann Arbor; the Department of Veterans Affairs Medical Center in Syracuse, N.Y.; the department of psychology at University of North Carolina in Charlotte; and the University of Denver in Denver.