title: Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers.
abstract: BACKGROUND
  Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures.
  
  
  METHODS
  Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC).
  
  
  RESULTS
  Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms.
  
  
  CONCLUSIONS
  Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
authors.affiliation: Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Luft
authors.forename: C
authors.initials: C
authors.lastname: Schechter
authors.forename: R
authors.initials: R
authors.lastname: Kotov
authors.forename: J
authors.initials: J
authors.lastname: Broihier
authors.forename: D
authors.initials: D
authors.lastname: Reissman
authors.forename: K
authors.initials: K
authors.lastname: Guerrera
authors.forename: I
authors.initials: I
authors.lastname: Udasin
authors.forename: J
authors.initials: J
authors.lastname: Moline
authors.forename: D
authors.initials: D
authors.lastname: Harrison
authors.forename: G
authors.initials: G
authors.lastname: Friedman-Jimenez
authors.forename: R H
authors.initials: RH
authors.lastname: Pietrzak
authors.forename: S M
authors.initials: SM
authors.lastname: Southwick
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D004391:Dust; D005260:Female; D006801:Humans; D008297:Male; D009314:National Institute for Occupational Safety and Health, U.S.; D009518:New York / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D016495:Police / Q000706:statistics & numerical data; D018635:Rescue Work / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D014481:United States; D014797:Vital Capacity
chemical_list: D004391:Dust