A wide range of mental and physical health problems occurred following the September 11, 2001 trauma. That’s not surprising given the severity of injuries, threat to life, loss of lives, the unexpected and unpredictable nature of the event, and the amount of destruction and damage that occurred. 

Most people experienced a diminished sense of control, safety, and well-being. In fact, the reduced sense of control and fear for safety continues to this day. 

Posttraumatic stress disorder (PTSD) among those highly and directly exposed to 9/11 was significant. Most people experienced some acute symptoms of trauma such as anxiety, anger and sadness and mood irritability. Distressing thoughts and images, bad dreams, sleep difficulties and hypervigilance were also common.  

In addition to PTSD, other mental health conditions also increased such as depression, generalized anxiety disorder, anxiety and panic, bereavement related symptoms, and substance abuse such as increases in tobacco use, and drugs and alcohol.

A recent review of literature among highly exposed populations by Neria, DiGrande and Adams (2011) published in American Psychologist, found that PTSD among those with high exposure to 9/11 was significant and various factors contributing to PTSD.

Why did some people develop PTSD and others didn’t? Some of the factors that have contributed to the risk of PTSD, including the risk of PTSD years after 9/11 have included: 

• close proximity to the sites that were attacked
• seeing or hearing the attacks in person
• exposure to the dust cloud that occurred from the collapses
• witnessing horrific events such as people being injured or falling from buildings; rescue and recovery workers
• extensive television viewing on 9/11
• sustaining personal injury or a loved one being injured
• death of a loved one; psychological problems prior to 9/11
• physical illness. 

 There have been a number of factors that have been associated with increased risk of developing PTSD.

• lack of social support following the traumatic event
• job loss as a result of the trauma
• high level of stress or negative life events prior to 9/11
• significant negative life events or stressors after 9/11  

A recent study published in The Lancet on the persistence of illnesses in World Trade Center rescue and recovery workers found that nine years after the 9/11 trauma, the workers continue to experience significant physical and mental health problems. For police officers, the incidence of depression was 7%, the incidence of PTSD was 9.3%, and the incidence of panic disorder was 8.4%. Among rescue and recovery workers, the incidence of depression was 27.5%, PTSD was 31.9% and panic disorder was 21.2%. 

The psychological impact of 9/11 on children and youths was also significant. Some psychological symptoms included anxiety, decreased school performance, separation anxiety from parents, mood irritability, feeling upset, and sleep problems. Anxiety prior to trauma, extensive television viewing on 9/11, loss of a parent or family members being directly exposed to the attacks were among the factors contributing to stronger negative psychological effects among children. 

People have coped in various ways following the traumatic 9/11 event. Positive and healthy coping strategies that have helped people have included avoiding excessive television viewing on 9/11 coverage, supportive seeking and turning to others for help, talking and sharing with another about thoughts and feelings.   

Traumatic events tend to challenge the beliefs we hold about self, others, the world and the future. Traumas tend to, for instance, make us feel less safe and less secure, to view the world as less predictable, or to feel that self is not worthy.

A study from 2008 in the Journal of Personality and Social Psychology found that searching for meaning predicted greater posttraumatic stress symptoms in the following two years of 9/11 trauma. 

Finding meaning, however, was associated with lower trauma symptoms, even after controlling for mental health prior to 9/11, exposure to 9/11, and acute stress response.

Some healthy coping strategies that helped people have included finding some ways of explaining the traumatic event and looking for positive consequences such as self-growth, self-learning, social ties, and strengthen relationships.