Monday, September 12, 2016

Study Reveals PTSD Trajectories for 9/11 Responders Over 12-Year Period

Tens of thousands of trained and untrained disaster responders were involved in the rescue, recovery, and cleanup following the attacks on the World Trade Center (WTC) on September 11, 2001. A study in the Journal of Psychiatric Research demonstrates how the long-term follow-up of this unique cohort of responders continues to yield new insights into risks and trajectories of posttraumatic stress disorder (PTSD). Researchers hope this information will serve to inform prevention, monitoring, and treatment efforts.

A total of 1,874 police and 2,613 other responders involved during and after the WTC attacks were given the PTSD Checklist Specific-Stressor (PCL-S) as part of a health survey three, six, eight, and 12 years after 9/11. Participants also answered questions about various life stressors that took place in the year before and since 9/11. 

Among police responders, WTC-related PTSD symptoms grouped into four distinct trajectories, with 76.1% reporting continual no/low symptoms, 4.4% continual high symptoms, 12.1% worsening over time, and 7.5% improving over time. For non-police responders, five distinct PTSD symptom trajectories emerged over time. A total of 55.5% reported no/low symptoms; 10.8% high symptoms; 19.3% and 5.9% with subtly and steeply worsening trajectories, respectively; and 8.5% reported symptom improvements.

Many variables were consistent predictors of PTSD trajectories across both responder groups; for example Hispanic ethnicity, psychiatric history prior to 9/11, greater  exposure to the devastation caused by WTC attacks, and maladaptive coping (such as substance use) strongly increased the risk of a symptomatic PTSD trajectory (everything but no/low symptoms). In contrast, higher perceived preparedness and a greater sense of purpose lowered the risk of symptomatic PTSD.

There were also notable differences between the responder groups; female police responders, but not other female responders, had a greater risk of worsening and continually high trajectories, while being widowed, separated, or divorced was a strong risk for chronic PTSD, but only among non-police responders. Coping mechanisms also differed between the groups, with police responders showing a strong association between active coping strategies and improving PTSD symptoms, while non-police responders who engaged in positive emotion-based coping (such as humor, reframing, or acceptance) had far less risk of high or steeply worsening symptoms.

“Taken together, these findings can inform recommendations for future disaster preparedness and planning, including pre-screening and education of responders about the potential impact of preexisting anxiety and depressive disorders; decisions about who might be best suited for front-line disaster response versus other supportive roles; and maximizing training and preparedness, especially for non-traditional disaster responders such as clean-up workers,” the authors wrote.

For related information, see the Psychiatric News article “Risk of PTSD Symptoms Among Police May Be Predictable Years Ahead.”

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