Patterns of Comorbidity Among Bereaved Family Members 14 Years after the September 11th, 2001, Terrorist Attacks

Abstract

Studies of terrorism‐related deaths are few and mostly focus on short‐term effects. To characterize long‐term bereavement outcomes, including resilience/recovery and patterns of comorbidity, following the September 11, 2001 (9/11), terrorist attacks, we report mental health conditions and grief‐related impairment in 454 9/11 bereaved family members. In addition, the contribution of non‐9/11 lifetime traumas, pre‐9/11 mental health conditions, post‐9/11 interim life events, grief services, income adequacy, and social support were examined. Latent class analyses yielded three groups: healthy, comorbid without PTSD (comorbid/noPTSD), and comorbid with PTSD and impaired (comorbid/PTSD+I). Participants in the healthy group (66.1%) were least likely to meet thresholds for mental conditions, whereas those in the comorbid/noPTSD (21.3%) and comorbid/PTSD+I (12.6%) groups had higher probabilities of meeting depression, grief, and anxiety thresholds. These groups also endorsed more negatively valenced post‐9/11 interim life events than the healthy group: comorbid/noPTSD vs. healthy, odds ratio (OR) = 0.84, 95% CI [0.76, 0.94]; comorbid/PTSD+I vs. healthy, OR = 0.85, 95% CI [0.76, 0.96]. Comorbid/PTSD+I was the only group with elevated probabilities of meeting clinical thresholds for PTSD (.64) and grief‐related impairment (.94). This group was also more likely to include bereaved parents: comorbid/PTSD+I vs. healthy, OR = 12.96, 95% CI [1.97, 85.41]; comorbid/PTSD+I vs. comorbid/noPTSD, OR = 15.55, 95% CI [1.63, 148.41]); and to experience more non‐9/11 lifetime traumas: comorbid/PTSD+I vs. healthy, OR = 4.34, 95% CI [1.28, 14.70]; comorbid/PTSD+I vs. comorbid/noPTSD, OR = 6.54, 95% CI [1.53, 27.95]. Clinical and community programs should target this high‐risk group to identify individuals in need of services.

Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature

“…Persons with this condition are likely to have a significant degree of functional impairment and intransigence to traditional treatments. Further research on CG among survivors especially those with PTSD would be important for establishing the basis for developing interventions to ameliorate unresolved effects of CG [49].…”

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack

“…Terrorism has a widespread impact on societies and individuals, as well as on social, economic, mental, and physical health (Cozza et al, 2019 ; Stene et al, 2016 ). Research on bereavement indicates that people generally are resilient, as they tend to adjust to loss and regain functioning over time; however, some bereaved individuals continue to struggle and develop prolonged grief (PG) (Bonanno et al, 2002 ; Cozza et al, 2019 ). The core feature of PG is a persistent and pervasive longing and preoccupation with the deceased.…”

“…The violent death of a child has been associated with negative parental outcomes, intense suffering, and longer time for adjustment than after natural losses of adults (Cozza et al, 2019 ; Séguin et al, 1995 ) . Studies have documented high levels of prolonged grief disorder (PGD) even several decades after a traumatic loss (Pivar & Field, 2004 ; Schaal et al, 2010 ; Stammel et al, 2013 ).…”

Latent classes of posttraumatic psychiatric comorbidity in the general population

“…In addition, most studies have focused exclusively on comorbidity among individuals with PTSD. However, there is evidence of profiles of posttraumatic comorbidity that do not include PTSD (Cozza et al, 2019;Forbes et al, 2015). Accordingly, to fully understand the expression, prevention, and treatment of posttraumatic comorbidity, research is needed to assess the full spectrum of psychopathology in a population of individuals exposed to traumatic events.…”