title: Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003-2012.
abstract: Group-based trajectory modeling was used to explore empirical trajectories of symptoms of posttraumatic stress disorder (PTSD) among 17,062 adult area residents/workers (nonrescue/recovery workers) enrolled in the World Trade Center (WTC) Health Registry using 3 administrations of the PTSD Checklist (PCL) over 9 years of observation. Six trajectories described PTSD over time: low-stable (48.9%), moderate-stable (28.3%), moderate-increasing (8.2%), high-stable (6.0%), high-decreasing (6.6 %), and very high-stable (2.0%). To examine factors associated with improving or worsening PTSD symptoms, groups with similar intercepts, but different trajectories were compared using bivariate analyses and logistic regression. The adjusted odds of being in the moderate-increasing relative to the moderate-stable group were significantly greater among enrollees reporting low social integration (OR = 2.18), WTC exposures (range = 1.34 to 1.53), job loss related to the September 11, 2001 disaster (OR = 1.41), or unmet mental health need/treatment (OR = 4.37). The odds of being in the high-stable relative to the high-decreasing group were significantly greater among enrollees reporting low social integration (OR = 2.23), WTC exposures (range = 1.39 to 1.45), or unmet mental health need/treatment (OR = 3.42). The influence of severe exposures, scarce personal/financial resources, and treatment barriers on PTSD trajectories suggest a need for early and ongoing PTSD screening postdisaster.
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, USA.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Welch
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Caramanica
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, USA.
authors.forename: Carey B
authors.initials: CB
authors.lastname: Maslow
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, 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, Queens, New York, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004190:Disasters; D060731:Emergency Responders / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D012042:Registries; D055500:Resilience, Psychological; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult