Are Post-9/11 Resilience Data Good or Troubling News?

Sixty-five percent of participants were resilient, the investigators found. Of particular interest to the researchers were the two small groups most directly endangered by the attack: the 22 individuals who were in the World Trade Center buildings at the time of the attack and the 59 individuals who were injured because they were near the attack site. Even though 25 percent of the 22 individuals who were in the buildings had probable PTSD, more than half met resilience criteria. And even though 26 percent of the 59 injured individuals had probable PTSD, about one-third showed resilience.

In fact, even in instances where people experienced multiple traumas, they often exhibited resilience. For example, a third of the 142 individuals who both experienced the death of a loved one through the attack and witnessed the attack were found to be resilient.

The researchers also explored using either a more stringent or more liberal definition of resilience. Even here, the results did not change to any substantial degree. For example, because some respondents may have been depressed even in the absence of PTSD symptoms, the investigators tried further narrowing the definition of resilience to include the absence of depression. However, this restriction did not appreciably lower the proportions of people showing resilience across exposure categories.

“On the whole, these findings demonstrate widespread resilience in the New York City area during the six months after the September 11th attack,” Bonanno and his team concluded. “Even among the groups with the most pernicious levels of exposure and highest probable PTSD, the proportion that were resilient never dropped below one-third.”

“This investigation is an exemplary attempt to study the poorly understood concept of resilience using an existing database to capture the opposite—that is, the presence of serious mental health consequences of 9/11,” Randall Marshall, M.D., director of trauma studies and services at Columbia University, told Psychiatric News. “Dr. Bonanno is right about the need to take resilience seriously as a subject of scientific investigation, meaning future studies have to be designed to capture and understand resilience as an outcome and a process that is much more than the `absence of psychopathology.'

“That said, I cannot agree with the conclusion [that since 65 percent of New Yorkers showed resilient reactions, it demonstrates] high levels of resilience in the general population.... If we were discussing medical illness after exposure to an environmental pathogen, no one would be reassured that only 65 percent of persons did not experience any symptoms of illness at all.... Resilience should have been in the 90th percentile....

“[In short] large numbers of people did not demonstrate resilience after 9/11, and therefore we should devote much more attention to ways to enhance resilience and promote recovery.”

The study was funded by the National Institute of Mental Health.

“Psychological Resilience After Disaster: New York City in the Aftermath of the September 11th Terrorist Attack” will be posted at<www.ingenta.com/journals/browse/bpl/psci> once it is published. ▪