9/11-related PTSD among highly exposed populations: a systematic review 15 years after the attack

Abstract

Background: The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited.

Methods: The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies.

Results: Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies.

Conclusion: Future directions for research, treatment, and healthcare policy are discussed.

Keywords: 2001; 9/11; September 11; post-traumatic stress disorder (PTSD); trauma exposure severity; treatment of PTSD.

Fig. 1

Prevalence of estimated PTSD of first responders/rescue recovery workers by study. Multiple articles using the same data set are listed only once. Zvolensky et al. (2015) was excluded due to lack of information regarding specific time points. Studies that used a range of time points (e.g. data collected at 2–3 years post-9/11) include notation at the both upper and lower ranges.

Fig. 2

Prevalence of estimated PTSD for non-first responders/rescue recovery workers by study. Silver et al. (2005a) estimated acute stress disorder, rather than PTSD, for the first time point. Studies that used a range of time points (e.g. data collected at 2–3 years post-9/11) include notation at the both upper and lower ranges.