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Regional prevalence of fatiguing illness in the United States before and after the terrorist attacks of September 11, 2001.
Heim C, Bierl C, Nisenbaum R, Wagner D, Reeves WC.Regional prevalence of fatiguing illness in the United States before and after the terrorist attacks of September 11, 2001.
Psychosomatic Medicine 2004;66:672-678.
Summary
CFS is most likely does not occur because of one risk factor but rather is due to interaction of several environmental factors with individual traits such as gender and genetic disposition. In particular infectious, physical, and emotional stress have been associated with occurrence of CFS. In addition, unusual worsening of illness following physical and mental exertion is one of the 8 CFS defining symptoms. Clinical studies have reported that CFS patients living in South Florida suffered severe relapse and functional impairment following Hurricane Andrew. In this study we evaluated the occurrence of CFS-like illness in different regions of the US before and immediately following the terrorist attacks of September 11, 2001. We were surprised to find that prevalence of fatiguing illnesses within 2 months after the attacks was significantly lower than 2 months before the attacks. The decrease in occurrence following the attacks was more pronounced in urban regions of the country.
Abstract
Objective: Stress or emotional traumas are considered risk factors for unexplained fatiguing illnesses. From July to December 2001, the Centers for Disease Control and Prevention conducted a multi geographical pilot study to test the feasibility of a survey to estimate the prevalence of fatiguing illnesses in the United States. We used data obtained during this survey to estimate the effect of the coincidentally occurring terrorist attacks of September 11, 2001, on the regional prevalence of fatiguing illnesses.
Methods: Identified by random-digit dialing, 2,728 households in eight regional strata were interviewed, and 7,317 respondents were screened for severe fatigue of at least 1-month duration. Identified fatigued people of age 18 to 69 years (N = 440) and a sample of non-fatigued people of the same age range (N = 444) were interviewed in detail concerning fatigue, other symptoms, and medical and psychiatric histories.
Results: Weighted prevalence estimates based on interviews performed after the attacks were significantly lower compared with estimates based on interviews performed before the attacks (prolonged fatigue: 5,450 vs. 1,530/100,000, p = .010; chronic fatigue: 18,510 vs. 10,070/100,000, p = .002; chronic fatigue syndrome-like illness: 2,510 vs. 960/100,000, p = .014).
Conclusions: Our findings suggest decreased regional prevalence of fatiguing illnesses in the aftermath of the terrorist attacks. The causes of this effect are unknown but might involve acute psychological and physiological adaptations that modify the perception or manifestation of fatigue. Future studies should be specifically designed to scrutinize the relationship between stress and fatiguing illnesses and the mediating mechanisms of such a relationship.
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