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Trends in Probable PTSD in Firefighters Exposed to the World Trade Center Disaster, 2001–2010

Published online by Cambridge University Press:  08 April 2013

Jackie Soo ,
Mayris P. Webber ,
Jackson Gustave ,
Roy Lee ,
Charles B. Hall ,
Hillel W. Cohen ,
Kerry J. Kelly  and
David J. Prezant
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Abstract

Objective: We present the longest follow-up, to date, of probable posttraumatic stress disorder (PTSD) after the 2001 terrorist attacks on the World Trade Center (WTC) in New York City firefighters who participated in the rescue/recovery effort.

Methods: We examined data from 11 006 WTC-exposed firefighters who completed 40 672 questionnaires and reported estimates of probable PTSD by year from serial cross-sectional analyses. In longitudinal analyses, we used separate Cox models with data beginning from October 2, 2001, to identify variables associated with recovery from or delayed onset of probable PTSD.

Results: The prevalence of probable PTSD was 7.4% by September 11, 2010, and continued to be associated with early arrival at the WTC towers during every year of analysis. An increasing number of aerodigestive symptoms (hazard ratio [HR] 0.89 per symptom, 95% confidence interval [CI] 0.86-.93) and reporting a decrease in exercise, whether the result of health (HR 0.56 vs no change in exercise, 95% CI 0.41-.78) or other reasons (HR 0.76 vs no change in exercise, 95% CI 0.63-.92), were associated with a lower likelihood of recovery from probable PTSD. Arriving early at the WTC (HR 1.38 vs later WTC arrival, 95% CI 1.12-1.70), an increasing number of aerodigestive symptoms (HR 1.45 per symptom, 95% CI 1.40–1.51), and reporting an increase in alcohol intake since September 11, 2001 (HR 3.43 vs no increase in alcohol intake, 95% CI 2.67-4.43) were associated with delayed onset of probable PTSD.

Conclusions: Probable PTSD continues to be associated with early WTC arrival even 9 years after the terrorist attacks. Concurrent conditions and behaviors, such as respiratory symptoms, exercise, and alcohol use also play important roles in contributing to PTSD symptoms.

(Disaster Med Public Health Preparedness. 2011;5:S197-S203)

Keywords

World Trade Centermental healthpsychological symptomsfirefightersstress disorders, post-traumaticoccupational healthSeptember 11 terrorist attacksNew York Cityterrorismdisaster response
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 5 , Issue S2 , September 2011 , pp. S197 - S203
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2011

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References

REFERENCES

1.Galea, S, Nandi, A, Vlahov, D.The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27:78–91.Google Scholar
2.Perrin, MA, DiGrande, L, Wheeler, K, Thorpe, L, Farfel, M, Brackbill, R.Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry. 2007;164 (9):1385–1394.CrossRefGoogle ScholarPubMed
3.Stellman, JM, Smith, RP, Katz, CL.Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environ Health Perspect. 2008;116 (9):1248–1253.CrossRefGoogle ScholarPubMed
4.Brackbill, RM, Hadler, JL, DiGrande, L.Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009;302 (5):502–516.Google Scholar
5.Adams, RE, Boscarino, JA, Galea, S.Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City. Am J Drug Alcohol Abuse. 2006;32 (2):203–224.Google Scholar
6.North, CS, McCutcheon, V, Spitznagel, EL, Smith, EM.Three-year follow-up of survivors of a mass shooting episode. J Urban Health. 2002;79 (3):383–391.Google Scholar
7.Banerjea, R, Findley, PA, Smith, B, Findley, T, Sambamoorthi, U.Co-occurring medical and mental illness and substance use disorders among veteran clinic users with spinal cord injury patients with complexities. Spinal Cord. 2009;47 (11):789–795.Google Scholar
8.Berninger, A, Webber, MP, Cohen, HW.Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005. Public Health Rep. 2010;125 (4):556–566.Google Scholar
9.Prezant, DJ, Weiden, M, Banauch, GI.Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Engl J Med. 2002;347 (11):806–815.Google Scholar
10.Weathers, FW, Litz, BT, Herman, DS, Huska, JA, Keane, TMThe PTSD Checklist (PCL): reliability, validity, and diagnostic utility.Paper presented at the 9th Conference of the International Society for Traumatic Stress Studies, San Antonio, TX; 1993.Google Scholar
11.Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Fourth Edition, Text Revision.Washington, DC: American Psychiatric Association; 2000.Google Scholar
12.DiGrande, L, Perrin, MA, Thorpe, LE.Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008;21 (3):264–273.CrossRefGoogle ScholarPubMed
13.Corrigan, M, McWilliams, R, Kelly, KJ.A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse. Am J Public Health. 2009;99(Suppl 3)S702–S709.Google Scholar
14.Buckley, TC, Mozley, SL, Bedard, MA, Dewulf, AC, Greif, J.Preventive health behaviors, health-risk behaviors, physical morbidity, and health-related role functioning impairment in veterans with post-traumatic stress disorder. Mil Med. 2004;169 (7):536–540.Google Scholar
15.National Comorbidity Survey Replication appendix tables.Table 1. Lifetime prevalence of DSM-IV /WMH-CIDI disorders by sex and cohort. Table 2.Twelve-month prevalence of DSM-IV /WMH-CIDI disorders by sex and cohort. http://www.hcp.med.harvard.edu/ncs/publications.php. Published 2007. Accessed May 20, 2010.Google Scholar
16.Kessler, RC, Ustün, TB.The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13 (2):93–121.Google Scholar
17.Rintamaki, LS, Weaver, FM, Elbaum, PL, Klama, EN, Miskevics, SA.Persistence of traumatic memories in World War II prisoners of war. J Am Geriatr Soc. 2009;57 (12):2257–2262.Google Scholar
18.Hong, X, Currier, GW, Zhao, X, Jiang, Y, Zhou, W, Wei, J.Posttraumatic stress disorder in convalescent severe acute respiratory syndrome patients: a 4-year follow-up study. Gen Hosp Psychiatry. 2009;31 (6):546–554.Google Scholar
19.Engdahl, B, Dikel, TN, Eberly, R, Blank, A JrPosttraumatic stress disorder in a community group of former prisoners of war: a normative response to severe trauma. Am J Psychiatry. 1997;154 (11):1576–1581.Google Scholar
20.Ularntinon, S, Piyasil, V, Ketumarn, P.Assessment of psychopathological consequences in children at 3 years after tsunami disaster. J Med Assoc Thai. 2008;91(Suppl 3)S69–S75.Google Scholar
21.Nugent, NR, Saunders, BE, Williams, LM, Hanson, R, Smith, DW, Fitzgerald, MM.Posttraumatic stress symptom trajectories in children living in families reported for family violence. J Trauma Stress. 2009;22 (5):460–466.Google Scholar
22.Nandi, A, Galea, S, Tracy, M.Job loss, unemployment, work stress, job satisfaction, and the persistence of posttraumatic stress disorder one year after the September 11 attacks. J Occup Environ Med. 2004;46 (10):1057–1064.Google Scholar
23.Sareen, J, Cox, BJ, Stein, MB, Afifi, TO, Fleet, C, Asmundson, GJ.Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med. 2007;69 (3):242–248.Google Scholar
24.Spitzer, C, Barnow, S, Völzke, H, John, U, Freyberger, HJ, Grabe, HJ.Trauma, posttraumatic stress disorder, and physical illness: findings from the general population. Psychosom Med. 2009;71 (9):1012–1017.Google Scholar
25.Boscarino, JA.Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosom Med. 1997;59 (6):605–614.Google Scholar
26.Niles, JK, Webber, MP, Gustave, J.Co-morbid trends in World Trade Center cough syndrome and probable PTSD in firefighters. Chest. 2011 May5Epub ahead of print21546435.Google Scholar
27. McFarlane, AC, Atchison, M, Rafalowicz, E, Papay, P.Physical symptoms in post-traumatic stress disorder. J Psychosom Res. 1994;38 (7):715–726.Google Scholar
28.Vlahov, D, Galea, S, Ahern, J.Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks. Am J Drug Alcohol Abuse. 2004;30 (2):385–407.Google Scholar
29.Webber, MP, Gustave, J, Lee, R.Trends in respiratory symptoms of firefighters exposed to the world trade center disaster: 2001-2005. Environ Health Perspect. 2009;117 (6):975–980.Google Scholar
30.Stewart, AL, Hays, RD, Wells, KB, Rogers, WH, Spritzer, KL, Greenfield, S.Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the Medical Outcomes Study. J Clin Epidemiol. 1994;47 (7):719–730.Google Scholar
31.Dunn, AL, Trivedi, MH, O'Neal, HA.Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc.2001;33(6 Suppl):S587-S597; discussion S609-S610.Google Scholar
32.Otter, L, Currie, J.A long time getting home: Vietnam Veterans' experiences in a community exercise rehabilitation programme. Disabil Rehabil. 2004;26 (1):27–34.Google Scholar