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9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack

  • A. Lowell (a1) (a2), B. Suarez-Jimenez (a1) (a2), L. Helpman (a1) (a2), X. Zhu (a1) (a2), A. Durosky (a2), A. Hilburn (a2), F. Schneier (a1) (a2), R. Gross (a3) (a4) (a5) and Y. Neria (a1) (a2) (a3)...
Abstract
Background

The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited.

Methods

The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies.

Results

Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies.

Conclusion

Future directions for research, treatment, and healthcare policy are discussed.

Copyright
Corresponding author
*Address for correspondence: Y. Neria, Ph.D., Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, Unit #69,1051 Riverside Drive, New York, NY 10032, USA. (Email: ny126@cumc.columbia.edu)
References
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Adams, RE, Boscarino, JA (2006). Predictors of PTSD and delayed PTSD after disaster: the impact of exposure and psychosocial resources. The Journal of Nervous and Mental Disease 194, 485493.
Andrews, B, Brewin, CR, Philpott, R, Stewart, L (2007). Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. American Journal of Psychiatry 164, 13191326.
Berger, W, Coutinho, ESF, Figueira, I, Marques-Portella, C, Luz, MP, Neylan, TC, Marmar, CR, Mendlowicz, MV (2012). Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology 47, 10011011.
Berninger, A, Webber, MP, Cohen, HW, Gustave, J, Lee, R, Niles, JK, Chiu, S, Zeig-Owens, R, Soo, J, Kelly, K, Prezant, DJ et al. (2010a). Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005. Public Health Reports 125, 556566.
Berninger, A, Webber, MP, Niles, JK, Gustave, J, Lee, R, Cohen, HW, Kelly, K, Corrigan, M, Prezant, DJ (2010 b). Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster. American Journal of Industrial Medicine 53, 11771185 (http://www.ncbi.nlm.nih.gov/pubmed/20862700).
Bills, CB, Levy, NAS, Sharma, V, Charney, DS, Herbert, R, Moline, J, Katz, CL (2008). Mental health of workers and volunteers responding to events of 9/11: review of the literature. The Mount Sinai Journal of Medicine 75, 173–115–127.
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 7590 (http://www.ncbi.nlm.nih.gov/pubmed/7712061).
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy 34, 669673.
Bowler, RM, Harris, M, Li, J, Gocheva, V, Stellman, SD, Wilson, K, Alper, H, Schwarzer, R, Cone, JE (2012). Longitudinal mental health impact among police responders to the 9/11 terrorist attack. American Journal of Industrial Medicine 55, 297312.
Brackbill, RM, Hadler, JL, DiGrande, L, Ekenga, CC, Farfel, MR, Friedman, S, Perlman, SE, Stellman, SD, Walker, DJ, Wu, D, Yu, S, Thorpe, LE (2009). Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA 302, 502516.
Brennstuhl, MJ, Tarquinio, C, Montel, S (2015). Chronic pain and PTSD: evolving views on their comorbidity. Perspectives in Psychiatric Care 51, 295304.
Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Archives of General Psychiatry 55, 626632.
Breslau, N, McNally, RJ (2008). The epidemiology of 9–11: technical advances and conceptual conundrums. In 9/11: Mental Health in the Wake of Terrorist Attacks (ed. Neria, Y., Gross, R., Marshall, R. D.), pp. 521528. Cambridge University Press: Cambridge, UK.
Bromet, EJ, Hobbs, MJ, Clouston, SAP, Gonzalez, A, Kotov, R, Luft, BJ (2016). DSM-IV post-traumatic stress disorder among World Trade Center responders 11–13 years after the disaster of 11 September 2001 (9/11). Psychological Medicine 46, 771783.
Caramanica, K, Brackbill, RM, Liao, T, Stellman, SD (2014). Comorbidity of 9/11-related PTSD and depression in the World Trade Center health registry 10–11 years postdisaster. Journal of Traumatic Stress 27, 680688.
CATS Consortium (2007). Implementing CBT for traumatized children and adolescents after September 11: lessons learned from the Child and Adolescent Trauma Treatments and Services (CATS) Project. Journal of Clinical Child and Adolescent Psychology: the Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 36, 581592 (http://www.ncbi.nlm.nih.gov/pubmed/18088216).
CATS Consortium (2010). Implementation of CBT for youth affected by the World Trade Center disaster: matching need to treatment intensity and reducing trauma symptoms. Journal of Traumatic Stress 23, 699707 (http://www.mendeley.com/catalog/implementation-cbt-youth-affected-world-trade-center-disaster-matching-need-treatment-intensity-redu/). Accessed 6 January 2016.
Comer, JS, Kendall, PC (2007). Terrorism: the psychological impact on youth. Clinical Psychology: Science and Practice 14, 179212.
Cone, JE, Li, J, Kornblith, E, Gocheva, V, Stellman, SD, Shaikh, A, Schwarzer, R, Bowler, RM, Mph, Ã (2015). Chronic probable PTSD in police responders in the World Trade Center Health Registry ten to eleven years after 9 / 11. American Journal of Industrial Medicine 58, 483493.
Costantino, G, Primavera, LH, Malgady, RG, Costantino, E (2014). Culturally oriented trauma treatments for Latino children post 9/11. Journal of Child and Adolescent Trauma 7, 247255.
Cukor, J, Wyka, K, Mello, B, Olden, M, Jayasinghe, N, Roberts, J (2011). The longitudinal course of PTSD among disaster worker deployed to the World Trade Center following the attacks of September 11th. Journal of Traumatic Stress 24, 506514.
Debchoudhury, I, Welch, AE, Fairclough, MA, Cone, JE, Brackbill, RM, Stellman, SD, Farfel, MR (2011). Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry. Preventive Medicine 53, 359363 (http://dx.doi.org/10.1016/j.ypmed.2011.08.034).
Difede, J, Cukor, J (2009). Evidence-based long-term treatment of mental health consequences of disasters among adults. In Mental Health and Disasters (ed. Neria, Y., Galea, S., Norris, F. H.), pp. 336349. Cambridge University Press: Cambridge (http://ebooks.cambridge.org/ref/id/CBO9780511730030A033). Accessed 23 March 2017.
Difede, J, Cukor, J, Patt, I, Giosan, C, Hoffman, H (2006). The application of virtual reality to the treatment of PTSD following the WTC attack. Annals of the New York Academy of Sciences 1071, 500501 (http://doi.wiley.com/10.1196/annals.1364.052).
Difede, J, Malta, LS, Best, S, Henn-Haase, C, Metzler, T, Bryant, R, Marmar, C (2007). A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers. The Journal of Nervous and Mental Disease 195, 861865 (http://www.ncbi.nlm.nih.gov/pubmed/18043528).
DiGrande, L, Neria, Y, Brackbill, RM, Pulliam, P, Galea, S (2011). Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. American Journal of Epidemiology 173, 271281 (http://aje.oxfordjournals.org/cgi/doi/10.1093/aje/kwq372).
First, M, Spitzer, R, Gibbon, M, Williams, J (1995). Structured Clinical Interview for DSM-IV, Axis I Disorders, Non-Patient Edition (SCID-N/P, Version 2.0) . New York State Psychiatric Institute, Department of Biometrics Research: New York, NY.
Foa, EB, Cahill, SP, Boscarino, JA, Hobfoll, SE, Lahad, M, Mcnally, RJ, Solomon, Z (2005). Social, psychological, and psychiatric interventions following terrorist attacks: recommendations for practice and research. Neuropsychopharmacology 30, 18061817.
Galea, S, Maxwell, AR (2009). Methodological challenges in studying the mental health consequences of disasters. In Mental Health and Disasters (ed. Neria, Y., Galea, S., Norris, F. H.), pp. 579593. Cambridge University Press: Cambridge (http://ebooks.cambridge.org/ref/id/CBO9780511730030A049). Accessed 13 March 2017.
Galea, S, Nandi, A, Vlahov, D (2005). The epidemiology of post-traumatic stress disorder after disasters. Epidemiologic Reviews 27, 7891 (http://epirev.oxfordjournals.org/content/27/1/78.full). Accessed 16 May 2016.
Galea, S, Vlahov, D, Resnick, H, Ahern, J, Susser, E, Gold, J, Bucuvalas, M, Kilpatrick, D (2003). Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology 158, 514524.
Garcia-Vera, MP, Sanz, J, Gutierrez, S (2016). A systematic review of the literature on posttraumatic stress disorder in victims of terrorist attacks. Psychological Reports 119, 328359 (http://prx.sagepub.com/lookup/doi/10.1177/0033294116658243). Accessed 22 March 2017.
Haugen, PT, Evces, M, Weiss, DS (2012). Treating posttraumatic stress disorder in first responders: a systematic review. Clinical Psychology Review 32, 370380 (http://dx.doi.org/10.1016/j.cpr.2012.04.001).
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602 (http://www.ncbi.nlm.nih.gov/pubmed/15939837). Accessed 10 July 2014.
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, C (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060 (http://www.ncbi.nlm.nih.gov/pubmed/7492257). Accessed 20 July 2015.
Kunreuther, H, Michel-Kerjan, E, Porter, B (2003). Assessing, Managing, and Financing Extreme Events: Dealing with Terrorism (http://www.nber.org/papers/w10179). Accessed 16 February 2016.
Levitt, JT, Malta, LS, Martin, A, Davis, L, Cloitre, M (2007). The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack. Behaviour Research and Therapy 45, 14191433.
Liu, B, Tarigan, LH, Bromet, EJ, Kim, H (2014). World trade center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: a meta-analysis. PLoS ONE 9, e101491 (http://dx.plos.org/10.1371/journal.pone.0101491).
Lopes, AP, Macedo, TF, Coutinho, ESF, Figueira, I, Ventura, PR (2014). Systematic review of the efficacy of cognitive-behavior therapy related treatments for victims of natural disasters: a worldwide problem L. Chao, ed. PLoS ONE 9, e109013 (http://dx.plos.org/10.1371/journal.pone.0109013). Accessed 23 March 2017.
McCaslin, SE, Inslicht, SS, Henn-Haase, C, Chemtob, C, Metzler, TJ, Neylan, TC, Marmar, CR (2009). Uniformed rescue workers responding to disaster. In Mental Health and Disasters (ed. Neria, Y., Galea, S., Norris, F. H.), pp. 302318. Cambridge University Press: Cambridge (http://ebooks.cambridge.org/ref/id/CBO9780511730030A030). Accessed 22 March 2017.
Neria, Y, DiGrande, L, Adams, BG (2011). Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. American Psychologist 66, 429446 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3386850&tool=pmcentrez&rendertype=abstract).
Neria, Y, Nandi, A, Galea, S (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine 38, 467480 (http://www.ncbi.nlm.nih.gov/pubmed/17803838). Accessed 17 May 2016.
Neria, Y, Olfson, M, Gameroff, MJ, DiGrande, L, Wickramaratne, P, Gross, R, Pilowsky, DJ, Neugebaur, R, Manetti-Cusa, J, Lewis-Fernandez, R, Lantigua, R, Shea, S, Weissman, MM (2010). Long-term course of probable PTSD after the 9/11 attacks: a study in urban primary care. Journal of Traumatic Stress 23, 474482.
Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E, Kaniasty, K (2002). 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207239.
Perrin, MA, Digrande, L, Wheeler, K, Thorpe, L (2007). Differences in PTSD prevalence and associated risk factors among world trade. American Journal of Psychiatry 164, 13851394 (http://www.ncbi.nlm.nih.gov/pubmed/17728424).
Pfeffer, CR, Altemus, M, Heo, M, Jiang, H (2007). Salivary cortisol and psychopathology in children bereaved by the September 11, 2001 terror attacks. Biological Psychiatry 61, 957965.
Pfefferbaum, BJ, Devoe, ER, Stuber, J, Schiff, M, Klein, TP, Fairbrother, G (2004). Psychological impact of terrorism on children and families in the United States. Journal of Aggression, Maltreatment & Trauma 9, 305317 (http://www.tandfonline.com/doi/abs/10.1300/J146v09n03_01).
Pfefferbaum, BJ, Weems, CF, Scott, BG, Nitiéma, P, Noffsinger, MA, Pfefferbaum, RL, Varma, V, Chakraburtty, A (2013). Research methods in child disaster studies: a review of studies generated by the September 11, 2001, terrorist attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Child & Youth Care Forum 42, 285337 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3892998&tool=pmcentrez&rendertype=abstract).
Pietrzak, RH , Feder, A, Singh, R, Schechter, CB, Bromet, EJ, Katz, CL, Reissman, DB, Ozbay, F, Sharma, V, Crane, M, Harrison, D, Herbert, R, Levin, SM, Luft, BJ, Moline, JM, Stellman, JM, Udasin, IG, Landrigan, PJ, Southwick, SM (2014). Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study. Psychological Medicine 44, 205219 (http://journals.cambridge.org/action/displayFulltext?type=6&fid=9111650&jid=PSM&volumeId=44&issueId=01&aid=9111649&bodyId=&membershipNumber=&societyETOCSession=&fulltextType=RA&fileId=S0033291713000597).
Schneier, FR, Neria, Y, Pavlicova, M, Hembree, E, Suh, EJ, Amsel, L, Marshall, RD (2012). Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial. American Journal of Psychiatry 169, 8089.
Silver, RC, Holman, EA, McIntosh, DN, Poulin, M, Gil-Rivas, V, Pizarro, J (2005 a). Coping with a national trauma: a nationwide longitudinal study of responses to the terrorist attacks of September 11th. In 9/11: Mental Health in the Wake of Terrorist Attacks, pp. 4570. Trauma of Terrorism: Sharing Knowledge and Shared Care, An International Handbook (ed. Danieli, Y., Brom, D., Sills, J.). The Haworth Maltreatment & Trauma Press, an imprint of The Haworth Press, Inc., 2005
Silver, SM, Rogers, S, Knipe, J, Colelli, G (2005 b). EMDR therapy following the 9/11 terrorist attacks: a community-based intervention project in New York City. International Journal of Stress Management 12, 2942.
Susser, E, Schwartz, S, Morabia, A, Bromet, EJ (2006). Psychiatric Epidemiology, 1st edn. Oxford University Press: New York.
Tapp, LC, Baron, S, Bernard, B, Driscoll, R, Mueller, C, Wallingford, K (2005). Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks. American Journal of Industrial Medicine 47, 475483.
Wilson, LC (2015). A systematic review of probable posttraumatic stress disorder in first responders following man-made mass violence. Psychiatry Research 229, 2126 (http://linkinghub.elsevier.com/retrieve/pii/S0165178115003637).
Zvolensky, MJ, Kotov, R, Schechter, CB, Gonzalez, A, Vujanovic, A, Pietrzak, RH, Crane, M, Kaplan, J, Moline, J, Southwick, SM, Feder, A, Udasin, I, Reissman, DB, Luft, BJ (2015). Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster. Journal of Psychiatric Research 61, 97105 (http://www.sciencedirect.com/science/article/pii/S0022395614003203).
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