Remembering 9-11

I will never forget where I was eight years ago on 09-11-01. I was a sophomore in college at North Carolina State University in Raleigh, NC. I was up early enjoying my Tuesday weight training class at the gym. I left the gym and went on with my morning. I was sitting in calculus when a friend leaned over and asked if I had heard about what happened in New York at the Twin Towers. Since iPhones or Blackberry’s weren’t yet around and I still took notes on paper, I made a mad dash home after class ended to watch the story on TV and read about it on my desktop computer. I called my family to make sure we didn’t know anyone in NY and to tell them I loved them. A sense of devastation and worry came over me; I was in disbelief and didn’t know what was going to happen next.

Luckily for me, I did not experience any direct psychological trauma as a result of 9/11. Since the event, however, there has been much discussion in the healthcare community about the resulting depression, panic, substance abuse, anxiety, and posttraumatic stress that has affected those directly involved in the rescue efforts, family and friends of those that lost their lives, and those that witnessed or lived in the area of the attack.

Mental health screening tools are a valuable part of an initial assessment in the primary care setting. A study to assess generalized anxiety disorder (GAD) in those affected by 9/11 (1) included the following mental health screening tools (with links to the forms I could find!):

• Life Events Checklist (LEC): screening for various types of common traumatic events
• Patient Health Questionnaire (PHQ): depression, panic disorder, substance use disorders, and GAD
• Patient Health Questionaire-9 (PHQ-9): screening tool for depression
• PTSD Checklist-Civilian Version (PCL-C): Screening for PTSD Symptoms
• Short Form Health Survey (SF-12): perceived physical and mental disability
• Sheehan Disability Scale (SDS): screening for impairment in work, social life, and family life/home responsibilities

As naturopathic doctors address the “whole person” and treat the “root cause” of disease, mental emotional health is an important consideration. Whether it is something we will treat or will refer for treatment by psychiatrists, psychologists, or counselors, it should not be forgotten in an initial assessment. I have had experience using the PHQ-9 on a rotation for a patient who presented for nutrition advice and weight loss. It was a valuable exercise for me as the student doctor and for the patient to see the progress that took place over the course of two months. The patient went from being in the category of “moderately severe” depression at her initial intake to “minimal symptoms.” Although her mental health was not a chief concern of hers nor did we spend much additional time discussing it, we were able to address the mental emotional aspect of her condition in our treatment using the scale as a screening and reference tool. This information about her mental state inevitably resulted in a more favorable treatment outcome.

I am thankful for those persons who helped save lives on 9/11, the military personnel who continue to fight to end terrorism, and those who witnessed the attacks or were otherwise involved and are alive to share their story. For those that are no longer with us, I know that your legacy will live on in the hearts of family and friends as they share your story with the world.

Reference:
1: Ghafoori B, Neria Y, Gameroff MJ, Olfson M, Lantigua R, Shea S, Weissman MM. Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care. Journal of Trauma Stress. 2009 Jun; 22(3):218-26.