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Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers.

Luft BJ; Schechter C; Kotov R; Broihier J; Reissman D; Guerrera K; Udasin I; Moline J; Harrison D; Friedman-Jimenez G; Pietrzak RH; Southwick SM; Bromet EJ
Psychol Med 2012 May; 42(5):1069-1079
Background. Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. Method. Participants were 8508 police and 12,333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). Results. Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. Conclusions. Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
Employee-health; Employee-exposure; Emergency-responders; Rescue-workers; Respirable-dust; Psychological-effects; Psychological-stress; Mental-health; Mental-stress; Respiratory-system-disorders; Police-officers; Health-programs; Medical-monitoring; Risk-analysis; Risk-factors; Exposure-assessment; Pulmonary-function; Lung-function; Surveillance-programs; Statistical-analysis; Mathematical-models; Clinical-diagnosis
E. Bromet, Ph.D., Distinguished Professor, Departments of Psychiatry and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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-008223; Cooperative-Agreement-Number-U10-OH-008239; Cooperative-Agreement-Number-U10-OH-008275; Contract-200-2002-0038; Contract-200-2011-39377; Contract-200-2011-39356; B05102012
Issue of Publication
NIOSH Division
Source Name
Psychological Medicine
Performing Organization
Mount Sinai School of Medicine of New York
Page last reviewed: March 25, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division