title: DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11).
abstract: BACKGROUND
  Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.
  
  
  METHODS
  Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit.
  
  
  RESULTS
  In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life.
  
  
  CONCLUSIONS
  This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.
authors.affiliation: Department of Psychiatry,Putnam Hall-South Campus,Stony Brook University,Stony Brook,NY,USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: Department of Psychiatry,Putnam Hall-South Campus,Stony Brook University,Stony Brook,NY,USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hobbs
authors.affiliation: Program in Public Health and Department of Preventive Medicine,Stony Brook University,Stony Brook,NY,USA.
authors.forename: S A P
authors.initials: SA
authors.lastname: Clouston
authors.affiliation: Department of Psychiatry,Putnam Hall-South Campus,Stony Brook University,Stony Brook,NY,USA.
authors.forename: A
authors.initials: A
authors.lastname: Gonzalez
authors.affiliation: Department of Psychiatry,Putnam Hall-South Campus,Stony Brook University,Stony Brook,NY,USA.
authors.forename: R
authors.initials: R
authors.lastname: Kotov
authors.affiliation: Department of Medicine,Stony Brook University,Stony Brook,NY,USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Luft
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D060731:Emergency Responders / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology
keywords: 9/11; Disaster responders; World Trade Center; exposure; post-traumatic stress disorder; psychosocial well-being