Overexposure to graphic images like 9/11 attacks may be harmful to mental, physical health

Repeated exposure to violent images related to the Sept. 11, 2001, terrorist attacks and the Iraq War was associated with greater posttraumatic stress disorder symptoms and acute stress, according to a University of California, Irvine study appearing in a forthcoming issue of Psychological Science.

“At a time when footage of vivid, disturbing images of 9/11 will likely appear on our television screens at the eleventh anniversary of the attacks, when graphic images of individuals being overcome by the 2011 tsunami in Japan were shown repeatedly, and a vigorous debate occurred last year regarding whether gruesome death photos of Osama bin Laden be released, we believe that the topic of our paper has something important to say regarding the impact of repeated exposure to graphic traumatic images,” said study researcher Roxane Cohen Silver, PhD, a UCI professor of psychology and social behavior, medicine and public health.

Roxane Cohen Silver

For the study, a nationally representative sample of 2,189 adults completed Internet-based surveys 1 to 3 weeks after 9/11, reporting how much time they spent watching news coverage of the attacks. A subgroup of 1,322 participants completed surveys within the first 10 days of the Iraq War, indicating how frequently they had seen aversive war images.

The study included assessments of participants’ psychological and physical health — including asthma and hypertension — before the 9/11 attacks. Posttraumatic stress and acute stress symptoms were assessed using standardized scales based on DSM-IV criteria, and the researchers conducted follow-up assessments in the 3 years after the 9/11 attacks.

Results showed that 11.85% of participants reported high levels of acute stress related to watching images of the 9/11 attacks, and 7.3% reported high acute stress associated with images of the Iraq War. Controlling for pre-9/11 mental health, demographics and lifetime trauma, Silver and colleagues found that watching 4 or more hours of 9/11-related media images a day predicted a 51% increased likelihood of reporting high acute stress (adjusted OR=1.51; 95% CI, 1.10-2.07). Watching more than 4 hours of war-related television (OR=3.13; 95% CI, 1.69-5.80) and the frequency of seeing war-related images (OR=1.58; 95% CI, 1.14-2.19) were associated with acute stress symptoms.

Two war images were strongly associated with symptoms of acute stress: Allied prisoners of war (adjusted OR=1.48; 95% CI, 1.12-1.95) and images of dead Iraqi children (adjusted OR=1.50; 95% CI, 1.17-1.92). Two war images associated with posttraumatic stress symptoms were soldiers engaged in battle (P=0.31) and dead US or Allied soldiers (P<.001).

Watching more than 4 hours of 9/11-related television a day predicted a 33% increase in reports of physical health problems 2 to 3 years after the attacks (adjusted IRR=1.33; 95% CI, 1.12-1.57). Adjusted analyses also showed that 9/11 television viewing was associated with posttraumatic stress symptoms at 2 and 3 years after the attacks.

“Our data suggest that media exposure has measurable negative psychological and physical effects, and that exposure to graphic media images, specifically, may be an important mechanism through which the negative impact of a collective trauma is dispersed widely,” the researchers wrote.

Disclosure: Silver reports no relevant financial disclosures.