Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003–2012

Abstract

Group-based trajectory modeling was used to explore empirical trajectories of symptoms of posttraumatic stress disorder (PTSD) among 17,062 adult area residents/workers (nonrescue/recovery workers) enrolled in the World Trade Center (WTC) Health Registry using 3 administrations of the PTSD Checklist (PCL) over 9 years of observation. Six trajectories described PTSD over time: low-stable (48.9%), moderate-stable (28.3%), moderate-increasing (8.2%), high-stable (6.0%), high-decreasing (6.6 %), and very high-stable (2.0%). To examine factors associated with improving or worsening PTSD symptoms, groups with similar intercepts, but different trajectories were compared using bivariate analyses and logistic regression. The adjusted odds of being in the moderate-increasing relative to the moderate-stable group were significantly greater among enrollees reporting low social integration (OR = 2.18), WTC exposures (range = 1.34 to 1.53), job loss related to the September 11, 2001 disaster (OR = 1.41), or unmet mental health need/treatment (OR = 4.37). The odds of being in the high-stable relative to the high-decreasing group were significantly greater among enrollees reporting low social integration (OR = 2.23), WTC exposures (range = 1.39 to 1.45), or unmet mental health need/treatment (OR = 3.42). The influence of severe exposures, scarce personal/financial resources, and treatment barriers on PTSD trajectories suggest a need for early and ongoing PTSD screening postdisaster.

Posttraumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change

“…The four trajectories identified in WTC tower survivors are similar to those found in WTC police responders and the general population, which demonstrates that similar posttraumatic responses are found across populations of first responders and civilians (Feder et al., ; Galatzer‐Levy et al., ; Pietrzak, Feder, Singh et al., ). When considering other WTC cohorts, fewer tower survivors from the current study were identified as having stable low symptoms and more were identified as having chronically elevated PTSS (10.4%) than in samples of police responders (4.4–5.3%; Feder et al., ; Pietrzak, Feder, Singh et al., ); New York area residents and workers (8.0%; Welch et al., ); and rescue, recovery, and clean‐up workers (4.0%; Maslow et al., ). The disparate findings are likely dependent on several factors but may be due in part to the proximity and number of unique exposures experienced by WTC tower survivors who received little or no prior training or mental preparedness to deal with such events.…”

“…Studies of WTC first responders, rescue and recovery workers, and New York metropolitan–area residents have identified between four and six PTSS trajectories (Feder et al., ; Maslow et al., ; Pietrzak, Feder, Singh et al., ; Welch et al., ). Similar to findings related to WTC survivors, other studies of PTSS in various populations and in response to numerous types of traumas have typically found four trajectories: low symptom, recovering, worsening, and chronically elevated (see Bonanno & Mancini, ; Galatzer‐Levy, Huang, & Bonanno, ).…”

“…The prevalence of PTSD among individuals who were directly exposed to the WTC events (i.e., tower survivors, first responders, residents, and local workers) has been reported as ranging from 5.4% to 29.3%, with WTC tower survivors among those with the highest prevalence (12.6-29.3%) of PTSD and first responders (i.e., police, fire fighters) often with the lowest prevalence (Adams et al, 2018;Bowler et al, 2012Bowler et al, , 2016Bowler et al, , 2017Caramanica, Brackbill, Liao, & Stellman, 2014;Cone et al, 2015;DiGrande et al, 2008DiGrande et al, , 2011Farfel et al, 2008;Galea et al, 2002Galea et al, , 2008Liu, Tarigan, Bromet, & Kim, 2014;Stellman et al, 2008). Although WTC-exposed individuals shared exposure to a mass trauma, findings have demonstrated wide variation in their posttraumatic responses over time (Feder et al, 2016;Maslow et al, 2015;Pietrzak, Feder, Singh et al, 2014;Welch et al, 2016). Further understanding these variations in PTSD as heterogeneous symptom trajectories as well as understanding the underlying symptomatology are important to the provision of more individualized and targeted clinical interventions for PTSD.…”

Comorbidity amplifies the effects of post-9/11 posttraumatic stress disorder trajectories on health-related quality of life

“…PTSD symptoms can last for many years [ 7 ]. Chronic PTSD symptoms among 9/11-exposed responders and civilians over 8–9 years of follow-up have been reported [ 8 – 10 ]. Pietrzak et al reported that 5.3% of police and 9.5% of non-traditional responders experienced chronic PTSD, while 8.5% of police and 6.7% of non-traditional responders reported delayed-onset PTSD [ 8 ].…”

Psychological Distress in Parents and School-Functioning of Adolescents: Results from the World Trade Center Registry

“…The terrorist attack on the World Trade Center (WTC) in New York City on September 11, 2001 (9/11) has had long-term mental and physical health consequences[ 1 – 4 ]. Among adults, exposure to the events of 9/11 has been associated with mental health conditions including post-traumatic stress disorder (PTSD) and depression as well as physical health conditions including asthma and cardiovascular disease[ 1 , 5 – 7 ].…”