Hurricane Sandy Exposure and the Mental Health of World Trade Center Responders

Abstract

The psychological consequences of a second disaster on populations exposed to an earlier disaster have rarely been studied prospectively. Using a pre- and postdesign, we examined the effects of Hurricane Sandy on possible World Trade Center (WTC) related posttraumatic stress disorder (PTSD Checklist score of ≥ 50) and overall depression (major depressive disorder [MDD]; Patient Health Questionnaire depression score of ≥ 10) among 870 WTC responders with a follow-up monitoring visit at the Long Island WTC Health Program during the 6 months post-Hurricane Sandy. The Hurricane Sandy exposures evaluated were damage to home (8.3%) and to possessions (7.8%), gasoline shortage (24.1%), prolonged power outage (42.7%), and filing a Federal Emergency Management Agency claim (11.3%). A composite exposure score also was constructed. In unadjusted analyses, Hurricane Sandy exposures were associated with 1.77 to 5.38 increased likelihood of PTSD and 1.58 to 4.13 likelihood of MDD; odds ratios for ≥ 3 exposures were 6.47 for PTSD and 6.45 for MDD. After adjusting for demographic characteristics, WTC exposure, pre-Hurricane Sandy mental health status, and time between assessments, reporting ≥ 3 Hurricane Sandy exposures was associated with a 3.29 and 3.71 increased likelihood of PTSD and MDD, respectively. These findings underscore the importance of assessing the impact of a subsequent disaster in ongoing responder health surveillance programs.

Re-experiencing 9/11-Related PTSD Symptoms Following Exposure to Hurricane Sandy

“…As would be expected and consistent with other studies (Caramanica et al, 2015; Bromet et al, 2017), persons who had previously reported re-experiencing 9/11 symptoms were nine times more likely to have symptoms of re-experiencing 9/11 following Sandy than those who did not have reported prior symptoms of re-experiencing 9/11. This association was independent of Sandy exposure and other risk factors.…”

“…For the most part pre-existing PTSD symptoms predict an increased risk of PTSD-related symptoms to a subsequent trauma or disaster (Breslau et al, 2008; Caramanica et al, 2015; Bromet et al, 2017). Even though we found this to be the case overall, it does not appear that exposure to a new trauma (Hurricane Sandy) significantly increases the risk of re-experiencing 9/11 among those with pre-existing PTSD symptoms.…”

“…Preexisting mental health disorders may also increase vulnerability to subsequent trauma (Breslau et al 2008; Caramanica et al, 2015; Bromet et al, 2017). A study of 9/11-exposed populations including WTC responders and non-responders found those with pre-Sandy 9/11-related PTSD symptoms were nearly 7 times more likely to report having Sandy-related PTSD symptoms 5–12 months post-Sandy than those without pre-Sandy PTSD symptoms (Caramanica et al, 2015).…”

“…This study also showed prior trauma was not associated with the risk of PTSD from subsequent trauma when there was an absence of prior trauma-related PTSD. The mental health impact of Sandy was studied in a high risk cohort of WTC responders in a health-monitoring program; in the six months following Sandy, those with pre-Sandy probable 9/11-related PTSD were 33 times more likely to report having 9/11-related PTSD symptoms than those without (Bromet et al, 2017). …”

Differential effect of Hurricane Sandy exposure on PTSD symptom severity: comparison of community members and responders

“…Moreover, a longitudinal study in the tristate area (New York, New Jersey and Connecticut) reported a 31.2% PTSD prevalence in individuals who sustained an injury in Sandy-inundated areas and 4.4% in non-inundated areas 5 months after the disaster. 14 In addition, high Sandy exposure (assessed by damage to home and possessions, gasoline shortage, prolonged power outage and filing a Federal Emergency Management Agency claim) was associated with a threefold increased likelihood of probable PTSD in World Trade Center (WTC) responders, 15 suggesting that while community members are more vulnerable to PTSD than responders, exposure severity may not be differentially associated with PTSD symptom onset.…”