Risk, coping and PTSD symptom trajectories in World Trade Center responders

Details

• Personal Author:
  Bromet EJ ; Cancelmo LM ; Crane M ; Feder A ; Harrison DJ ; Herbert R ; Katz CL ; Kotov R ; Landrigan, Philip J. ; Levin SM ; Luft BJ ; Moline JM ; Mota N ; Ozbay F ; Pietrzak RH ; Reissman, Dori B. ; Rodriguez J ; Salim R ; Schaffer J ; Schechter CB ; Singh R ; Southwick SM ; Stellman JM ; Udasin IG ; Yehuda R ; Zvolensky MJ
• Description:
  Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. Findings in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Mental Health Nervous System Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Author Keywords: Posttraumatic Stress Disorder Coping Coping Behavior Disaster Recovery Emergency Responders Mental Health Post-traumatic Stress Disorder Psychosocial Factors PTSD Rescue Workers Responders Risk Trajectories World Trade Center WTC

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• ISSN:
  0022-3956
• 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 ; OSHA Region 6 ; Texas
• 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:
  68-79
• Volume:
  82
• NIOSHTIC Number:
  nn:20048410
• Citation:
  J Psychiatr Res 2016 Nov; 82:68-79
• Contact Point Address:
  Adriana Feder, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA
• Email:
  adriana.feder@mssm.edu
• Federal Fiscal Year:
  2017
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  True
• Source Full Name:
  Journal of Psychiatric Research
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:b31d384e84becbd104c3850f8ac94b42cc529d56b84a6d1f7155233ff8500ccc33c79d6c7b102f1cda562a69eff663269cc83f23063b54fabb38501dab54176c
• Download URL:
  https://stacks.cdc.gov/view/cdc/203169/cdc_203169_DS1.pdf
• File Type:
  [PDF - 364.73 KB ]