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

Abstract

BackgroundThousands 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.MethodParticipants 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).ResultsFewer 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.ConclusionsAlthough 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.

Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster

“…Although the mental health effects among responders often vary by occupational type (e.g., police versus non-traditional responders such as construction workers), (Perrin et al, 2007;Wisnivesky et al, 2011) WTC-related exposure(s), which include, losing a colleague in the disaster, being exposed to the dust cloud, and working in close proximity to disaster site, have been routinely associated with the onset of a variety of mental health symptoms, most commonly posttraumatic stress. (Luft et al, 2012;Pietrzak et al, 2014;Chiu et al, 2011;Perrin et al, 2007;Brackbill et al, 2009;Perlman et al, 2011) These findings are generally consistent with the trauma exposure literature. (Pfefferbaum et al, 2012;van den Berg et al, 2012)..…”

“…(Aldrich et al, 2010;Levin et al, 2002;Luft et al, 2012;Niles et al, 2011;Pietrzak et al, 2014) Mental health-oriented work has found elevated rates of probable postraumatic stress disorder (PTSD), (Farfel et al, 2008;Berninger et al, 2010aBerninger et al, , 2010bStellman et al, 2008) depression, (Chiu et al, 2011) certain anxiety disorders, (Farach et al, 2008;Cukor et al, 2011aCukor et al, , 2011b and functional impairment (Farfel et al, 2008) among rescue and recovery workers. Although the mental health effects among responders often vary by occupational type (e.g., police versus non-traditional responders such as construction workers), (Perrin et al, 2007;Wisnivesky et al, 2011) WTC-related exposure(s), which include, losing a colleague in the disaster, being exposed to the dust cloud, and working in close proximity to disaster site, have been routinely associated with the onset of a variety of mental health symptoms, most commonly posttraumatic stress.…”

“…We focused on three exposures: losing a co-worker, friend, or a relative in the disaster; co-worker, friend, or a relative injured in the disaster; and being exposed to the dust cloud on 9/11. (Luft et al, 2012;Webber et al, 2011) We selected exposures that predicted health outcomes in previous literature, which includes our own work and Registry data. (Luft et al, 2012;Perrin et al, 2007) Moreover, on a theoretical basis, WTC exposures included in the model are associated with life threat and witnessing of horror, which are linked to increased risk of PTSD in past work.…”

“…(Luft et al, 2012;Herbert et al, 2006) The WTC-HP provides yearly health monitoring and treats WTC-related conditions of responders with documented involvement in the WTC clean-up and recovery efforts, except for New York City firefighters as they are enrolled in a parallel program. (Prezant, 2008) The Institutional Review Boards (IRB) of all participating organizations monitor the study and review it annually.…”

“…These two groups differed in prior-disaster training and on study variables, as shown previously (Luft et al, 2012;Pietrzak et al, 2014); therefore, analyses were stratified by occupational group.…”