The objectives of this study are to (1) characterize longitudinal trajectories of World Trade Center (WTC)-related post-traumatic stress disorder (PTSD) and depressive symptoms in WTC responders; (2) examine specific risk and protective determinants of these trajectories; and (3) identify personal and psychosocial factors associated with resilience and recovery trajectories, with the ultimate goal of maximizing preparedness and improving mental health outcomes in disaster responders. The study shall make use of the unique dataset collected prospectively at the WTC Health Program, beginning in 2002, to study longitudinal trajectories of WTC-related PTSD and depressive symptoms in 10,800 cohort members who completed three monitoring visits at the WTC Health Program, each approximately two years apart.
The objectives of the World Trade Center (WTC) Trajectories study are to (1) characterize longitudinal trajectories of WTC-related posttraumatic stress disorder (PTSD) in WTC responders; (2) examine specific risk and protective determinants of these trajectories; and (3) identify personal and psychosocial factors associated with resilience and recovery trajectories, with the ultimate goal of maximizing preparedness and improving mental health outcomes in disaster responders.
A total of 10,835 WTC rescue, recovery and clean-up workers, including 4,035 police responders and 6,800 non-traditional responders (e.g., construction workers), completed health monitoring visits at the WTC Health Program an average of 3, 6 and 8 years after 9/11/01. In police responders, the focus of this presentation, longitudinal PTSD symptoms were best characterized by 4 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. The following predictors were most strongly associated with symptomatic trajectories: psychiatry history prior to 9/11/01, Hispanic ethnicity, WTC exposure severity and WTC-related medical conditions. Greater education, and family and work support while working for the WTC recovery effort were protective.
Further, confirmatory factor analyses suggested that five stable symptom clusters best represent PTSD symptom dimensionality in WTC responders. Results of autoregressive cross-lagged panel regressions revealed that hyperarousal symptoms had a prominent role in predicting other PTSD symptom clusters over time.
Study results underscore the importance of prevention, screening and treatment efforts targeting high-risk disaster responders, in particular those with prior psychiatric history, higher disaster-related trauma exposure and work-related medical conditions. These results also highlight the importance of early assessment and treatment of hyperarousal symptoms in disaster responders.
Results of our WTC Trajectories study suggest that WTC-related posttraumatic stress disorder (PTSD) symptoms in WTC responders are heterogeneous in nature 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 (77.8% vs. 58.0%). 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. They further suggest that assessment, monitoring and early intervention of hyperarousal symptoms may help mitigate chronicity of disaster-related PTSD symptoms in WTC and other disaster responders.
Robert H. Pietrzak, PhD, MPH; Steven M. Southwick, MD; Clyde B. Schechter, MD; Evelyn J. Bromet, PhD; Jeanne M. Stellman, PhD; and many others
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