title: Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers.
abstract: The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Carey B
authors.initials: CB
authors.lastname: Maslow
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Caramanica
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Welch
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
mesh_terms: D000293:Adolescent; D000328:Adult; D001601:Bereavement; D060389:Construction Industry; D004634:Emergency Medical Technicians / Q000523:psychology; D005260:Female; D061388:Firefighters / Q000523:psychology; D006077:Government Agencies; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000523:psychology; D016495:Police / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000523:psychology; D018635:Rescue Work; D012499:Sanitation; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D014478:Unemployment / Q000523:psychology; D014947:Wounds and Injuries / Q000523:psychology; D055815:Young Adult