title: 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.
abstract: BACKGROUND
  The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures.
  
  
  OBJECTIVE
  Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children.
  
  
  METHODS
  Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire.
  
  
  RESULTS
  Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers.
  
  
  CONCLUSIONS
  Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Jeanne Mager
authors.initials: JM
authors.lastname: Stellman
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Smith
authors.forename: Craig L
authors.initials: CL
authors.lastname: Katz
authors.forename: Vansh
authors.initials: V
authors.lastname: Sharma
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Charney
authors.forename: Robin
authors.initials: R
authors.lastname: Herbert
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Moline
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
authors.forename: Steven
authors.initials: S
authors.lastname: Markowitz
authors.forename: Iris
authors.initials: I
authors.lastname: Udasin
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Sherry
authors.initials: S
authors.lastname: Baron
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Levin
authors.forename: Steven
authors.initials: S
authors.lastname: Southwick
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016273:Occupational Exposure; D016584:Panic Disorder / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
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