The September 11, 2001, terrorist attacks, media exposure, and psychotic experiences among Asian and Latino Americans

Research has indicated that traumatic events may be important for the occurrence/onset of psychotic experiences (PE),1 that is, subclinical hallucinations and delusions similar to the symptoms of psychotic disorder but not as distressful, persistent, or impairing.2 However, studies have yet to determine whether exposure to traumatic events via the media might be linked to PE. An earlier literature review found that traumatic media images were associated with an increased risk for poorer mental health.3 Given this, we examined if exposure to media relating to the 11 September 2001 terrorist attacks (hereafter 9/11) was associated with reporting PE among Asians and Latinos in the general population in the USA. Data were analyzed from 4624 participants in the National Latino and Asian American Study (NLAAS), a nationally representative, cross-sectional probability survey administered between May 2002 and November 2003. This sample comprised non-institutionalized residents of the coterminous United States who were at least 18 years of age and of Hispanic, Spanish, Latino, or Asian descent.4 The Institutional Review Boards at the Cambridge Health Alliance, the University of Washington, and the University of Michigan approved sampling and consent procedures and informed consent was obtained from all participants. The 12-month occurrence of PE (hallucinations and delusions) was assessed with the World Health Organization's Composite International Diagnostic Interview psychosis screen.5 To assess media exposure, respondents were asked: ‘In the first weeks after the terrorist attacks, how much time, on average, did you spend each day getting information about the attacks from the media (e.g., TV, radio, newspapers, magazines, internet)?’ The response options included: None; Up to one hour; More than 1 hour, but up to 2 hours; More than 2 hours, but up to 4 hours; More than 4 hours, but up to 8 hours; More than 8 hours, but up to 12 hours; and More than 12 hours. Descriptive statistics of the study sample are presented in Table S1. Individuals with PE were more likely to have had both >8–12 h and >12 h of media exposure although the difference was only statistically significant for the latter (see Fig. S1). In a fully adjusted logistic regression analysis that examined a categorical measure of media exposure, more than 12 h of exposure was associated with three times higher odds of PE compared with 1–4 h exposure (Table 1, Model 4; full variable description and model results are presented in Table S2). When examining the association between media exposure as a continuous variable and PE, increasing media use was also associated with increased odds for PE (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.04–1.43; Model 4, Table S3). The results were robust in sensitivity analyses where ‘0 hours’ was used as the reference category and with adjustments for direct exposure (i.e., knowing someone who was injured/killed in the attacks). The finding that the experience of more hours of 9/11 media exposure was linked to PE accords with research that shows that the events of 9/11 were associated with the onset of psychotic symptoms in some individuals.6, 7 It also supports the conclusion of an earlier literature review that there is a relation between disaster media coverage and worse psychological health.3 Increased media coverage was linked to PE even after controlling for the presence of concurrent mental illness. Although our study has several limitations, including that we used cross-sectional data and were therefore not able to establish causality or the direction of the observed associations, and that the study sample was restricted to Asian and Latino Americans, possibly limiting the generalizability of our results, the finding that greater 9/11 terror-related media exposure was linked to PE is important, especially as the mental and physical health effects of 9/11 media exposure may have been long-lasting.8 Given this, even though the mechanisms linking traumatic media exposure and PE remain uncertain, measures to reduce exposure to potentially traumatic media might be important for population mental health – including reducing incidence of PE. For example, media companies may consider reducing the frequency of graphic disaster-related imagery broadcast, and warning viewers before traumatic images are televised.9 It might also be beneficial if the public is informed about the possible association between prolonged exposure to disaster-related media and poorer psychological health.10 In this regard, traumatic media might also include natural disasters, hate crimes perpetrated by groups such as white nationalists/supremacists, mass shootings, and other depictions of violence. In addition, collecting information about exposure to both direct and indirect (media) forms of trauma may be important for formulating comprehensive treatment programs for individuals presenting with psychotic symptoms. The authors declare no conflict of interest. Table S1 Descriptive characteristics of the study sample stratified by hours of exposure to 9/11 media coverage. Table S2. Association between 9/11 media exposure and reporting of 12-month psychotic experiences (categorical). Table S3. Association between 9/11 media exposure and reporting of 12-month psychotic experiences (continuous). Fig. S1 Frequency of media exposure to the 9/11 terrorist attacks by the presence of past 12-month psychotic experiences (PE). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.