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DSM-IV post-traumatic stress disorder among World Trade Center responders 11–13 years after the disaster of 11 September 2001 (9/11)

  • E. J. Bromet (a1), M. J. Hobbs (a1), S. A. P. Clouston (a2), A. Gonzalez (a1), R. Kotov (a1) and B. J. Luft (a3)...
Abstract
Background

Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11–13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.

Method

Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit.

Results

In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life.

Conclusions

This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: E. J. Bromet, Ph.D., Department of Psychiatry, Putnam Hall-South Campus, Stony Brook University, Stony Brook, NY 11794-8790, USA. (Email: evelyn.bromet@stonybrookmedicine.edu)
References
Hide All
Alexander, DA, Klein, S (2009). First responders after disasters: a review of stress reactions, at-risk, vulnerability, and resilience factors. Prehospital and Disaster Medicine 24, 8794.
Arbisi, PA, Kaler, ME, Kehle-Forbes, SM, Erbes, CR, Polusny, MA, Thuras, P (2012). The predictive validity of the PTSD Checklist in a nonclinical sample of combat-exposed National Guard troops. Psychological Assessment 24, 10341040.
Benedek, DM, Fullerton, C, Ursano, RJ (2007). First responders: mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health 28, 5568.
Berger, W, Coutinho, ES, 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.
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.
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669673.
Bohn, MJ, Babor, TF, Kranzler, HR (1995). The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol 56, 423432.
Breslau, N, Davis, GC, Peterson, EL, Schultz, LR (2000). A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biological Psychiatry 48, 902909.
Breslau, N, Lucia, VC, Davis, GC (2004). Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychological Medicine 34, 12051214.
Chapman, C, Mills, K, Slade, T, McFarlane, AC, Bryant, RA, Creamer, M, Silove, D, Teesson, M (2012). Remission from post-traumatic stress disorder in the general population. Psychological Medicine 42, 16951703.
Chiu, S, Webber, MP, Zeig-Owens, R, Gustave, J, Lee, R, Kelly, KJ, Rizzotto, L, Schorr, JK, North, CS, Prezant, DJ (2011). Performance characteristics of the PTSD Checklist in retired firefighters exposed to the World Trade Center disaster. Annals of Clinical Psychiatry 23, 95104.
Cone, JE, Li, J, Kornblith, E, Gocheva, V, Stellman, SD, Shaikh, A, Schwarzer, R, Bowler, RM (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.
Cukor, J, Wyka, K, Mello, B, Olden, M, Jayasinghe, N, Giosan, C, Crane, M, Difede, J (2011). The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th. Journal of Traumatic Stress 24, 506514.
Dasaro, CR, Holden, WL, Berman, KD, Crane, MA, Kaplan, JR, Lucchini, RG, Luft, BJ, Moline, JM, Teitelbaum, SL, Tirunagari, US, Udasin, IG, Weiner, JH, Zigrossi, PA, Todd, AC (2015). Cohort profile: World Trade Center Health Program General Responder Cohort. International Journal of Epidemiology. Published online 20 June 2015. doi:10.1093/ije/dyv099.
Del Gaizo, AL, Elhai, JD, Weaver, TL (2011). Posttraumatic stress disorder, poor physical health and substance use behaviors in a national trauma-exposed sample. Psychiatry Research 88, 390395.
Dohrenwend, BP, Turner, JB, Turse, NA, Lewis-Fernandez, R, Thomas, J, Yager, TJ (2008). War-related post-traumatic stress disorder in black, Hispanic, and majority white Vietnam veterans: the roles of exposure and vulnerability. Journal of Traumatic Stress 21, 133141.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBM (1996). Structured Clinical Interview Diagnosis (SCID) for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.
Friedman, SM, Farfel, MR, Maslow, CB, Cone, JE, Brackbill, RM, Stellman, SD (2013). Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5–6 years post-9/11 in responders enrolled in the World Trade Center Health Registry. American Journal of Industrial Medicine 56, 12511261.
Fullerton, CS, Ursano, RJ, Wang, L (2004). Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. American Journal of Psychiatry 161, 13701376.
Huffman, JC, Niazi, SK, Rundell, JR, Sharpe, M, Katon, WJ (2014). Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the Academy of Psychosomatic Medicine Research and Evidence-Based Practice Committee. Psychosomatics 55, 109122.
Huizink, AC, Slottje, P, Witteveen, AB, Bijlsma, JA, Twisk, JW, Smidt, N, Bramsen, I, van Mechelen, W, van der Ploeg, HM, Bouter, LM, Smid, T (2006). Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters. Occupational and Environmental Medicine 63, 657662.
Idler, EL, Benyamini, Y (1997). Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior 38, 2137.
Kilpatrick, DG, Resnick, HS, Milanak, ME, Miller, MW, Keyes, KM, Friedman, MJ (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress 26, 537547.
Koenen, KC, Stellman, SD, Sommer, JF Jr., Stellman, JM (2008). Persistent posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: a 14-year follow-up. Journal of Traumatic Stress 21, 4957.
Kotov, R, Bromet, EJ, Schechter, C, Broihier, J, Feder, A, Friedman-Jimenez, G, Gonzalez, A, Guerrera, K, Kaplan, J, Moline, J, Pietrzak, RH, Reissman, D, Ruggero, C, Southwick, SM, Udasin, I, Von Korff, M, Luft, BJ (2015). Posttraumatic stress disorder and the risk of respiratory problems in World Trade Center responders: longitudinal test of a pathway. Psychosomatic Medicine 77, 438448.
Leon, A, Solomon, DA, Mueller, TI, Turvey, CL, Endicott, J, Keller, MD (1999). The Range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine 29, 869878.
Liu, B, Tarigan, LH, Bromet, EJ, Kim, HJ (2014). World Trade Center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: a meta-analysis. PLOS ONE 9, e101491.
Loganovsky, K, Havenaar, JM, Tintle, N, Tung, L, Kotov, RI, Bromet, EJ (2008). The mental health of clean-up workers 18 years after the Chernobyl accident. Psychological Medicine 38, 481488.
Luft, BJ, Schechter, CB, Broihier, J, Reissman, DB, Guerrera, K, Udasin, I, Moline, J, Harrison, D, Freidman-Jimenez, G, Pietrzak, RH, Southwick, SM, Bromet, EJ (2012). Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers. Psychological Medicine 42, 10691079.
McFarlane, AC (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry 9, 310.
Nair, HP, Ekenga, CC, Cone, JE, Brackbill, R, Farfel, M, Stellman, SD (2012). Co-occurring lower respiratory symptoms and posttraumatic stress disorder 5 to 6 years after the World Trade Center terrorist attack. American Journal of Public Health 102, 19641973.
North, CS, Tivis, L, McMillen, JC, Pfefferbaum, B, Spitznagel, EL, Cox, J, Nixon, S, Bunch, KP, Smith, EM (2002). Psychiatric disorders in rescue workers after the Oklahoma City bombing. American Journal of Psychiatry 159, 857859.
O'Toole, BI, Catts, SV (2008). Trauma, PTSD, and physical health: an epidemiological study of Australian Vietnam veterans. Journal of Psychosomatic Research 64, 3340.
Ozbay, F, Auf der Heyde, T, Reissman, D, Sharma, V (2013). The enduring mental health impact of the September 11th terrorist attacks: challenges and lessons learned. Psychiatric Clinics of North America 36, 417429.
Pacella, ML, Hruska, B, Delahanty, DL (2013). The physical health consequences of PTSD and PTSD symptoms. Journal of Anxiety Disorders 27, 3346.
Perrin, MA, DiGrande, L, Wheeler, K, Thorpe, L, Farfel, M, Brackbill, R (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry 164, 13851394.
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, I, 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.
Rosen, RC, Marx, BP, Maserejian, NN, Holowka, DW, Gates, MA, Sleeper, LA, Vasterling, JJ, Kang, HK, Keane, TM (2012). Project VALOR: design and methods of a longitudinal registry of post-traumatic stress disorder (PTSD) in combat-exposed veterans in the Afghanistan and Iraqi military theaters of operations. International Journal of Methods in Psychiatric Research 21, 516.
Schlenger, WE, Kulka, RA, Fairbank, JA, Hough, RL, Jordan, BK, Marmar, CR, Weiss, DS (2007). The psychological risks of Vietnam: the NVVRS perspective. Journal of Traumatic Stress 20, 467479.
Schwarzer, R, Bowler, RM, Cone, JE (2014). Social integration buffers stress in New York police after the 9/11 terrorist attack. Anxiety, Stress, and Coping 27, 1826.
Solomon, Z, Horesh, D, Ein-Dor, T (2009). The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. Journal of Clinical Psychiatry 70, 837843.
Stander, VA, Thomsen, CJ, Highfill-McRoy, RM (2014). Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clinical Psychology Review 34, 8798.
Stellman, JM, Smith, RP, Katz, CL, Sharma, V, Charney, DS, Herbert, R, Moline, J, Luft, BJ, Markowitz, S, Udasin, I, Harrison, D, Baron, S, Landrigan, PJ, Levin, SM, Southwick, S (2008). Enduring mental health morbidity and social function impairment in the World Trade Center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environmental Health Perspectives 116, 12481253.
Terhakopian, A, Sinaii, N, Engel, CC, Schnurr, PP, Hoge, CW (2008). Estimating population prevalence of posttraumatic stress disorder: an example using the PTSD Checklist. Journal of Traumatic Stress 21, 290300.
Watts, BV, Schnurr, PP, Mayo, L, Young, Y, Weeks, WB, Friedman, MJL (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. Journal of Clinical Psychiatry 74, e541e550.
Webber, MP, Glaser, MS, Weakley, J, Soo, J, Ye, F, Zeig-Owens, R, Weiden, MD, Nolan, A, Aldrich, T, Kelly, K, Prezant, D (2011). Physician-diagnosed respiratory conditions and mental health symptoms 7–9 years following the World Trade Center disaster. American Journal of Industrial Medicine 54, 661671.
Welch, AE, Jasek, JP, Caramanica, K, Chiles, MC, Johns, M (2015). Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003–12. Preventive Medicine 73, 9499.
Wilkins, KC, Lang, A, Norman, SB (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) military, civilian and specific versions. Depression and Anxiety 28, 569606.
Winship, C, Radbill, L (1994). Sampling weights and regression analysis. Sociological Methods and Research 23, 230257.
Wisnivesky, JP, Teitelbaum, SL, Todd, AC, Boffetta, P, Crane, M, Crowley, L, de la Hoz, RE, Dellenbaugh, C, Harrison, D, Herbert, R, Kim, H, Jeon, Y, Kaplan, J, Katz, C, Levin, S, Luft, B, Markowitz, S, Moline, JM, Ozbay, F, Pietrzak, RH, Shapiro, M, Sharma, V, Skloot, G, Southwick, S, Stevenson, LA, Udasin, I, Wallenstein, S, Landrigan, PJ (2011). Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet 378, 888897.
Yip, J, Zeig-Owens, R, Webber, MP, Kablanian, A, Hall, CB, Vossbrinck, M, Liu, X, Weakley, J, Schwartz, T, Kelly, KJ, Prezant, DJ (2015). World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers. Occupational and Environmental Medicine. Published online 15 April 2015. doi:10.1136/oemed-2014-102601.
Zimering, R, Gulliver, SB, Knight, J, Munroe, J, Keane, TM (2006). Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero. Journal of Traumatic Stress 19, 553557.
Zvolensky, MJ, Farris, SG, Kotov, R, Schechter, CB, Bromet, E, Gonzalez, A, Vujanovic, A, Pietrzak, R, Crane, M, Kaplan, J, Moline, J, Southwick, SM, Feder, A, Udasin, I, Reissman, DB, Luft, BJ (2015). World Trade Center disaster and sensitization to subsequent life stress: a longitudinal study of disaster responders. Preventive Medicine 75, 7074.
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