New York -- Long after the dust settled in lower Manhattan, thousands of volunteers, rescue workers, and New York City residents are still feeling the effects of 9/11 -- not only in their hearts but in their minds and bodies as well.
While the psychological impact of 9/11 is nearly impossible to quantify on a nationwide level, health officials in New York and the surrounding areas are just beginning to understand the scope of physical and mental effects of the disaster. The "World Trade Center cough," respiratory problems, smaller babies, and post-traumatic stress disorder (PTSD) are just a few of the issues linked to exposure to the smoke, dust, and toxic fumes that permeated lower Manhattan for days and weeks after the disaster.
"We never had an exposure like this," says Paul Lioy, PhD, of the Environmental and Occupational Health Sciences Institute. "It was an unprecedented collapse of two large buildings turning into dust, literally, and then residual smoke and a complex mixture we've never seen or ever dealt with before."
"So in terms of the long-term effects from short-term exposure, we don't know whether or not they will remain for many, many years or eventually go away," says Lioy. "We have to monitor it."
To that end, health officials in New York recently announced the creation of the World Trade Center Health Registry to track and evaluate the long-term health effects of 9/11.
"The effects of 9/11 are still being felt today by all New Yorkers, and all Americans," says Thomas R. Frieden, MD, MPH, New York City Health and Mental Hygiene Commissioner, in a news release.
"Hundreds of thousands of people from all walks of life were in the vicinity of the twin towers when they collapsed, and were exposed to a combination of smoke, dust, and debris," says Frieden. "We need to study the health of these people in order to understand the possible health consequences related to 9/11."
Health Effects Linger for Locals and Rescue Workers
The World Trade Center Worker & Volunteer Medical Screening Program in New York City offers free and confidential medical screening examinations nationwide for those who helped with post-9/11 rescue, recovery, and cleanup efforts.
Earlier this year, researchers released preliminary findings based on a sample of 250 of the program's participants. The results show that about half of the participants experienced persistent lung, ear, nose, and throat, and/or mental health symptoms 10 months to a year after the terrorist attacks.
Other findings include:
- 78% of emergency responders reported at least one WTC-related lung symptom that first developed or worsened as a result of their WTC work.
- 88% reported at least one WTC-related ear, nose, or throat symptom.
- 52% of participants reported mental health symptoms that require further medical evaluation, and one in five reported symptoms consistent with post-traumatic stress disorder.
Researchers say the persistence of these symptoms 10 months to a year after 9/11 is alarming. Although long-term results have not yet been published, they say the same issues are continuing at similar rates.
"When we looked at patients seen through April 2003, we're still seeing a significant number of upper respiratory problems -- meaning nasal congestion, rhinitis, and sinusitis -- and we're seeing a lot of cough and persistent shortness of breath," says Jacqueline Moline, MD, medical core director of the screening program.
Another effect of 9/11 researchers will be watching for in the future will be the impact of asbestos exposure. Long-term exposure to asbestos is known to increase the risk of cancer, but it can take decades for those cancers to appear.
Moline says she's hopeful that rescue workers won't experience an increase in cancer risk due to asbestos exposure. It will depend on the extent of exposure for each individual, but she says that the risk is certainly not as great as the risk seen by those who worked with asbestos for many years.
Even so, the health effects of 9/11 may also linger for generations to come. A study published earlier this year in The Journal of the American Medical Association showed that babies born to mothers who were exposed to the toxic plume of smoke that followed 9/11 were twice as likely to have suffered growth problems while in the womb.
Debate Still Burning over Exposure Dangers
The extent of exposure to various elements following the collapse of the World Trade Center and subsequent fires is also a source of debate among officials and researchers and may play a large part in determining the actual health effects of 9/11 in the future.
"The air quality issues surrounding the first 24 hours after the attack were unprecedented," says Lioy. "The only thing that would come close would be a volcano eruption, but then you wouldn't have glass literally turning into very small fibers and building materials."
But a report issued last month from the Office of the Inspector General shows that the Environmental Protection Agency (EPA) may have misled the public and local officials about the air quality in New York City following 9/11.
According to the report, the EPA made an announcement Sept. 18, 2001 that the air in the Ground Zero area was "safe" to breathe, but at that time the agency "did not have sufficient data and analyses to make such a blanket statement."
At that time, air-monitoring data for several pollutants of particular health concern was lacking, including information on PCBs (polychlorinated biphenyls), which have been linked to cancer.
"I find that very frustrating as a physician and someone who was asked repeatedly if the air quality was safe," says Moline. "The fact that we may have given people advice based on flawed data, for me as a doctor, makes me sick.
"At this point, hopefully going forward they will be more transparent and actually tell people what they were measuring and not make overreaching statements," Moline tells WebMD. "Hopefully we will have a lesson learned from this."
Psychological Effects Near and Far
The screening program in New York has also revealed that about 20% of the workers and volunteers involved in World Trade Center recovery efforts caused some element of psychological impairment, such as post-traumatic stress disorder or symptoms related to them such as depression and anxiety.
Trauma researcher Roxone Cohen Silver, PhD, of the University of California, Irvine, says that in order for a person to be diagnosed with PTSD they would have to have been directly exposed to the traumatic event. But that doesn't mean that the psychological effects of a major national trauma are limited to people who live in New York, Washington, D.C., and Pennsylvania.
Silver conducted a study that measured symptoms of anxiety and depression that closely mirror post-traumatic stress disorder among a nationwide sample of Americans at various intervals after 9/11. Long-term data from the study is currently being analyzed, but the results after six months were published in TheJournal of the American Medical Association last year.
Silver says the study showed about 60% the participants said they saw the attacks occur live on TV and watched them in real time, which constitutes a different kind of exposure.
She says PTSD-like symptoms, such as nightmares, ruminations, anxiety, and avoiding reminders of the attacks, have clearly declined since the early days after 9/11. But there are also other ways in which the attacks have played out in the national psyche.
For example, Silver points to the reactions to the recent blackout on the East Coast.
"Most people that I spoke to immediately hypothesized that the blackout might be the result of some kind of terrorist activity. In 1965, probably no one generated that as hypothesis for what happened with the blackout on the East Coast," Silver tells WebMD.
Silver says this type of ongoing anxiety and uncertainty about terrorist activity on our soil will certainly continue to impact many Americans over time in ways that are impossible to predict. But feelings of anxiety and depression aren't necessarily symptoms of a psychological disorder.
"We felt that these symptoms were a normal reaction to abnormal trauma rather than signs of serious psychopathology," says Silver. "Ongoing anxiety is not an unjustifiable reaction at this point in our history."
However, when those symptoms start to interfere with a person's daily functions, they might be signs of a more serious problem. The study showed that people with a prior history of mental problems were more likely to develop a psychological disorder, such as depression or anxiety disorders, following 9/11.
Recovery Is a Long Road
While the physical wounds of 9/11 can be eased by medical treatment, experts say that only time can help heal the psychological scars left by the terrorist attacks.
Silver says research on the long-term effects of trauma suggests that Americans will continue to feel the psychological effects of 9/11 for many years to come.
"I think an assumption that we will bounce back and get back to where we were on September 10th would be a myth," says Silver. "Most individuals who have encountered major life traumas indicate that recovery doesn't mean forgetting but learning to live with consequences of a changed circumstance."