title: A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: a growth curve analysis.
abstract: Exposure to the terrorist attack on the World Trade Center (WTC) on 9/11/2001 resulted in continuing stress experience manifested as Posttraumatic Stress Disorder (PTSD) Symptoms in a minority of the police responders. The WTC Health Registry has followed up a large number of individuals, including police officers, at three waves of data collection from 2003 to 2011. This analysis examines the relationship between initial exposure levels, long-term PTSD symptoms, and subsequent emotional support among police responders.
  
  
  
  The study population included police responders who had reported their 9/11 exposure levels at Wave 1 (2003/4), provided three waves of data on PTSD symptoms using the 17-item PCL scale, and rated their received emotional support at Wave 3 (N = 2,204, 1,908 men, 296 women, mean age: 38 years at exposure). A second-order growth curve reflected a PTSD symptom trajectory which was embedded in a structural equation model, with exposure level specified as an exogenous predictor, and emotional support specified as an endogenous outcome.
  
  
  
  Exposure had a main effect on mean symptom levels (intercept) across three waves but it made no difference in changes in symptoms (slope), and no difference in emotional support. The symptom trajectory, on the other hand, had an effect on emotional support. Its intercept and slope were both related to support, indicating that changes in symptoms affected later emotional support.
  
  
  
  Initial trauma exposure levels can have a long-term effect on mean symptom levels. Emotional support is lower in police responders when PTSD symptoms persist over seven years, but becomes higher when reduction in symptoms occurs.
authors.affiliation: Institute for Positive Psychology and Education, Australian Catholic University, Sydney, Australia. Ralf.Schwarzer@acu.edu.au.|SWPS University of Social Sciences and Humanities, Wroclaw, Poland. Ralf.Schwarzer@acu.edu.au.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schwarzer
authors.affiliation: World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
authors.affiliation: World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA.
authors.forename: Jiehui
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Psychology, San Francisco State University, San Francisco, CA, USA.
authors.forename: Rosemarie M
authors.initials: RM
authors.lastname: Bowler
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016495:Police / Q000523:psychology*; D012042:Registries; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology*
keywords: PTSD; Posttraumatic stress disorder; Social support; Stress; Symptoms; Trauma