BOSTON (AP) - Nearly half of American adults had pronounced symptoms of stress from the Sept. 11 attacks in a nationwide survey documenting the catastrophe's broad effect on public health.

``It's important for people to understand if they had these types of reactions, they're not alone, and they're not unusual,'' said Dr. Mark Schuster, a pediatrician who led the study at the Rand think tank in Santa Monica, Calif. ``It helps people to get over the symptoms if they realize these are normal reactions.''

The findings, published in Thursday's New England Journal of Medicine, confirm what other surveys have found: that the psychological impact of the terrorist attacks reverberated near and far.

The researchers conducted telephone interviews with a representative sample of 560 adults on the weekend after the Sept. 11 attacks.

The adults were asked if they felt upset when reminded of the attacks, were disturbed by repeated memories or dreams, had trouble concentrating or sleeping, or suffered from irritability or angry outbursts.

Ninety percent reported one symptom at least ``a little bit.'' Forty-four percent had at least one symptom ``quite a bit'' or ``extremely.''

The most common substantial symptom, shared by 30 percent, was feeling upset by reminders.

Women, minorities, people with prior mental health problems, heavy television watchers and those closer to the World Trade Center were most likely to report stress.

Asked how they coped, 98 percent of those surveyed said they talked to others, 90 percent turned to religion, 60 percent joined in group activities, and 36 percent made donations or did volunteer work. Only 18 percent bought extra food, gasoline or other supplies. Thirty-nine percent occasionally avoided television or other reminders of the attacks.

People clearly watched lots of television to learn details of the attacks - an average of eight hours on Sept. 11, according to the study.

The study was not designed to say if television ultimately eased or aggravated stress. Schuster said he suspects it can work either way.

Such stress reactions typically diminish over time, researchers say. The survey did not go beyond Sept. 16, but other surveys have indicated an easing of stress since then.

Those surveyed by Rand were also asked about children in their homes. They said 35 percent showed one or more stress symptoms. Forty-seven percent were said to be worried about their own safety or that of someone they love.

A third of the adults limited television for their children, and 99 percent talked to them about the attacks.

Dr. Carol S. North, a psychiatrist at Washington University in St. Louis who studied survivors of the 1995 bombing in Oklahoma City, said the Sept. 11 attacks appeared to shake society even more broadly.

"What's really interesting is its ability to reach out and touch someone quite a distance away,'' she said.

From Nejm.org