title: The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort.
abstract: BACKGROUND
  This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort.
  
  
  METHODS
  A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001.
  
  
  RESULTS
  The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4% and 15.4%, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs]=1.56-1.86), pre-9/11 stressors (ORs=1.30-1.50), family support (ORs=0.83-0.94), and union membership (ORs=0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR=1.36), performing search and rescue work (OR=1.29), and work support (OR=0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs=3.82-41.74), and somatic symptoms and functional difficulties (ORs=1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs=2.93-7.02; and ORs=1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1% and 19.8%, respectively, versus 6.8% in trauma controls).
  
  
  CONCLUSIONS
  These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel.
authors.affiliation: National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA. robert.pietrzak@yale.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.forename: Craig L
authors.initials: CL
authors.lastname: Katz
authors.forename: Dori B
authors.initials: DB
authors.lastname: Reissman
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozbay
authors.forename: Vansh
authors.initials: V
authors.lastname: Sharma
authors.forename: Michael
authors.initials: M
authors.lastname: Crane
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Robin
authors.initials: R
authors.lastname: Herbert
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Levin
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Moline
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Stellman
authors.forename: Iris G
authors.initials: IG
authors.lastname: Udasin
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D016495:Police / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology