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

Authors
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; StellmanJM; Udasin-IG; Landrigan-PJ; Southwick-SM
Source
Psychol Med 2014 Jan; 44(1):205-219
NIOSHTIC No.
20043103
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.
Keywords
Emergency-response; Emergency-responders; Rescue-workers; Job-stress; Stress; Mental-disorders; Mental-health; Mental-stress; Psychological-effects; Psychological-processes; Psychological-responses; Psychological-stress; Risk-factors; Long-term-study; Police-officers; Health-programs; Medical-monitoring; Surveillance-programs; Psychological-adaptation; Racial-factors; Medical-screening; Medical-treatment; Author Keywords: Disaster; latent modeling; longitudinal data; post-traumatic stress disorder; responders; risk factors
Contact
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
CODEN
PSMDCO
Publication Date
20140101
Document Type
Journal Article
Email Address
robert.pietrzak@yale.edu
Funding Type
Contract
Fiscal Year
2014
NTIS Accession No.
NTIS Price
Identifying No.
Contract-200-2011-41919; M082013
Issue of Publication
1
ISSN
0033-2917
NIOSH Division
WTCHP
Source Name
Psychological Medicine
State
CT; NY; DC; NJ
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