Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster

Abstract

Background Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster suffered from significant physical and psychological trauma. Studies of longitudinal psychological distress among those exposed to trauma have been limited to relatively short durations of follow-up among smaller samples. Methods The current study longitudinally assessed heterogeneity in trajectories of psychological distress among WTC Health Registry enrollees – a prospective cohort health study of responders, students, employees, passersby, and residents in the affected area (N = 30 839) – throughout a 15-year period following the WTC disaster. Rescue/recovery status and exposure to traumatic events of 9/11, as well as sociodemographic factors and health status, were assessed as risk factors for trajectories of psychological distress. Results Five psychological distress trajectory groups were found: none-stable, low-stable, moderate-increasing, moderate-decreasing, and high-stable. Of the study sample, 78.2% were classified as belonging to the none-stable or low-stable groups. Female sex, being younger at the time of 9/11, lower education and income were associated with a higher probability of being in a greater distress trajectory group relative to the none-stable group. Greater exposure to traumatic events of 9/11 was associated with a higher probability of a greater distress trajectory, and community members (passerby, residents, and employees) were more likely to be in greater distress trajectory groups – especially in the moderate-increasing [odds ratios (OR) 2.31 (1.97–2.72)] and high-stable groups [OR 2.37 (1.81–3.09)] – compared to the none-stable group. Conclusions The current study illustrated the heterogeneity in psychological distress trajectories following the 9/11 WTC disaster, and identified potential avenues for intervention in future disasters.

A Qualitative Longitudinal Study of Injuries and Medical Care, Assistance, and Losses Recounted by Oklahoma City Bombing Survivors after Nearly a Quarter Century

“…This study's qualitative findings are relatively consistent with the results of a 14-year post-9/11 study of members of a registry of affected individuals, 44% of whom were injured, especially with fractures and dislocations, burns, and head injuries. 1 Long-term MH findings of the existing quantitative research on disaster survivors [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] resonate with this long-term study's qualitative findings. The 9/11 study 1 found that emotional distress and employment difficulties arising from the disaster generally improved across time; for some, however, these problems continued for long periods, changing people's lives forever.…”

“…This study's qualitative findings are relatively consistent with the results of a 14-year post-9/11 study of members of a registry of affected individuals, 44% of whom were injured, especially with fractures and dislocations, burns, and head injuries. 1 Long-term MH findings of the existing quantitative research on disaster survivors [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] resonate with this long-term study's qualitative findings. A central strength of the current study is its prospective longitudinal, post-disaster follow-up, allowing survivors to describe their experiences and outcomes over a very long period of time spanning the time of the bombing to almost a quarter of a century later.…”

“…Numerous post-disaster studies focused on MH have conducted prospective examinations of survivors' long-term MH outcomes using quantitative methods. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] A large proportion of this research designated as "long term" has followed survivors for only ≤four years or even five-to-nine years; however, follow-up durations of ≥ten years are of the greatest relevance to the current study. Quantitative studies of MH outcome trajectories from early post-disaster periods up to 10-27 years have found that psychopathology, emotional distress, and impaired functioning including employment difficulties may generally improve across time, but for some survivors, these difficulties may continue for long periods.…”

“…Quantitative studies of MH outcome trajectories from early post-disaster periods up to 10-27 years have found that psychopathology, emotional distress, and impaired functioning including employment difficulties may generally improve across time, but for some survivors, these difficulties may continue for long periods. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Almost no longitudinal research using qualitative methods as long as a decade later has been conducted to determine how surviving a terrorist attack affects people's lives long term with the richness and detail that qualitative data can provide. Open-ended interviews allow participants to recount their experience in their own words, unconstrained and undirected by the interviews, allowing collection of information beyond data from quantitative interviews limited to restricted categories.…”

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches

“…First, in contrast to studies that have examined rescue and recovery workers (e.g., Feder et al., 2016; Maslow et al., 2015; Pietrzak et al., 2014), we analyzed data from community members, which increases the generalizability of the results to community samples. This also is important because trajectories of general distress post‐9/11 have been shown to differ between community members and rescue and recovery workers, with the former more likely to be in higher distress classes (Ko et al., 2021). Second, we analyzed data from the largest sample to date ( N = 37,545 enrollees in the WTCHR).…”