title: A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse.
abstract: OBJECTIVE
  We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health-related medical leave over the first 2.5 years after the attack.
  
  
  METHODS
  Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis.
  
  
  RESULTS
  Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health-related medical leave. Exposure-response gradients were significant for all outcomes.
  
  
  CONCLUSIONS
  This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.
authors.affiliation: Fire Department of City of New York, NY 11201, USA.
authors.forename: Malachy
authors.initials: M
authors.lastname: Corrigan
authors.forename: Rita
authors.initials: R
authors.lastname: McWilliams
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Justin
authors.initials: J
authors.lastname: Niles
authors.forename: Claire
authors.initials: C
authors.lastname: Cammarata
authors.forename: Kristina
authors.initials: K
authors.lastname: Jones
authors.forename: Daniel
authors.initials: D
authors.lastname: Wartenberg
authors.forename: William K
authors.initials: WK
authors.lastname: Hallman
authors.forename: Howard M
authors.initials: HM
authors.lastname: Kipen
authors.forename: Lara
authors.initials: L
authors.lastname: Glass
authors.forename: John K
authors.initials: JK
authors.lastname: Schorr
authors.forename: Ira
authors.initials: I
authors.lastname: Feirstein
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D005390:Fires; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects*; D018635:Rescue Work; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014584:User-Computer Interface; D000078329:Workforce; D055815:Young Adult