In 2001, bioterrorist activities involving the U.S. Postal Service infected 22 individuals with Bacillus anthracis (anthrax), according to background information in the article. Six survivors had inhalational anthrax and 11 cutaneous anthrax disease. Little is known about potential long-term health effects of bioterrorism-related anthrax infection.

Dori B. Reissman, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a cross-sectional health assessment approximately one year after the 2001 onset of anthrax infection to better characterize the somatic (affecting the body) symptoms, health status, and functional capacity of the bioterrorism-related anthrax survivors.

The study included assessment of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, two standardized self-administered questionnaires, and a review of available medical records.

The researchers found that the anthrax survivors reported symptoms affecting multiple body systems, significantly greater psychological distress, and significantly reduced health-related quality-of-life indices compared with U.S. referent populations. "Eight survivors (53 percent) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors. Available medical records could not explain the persisting health complaints," the authors write.

The most common health complaints included respiratory tract problems (e.g., chronic cough), fatigue, joint complaints (e.g., swelling, pain), and cognitive impairment (e.g., memory problems). The most frequently reported psychological distress symptoms included depression, anxiety, obsessive-compulsive and hostility.

The researchers write that these finding are "similar to findings reported after exposure to other types of traumatic events and highlights the importance of measuring these dimensions as standard practice. Many factors may contribute to the distress variance reported by the anthrax survivors, including differences in exposure characteristics, sociocultural and occupational considerations, and perceived inequities of case management."

"Our findings support those of other studies in the United States in which terrorism has led to significant chronic physical and mental health problems. Standard assessment of terrorism survivors should include medically unexplained health complaints and psychiatric comorbidity, such as symptoms of posttraumatic stress disorder, depression and anxiety disorders. Psychiatric and medical systems of care and rehabilitation should be coordinated to minimize functional impairment and improve health-related quality of life," the authors conclude.