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

Details

• Personal Author:
  Bromet EJ ; Crane M ; Feder A ; Harrison D ; Herbert R ; Katz CL ; Landrigan, Philip J. ; Levin SM ; Luft BJ ; Moline JM ; Ozbay F ; Pietrzak RH ; Reissman, Dori B. ; Schechter CB ; Sharma V ; Singh R ; Southwick SM ; Stellman JM ; Udasin IG
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Emergencies Emergency Responders Health Care Facilities Workforce And Services Health Promotion Law Enforcement Mental Disorders Mental Health Occupational Health Race Factors Risk Assessment Risk Factors Safety Stress, Psychological

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• Keywords:
  Author Keywords: Disaster Emergency-responders Emergency-response Health-programs Job-stress Latent Modeling Long-term-study Longitudinal Data Medical-monitoring Medical-screening Medical-treatment Mental-disorders Mental-health Mental-stress Police-officers Post-traumatic Stress Disorder Psychological-adaptation Psychological-effects Psychological-processes Psychological-responses Psychological-stress Racial-factors Rescue-workers Responders Risk-factors Risk Factors Stress Surveillance-programs

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• ISSN:
  0033-2917
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; District of Columbia ; New Jersey ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  WTCHP - World Trade Center Health Program
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  205-219
• Volume:
  44
• Issue:
  1
• NIOSHTIC Number:
  nn:20043103
• Citation:
  Psychol Med 2014 Jan; 44(1):205-219
• Contact Point Address:
  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:
  robert.pietrzak@yale.edu
• Federal Fiscal Year:
  2014
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Source Full Name:
  Psychological Medicine
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1f60931bd1dd1b84414c2e006d5adaf6515d0e1f47e5930b8b2bf432b29daf817769db539f7a96ef98630a1bc3f75984f87361213c672081190dcef8d2b450b6
• Download URL:
  https://stacks.cdc.gov/view/cdc/195116/cdc_195116_DS1.pdf
• File Type:
  [PDF - 374.43 KB ]