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An Exploratory Study of The Impact of 9/11 on Elderly Chinese and Hispanic Immigrants in New York City : 

An Exploratory Study of The Impact of 9/11 on Elderly Chinese and Hispanic Immigrants in New York City David L. Strug, Ph.D. and Susan E. Mason, Ph.D. Wurzweiler School of Social Work Yeshiva University (strug@yu.edu; masonse@yu.edu) 16th Annual GHEC Meeting Santo Domingo, D.R. February 15-17, 2007

The Impact of 9/11 on Older Chinese and Hispanic Immigrants in NYC : 

The Impact of 9/11 on Older Chinese and Hispanic Immigrants in NYC Older Chinese and Hispanic immigrants reacted to 9/11 in distinct, culture bound ways, which helped them cope with 9/11. We compare the two groups in terms of: How they reacted and coped. How cultural factors influenced their responses to 9/11.

The Problem: 

The Problem Chinese and Hispanic elderly immigrants in NYC may be at increased risk for the mental health consequences of 9/11 because of Age Ethnicity Cultural and socioeconomic marginality Migration history

The Research Questions: 

The Research Questions What similarities and differences exist in how older Chinese and Hispanic immigrants reacted to and coped with 9/11? What role did socio-cultural factors play? What implications are there for education, practice and research?

Underlying Socio-Cultural Assumptions : 

Underlying Socio-Cultural Assumptions The consequences of trauma are social and interpersonal, as well as psychological and individual. Individuals cope with trauma in ways that are culturally constructed and adaptive, and are based on the collective history of the culture.

9/11, A Uniquely Devastating National Trauma: 

9/11, A Uniquely Devastating National Trauma September 11 was a uniquely devastating national trauma. It elevated the risk of post-traumatic stress disorder (PTSD) for thousands of Americans Levels of post-9/11 symptoms were higher in NYC than for the rest of the country.

What is Posttraumatic Stress Disorder (PTSD)?: 

What is Posttraumatic Stress Disorder (PTSD)? Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a traumatic event. Most survivors of trauma return to normal over time. Some survivors may develop PTSD.

PTSD Symptoms: 

PTSD Symptoms Reliving the trauma in some way. Staying away from places or people that remind you of the trauma, and isolating from other people. Feeling on guard, irritable, or startling easily.

Slide12: 

Washington Heights Chinatown

Slide13: 

Chinatown is less than ten blocks from Ground Zero. 9/11 caused unprecedented disruptions in businesses, schools, and civic life. Multiple losses associated with the events of 9/11 posed severe strains on this community. Chinatown

Slide16: 

Washington Heights Chinatown

American Airlines Flight 587 November 12, 2001: 

American Airlines Flight 587 November 12, 2001

Grieving Family Members: 

Grieving Family Members

Slide21: 

51 Chinese subjects were interviewed in focus groups at 3 senior centers in July 2002. We asked subjects about: Experiences and perspectives in relation to the 9/11 attacks and post-9/11 coping and help-seeking behaviors. Chinese Subjects, N=51

Findings: Psychological Reactions : 

Findings: Psychological Reactions Feelings of fear and grief reminiscent of past losses in their lives, including, loss of family left behind in China. Somatic symptoms. Feelings of loss of security – America was no longer a safe place. Worries related to inability to protect family members from future attacks.

Voices: 

Voices “I used to feel so happy in the U.S. I believed that one only needed to work had and one would be all right in this country. Now the sense of security is gone.” “I endured a lot of hardships in the past. I thought I would have peace in America.” “Right now it feels like we can only live one day at a time…We are old, and we cannot deal with too much stress and tragedy in our lives.”

Coping Reactions: 

Coping Reactions Seeking comfort from others at the Senior Center. Engaging in activities at the center and volunteering to help others – “activities take away the pain.” Shying away from divulging personal feelings.

Voices: 

Voices “We were much happier after the senior center reopened. We can talk among ourselves and comfort each other.” “Friends who know each other well will pick up on what the other person really wants to say.” “The Chinese do not believe in talk therapy…What hurts inside can never be forgotten.”

Voices: 

Voices “It’s better not to talk about painful issues because it can stir up more painful feelings.” “It’s better to get involved in activities to lighten up a little than to dwell on the painful past all day long.”

Slide27: 

Focus groups were conducted with 31 Hispanic immigrants at senior centers in 2001- 2002. Individual and group interviews at 2 senior centers with 24 additional Hispanics in 2003-2004 about post-9/11 events. Hispanic Subjects, N=55

Slide28: 

Profile of Hispanic Subjects, N = 55

Questions: 

Questions How would you describe your reactions to 9/11? In what ways did you cope with the feelings 9/11 produced in you? 3. Did you feel that you needed to talk to someone in your community about these events and your feelings?

Findings: 

Findings Four months post-9/11 Most subjects had begun to recover from their acute post-911distress reactions. Many still experienced anxiety, deep sadness, hypervigilance, insomnia, somatization, startle responses, and disruption of daily routines.

Voices: 

Voices “My first reaction was as if an electric shock went through my whole body as I saw the smoke rise from the collapsed buildings.” “The other day I had a doctor’s appointment and I could not even get dressed. I felt like I might shout uncontrollably and tried to hold it back. I was that anxious. I still can’t sleep at night. I happened to see the date 9/11 mentioned in the newspaper and afterwards, I couldn’t eat or get dressed. I wanted to shout, to run, and I was too emotionally upset to go to my doctor’s appointment.”

Voices: 

Voices “I call my kids two or three times a day to make sure they are all right. I worry every time they get into the car. I worry if someone is planting a bomb somewhere. They ask “Mommy, what’s wrong? You were never this way before.”

Voices: 

Voices “I am gripped with fear and do not go out much. I sometimes cry. I think about the dead bodies and Ground Zero and the pain that family members of the dead must be feeling. I just don’t want to go outside.”

Coping Reactions: 

Coping Reactions Two-thirds of Hispanic respondents reported they used religion as a primary way of coping with 9/11. Some went to physicians for medication to calm their nerves and to help them sleep. Others turned to work or other activities. None went to mental health centers for help. Others coped through the exercise of will power.

Voices: 

Voices “I did not have to go to the doctor, because I have a doctor who is great and that doctor is God. Pray, pray, and with the help of God, everything will turn out okay.” “I can’t bring back the dead or do anything about the poor economy. I need to be strong, go outside and work, and move on with my life. So I don’t think excessively about 9/11.”

Destiny and Fate: 

Destiny and Fate Subjects’ belief in destino or destiny helped them cope with 9/11 and its aftermath: Destino refers to the belief that events unfold in a way intended by God. “Destiny is the law of life,” one Puerto Rican group member stated.

Slide37: 

“It is necessary to accept what God has to offer each one of us. We must accept what God has decided is our fate.” “Life is like waiting in a line, and when it is meant for us to depart this earth, we do so.” “I feel sad, not angry, about 9/11, because what happened was part of God’s plan, and one must not be against the Lord.” Voices

Comparison of Chinese and Hispanic Subjects: 

Comparison of Chinese and Hispanic Subjects Chinese and Hispanic subjects reported similar physical and psychological reactions to 9/11 including, insomnia, loss of appetite, nervousness, somatic complaints, curtailed activity levels and a diminished sense of well being, almost one year post-9/11.

Greater Pervasive Disillusionment among Chinese: 

Greater Pervasive Disillusionment among Chinese Chinese subjects reported a more pervasive disillusionment about the future than Hispanics. This may reflect the proximity of Chinatown to the 9/11 attack. Peace and security in NYC took on special meaning to the Chinese, given their chaotic pre-migration history.

Social Connection and Destiny : 

Social Connection and Destiny Study findings show patterns of behavior that can be traced to traditional culture. For the Chinese, cultural values associated with social connection played a major role in coping with 9/11. For Hispanics, belief in destiny or fate was most significant in coping.

Chinese Relational Coping and Suppression of Conflict: 

Chinese Relational Coping and Suppression of Conflict The Chinese coped in collectivistic and relational ways, in particular through peer interaction in senior centers. The importance of suppressing conflict rather than expressing anger and conflict may account for the expression of resignation and sadness that was common among Chinese subjects.

Anger and Indignation versus Resignation and Sadness: 

Anger and Indignation versus Resignation and Sadness Anger, indignation, shock and disbelief were the emotions Hispanic study subjects most frequently expressed. This contrasts with the expression of resignation and sadness reported by the Chinese.

Hispanics and ‘Destino’: 

Hispanics and ‘Destino’ Hispanic subjects’ increased religiosity as a response to 9/11 may have protected them from experiencing even greater levels of anxiety and depression when 9/11 occurred, because they perceived their personal destiny to be determined by forces outside of their control.

Implications: 

Implications Health care professionals need to identify and assess older Hispanic and Chinese immigrants who may be suffering from the effects of exposure to prior trauma or who may be at risk for developing debilitating trauma-related psychological disorders, including depression.

Alternative Models: 

Alternative Models Alternative models for emotional support must take into account: Culture, geography, pre- and post-migration stressors at the individual and group levels The mental health of group members prior to 9/11, availability of social networks, levels of education, integration within the larger society, and age and age-related history.

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