The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60605

William G Fernandez, MD¹, Sandro Galea, MD, MPH², William Chiang, MD³, Nealia Khan, BA⁴, Liz Kennedy, BS, MBA¹, Joanna Garritano, BS³, and David Vlahov, PhD². (1) Division of Emergency Medicine, New York Presbyterian Hospital, Columbia University, 600 West 168th Street, PH 137, New York City, NY 10032, 212.305.2995, billmanfernandez@hotmail.com, (2) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, (3) Division of Emergency Medicine, Bellevue Hospital Center, New York University, 462 1st Ave and 27th Streets, New York, NY 10016, (4) Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168 St, New York, NY 10032

INTRODUCTION: Research suggests that repeat traumas may have a cumulative detrimental effect on mental health. The September 11, 2001 terrorist attacks in New York City (NYC), were followed on November 12, 2001 by the American Airlines Flight 587 crash in Queens, NYC. We sought to assess the relationship between consecutive disasters and mental health among emergency department (ED) patients in NYC approximately one year after these events. METHODS: We conducted a cross-sectional questionnaire study July – October 2002 in two university hospitals EDs in NYC. A systematic sample of stable, adult patients was enrolled. The PTSD Checklist (PCL) was used to assess symptoms of PTSD. The single measure of distress (SMD) was used to determine nonspecific distress. Statistical analysis was done using Chi-square and logistic regression. RESULTS: 433 (52.7% females, 48.3% males) participated. Response rate was 73.4%. Latinos represented 48.9%, African-Americans 25.2%, Caucasians 15.1%, and others 10.8% in our sample. 6.9% of respondents had symptoms consistent with PTSD; 24.5% had high distress; 5.3% had both. In separate multivariate models, predictors of PTSD and high distress were: cumulative disaster exposures (OR=3.0 and 3.1, respectively) and disaster-related economic losses (OR=5.0 and 2.5, respectively), adjusting for demographic variables. CONCLUSIONS: A year after consecutive disasters in NYC, a sample of predominantly Latino ED patients had a substantial prevalence of PTSD symptoms and distress. Cumulative disaster exposure, and disaster-related economic setbacks were predictive of poor mental health. Clinicians should consider the role of mental health in patients presenting to the ED in the wake of disasters.

Learning Objectives:

• To discuss the long-term consequences of cumulative trauma on mental health
• To identify the determinants of mental health dysfunction among emergency department patients in New York City in the aftermath of consecutive disasters

Keywords: Disasters, Mental Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.