Exposure to bioterrorism and mental health response among staff on Capitol Hill.

The October 2001 anthrax attacks heralded a new era of bioterrorism threat in the U.S. At the time, little systematic data on mental health effects were available to guide authorities' response. For this study, which was conducted 7 months after the anthrax attacks, structured diagnostic interviews were conducted with 137 Capitol Hill staff workers, including 56 who had been directly exposed to areas independently determined to have been contaminated. Postdisaster psychopathology was associated with exposure; of those with positive nasal swab tests, PTSD was diagnosed in 27% and any post-anthrax psychiatric disorder in 55%. Fewer than half of those who were prescribed antibiotics completed the entire course, and only one-fourth had flawless antibiotic adherence. Thirty percent of those not exposed believed they had been exposed; 18% of all study participants had symptoms they suspected were symptoms of anthrax infection, and most of them sought medical care. Extrapolation of raw numbers to large future disasters from proportions with incorrect belief in exposure in this limited study indicates a potential for important public health consequences, to the degree that people alter their healthcare behavior based on incorrect exposure beliefs. Incorrect belief in exposure was associated with being very upset, losing trust in health authorities, having concerns about mortality, taking antibiotics, and being male. Those who incorrectly believe they were exposed may warrant concern and potential interventions as well as those exposed. Treatment adherence and maintenance of trust for public health authorities may be areas of special concern, warranting further study to inform authorities in future disasters involving biological, chemical, and radiological agents.

Change in smoking and drinking after september 11, 2001, in a national sample of ever smokers and ever drinkers.

Telephone survey methodology was used to examine smoking and drinking after the September 11 terrorist attacks in a representative national sample. Most ever smokers and ever drinkers reported no change in substance use after the attacks. Smokers and drinkers who increased substance use were significantly more likely than those who did not to endorse a number of emotional reactions and functional difficulties. The pattern of associations of decreased use with emotional reactions and functional difficulties differed between smokers and drinkers. In general, decreased smoking was associated with denial of emotional reactions and functional difficulties whereas decreased drinking was associated with endorsement of these reactions and difficulties. The results have implications for research, clinical practice, and public health.