The purpose of this study is to assess prevalence and correlates of psychological distress among residents of the New York City (NYC) metropolitan area 6 months after the World Trade Center disaster (WTCD). This study will also serve as a wave 1 interview for a planned longitudinal cohort study that will investigate long-term sequelae of the WTCD. The WTCD has had a profound impact on all aspects of life in and around NYC. The practical, and psychological, effects of the WTCD are only now being felt. Previous post-disaster research suggests that 4-5 percent or more of all residents of NYC may have chronic Post-Traumatic Stress Disorder (PTSD) 6 months after the incident; this would represent 400,000 New Yorkers. Given the density of NYC and the unparalleled human and financial losses resulting from the WTCD, the prevalence of psychological distress among residents of the NYC metropolitan area may be even higher. Assessment of the extent of psychological distress and its correlates is necessary to guide both current provision of services in NYC as well as future disaster planning and response. In addition, the scope of the WTCD in NYC presents a unique opportunity to assess hypotheses that have previously been formulated through research after smaller disasters. This research will provide a point estimate of the prevalence of psychological distress (particularly PTSD and depression) in the NYC metropolitan area. We will assess the role of correlates of psychological distress including event experiences (e.g., distance from WTC), demographics (e.g., age, gender, race/ethnicity, occupation), socioeconomic factors (e.g., socioeconomic status, social support); lifetime traumatic events, past victimization, past exposure to stressors and trauma, acute emotional events, and commonly occurring co-morbidities (e.g., substance use). We will also inventory availability of mental health and health care services related to post-WTCD sequelae and measure service utilization and perceived organizational responsiveness 6 months post-WTCD. In order to answer these questions we will carry out a random digit dial phone survey of the NYC metropolitan area, selecting participants from four zones radiating concentrically from the WTC site. We will oversample the central city area. We will administer well-validated diagnostic survey measures to respondents. We will recruit 2,670 persons for this study in anticipation of extending this research to a longitudinal cohort (and expecting 25 percent attrition over a 2 year period; i.e., n = 2,000 for the final cohort). Additional funding separate from this RAPID application will be sought for the longitudinal follow-up. By establishing a baseline for cohort follow-up through this study we will eventually be able to assess the prognostic role of the correlates of psychological distress. We will use multivariable analyses and hierarchical modeling to address key research hypotheses in this proposal.
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