Latent typologies of posttraumatic stress disorder in World Trade Center responders.
Posttraumatic stress disorder (PTSD) is a debilitating and often chronic psychiatric disorder. Following the 9/11/2001 World Trade Center (WTC) attacks, thousands of individuals were involved in rescue, recovery and clean-up efforts. While a growing body of literature has documented the prevalence and correlates of PTSD in WTC responders, no study has evaluated predominant typologies of PTSD in this population. Participants were 4352 WTC responders with probable WTC-related DSM-IV PTSD. Latent class analyses were conducted to identify predominant typologies of PTSD symptoms and associated correlates. A 3-class solution provided the optimal representation of latent PTSD symptom typologies. The first class, labeled "High-Symptom (n = 1,973, 45.3%)," was characterized by high probabilities of all PTSD symptoms. The second class, "Dysphoric (n = 1,371, 31.5%)," exhibited relatively high probabilities of emotional numbing and dysphoric arousal (e.g., sleep disturbance). The third class, "Threat (n = 1,008, 23.2%)," was characterized by high probabilities of re-experiencing, avoidance and anxious arousal (e.g., hypervigilance). Compared to the Threat class, the Dysphoric class reported a greater number of life stressors after 9/11/2001 (OR = 1.06). The High-Symptom class was more likely than the Threat class to have a positive psychiatric history before 9/11/2001 (OR = 1.7) and reported a greater number of life stressors after 9/11/2001 (OR = 1.1). The High-Symptom class was more likely than the Dysphoric class, which was more likely than the Threat class, to screen positive for depression (83% > 74% > 53%, respectively), and to report greater functional impairment (High-Symptom > Dysphoric [Cohen d = 0.19], Dysphoric > Threat [Cohen d = 0.24]). These results may help inform assessment, risk stratification, and treatment approaches for PTSD in WTC and disaster responders.
Department of Psychiatry, Icahn School of Medicine, New York, NY, USA. Electronic address: shorn@uoregon.edu.
Sarah R
SR
Horn
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.
Robert H
RH
Pietrzak
Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.
Clyde
C
Schechter
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Evelyn J
EJ
Bromet
Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
Craig L
CL
Katz
National Institute for Occupational Safety and Health, Washington, DC, USA.
Dori B
DB
Reissman
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Roman
R
Kotov
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Michael
M
Crane
Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA.
Denise J
DJ
Harrison
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Robin
R
Herbert
Department of Medicine, Division of Infection Diseases, Stony Brook University, Stony Book, NY, USA.
Benjamin J
BJ
Luft
Department of Occupational Medicine, Epidemiology and Prevention, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA.
Jacqueline M
JM
Moline
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY, USA.
Jeanne M
JM
Stellman
Department of Environmental and Occupational Medicine, UMDNJ - Robert Wood Johnson Medical School, Piscataway, NJ, USA.
Iris G
IG
Udasin
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Philip J
PJ
Landrigan
Department of Psychology, University of Houston, USA.
Michael J
MJ
Zvolensky
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.
Steven M
SM
Southwick
Department of Psychiatry, Icahn School of Medicine, New York, NY, USA.
Adriana
A
Feder
D000328:Adult; D060731:Emergency Responders / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D047851:September 11 Terrorist Attacks / Q000523:psychology* / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000145:classification* / Q000453:epidemiology* / Q000523:psychology
Latent class analysis (LCA); Posttraumatic stress disorder (PTSD); Typologies; World Trade Center (WTC)