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Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study

Published online by Cambridge University Press:  03 April 2013

R. H. Pietrzak ,
A. Feder ,
R. Singh ,
C. B. Schechter ,
E. J. Bromet ,
C. L. Katz ,
D. B. Reissman ,
F. Ozbay ,
V. Sharma  and
M. Crane
...Show all authors
R. H. Pietrzak*
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
A. Feder
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
R. Singh
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
C. B. Schechter
Affiliation:
Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
C. L. Katz
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
D. B. Reissman
Affiliation:
Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA
F. Ozbay
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
V. Sharma
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
M. Crane
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
D. Harrison
Affiliation:
Department of Environmental Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY, USA
R. Herbert
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
S. M. Levin
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
B. J. Luft
Affiliation:
Department of Medicine, Division of Infectious Diseases, Stony Brook University, Stony Brook, NY, USA
J. M. Moline
Affiliation:
Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York, USA
J. M. Stellman
Affiliation:
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY, USA
I. G. Udasin
Affiliation:
Department of Environmental and Occupational Medicine, UMDNJ – Robert Wood Johnson Medical School, Piscataway, NJ, USA
P. J. Landrigan
Affiliation:
Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
S. M. Southwick
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
*
* Address for correspondence: R. H. Pietrzak, Ph.D., M.P.H., National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue 151E, West Haven, CT 06516, USA. (Email: robert.pietrzak@yale.edu)
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Abstract

Background

Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders.

Method

A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks.

Results

Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories.

Conclusions

Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Keywords

Disasterlatent modelinglongitudinal datapost-traumatic stress disorderrespondersrisk factors
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 205 - 219
Copyright
Copyright © Cambridge University Press 2013 

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References

Alexander, DA (1993). Stress among police body handlers. A long-term follow-up. British Journal of Psychiatry 163, 806–808.Google Scholar
Alexander, DA, Wells, A (1991). Reactions of police officers to body-handling after a major disaster. A before-and-after comparison. British Journal of Psychiatry 159, 547–555.Google Scholar
Berninger, A, Webber, MP, Cohen, HW, Gustave, J, Lee, R, Niles, JK, Chiu, S, Zeig-Owens, R, Soo, J, Kelly, K, Prezant, DJ (2010 a). Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001–2005. Public Health Reports 125, 556–566.CrossRefGoogle Scholar
Berninger, A, Webber, MP, Niles, JK, Gustave, J, Lee, R, Cohen, HW, Kelly, K, Corrigan, M, Prezant, DJ (2010 b). Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster. American Journal of Industrial Medicine 53, 1177–1185.Google Scholar
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.Google Scholar
Bonanno, GA, Mancini, AD, Horton, JL, Powell, TM, Leardmann, CA, Boyko, EJ, Wells, TS, Hooper, TI, Gackstetter, GD, Smith, TC (2012). Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study. British Journal of Psychiary 200, 317–323.Google Scholar
Bowler, RM, Han, H, Gocheva, V, Nakagawa, S, Alper, H, DiGrande, L, Cone, JE (2010). Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. American Journal of Industrial Medicine 53, 1186–1196.Google Scholar
Bowler, RM, Harris, M, Li, J, Gocheva, V, Stellman, SD, Wilson, K, Alper, H, Schwarzer, R, Cone, JE (2012). Longitudinal mental health impact among police responders to the 9/11 terrorist attack. American Journal of Industrial Medicine 55, 297–312.Google Scholar
Brackbill, RM, Hadler, JL, DiGrande, L, Ekenga, CC, Farfel, MR, Friedman, S, Perlman, SE, Stellman, SD, Walker, DJ, Wu, D, Yu, S, Thorpe, LE (2009). Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. Journal of the American Medical Association 302, 502–516.Google Scholar
Brewin, CR, Andrews, B, Valentine, JD (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748–766.CrossRefGoogle ScholarPubMed
Bryant, RA, O'Donnell, ML, Creamer, M, McFarlane, AC, Clark, CR, Silove, D (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167, 312–320.Google Scholar
Centers for Disease Control and Prevention (CDC) (2004). Mental health status of World Trade Center rescue and recovery workers and volunteers – New York City, July 2002-August 2004. Morbidity and Mortality Weekly Report 53, 812–815.Google Scholar
Charuvastra, A, Cloitre, M (2008). Social bonds and posttraumatic stress disorder. Annual Review of Psychology 59, 301–328.Google Scholar
Chiu, S, Niles, JK, Webber, MP, Zeig-Owens, R, Gustave, J, Lee, R, Rizzotto, L, Kelly, KJ, Cohen, HW, Prezant, DJ (2011). Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity. Public Health Reports 126, 201–209.Google Scholar
Cukor, J, Wyka, K, Jayasinghe, N, Weathers, F, Giosan, C, Leck, P, Roberts, J, Spielman, L, Crane, M, Difede, J (2011 a). Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001. Depression and Anxiety 28, 210–217.CrossRefGoogle Scholar
Cukor, J, Wyka, K, Mello, B, Olden, M, Jayasinghe, N, Roberts, J, Giosan, C, Crane, M, Difede, J (2011 b). The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th. Journal of Traumatic Stress 24, 506–514.Google Scholar
Curran, PJ, Hussong, AM (2003). The use of latent trajectory models in psychopathology research. Journal of Abnormal Psychology 112, 526–544.Google Scholar
deRoon-Cassini, TA, Mancini, AD, Rusch, MD, Bonanno, GA (2010). Psychopathology and resilience following traumatic injury: a latent growth mixture model analysis. Rehabilitation Psychology 55, 1–11.Google Scholar
Farfel, M, DiGrande, L, Brackbill, R, Prann, A, Cone, J, Friedman, S, Walker, DJ, Pezeshki, G, Thomas, P, Galea, S, Williamson, D, Frieden, TR, Thorpe, L (2008). An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. Journal of Urban Health 85, 880–909.Google Scholar
Friedman, MJ, Schnurr, PP, McDonagh-Coyle, A (1994). Post-traumatic stress disorder in the military veteran. Psychiatric Clinics of North America 17, 265–277.Google Scholar
Goldmann, E, Calabrese, JR, Prescott, MR, Tamburrino, M, Liberzon, I, Slembarski, R, Shirley, E, Fine, T, Goto, T, Wilson, K, Ganocy, S, Chan, P, Serrano, MB, Sizemore, J, Galea, S (2012). Potentially modifiable pre-, peri-, and postdeployment characteristics associated with deployment-related posttraumatic stress disorder among Ohio Army National Guard soldiers. Annals of Epidemiology 22, 71–78.Google Scholar
Herbert, R, Moline, J, Skloot, G, Metzger, K, Baron, S, Luft, B, Markowitz, S, Udasin, I, Harrison, D, Stein, D, Todd, A, Enright, P, Stellman, JM, Landrigan, PJ, Levin, SM (2006). The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program. Environmental Health Perspectives 114, 1853–1858.Google Scholar
Hobfoll, SE, Mancini, AD, Hall, BJ, Canetti, D, Bonanno, GA (2011). The limits of resilience: distress following chronic political violence among Palestinians. Social Science and Medicine 72, 1400–1408.Google Scholar
Johnson, SB, Langlieb, AM, Teret, SP, Gross, R, Schwab, M, Massa, J, Ashwell, L, Geyh, AS (2005). Rethinking first response: effects of the clean-up and recovery effort on workers at the World Trade Center disaster site. Journal of Occupational and Environmental Medicine 47, 386–391.Google Scholar
Kaniasty, K, Norris, FH (2008). Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. Journal of Traumatic Stress 21, 274–281.Google Scholar
Kessler, RC, McLaughlin, KA, Koenen, KC, Petukhova, M, Hill, ED (2012). The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiology and Psychiatric Sciences 21, 35–45.Google Scholar
Kristensen, P, Weisæth, L, Heir, T (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry 75, 76–97.Google Scholar
Landau, J, Mittal, M, Wieling, E (2008). Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma. Journal of Marital and Family Therapy 34, 193–209.Google Scholar
Landrigan, PJ, Lioy, PJ, Thurston, G, Berkowitz, G, Chen, LC, Chillrud, SN, Gavett, SH, Georgopoulos, PG, Geyh, AS, Levin, S, Perera, F, Rappaport, SM, Small, C (2004). Health and environmental consequences of the World Trade Center disaster. Environmental Health Perspectives 112, 731–739.Google Scholar
Li, J, Brackbill, RM, Stellman, SD, Farfel, MR, Miller-Archie, SA, Friedman, S, Walker, DJ, Thorpe, LE, Cone, J (2011). Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City. American Journal of Gastroenterology 106, 1933–1941.Google Scholar
Lo, Y, Mendell, N, Rubin, D (2001). Testing the number of components in a normal mixture. Biometrika 88, 767–778.Google Scholar
Luft, BJ, Schechter, C, Kotov, R, Broihier, J, Reissman, D, Guerrera, K, Udasin, I, Moline, J, Harrison, D, Friedman-Jimenez, G, Pietrzak, RH, Southwick, SM, Bromet, EJ (2012). Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers. Psychological Medicine 42, 1069–1079.Google Scholar
McLachlan, G, Peel, D (2000). Finite Mixture Models. Wiley: New York, NY.Google Scholar
Muthén, B (2004). Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In Handbook of Quantitative Methodology for the Social Sciences (ed. Kaplan, D.), pp. 345–368. Sage Publications: Newbury Park, CA.Google Scholar
Muthén, B, Muthén, L (2002). Mplus: The comprehensive Modeling Program for Applied Researchers. Muthén & Muthén: Los Angeles, CA.Google Scholar
Nagin, DS, Tremblay, RE (2001). Analyzing developmental trajectories of distinct but related behaviors: a group-based method. Psychological Methods 6, 18–34.Google Scholar
Neria, Y, Gross, R, Susser, E (2006). 9/11 Mental Health in the Wake of Terrorist Attacks. Cambridge University Press: New York.Google Scholar
Norris, F, Tracy, M, Galea, S (2009). Looking for resilience: understanding the longitudinal trajectories of responses to stress. Social Science and Medicine 68, 2190–2198.Google Scholar
Nylund, KL, Asparouhov, T, Muthén, B (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling. A Monte Carlo simulation study. Structural Equation Modeling 14, 535–569.Google Scholar
Ozer, EJ, Best, SR, Lipsey, TL, Weiss, DS (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin 129, 52–73.Google Scholar
Perrin, MA, DiGrande, L, Wheeler, K, Thorpe, L, Farfel, M, Brackbill, R (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry 164, 1385–1394.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Goldstein, RB, Southwick, SM, Grant, BF (2011). Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine 73, 697–707.Google Scholar
Pietrzak, RH, Schechter, CB, Bromet, EJ, Katz, CL, Reissman, DB, Ozbay, F, Sharma, V, Crane, M, Harrison, D, Herbert, R, Levin, SM, Luft, BJ, Moline, JM, Stellman, JM, Udasin, IG, Landrigan, PJ, Southwick, SM (2012). The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. Journal of Psychiatric Research 46, 835–842.Google Scholar
Renshaw, KD (2011). An integrated model of risk and protective factors for post-deployment PTSD symptoms in OEF/OIF era combat veterans. Journal of Affective Disorders 128, 321–326.Google Scholar
Robins, LN, Smith, EM (1983). The Diagnostic Interview Schedule/Disaster Supplement. Washington University School of Medicine: St Louis, MO.Google Scholar
Soo, J, Webber, MP, Gustave, J, Lee, R, Hall, CB, Cohen, HW, Kelly, KJ, Prezant, DJ (2011). Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001–2010. Disaster Medicine and Public Health Preparedness 5 (Suppl. 2), S197–S203.Google Scholar
Steenkamp, MM, Dickstein, BD, Salters-Pedneault, K, Hofmann, SG, Litz, BT (2012). Trajectories of PTSD symptoms following sexual assault: is resilience the modal outcome? Journal of Traumatic Stress 25, 469–474.Google Scholar
Stellman, JM, Smith, RP, Katz, CL, Sharma, V, Charney, DS, Herbert, R, Moline, J, Luft, BJ, Markowitz, S, Udasin, I, Harrison, D, Baron, S, Landrigan, PJ, Levin, SM, Southwick, S (2008). Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environmental Health Perspectives 116, 1248–1253.Google Scholar
van Buuren, S, Brand, JPL, Groothuis-Oudshoorn, CGM, Rubin, DB (2006). Fully conditional specification in multivariate imputation. Journal of Statistical Computation and Simulation 76, 1049–1064.Google Scholar
Walsh, F (2007). Traumatic loss and major disasters: strengthening family and community resilience. Family Process 46, 207–227.Google Scholar
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.Google Scholar
Weathers, F, Litz, B, Herman, D, Huska, J, Keane, T (1993). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
Wilson, JP, Drozdek, B, Turkovic, S (2006). Posttraumatic shame and guilt. Trauma, Violence and Abuse 7, 122–141.CrossRefGoogle ScholarPubMed
Wisnivesky, JP, Teitelbaum, S, Todd, A, Boffetta, P, Crane, M, Dellenbaugh, C, Harrison, D, Herbert, R, Jeon, Y, Kaplan, J, Levin, S, Luft, B, Markowitz, S, Moline, J, Pietrzak, RH, Shapiro, M, Southwick, SM, Stevenson, L, Udasin, I, Wallenstein, S, Landrigan, P (2011). Long persistence of multiple illnesses in September 11 responders. Lancet 378, 888–897.Google Scholar