Resilience Is Norm for Most Exposed to Trauma

Ten years ago, science generally looked at trauma as something that only affected individuals, said Sandro Galea, M.D., Dr.P.H., professor and chair of the Department of Epidemiology in the Mailman School of Public Health at Columbia University.

Today, thanks to research conducted in the wake of the September 11 attacks, there is an added appreciation for how trauma works on a population level, Galea told a conference on science, policy, and public health held at Columbia in September.

Galea began his talk with a major caveat. While researchers usually concentrate on pathological states, resilience is the norm for most people exposed to traumatic events.

"We read of the percentages of the exposed population that have PTSD or depression symptoms, but you almost never see that less than 50 percent have any pathology," said Galea. "The majority do not have physical or mental illnesses, so resilience should be one of the hallmark findings of 9/11 studies."

A consistent theme in those studies has been the role of exposure. For instance, rates of posttraumatic stress disorder (PTSD) in Manhattan after the attacks on the World Trade Center were 7 percent north of Canal Street, but 20 percent south of Canal Street, about three-quarters of a mile north of the site. And the sooner workers arrived at the site after the attack and the longer they worked there, the greater their exposure, and the greater their risk for disorders ranging from PTSD to asthma to gastroesophageal reflux disease.

Researchers observed other patterns too. The longer people had worked at the World Trade Center prior to the attack, the greater their risk for PTSD. Hispanics, especially Puerto Ricans and Dominicans, who are sizable ethnic populations in New York City, were at higher risk than other ethnic groups for reasons that remain unclear. In addition, research showed that people with less education had more psychopathology, as did people who worked on the rubble pile but were not trained for their tasks.

People aged 18 to 29 were at the highest risk for PTSD among age groups, while those aged 60 or older were at the lowest risk. Six months after the attack, 18 percent of New York City schoolchildren recorded PTSD symptoms, with girls displaying higher rates than boys. "This is a critical area that remains unclear," said Galea.