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.
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.
Stellman
Jeanne Mager
JM
Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
Smith
Rebecca P
RP
Katz
Craig L
CL
Sharma
Vansh
V
Charney
Dennis S
DS
Herbert
Robin
R
Moline
Jacqueline
J
Luft
Benjamin J
BJ
Markowitz
Steven
S
Udasin
Iris
I
Harrison
Denise
D
Baron
Sherry
S
Landrigan
Philip J
PJ
Levin
Stephen M
SM
Southwick
Steven
S
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
Environ Health Perspect. 2007 Aug;115(8):A404, A406-10
17687431
MMWR Morb Mortal Wkly Rep. 2004 Sep 10;53(35):812-5
15356455
Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
7492257
J Trauma Stress. 2006 Apr;19(2):301-6
16612825
Arch Gen Psychiatry. 1998 Jul;55(7):626-32
9672053
Appl Occup Environ Hyg. 2002 Feb;17(2):84-5
11843202
Environ Health Perspect. 2007 Aug;115(8):1154-9
17687441
JAMA. 2002 Aug 7;288(5):581-8
12150669
J Clin Psychiatry. 2000;61 Suppl 5:4-12; discussion 13-4
10761674
Int J Psychiatry Med. 1997;27(2):93-105
9565717
Am J Psychiatry. 2002 May;159(5):857-9
11986143
Stat Med. 2007 Apr 15;26(8):1688-701
17285683
Psychiatry. 2002 Fall;65(3):207-39
12405079
Am J Orthopsychiatry. 2005 Apr;75(2):190-200
15839756
N Engl J Med. 2001 Nov 15;345(20):1507-12
11794216
Am J Psychiatry. 2004 Aug;161(8):1370-6
15285961
J Clin Psychiatry. 2002 Jan;63(1):59-65
11838628
Environ Health Perspect. 2004 May;112(6):731-9
15121517
JAMA. 1984 Oct 12;252(14):1905-7
6471323
MMWR Morb Mortal Wkly Rep. 2004 Sep 10;53(35):807-12
15356454
Am J Psychiatry. 2007 Sep;164(9):1385-94
17728424
Psychiatr Clin North Am. 2004 Sep;27(3):589-602
15325495
JAMA. 1999 Nov 10;282(18):1737-44
10568646
Arch Gen Psychiatry. 2005 Jun;62(6):617-27
15939839
J Nerv Ment Dis. 1997 Aug;185(8):519-22
9284867
J Nerv Ment Dis. 2001 Jul;189(7):442-8
11504321
Am J Psychiatry. 1997 Dec;154(12):1690-5
9396947
Violence Vict. 2003 Apr;18(2):227-38
12816406
Ann N Y Acad Sci. 2006 Jul;1071:495-9
16891606
JAMA. 2002 Sep 11;288(10):1235-44
12215130
J Pers Assess. 1995 Jun;64(3):415-27
7760253
Behav Res Ther. 1996 Aug;34(8):669-73
8870294
Am J Epidemiol. 2003 Sep 15;158(6):514-24
12965877
Environ Health Perspect. 2002 Aug;110 Suppl 4:625-9
12194897
Am J Ind Med. 2005 Jun;47(6):475-83
15898096
N Engl J Med. 2004 Jul 1;351(1):13-22
15229303
Am J Psychiatry. 1997 Aug;154(8):1114-9
9247398