Skip to main content
×
Home
    • Aa
    • Aa

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

  • R. H. Pietrzak (a1) (a2) (a3), A. Feder (a3), R. Singh (a3), C. B. Schechter (a4), E. J. Bromet (a5), C. L. Katz (a3), D. B. Reissman (a6), F. Ozbay (a3), V. Sharma (a3), M. Crane (a7), D. Harrison (a8), R. Herbert (a7), S. M. Levin (a7), B. J. Luft (a9), J. M. Moline (a10), J. M. Stellman (a11), I. G. Udasin (a12), P. J. Landrigan (a7) and S. M. Southwick (a1) (a2) (a3)...
Abstract
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.

Copyright
Corresponding author
*Address for correspondence: 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)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

DA Alexander (1993). Stress among police body handlers. A long-term follow-up. British Journal of Psychiatry 163, 806808.

DA Alexander , A Wells (1991). Reactions of police officers to body-handling after a major disaster. A before-and-after comparison. British Journal of Psychiatry 159, 547555.

A Berninger , MP Webber , JK Niles , J Gustave , R Lee , HW Cohen , K Kelly , M Corrigan , DJ Prezant (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.

EB Blanchard , J Jones-Alexander , TC Buckley , CA Forneris (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669673.

GA Bonanno , AD Mancini , JL Horton , TM Powell , CA Leardmann , EJ Boyko , TS Wells , TI Hooper , GD Gackstetter , TC Smith (2012). Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study. British Journal of Psychiary 200, 317323.

RM Bowler , H Han , V Gocheva , S Nakagawa , H Alper , L DiGrande , JE Cone (2010). Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. American Journal of Industrial Medicine 53, 11861196.

RM Bowler , M Harris , J Li , V Gocheva , SD Stellman , K Wilson , H Alper , R Schwarzer , JE Cone (2012). Longitudinal mental health impact among police responders to the 9/11 terrorist attack. American Journal of Industrial Medicine 55, 297312.

RM Brackbill , JL Hadler , L DiGrande , CC Ekenga , MR Farfel , S Friedman , SE Perlman , SD Stellman , DJ Walker , D Wu , S Yu , LE Thorpe (2009). Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. Journal of the American Medical Association 302, 502516.

CRBrewin , BAndrews , JDValentine (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748766.

RA Bryant , ML O'Donnell , M Creamer , AC McFarlane , CR Clark , D Silove (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167, 312320.

A Charuvastra , M Cloitre (2008). Social bonds and posttraumatic stress disorder. Annual Review of Psychology 59, 301328.

J Cukor , K Wyka , N Jayasinghe , F Weathers , C Giosan , P Leck , J Roberts , L Spielman , M Crane , J Difede (2011 a). Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001. Depression and Anxiety 28, 210217.

J Cukor , K Wyka , B Mello , M Olden , N Jayasinghe , J Roberts , C Giosan , M Crane , J Difede (2011 b). 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.

PJ Curran , AM Hussong (2003). The use of latent trajectory models in psychopathology research. Journal of Abnormal Psychology 112, 526544.

TA deRoon-Cassini , AD Mancini , MD Rusch , GA Bonanno (2010). Psychopathology and resilience following traumatic injury: a latent growth mixture model analysis. Rehabilitation Psychology 55, 111.

M Farfel , L DiGrande , R Brackbill , A Prann , J Cone , S Friedman , DJ Walker , G Pezeshki , P Thomas , S Galea , D Williamson , TR Frieden , L Thorpe (2008). An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. Journal of Urban Health 85, 880909.

EGoldmann , JRCalabrese , MRPrescott , MTamburrino , ILiberzon , RSlembarski , EShirley , TFine , TGoto , KWilson , SGanocy , PChan , MBSerrano , JSizemore , SGalea (2012). Potentially modifiable pre-, peri-, and postdeployment characteristics associated with deployment-related posttraumatic stress disorder among Ohio Army National Guard soldiers. Annals of Epidemiology 22, 7178.

SE Hobfoll , AD Mancini , BJ Hall , D Canetti , GA Bonanno (2011). The limits of resilience: distress following chronic political violence among Palestinians. Social Science and Medicine 72, 14001408.

SB Johnson , AM Langlieb , SP Teret , R Gross , M Schwab , J Massa , L Ashwell , AS Geyh (2005). Rethinking first response: effects of the clean-up and recovery effort on workers at the World Trade Center disaster site. Journal of Occupational and Environmental Medicine 47, 386391.

K Kaniasty , FH Norris (2008). Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. Journal of Traumatic Stress 21, 274281.


P Kristensen , L Weisæth , T Heir (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry 75, 7697.

J Landau , M Mittal , E Wieling (2008). Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma. Journal of Marital and Family Therapy 34, 193209.

PJ Landrigan , PJ Lioy , G Thurston , G Berkowitz , LC Chen , SN Chillrud , SH Gavett , PG Georgopoulos , AS Geyh , S Levin , F Perera , SM Rappaport , C Small (2004). Health and environmental consequences of the World Trade Center disaster. Environmental Health Perspectives 112, 731739.

J Li , RM Brackbill , SD Stellman , MR Farfel , SA Miller-Archie , S Friedman , DJ Walker , LE Thorpe , J Cone (2011). Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City. American Journal of Gastroenterology 106, 19331941.

Y Lo , N Mendell , D Rubin (2001). Testing the number of components in a normal mixture. Biometrika 88, 767778.

G McLachlan , D Peel (2000). Finite Mixture Models. Wiley: New York, NY.

DS Nagin , RE Tremblay (2001). Analyzing developmental trajectories of distinct but related behaviors: a group-based method. Psychological Methods 6, 1834.

Y Neria , R Gross , E Susser (2006). 9/11 Mental Health in the Wake of Terrorist Attacks. Cambridge University Press: New York.

F Norris , M Tracy , S Galea (2009). Looking for resilience: understanding the longitudinal trajectories of responses to stress. Social Science and Medicine 68, 21902198.

KL Nylund , T Asparouhov , B Muthén (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling. A Monte Carlo simulation study. Structural Equation Modeling 14, 535569.

EJ Ozer , SR Best , TL Lipsey , DS Weiss (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin 129, 5273.

MA Perrin , L DiGrande , K Wheeler , L Thorpe , M Farfel , R Brackbill (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry 164, 13851394.

RH Pietrzak , RB Goldstein , SM Southwick , BF Grant (2011). Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine 73, 697707.

RH Pietrzak , CB Schechter , EJ Bromet , CL Katz , DB Reissman , F Ozbay , V Sharma , M Crane , D Harrison , R Herbert , SM Levin , BJ Luft , JM Moline , JM Stellman , IG Udasin , PJ Landrigan , SM Southwick (2012). The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. Journal of Psychiatric Research 46, 835842.

KD Renshaw (2011). An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans. Journal of Affective Disorders 128, 321326.


MM Steenkamp , BD Dickstein , K Salters-Pedneault , SG Hofmann , BT Litz (2012). Trajectories of PTSD symptoms following sexual assault: is resilience the modal outcome? Journal of Traumatic Stress 25, 469474.

JM Stellman , RP Smith , CL Katz , V Sharma , DS Charney , R Herbert , J Moline , BJ Luft , S Markowitz , I Udasin , D Harrison , S Baron , PJ Landrigan , SM Levin , S Southwick (2008). Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environmental Health Perspectives 116, 12481253.

S van Buuren , JPL Brand , CGM Groothuis-Oudshoorn , DB Rubin (2006). Fully conditional specification in multivariate imputation. Journal of Statistical Computation and Simulation 76, 10491064.

F Walsh (2007). Traumatic loss and major disasters: strengthening family and community resilience. Family Process 46, 207227.

PS Wang , M Lane , M Olfson , HA Pincus , KB Wells , RC Kessler (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629640.

JP Wilson , B Drozdek , S Turkovic (2006). Posttraumatic shame and guilt. Trauma, Violence and Abuse 7, 122141.

JP Wisnivesky , S Teitelbaum , A Todd , P Boffetta , M Crane , C Dellenbaugh , D Harrison , R Herbert , Y Jeon , J Kaplan , S Levin , B Luft , S Markowitz , J Moline , RH Pietrzak , M Shapiro , SM Southwick , L Stevenson , I Udasin , S Wallenstein , P Landrigan (2011). Long persistence of multiple illnesses in September 11 responders. Lancet 378, 888897.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: