A computerized, self-administered questionnaire to evaluate posttraumatic stress among firefighters after the World Trade Center collapse.
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.
Corrigan
Malachy
M
Fire Department of City of New York, NY 11201, USA.
McWilliams
Rita
R
Kelly
Kerry J
KJ
Niles
Justin
J
Cammarata
Claire
C
Jones
Kristina
K
Wartenberg
Daniel
D
Hallman
William K
WK
Kipen
Howard M
HM
Glass
Lara
L
Schorr
John K
JK
Feirstein
Ira
I
Prezant
David J
DJ
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