title: Post-disaster stressful life events and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among responders to the World Trade Center disaster.
abstract: BACKGROUND
  The current study examined contributions of post-disaster stressful life events in relation to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning among rescue, recovery, and clean-up workers who responded to the September 11, 2001 World Trade Center (WTC) terrorist attacks.
  
  
  METHODS
  Participants were 18,896 WTC responders, including 8466 police officers and 10,430 non-traditional responders (85.8% male; 86.4% Caucasian; M(age) = 39.5, SD = 8.8) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and who were reassessed, on average, 2.5 years later.
  
  
  RESULTS
  Path analyses were conducted to evaluate contributions of life events to the maintenance of WTC-related posttraumatic stress, depressive symptoms, and overall functioning. These analyses were stratified by police and non-traditional responder groups and adjusted for age, sex, time from 9/11 to initial visit, WTC exposures (three WTC contextual exposures: co-worker, friend, or a relative died in the disaster; co-worker, friend, or a relative injured in the disaster; and responder was exposed to the dust cloud on 9/11), and interval from initial to first follow-up visit. In both groups, WTC-related posttraumatic stress, depressive symptoms, and overall functioning were stable over the follow-up period. WTC exposures were related to these three outcomes at the initial assessment. WTC-related posttraumatic stress, depressive symptoms, and overall functioning, at the initial assessment each predicted the occurrence of post-disaster stressful life events, as measured by Disaster Supplement of the Diagnostic Interview Schedule. Post-disaster stressful life events, in turn, were associated with subsequent mental health, indicating partial mediation of the stability of observed mental health.
  
  
  CONCLUSIONS
  The present findings suggest a dynamic interplay between exposure, post-disaster stressful life events, and WTC-related posttraumatic stress, depressive symptoms, and overall functioning among WTC disaster responders.
authors.affiliation: University of Houston, Department of Psychology, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, USA. Electronic address: mjzvolen@central.uh.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zvolensky
authors.affiliation: Stony Brook University, Department of Psychiatry, Stony Brook, NY, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Kotov
authors.affiliation: Albert Einstein College of Medicine, Department of Family & Social Medicine, Bronx, NY, USA.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Stony Brook University, Department of Psychiatry, Stony Brook, NY, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Gonzalez
authors.affiliation: University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, TX, USA.
authors.forename: Anka
authors.initials: A
authors.lastname: Vujanovic
authors.affiliation: United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Icahn School of Medicine at Mt. Sinai, Department of Preventive Medicine, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Crane
authors.affiliation: Icahn School of Medicine at Mt. Sinai, Department of Preventive Medicine, New York, NY, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Kaplan
authors.affiliation: North Shore-LIJ Health System, Department of Population Health, Great Neck, NY, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Moline
authors.affiliation: United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Feder
authors.affiliation: University of Medicine & Dentistry of New Jersey, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Udasin
authors.affiliation: WTC Health Program, NIOSH, USA.
authors.forename: Dori B
authors.initials: DB
authors.lastname: Reissman
authors.affiliation: Stony Brook University, Department of Medicine, Stony Brook, NY, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D004190:Disasters; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D016495:Police; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Depression; Disaster; Stress exposure; Stress generation; Trauma