title: Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study.
abstract: BACKGROUND
  Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders.
  
  
  METHODS
  A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks.
  
  
  RESULTS
  Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories.
  
  
  CONCLUSIONS
  Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
authors.affiliation: National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Pietrzak
authors.forename: A
authors.initials: A
authors.lastname: Feder
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: C B
authors.initials: CB
authors.lastname: Schechter
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
authors.forename: C L
authors.initials: CL
authors.lastname: Katz
authors.forename: D B
authors.initials: DB
authors.lastname: Reissman
authors.forename: F
authors.initials: F
authors.lastname: Ozbay
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Crane
authors.forename: D
authors.initials: D
authors.lastname: Harrison
authors.forename: R
authors.initials: R
authors.lastname: Herbert
authors.forename: S M
authors.initials: SM
authors.lastname: Levin
authors.forename: B J
authors.initials: BJ
authors.lastname: Luft
authors.forename: J M
authors.initials: JM
authors.lastname: Moline
authors.forename: J M
authors.initials: JM
authors.lastname: Stellman
authors.forename: I G
authors.initials: IG
authors.lastname: Udasin
authors.forename: P J
authors.initials: PJ
authors.lastname: Landrigan
authors.forename: S M
authors.initials: SM
authors.lastname: Southwick
mesh_terms: D000328:Adult; D015331:Cohort Studies; D060731:Emergency Responders / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016495:Police / Q000706:statistics & numerical data; D011446:Prospective Studies; D055500:Resilience, Psychological; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*