title: Quality of Life of Persons Injured on 9/11: Qualitative Analysis from the World Trade Center Health Registry.
abstract: BACKGROUND
  A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing physical health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors.  Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis.
  
  
  RESULTS
  Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life.
  
  
  CONCLUSIONS
  This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.
authors.affiliation: New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Division of Epidemiology, Long Island City, New York, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gargano
authors.affiliation: Philip R. Lee Institute for Health Policy Studies and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Robyn R
authors.initials: RR
authors.lastname: Gershon
authors.affiliation: New York City Department of Health, World Trade Center Health Registry, New York, New York, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill