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

Abstract

<jats:title>ABSTRACT</jats:title><jats:p><jats:bold>Objective:</jats:bold> 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.</jats:p><jats:p><jats:bold>Methods:</jats:bold> 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.</jats:p><jats:p><jats:bold>Results:</jats:bold> 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.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold> 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.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2011;5:S197-S203)</jats:p>

Comorbid Trends in World Trade Center Cough Syndrome and Probable Posttraumatic Stress Disorder in Firefighters

“…However, this modifi ed version had been used previously in the FDNY population, 8,34,35 and was found to agree well with the PCL-17. 24 We believe that a considerable strength of this study is our use of the same tool and method of administration at both time points, and reported prevalence estimates that were consistent with other studies. 22 One fi nal limitation is that we could not estimate the precise timing of delayed-onset symptoms, because of the time interval between baseline and follow-up questionnaires.…”

“…In a recent analysis, agreement between the PCL-m and the PCL was high ( k 5 0.85) in our population. 24 The Cronbach a values for the original PCL and the PCL-m were 0.95 and 0.91, respectively. The Cronbach a values for individual domains were 0.87 and 0.81 for arousal, 0.90 and 0.85 for avoidance, and 0.90 and 0.75 for reexperiencing, respectively.…”

An investigation of the rescue personality in firefighter recruits.

“…For firefighters who responded to the World Trade Center (WTC) terrorist attacks that took place on September 11,2001, the prevalence o f probable PTSD ranged between 11% and 19.5% (Soo et al, 2011). The incidence o f probable PTSD reported in the first six months following the attacks was 8.6%, which then increased to a cumulative incidence o f 11.1% over 3 years (Beminger et al, 2010), and again to 31.9% over nine years (Wisnivesky et al, 2011).…”

“…Firefighters with closer proximity to the traumatic event are more likely to handle dead or severely injured bodies, and to be exposed to greater risk o f injury or death to themselves or their colleagues (Baker & Williams, 2001;De Soir et al, 2012;Soo et al, 2011). Specifically, the greatest levels o f stress are reported after traumatic events involving children, especially when the attending firefighter has or is closely related to a child o f the same age (Baker & Williams, 2001;De Soir et al, 2012;Haslam & Mallon, 2003;Soo et al, 2011). The manageability o f the scene has also been cited as a factor related to post traumatic stress, with more manageable situations resulting in less stress (De Soir et al, 2012).…”

“…Combining all o f these factors in the case o f a disaster event, response time to the scene has also been associated with levels o f PTSD. Specifically, those who report to the scene o f a major disaster the earliest and work the longest are also the most likely to experience delayed onset PTSD with sub-clinical levels o f posttraumatic stress shortly after the event (Beminger et al, 2010;Soo et al, 2011).…”