Evaluation of the Mental Health Impact of 911: Results from the Pentagon Post Disaster Health Assess

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Evaluation of the Mental Health Impact of 9/11
Results from the Pentagon Post Disaster Health
Assessment Survey

• American Statistical Association Conference
• Raleigh, NC, October 2002
• Nikki N. Jordan1, Charles Hoge2, Steve Tobler1,
• James Wells1, George Dydek1, Walter Egerton1
• 1U.S. Army Center for Health Promotion and
  Preventive Medicine (USACHPPM)
• 2Walter Reed Army Institute of Research (WRAIR)

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Acknowledgements

• U.S. Army Center for Health Promotion and
  Preventive Medicine (USACHPPM)
• North Atlantic Regional Medical Command (NARMC)
• Walter Reed Army Institute of Research (WRAIR)
• TRICARE Management Activity
• Service Surgeon Generals
• Uniformed Services University of the Health
  Sciences (USUHS)
• Freedom of Information Act Office (FOIA)
• Defense Manpower Data Center (DMDC)
• Assistant Secretary of Defense for Health Affairs
• Undersecretary of Defense for Personnel and
  Readiness

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Objectives

• The Pentagon Post Disaster Health Assessment
  (PPDHA) was initiated with the following
  objectives
• To assist medical assets in providing optimum
  early care
• To understand and document the extent of
  injuries, illnesses, and exposures
• To provide Pentagon employees with information on
  attacks effects on themselves and their
  coworkers
• To provide engineers with useful data

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Operation Timeline
Analysis
Development Deployment Data Collection
11 Sep 01
15 Oct 01 Survey Available
15 Jan 02 Survey terminated
15 Dec 01 Interim Report
28 May 02 Tech Report Completed
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Mental Health Outcomes

• High risk groups were formulated based on symptom
  domains considered to be most important following
  a terrorist attack
• Posttraumatic stress disorder (PTSD)
• Depression
• Generalized Anxiety
• Panic attacks
• Alcohol abuse

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PTSD High Risk Group
Traumatic event that threatens safety and causes
fear
Considered met for all Pentagon Personnel
Traumatic event re-experienced?
No
Yes
Increased arousal?
Low risk for PTSD
No
Yes
No
Avoidance of stimuli associated with the trauma?
AND
OR
Yes
No
General numbing?
High risk for PTSD
Responses on Likert scale - moderate to extreme
levels considered positive
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Depression High Risk Group
More than half the days Nearly every day
Absence of pleasure/interests?
High Risk for Depression
OR
More than half the days Nearly every day
Depressed mood?
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Generalized Anxiety High Risk Group
Nervous, anxious, on edge or worrying a lot?
More than half the days Nearly every day
High Risk for Generalized Anxiety
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Panic Attacks High Risk Group
High Risk for Panic Attacks
Yes
Sudden feelings of panic or fear (panic attacks)?
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Alcohol Abuse High Risk Group
Used more alcohol than meant to?
Felt the need to cut down?
AND
Yes
Yes
High Risk for Alcohol Abuse
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Validation

• An overall measure of mental health functioning
  was included to test the validity of the risk
  groups.
• Use of counseling services following the attack
  was used as an additional check.
• Analysis of expected risk factors provided a
  means of confirmation

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Risk Factors

• Gender
• Age
• Military status
• Injuries from attack
• Being trapped during the attack
• Knowing some one killed or seriously injured
• Witnessing some one killed or seriously injured
• Prior mental health care use
• Prior trauma
• Social support

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Statistical Analysis

• Statistical Analysis of high risk groups was
  performed using SPSS 10.1.
• Associations were examined through both bivariate
  analysis and binary logistic regression.
• Odds ratios with 95 Confidence Intervals were
  generated.
• Results with an alpha lt0.05 were considered
  statistically significant.

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PPDHA Survey Results Sample size
N4739Response Rate 24.5
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Limitations

• Short length of the survey precluded making
  clinical mental health diagnoses
• Low response rate to the survey
• Inability to generalize results to the Pentagon
  population at large

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Conclusion

• Despite limitations, high risk groups for mental
  health symptom domains were strongly correlated
  with reduced functioning and increased use of
  counseling services.
• Risk factors known to be associated with
  traumatic events were strongly predictive of the
  high risk categories identified.
• Results suggest that the PPDHA mental health
  screening tool was valid and could serve as a
  prototype for rapid public health assessment of
  future traumatic events.
• Also, the high prevalence of mental health
  symptoms among respondents suggest the need for
  continued surveillance of mental health outcomes.

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Questions?