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. 2016 Mar;46(4):771-83.
doi: 10.1017/S0033291715002184. Epub 2015 Nov 25.

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)

E J Bromet  1 , M J Hobbs  1 , S A P Clouston  2 , A Gonzalez  1 , R Kotov  1 , B J Luft  3
Affiliations

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)

E J Bromet et al. Psychol Med. 2016 Mar.

Abstract

Background: Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.

Method: Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit.

Results: In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life.

Conclusions: This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Keywords: 9/11; Disaster responders; World Trade Center; exposure; post-traumatic stress disorder; psychosocial well-being.

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Figures

Fig. 1.
Fig. 1.
Distribution of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) criteria B (intrusive recollection), C (avoidance/numbing) and D (hyperarousal) symptoms among responders with active World Trade Center PTSD in 2012–2014. Values are percentages, with 95% confidence intervals represented by vertical bars.
Fig. 2.
Fig. 2.
Predicted trajectories derived from longitudinal models of PTSD Checklist data for responders with no history of World Trade Center (WTC) post-traumatic stress disorder (PTSD) (––), and partial (- - -), remitted (– – –) and active WTC-PTSD (· · ·). The boxes outlined in solid gray represent 95% confidence intervals.
See this image and copyright information in PMC

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