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Television Images and Psychological Symptoms After the September 11 Terrorist Attacks

DOI:10.1521/psyc.65.4.289.20240
Authors:
Jennifer Ahern at University of California, Berkeley
Jennifer Ahern
Sandro Galea at Boston University
Sandro Galea
Heidi Resnick at Medical University of South Carolina
Heidi Resnick
Dean G Kilpatrick at Medical University of South Carolina
Dean G Kilpatrick
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Abstract

Exposure to graphic television images may exacerbate psychological symptoms in disaster situations. We tested the hypotheses that (1) more frequent viewing of television images of the September 11 terrorist attacks was associated with posttraumatic stress disorder (PTSD) and depression, and that (2) direct exposure to disaster events had an interactive effect with media viewing. We recruited 1,008 adult residents of the borough of Manhattan in New York City through a random-digit-dial telephone survey conducted between October 16 and November 15, 2001. Respondents who repeatedly saw "people falling or jumping from the towers of the World Trade Center" had higher prevalence of PTSD (17.4%) and depression (14.7%) than those who did not (6.2% and 5.3%, respectively). Among respondents who were directly affected by the attacks (e.g., had a friend killed), those who watched this television image frequently were more likely to have PTSD and depression than those who did not. Among respondents not directly affected by the attacks, prevalence of PTSD and depression was not associated with frequency of television image viewing. Specific disaster-related television images were associated with PTSD and depression among persons who were directly exposed to a disaster. Future research should address causal directionality of this association.
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... It takes into account that visual communication is a complex process which entails cognitive and emotional reactions to perceived visuals (Müller et al., 2012). While there are strong indications that not only experiencing a traumatic situation, but also experiencing convincing factual photo coverage of a traumatic event can have serious psychological consequences that are similar to e.g., post-traumatic stress disorder (Ahern et al., 2002(Ahern et al., , 2004Saylor et al., 2003;Liu and Liu, 2020), this study will only allow for the analysis of self-reported empathic states as well as observed empathic reactions. No therapeutic or psychiatric assessment of the actually experienced emotional states during the viewing and subsequent reflection on the press photographs took place, since this is no psychological study. ...
... However, a particular "Note" is added in the DSM5 (American Psychiatric Association, 2013, p. 273) that this type of vicarious traumatization "does not include events that are witnessed only in electronic media, television, movies, or pictures." Yet, several studies indicate that watching visuals particularly on digital media can lead to symptoms similar to those of experiencing the traumatic event yourself (Ahern et al., 2002(Ahern et al., , 2004Saylor et al., 2003;Liu and Liu, 2020). In a pivotal study on New Yorkers' visual coping after 9/11, Ahern et al. (2002) assume that "more frequent viewing of television images of the September 11 terrorist attacks" is "associated with posttraumatic stress disorder (PTSD) and depression" (Ahern et al., 2002, p. 289). ...
... Yet, several studies indicate that watching visuals particularly on digital media can lead to symptoms similar to those of experiencing the traumatic event yourself (Ahern et al., 2002(Ahern et al., , 2004Saylor et al., 2003;Liu and Liu, 2020). In a pivotal study on New Yorkers' visual coping after 9/11, Ahern et al. (2002) assume that "more frequent viewing of television images of the September 11 terrorist attacks" is "associated with posttraumatic stress disorder (PTSD) and depression" (Ahern et al., 2002, p. 289). The telephone survey conducted with 1,008 adult residents of the borough Manhattan in the two months directly following the attack resulted in frequent-TV-watchers having a much higher likelihood of PTSD and/or depression than those participants showing a lower media consumption pattern (Ahern et al., 2002, p. 289). ...
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... Exposure to disaster media coverage is considered as deleterious as direct trauma exposure (Lubens & Holman, 2017), depending upon the type of disaster and individuals' attributes (Pfefferbaum et al., 2019). This issue has been most frequently studied in terrorist incidents (Ahern et al., 2002(Ahern et al., , 2004Busso et al., 2014;Pfefferbaum et al., 2001Pfefferbaum et al., , 2019Stickley et al., 2020). Television images of the September 11 Terrorist Attacks are suggested to be linked to PTSD (Ahern et al., 2002(Ahern et al., , 2004, although non-work-related television exposure is no longer included in the current diagnostic criteria of PTSD in the DSM-5 (American Psychiatric Association, 2013). ...
... This issue has been most frequently studied in terrorist incidents (Ahern et al., 2002(Ahern et al., , 2004Busso et al., 2014;Pfefferbaum et al., 2001Pfefferbaum et al., , 2019Stickley et al., 2020). Television images of the September 11 Terrorist Attacks are suggested to be linked to PTSD (Ahern et al., 2002(Ahern et al., , 2004, although non-work-related television exposure is no longer included in the current diagnostic criteria of PTSD in the DSM-5 (American Psychiatric Association, 2013). The issue was also studied in natural disasters. ...
... In the present study, images of victims facing adverse events associated with the earthquake were implicated in producing persistent psychological impacts. A previous study showed that an image of 'people falling or jumping from the towers of the WTC' after the September 11 Terrorist Attacks was most consistently associated with PTSD and depression, compared with those of airplane crashes or building collapses (Ahern et al., 2002). In the present study, human images were also shown to have significant and persistent psychological impacts, although we did not compare them to the impacts of non-human images. ...
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Article
Full-text available
  • Jan 2023
Background: Exposure to natural disaster media coverage is associated with mental health problems, but its long-term impacts are still unclear. Also, no study has analysed the psychological impact of exposure to natural disaster media coverage among children who are generally sensitive to threatening events. Objective: We aimed to examine how television images of victims after the 2011 Great East Japan Earthquake were associated with mental health among children and their parents. Methods: In 2012, questionnaires for sociodemographic factors were distributed to 2053 families. Parents who provided written consent were contacted in 2013 and invited to provide information on mental health problems (outcome) and retrospectively provide information on television watching at the time of the earthquake (exposure). We used data from 159 parents who completed the survey as the final sample. We used a dichotomous variable to evaluate exposure to media coverage. Multivariable regression was used to examine the association between exposure to television images of victims and mental health, adjusting for potential confounders. Bias-corrected and accelerated bootstrap confidence intervals (CIs) were used. Results: Exposure to television images of victims was significantly associated with worse psychopathology among children (β, 1.51; 95% CI, 0.07–2.96) and greater psychological distress among their parents (β, 1.49; 95% CI, 0.28–2.70). Child psychopathology and parental psychological distress were significantly correlated (r = 0.36, p < .001). Conclusions: Exposure to television images of disaster victims may produce long-term impacts on mental health among children and their parents. To reduce the likelihood of mental health problems associated with disasters, clinicians may recommend reducing exposure to television images of victims.
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... But on the other hand, since the coverage in question typically concerns traumatic content such as mass casualties and a potential nuclear conflict, it might unintentionally affect millions of media users in an emotionally negative way (Neria and Sullivan, 2011). Based on available studies concerning responses to the media coverage of other military conflicts (Palgi et al., 2017), health crises (Garfin et al., 2020;Levaot et al., 2022;Scrivner et al., 2021), and disasters (Pfefferbaum et al., 2014;Cho et al., 2003;Ahern et al., 2002), such responses might include symptoms of anxiety, distress and lowered psychological resilience. ...
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... First, the mental health consequences of such events among those indirectly exposed to a disaster may be just as deteriorating as those directly exposed to or close to the disaster epicenter (40). Most of the people interviewed in the post-9/11 national surveys reported that they were indirectly exposed to the attacks, mostly through TV broadcasts (67). Studies have found that religious coping, a secure relationship with God, and belief in the meaning of life are inversely related to PTSD. ...
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Natural disasters, which are considered as one of the most important problems of recent times, affecting all humanity, have become a public health problem. Disasters have effects on both individuals and society in different dimensions, including health, economic, social, and psychological, and can have serious negative consequences. The number of individuals affected by natural disasters is increasing every year. While it is clear that natural disasters threaten human life and bodily health, little attention has been paid to their effects on mental health. Natural disasters threaten our psychological well-being in many ways, cause both short-term and long-term psychological distress and create a significant psychological burden. Post-traumatic stress disorder (PTSD) is a syndrome that occurs as a result of a serious threat or physical injury, a near-death experience, war-related trauma, sexual assault, interpersonal conflicts, child abuse, or a medical illness. When the literature is examined comprehensively, it has been determined that the incidence of PTSD after natural disasters is quite high. Causes of post-disaster PTSD include the nature of the trauma, its severity, loss of relatives and/or property, poor coping skills, displacement, and direct exposure to disaster. Studies have shown that both non-pharmacological and pharmacological treatments are effective on PTSD.
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... Most of the studies investigating this were based on the attacks in the United States on 11 September 2001 (hereafter 9/11). One such study showed that post-traumatic stress reactions could be linked with seeing images of the attacks on the Twin Towers, as well as seeing people jump out of the towers [2]. Another study, in a representative sample in the U.S., showed that 22% of the population reported 9/11 to be their worst life event, even though they only viewed it through the media [3]. ...
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