title: Risk, coping and PTSD symptom trajectories in World Trade Center responders.
abstract: Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. Findings in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders.
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA. Electronic address: adriana.feder@mssm.edu.
authors.forename: Adriana
authors.initials: A
authors.lastname: Feder
authors.affiliation: U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Mota
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Salim
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Ritika
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Schaffer
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Leo M
authors.initials: LM
authors.lastname: Cancelmo
authors.affiliation: Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Katz
authors.affiliation: Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA.
authors.forename: Dori B
authors.initials: DB
authors.lastname: Reissman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozbay
authors.affiliation: Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Kotov
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Crane
authors.affiliation: Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, NYU, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Herbert
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Levin
authors.affiliation: Department of Medicine, Division of Infection Diseases, Stony Brook University, Stony Book, NY, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
authors.affiliation: Department of Occupational Medicine, Epidemiology and Prevention, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Moline
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Stellman
authors.affiliation: Department of Environmental and Occupational Medicine, UMDNJ - Robert Wood Johnson Medical School, Piscataway, NJ, USA.
authors.forename: Iris G
authors.initials: IG
authors.lastname: Udasin
authors.affiliation: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zvolensky
authors.affiliation: Department of Psychiatry, Icahn School of Medicine, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yehuda
authors.affiliation: U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Southwick
authors.affiliation: U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
mesh_terms: D000328:Adult; D015331:Cohort Studies; D060731:Emergency Responders / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*
keywords: Coping; Posttraumatic stress disorder; Responders; Risk; Trajectories; World Trade Center