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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.

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
Environ Health Perspect 2008 Sep; 116(9):1248-1253
BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. OBJECTIVES: Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. METHODS: Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. RESULTS: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. CONCLUSIONS: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.
Psychological-adaptation; Psychological-disorders; Psychological-effects; Psychological-factors; Psychological-fatigue; Psychological-processes; Psychological-reactions; Psychological-responses; Psychological-stress; Psychological-testing; Mental-health; Mental-fatigue; Mental-processes; Mental-stress; Children; Families; Stress; Sociological-factors; Questionnaires; Surveillance-programs
Vansh Sharma, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Contract; Cooperative Agreement
Fiscal Year
Identifying No.
Cooperative-Agreement-Number-U10-OH-008232; Cooperative-Agreement-Number-U10-OH-008225; Cooperative-Agreement-Number-U10-OH-008216; Cooperative-Agreement-Number-U10-OH-008275; Cooperative-Agreement-Number-U10-OH-008223; Cooperative-Agreement-Number-U10-OH-008239
Issue of Publication
NIOSH Division
Priority Area
Source Name
Environmental Health Perspectives
Performing Organization
Mount Sinai School of Medicine of New York University
Page last reviewed: August 19, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division