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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1357-1366

Reactions and Needs of Tristate-Area Pediatricians After the Events of September 11th: Implications for Children's Mental Health Services

Danielle Laraque, MD*,{ddagger}, Joseph A. Boscarino, PhD, MPH§, Anthony Battista, MD||, Alan Fleischman, MD§, Marie Casalino, MD, MPH{ddagger}, Yue-Yung Hu, BS*, Sandra Ramos, PhD§, Richard E. Adams, PhD§, Jessica Schmidt, BA{ddagger},|| and Claude Chemtob, PhD*

* Mount Sinai School of Medicine, New York, New York
{ddagger} American Academy of Pediatrics, District II, NY Chapter 3, New York, New York
§ New York Academy of Medicine, New York, New York
|| American Academy of Pediatrics, District II, NY Chapter 2, New York, New York

Objective. The terrorist attacks of September 11, 2001, caused mass destruction in Lower Manhattan, the Pentagon, and rural Pennsylvania and resulted in the death of >3000 people. Children were prominent among those affected. Given the wide impact of the attacks, we hypothesized that primary care professionals would see the broad population of affected children but would feel ill-prepared to respond to children's mental health needs.

Methods. One year after the September 11th disaster, a hyperlink to a web-based 42-item survey was sent to all New York, Connecticut, and New Jersey American Academy of Pediatrics members with e-mail addresses (N = 4330), and a paper version of the survey was sent via postal mail to a random sample of those without e-mail (N = 1320). The survey requested demographic data, personal and practice experience of 9/11, perceived knowledge and skills regarding mental health, and perceived barriers to accessing mental health services for their patients. Both groups were contacted a total of 3 times at 2-week intervals, resulting in 1396 completed surveys from providers who were actively seeing patients.

Results. Twenty-nine percent of respondents stated that they were seeing affected patients, and 32.6% reported seeing children who were exposed to at least 1 9/11 event. Sixty-four percent of the respondents identified behavioral problems in directly affected children: 41.6% identified acute stress disorder, and 26.3% identified posttraumatic stress disorder (PTSD). However, a majority of these professionals indicated that they either lacked or were uncertain (50.8% PTSD, 51.7% acute stress disorder) of their skills to identify children with mental health problems and that they were "not" or only "somewhat" knowledgeable (76.8% PTSD) in these areas. The majority agreed that child health professionals should be trained to screen for these 2 disorders. Generalists as compared with specialists were more likely to report seeing patients who were affected by 9/11. Gender, race/ethnicity, and geographic location were associated with reported effects of 9/11 on respondents' practice and perceived skills and knowledge related to the psychological effects of community disasters.

Conclusions. Pediatric practitioners in the tristate area reported that children/families sought care for an array of mental health–related concerns. Generalists in the areas affected and those who identified gaps in knowledge or skills in responding to the psychological effects of community disasters should be targeted for additional education.

Key Words: children • mental health • acute stress disorder • posttraumatic stress disorder • depression • bioterrorism • environmental health • toxins

Abbreviations: AAP, American Academy of Pediatrics • ASD, acute stress disorder • PTSD, posttraumatic stress disorder • WTC, World Trade Center • WTCD, World Trade Center Disaster • OR, odds ratio • CI, confidence interval

Received for publication Jun 24, 2003; Accepted Oct 23, 2003.




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