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

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 IG; Landrigan PJ; Southwick SM
Psychol Med 2014 Jan; 44(1):205-219
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.
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
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
Publication Date
Document Type
Journal Article
Email Address
Funding Type
Fiscal Year
Identifying No.
Contract-200-2011-41919; Contract-200-2011-39377; Contract-200-2011-39356; M082013
Issue of Publication
NIOSH Division
Source Name
Psychological Medicine
Performing Organization
Icahn School of Medicine at Mount Sinai, New York
Page last reviewed: November 6, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division