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Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study

Published online by Cambridge University Press:  03 April 2013

R. H. Pietrzak ,
A. Feder ,
R. Singh ,
C. B. Schechter ,
E. J. Bromet ,
C. L. Katz ,
D. B. Reissman ,
F. Ozbay ,
V. Sharma  and
M. Crane
...Show all authors
R. H. Pietrzak*
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
A. Feder
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
R. Singh
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
C. B. Schechter
Affiliation:
Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
C. L. Katz
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
D. B. Reissman
Affiliation:
Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA
F. Ozbay
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
V. Sharma
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
M. Crane
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
D. Harrison
Affiliation:
Department of Environmental Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY, USA
R. Herbert
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
S. M. Levin
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
B. J. Luft
Affiliation:
Department of Medicine, Division of Infectious Diseases, Stony Brook University, Stony Brook, NY, USA
J. M. Moline
Affiliation:
Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York, USA
J. M. Stellman
Affiliation:
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY, USA
I. G. Udasin
Affiliation:
Department of Environmental and Occupational Medicine, UMDNJ – Robert Wood Johnson Medical School, Piscataway, NJ, USA
P. J. Landrigan
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
S. M. Southwick
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
*
* Address for correspondence: R. H. Pietrzak, Ph.D., M.P.H., National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue 151E, West Haven, CT 06516, USA. (Email: [email protected])
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Abstract

Background

Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders.

Method

A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks.

Results

Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories.

Conclusions

Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Keywords

Disasterlatent modelinglongitudinal datapost-traumatic stress disorderrespondersrisk factors
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 205 - 219
Copyright
Copyright © Cambridge University Press 2013 

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