title: World Trade Center disaster and sensitization to subsequent life stress: A longitudinal study of disaster responders.
abstract: OBJECTIVE
  The current study examined the role of World Trade Center (WTC) disaster exposure (hours spent working on the site, dust cloud exposure, and losing friend/loved one) in exacerbating the effects of post-disaster life stress on posttraumatic stress disorder (PTSD) symptoms and overall functioning among WTC responders.
  
  
  METHODS
  Participants were 18,896 responders (8466 police officers and 10,430 non-traditional responders) participating in the WTC Health Program who completed an initial examination between July, 2002 and April, 2010 and were reassessed an average of two years later.
  
  
  RESULTS
  Among police responders, there was a significant interaction, such that the effect of post-disaster life stress on later PTSD symptoms and overall functioning was stronger among police responders who had greater WTC disaster exposure (β's=.029 and .054, respectively, for PTSD symptoms and overall functioning). This moderating effect was absent in non-traditional responders. Across both groups, post-disaster life stress also consistently was related to the dependent variables in a more robust manner than WTC exposure.
  
  
  CONCLUSIONS
  The present findings suggest that WTC exposure may compound post-disaster life stress, thereby resulting in a more chronic course of PTSD symptoms and reduced functioning among police 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: University of Houston, Department of Psychology, Houston, TX, USA.
authors.forename: Samantha G
authors.initials: SG
authors.lastname: Farris
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: Evelyn
authors.initials: E
authors.lastname: Bromet
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: Rutgers Robert Wood Johnson Medical School, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Udasin
authors.affiliation: World Trade Center Health Program, National Institute for Occupational Safety and Health & U.S. Public Health Service, Washington, D.C., 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 / Q000209:etiology; D004190:Disasters; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009519:New York City; D016495:Police / Q000523:psychology*; D011581:Psychological Tests; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Disaster; Functioning; Posttraumatic stress; Responder; Stress exposure; Trauma