Masters of disaster: survey taps resilience of post-9/11 New York.

In the months after the Sept. 11, 2001, terrorist attacks on the World Trade Center, rates of stress-related symptoms and posttraumatic stress disorder (PTSD) soared among survivors and emergency workers. Nonetheless, a large majority of people living in and around New York City experienced no more than one stress symptom during the 6 months after the devastating strike. That's a sign of widespread psychological resilience, according to a new survey. Even among people injured in the attack, one-third displayed resilience.

The results "provide the most convincing data to date that resilience is prevalent even following the most pernicious and potentially traumatic levels of exposure," says psychologist George A. Bonanno of Columbia University. Previous resilience research had focused mainly on recovery from personal traumas, such as a spouse's death (SN: 3/2/02, p. 131).

Bonanno's team conducted telephone interviews with 2,752 randomly selected adults living in or near the city about 6 months after 9/11. Resilience was defined as reporting either no stress-related symptoms or one such symptom since the attack.

PTSD consists of up to 17 stress symptoms that include intrusive memories of a traumatic event, a need to avoid reminders of the event, detachment from others, sleep difficulties, and an exaggerated startle response. Since sleep problems and some other symptoms can occur without exposure to a traumatic event, the researchers allowed for one PTSD symptom in resilient individuals. A diagnosis of PTSD rests on the number, type, and severity of symptoms.

Resilience characterized 1,672 participants, or 65 percent of the total, Bonanno and his coworkers report in the March Psychological Science. About 6 percent of the interviewees had PTSD, a figure comparable to the disorder's lifetime prevalence in U.S. adults. The rest reported two or more stress symptoms that fell short of PTSD.

Even New Yorkers most affected by 9/11 events frequently displayed resilience. For instance, more than half of the people who saw the attack in person or who lost a friend or relative in the attack fit the definition of resilience. Although about one-quarter of the 59 survey participants with 9/11-related injuries suffered from PTSD, a large fraction of them were resilient. Among 22 participants who had been in the World Trade Center during the attack, 6 developed PTSD, while 12 showed resilience.

Resilience was tougher to achieve for people who had been exposed to 9/11 in two or more ways. For example, a resilience rate of 51 percent among those involved in rescue efforts fell to 40 percent for rescue workers who had seen the attack in person.

The findings confirm that psychological interventions after disasters need to be targeted to people who truly need them, Bonanno holds. "There are still a lot of unknowns about how best to help people emotionally," he says.

Psychologist Glenn I. Roisman of the University of Illinois at Urbana-Champaign agrees that people's resilience after traumatic events is often underestimated. However, since the new study doesn't address whether people with one or no PTSD symptoms had work or family problems, the findings may overstate resilience's reach, Roisman says.

Researchers now need to examine whether exposure to 9/11 undermined people's capacity to cope with ensuing adversity, remarks psychiatrist Rachel Yehuda of Mount Sinai School of Medicine in New York City.