The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th

Abstract

This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.

Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

“…In particular, several large longitudinal and population-based studies of US and UK military personnel and of citizens and professionals exposed to the 9/11 terror attacks adds to this new knowledge base (9,18,47,48,64). Across all 39 prospective studies encompassing some 30 000 participants, the occurrence of delayed-onset PTSD was ascertained by interview or questionnaire in 7% at some timepoint during followup and among some 25% of these cases the onset was delayed ≥6 months.…”

“…A total of 39 studies were eligible for inclusion into the review. In 29 studies, the first baseline examination was performed 1-6 months after the trauma or the end of a potentially traumatic period (13, and in 10 studies, the baseline examination was performed >6 months after the trauma (9,10,(46)(47)(48)(49)(50)(51)(52)(53), see figure 2. Five studies included in the Smid et al (17) review were not included in the present study (two addressing children and adolescents, two with <25 participants and one in Polish), while three other studies published before 2009 were added (21,25,28).…”

“…Only eight studies provided data on the presence of subthreshold PTSD symptoms during the initial six months (9,14,18,19,28,37,48,53).…”

“…The average number of participants was 775 but 3 studies enrolled >2500 persons (18,38,48). Exposure to terrorism was the traumatic event most often studied, followed by technological disasters and accidents, military deployment, injury (and disease), and natural disasters (table 2).…”

“…In this professional group with extended exposure, only 8.2% (N=32) of all delayed-onset PTSD cases (N=391) did not have sub-threshold symptoms at the baseline examination taking place three months after the disaster. Second, a large survey of non-rescue disaster workers at NYC 9/11 (disaster recovery utility workers assisting in clean-up and utility service restoration) also reported few delayed-onset PTSD cases without initial sub-threshold PTSD symptoms (3 of 28 delayed-onset PTSD cases, 10.7%) at earlier follow-up waves (48). Third, four smaller studies did not report any cases of delayed-onset PTSD without prior sub-threshold PTSD symptoms.…”