Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder

Abstract

Posttraumatic stress disorder (PTSD) is associated with self-reported difficulties navigating the social and physical world and may also be associated with risk of functional limitations. The Short Physical Performance Battery (SPPB), an objective functional assessment, was administered during monitoring exams between January and December 2015 to a consecutive sample of 1,268 rescue workers, volunteers, and other responders who had aided in response, recovery, and cleanup efforts at the World Trade Center (WTC) in New York after the September 11, 2011 attacks. Data were linked with diagnostic and longitudinal data from the WTC monitoring study. Multivariable analyses were used to examine predictors of functional limitations. Prevalence estimates weighted to the general responder population revealed a relatively high prevalence of functional limitations, SPPB ≤ 9; 16.0%, 95% CI [13.7, 18.4]. Current PTSD was associated with a twofold increased risk of functional limitations after controlling for predisposing factors, trauma severity, behavioral factors, and WTC-related medical conditions, adjusted risk ratio (aRR) = 2.11, 95% CI [1.48, 3.01]. Exposure to ergonomic risk factors at the WTC also increased the risk of functional impairments, aRR = 1.34 95% CI [1.05, 1.70]. Longitudinal results suggest that individuals with current functional limitations experienced high baseline PTSD severity, B = 2.94, SE = 1.33, and increasing PTSD symptom severity, B = 0.29, SE = 0.10, since September 11, 2001. This study identified a cross-sectional relationship between functional limitations and PTSD and a worsening of PTSD symptoms in persons who eventually demonstrated functional limitations. Results highlight the potential role of chronic PTSD in functional limitations.

Figure 1

Comparing the risk of low physical functioning and functional limitations among responders to the September 11, 2001 World Trade Center (WTC) attacks and those of The National Health and Aging Trends Study (NHATS) respondents aged 65 to 69 years. Data were for 170 NHATS respondents (dark gray) and 81 WTC responders (light gray). 95% confidence intervals provided as error bars. *p = .003.

Figure 2

Longitudinal trajectories of change in posttraumatic stress disorder symptom severity by functional limitation status among responders to the September 11, 2001 World Trade Center (WTC) attacks (full results available in Table S1). Dashed black lines (- -) indicate those with functional limitations in 2015 and solid black lines (—) indicate those without functional limitations. 95% Confidence intervals (gray solid lines) were also provided. PTSD = posttraumatic stress disorder; WTC = World Trade Center.