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Patterns of Comorbidity Among Bereaved Family Members 14 Years after the September 11th, 2001, Terrorist Attacks
Author(s) -
Cozza Stephen J.,
Fisher Joscelyn E.,
Fetchet Mary A.,
Chen Shenglin,
Zhou Jing,
Fullerton Carol S.,
Ursano Robert J.
Publication year - 2019
Publication title -
journal of traumatic stress
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.259
H-Index - 134
eISSN - 1573-6598
pISSN - 0894-9867
DOI - 10.1002/jts.22407
Subject(s) - comorbidity , complicated grief , psychiatry , mental health , depression (economics) , national comorbidity survey , interim , grief , psychology , anxiety , clinical psychology , medicine , history , archaeology , economics , macroeconomics
Studies of terrorism‐related deaths are few and mostly focus on short‐term effects. To characterize long‐term bereavement outcomes, including resilience/recovery and patterns of comorbidity, following the September 11, 2001 (9/11), terrorist attacks, we report mental health conditions and grief‐related impairment in 454 9/11 bereaved family members. In addition, the contribution of non‐9/11 lifetime traumas, pre‐9/11 mental health conditions, post‐9/11 interim life events, grief services, income adequacy, and social support were examined. Latent class analyses yielded three groups: healthy , comorbid without PTSD (comorbid/noPTSD), and comorbid with PTSD and impaired (comorbid/PTSD+I). Participants in the healthy group (66.1%) were least likely to meet thresholds for mental conditions, whereas those in the comorbid/noPTSD (21.3%) and comorbid/PTSD+I (12.6%) groups had higher probabilities of meeting depression, grief, and anxiety thresholds. These groups also endorsed more negatively valenced post‐9/11 interim life events than the healthy group: comorbid/noPTSD vs. healthy, odds ratio ( OR ) = 0.84, 95% CI [0.76, 0.94]; comorbid/PTSD+I vs. healthy, OR = 0.85, 95% CI [0.76, 0.96]. Comorbid/PTSD+I was the only group with elevated probabilities of meeting clinical thresholds for PTSD (.64) and grief‐related impairment (.94). This group was also more likely to include bereaved parents: comorbid/PTSD+I vs. healthy, OR = 12.96, 95% CI [1.97, 85.41]; comorbid/PTSD+I vs. comorbid/noPTSD, OR = 15.55, 95% CI [1.63, 148.41]); and to experience more non‐9/11 lifetime traumas: comorbid/PTSD+I vs. healthy, OR = 4.34, 95% CI [1.28, 14.70]; comorbid/PTSD+I vs. comorbid/noPTSD, OR = 6.54, 95% CI [1.53, 27.95]. Clinical and community programs should target this high‐risk group to identify individuals in need of services.