Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort

Diab, Olivia; DePierro, Jonathan; Cancelmo, Leo; Schaffer, Jamie; Schechter, Clyde B.; Dasaro, Christopher R.; Todd, Andrew C.; Crane, Michael; Udasin, Iris; Harrison, Denise; Moline, Jacqueline; Luft, Benjamin J.; Southwick, Steven M.; Feder, Adriana; Pietrzak, Robert H.

doi:10.1007/s10488-019-00998-z

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…30,31 Even almost 20 years later, the prevalence of mental health disorders and need for mental health treatment remains elevated among this group of 9/11 responders, with almost one-half of all responders reporting an on-going need for mental health care. 36 An emerging threat for this cohort of responders will be cancers associated with exposure to asbestos at the WTC site. As of 2016, at least 352 responders had been diagnosed with asbestosis and at least 444 had been diagnosed with pulmonary fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Smith

Holmes

Larkin

2021

Prehosp. Disaster med.

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Introduction: In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. Methods: The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. Results: A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Discussion: Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Conclusion: Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

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Section: Discussionmentioning

confidence: 99%

Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Smith

Holmes

Larkin

2021

Prehosp. Disaster med.

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“…Endorsement of any service need was used as a categorical predictor variable. This variable and rates of endorsement of specific needs are described in detail elsewhere 10 …”

Section: Methodsmentioning

confidence: 99%

“…9 Yet, rates and predictors of endorsement among nontraditional responders, who as a group had little or no mass casualty disaster experience at the time of September 11, 2001, remain largely unknown. Given that nontraditional responders have been found to have greater pre-9/11 psychiatric complaints and WTC-related PTSD symptoms, increased likelihood of suicidal ideation, and more self-rated mental health service needs than police responders, 2,5,10 it is especially critical to characterize mental health stigma and barriers to care concerns in this population.…”

Section: Introductionmentioning

confidence: 99%

Mental health stigma and barriers to care in World Trade Center responders: Results from a large, population‐based health monitoring cohort

DePierro

Lowe

Haugen

et al. 2020

American J Industrial Med

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Background Nearly 20 years after the terrorist attacks of September 11, 2001, multiple studies have documented the adverse mental consequences among World Trade Center (WTC) rescue, recovery, and clean‐up workers. However, scarce research has examined mental health stigma and barriers to care in WTC‐exposed individuals, and no known study has examined whether rates of endorsement may differ between police and “nontraditional” responders, the latter comprising a heterogeneous group of workers and volunteers. Objective To identify the prevalence and correlates of mental health stigma and barriers to care in WTC responders. Methods Mental health stigma and barriers to care and their correlates were examined in 6,777 police and 6,272 nontraditional WTC responders. Results Nontraditional responders endorsed more stigma or barriers to care concerns than police responders. Within a subsample who screened positive for a psychiatric disorder, police were more likely than nontraditional responders to endorse “concerns that negative job consequences might result” (17.9% vs. 9.1%), while nontraditional responders were more likely to endorse “I don't know where to go to find counseling services” (18.4% vs.6.6%). Within this subsample, mental health service need and more severe WTC‐related posttraumatic stress disorder symptoms were associated with increased likelihood of endorsing stigma or barriers; pre‐9/11 psychiatric history and non‐Hispanic Black race/ethnicity were associated with lower likelihood of endorsing stigma or barriers. Conclusions Results of this study underscore the burden of mental health stigma and barriers to care in WTC responders, and highlight the need for targeted interventions to address these concerns and promote mental healthcare utilization in this population.

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“…An average of 6.5 years after the 9/11WTC attacks, 8881 police officers were interviewed and completed questionnaires as part of the first annual health surveillance visit with the WTC Health Program; 20.6% of the participants required mental healthcare. 39 Nine to 10 years after the attacks, the prevalence rate of PTSD (results from questionnaires) for 2204 police officers was 11.0%. 37 Another study 9-10 years after the attacks reported a 12.9% PTSD prevalence (results from questionnaires) in police officers.…”

Section: Descriptive Statistics Of the Studiesmentioning

confidence: 99%

“…Risk factors included old age; female gender; a diagnosis of depression, anxiety and/or PTSD before the attacks; positive screens for PTSD related to the attacks; alcohol misuse; several somatic diagnoses; functional impairment in work and more life stressors since the attacks. 39 In a longitudinal study with measurements 3, 6 and 8 years after the 9/11 WTC attacks, 4035 police officers were assessed. Risk factors for the severe chronic trajectory were exposure to human remains, on-site somatic injuries/illnesses, acquaintances with injuries and the traumatic death of a colleague, friend or family member.…”

Section: Risk Factors For Mental Disordersmentioning

confidence: 99%

Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review

Wesemann

Applewhite²,

Himmerich³

2022

BJPsych open

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Background Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions. Aims The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors. Method A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the ‘Guidance on the Conduct of Narrative Synthesis in Systematic Reviews’. Results Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation. Conclusions The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.

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Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort

Cited by 9 publications

References 27 publications

Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Mental health stigma and barriers to care in World Trade Center responders: Results from a large, population‐based health monitoring cohort

Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review

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