Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

R. H. Pietrzak, A. Feder, Clyde B. Schechter, R. Singh, L. Cancelmo, E. J. Bromet, C. L. Katz, D. B. Reissman, F. Ozbay, V. Sharma, M. Crane, D. Harrison, R. Herbert, S. M. Levin, B. J. Luft, J. M. Moline, J. M. Stellman, I. G. Udasin, R. El-Gabalawy, P. J. Landrigan & 1 others S. M. Southwick

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. Method Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. Results CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. Conclusions Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

Original languageEnglish (US)
Pages (from-to)2085-2098
Number of pages14
JournalPsychological Medicine
Volume44
Issue number10
DOIs
StatePublished - 2014

Fingerprint

Post-Traumatic Stress Disorders
Arousal
Police
Disasters
Statistical Factor Analysis
National Institute for Occupational Safety and Health (U.S.)
Structural Models
Health
Anger
Sleep
Anxiety
Regression Analysis
Population

Keywords

  • Confirmatory factor analysis
  • Disaster
  • Post-traumatic stress disorder

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders. / Pietrzak, R. H.; Feder, A.; Schechter, Clyde B.; Singh, R.; Cancelmo, L.; Bromet, E. J.; Katz, C. L.; Reissman, D. B.; Ozbay, F.; Sharma, V.; Crane, M.; Harrison, D.; Herbert, R.; Levin, S. M.; Luft, B. J.; Moline, J. M.; Stellman, J. M.; Udasin, I. G.; El-Gabalawy, R.; Landrigan, P. J.; Southwick, S. M.

In: Psychological Medicine, Vol. 44, No. 10, 2014, p. 2085-2098.

Research output: Contribution to journalArticle

Pietrzak, RH, Feder, A, Schechter, CB, Singh, R, Cancelmo, L, Bromet, EJ, Katz, CL, Reissman, DB, Ozbay, F, Sharma, V, Crane, M, Harrison, D, Herbert, R, Levin, SM, Luft, BJ, Moline, JM, Stellman, JM, Udasin, IG, El-Gabalawy, R, Landrigan, PJ & Southwick, SM 2014, 'Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders', Psychological Medicine, vol. 44, no. 10, pp. 2085-2098. https://doi.org/10.1017/S0033291713002924
Pietrzak, R. H. ; Feder, A. ; Schechter, Clyde B. ; Singh, R. ; Cancelmo, L. ; Bromet, E. J. ; Katz, C. L. ; Reissman, D. B. ; Ozbay, F. ; Sharma, V. ; Crane, M. ; Harrison, D. ; Herbert, R. ; Levin, S. M. ; Luft, B. J. ; Moline, J. M. ; Stellman, J. M. ; Udasin, I. G. ; El-Gabalawy, R. ; Landrigan, P. J. ; Southwick, S. M. / Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders. In: Psychological Medicine. 2014 ; Vol. 44, No. 10. pp. 2085-2098.
@article{1b974aaf3955450b941a38568c34a436,
title = "Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders",
abstract = "Background Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. Method Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. Results CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. Conclusions Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.",
keywords = "Confirmatory factor analysis, Disaster, Post-traumatic stress disorder",
author = "Pietrzak, {R. H.} and A. Feder and Schechter, {Clyde B.} and R. Singh and L. Cancelmo and Bromet, {E. J.} and Katz, {C. L.} and Reissman, {D. B.} and F. Ozbay and V. Sharma and M. Crane and D. Harrison and R. Herbert and Levin, {S. M.} and Luft, {B. J.} and Moline, {J. M.} and Stellman, {J. M.} and Udasin, {I. G.} and R. El-Gabalawy and Landrigan, {P. J.} and Southwick, {S. M.}",
year = "2014",
doi = "10.1017/S0033291713002924",
language = "English (US)",
volume = "44",
pages = "2085--2098",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "Cambridge University Press",
number = "10",

}

TY - JOUR

T1 - Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

AU - Pietrzak, R. H.

AU - Feder, A.

AU - Schechter, Clyde B.

AU - Singh, R.

AU - Cancelmo, L.

AU - Bromet, E. J.

AU - Katz, C. L.

AU - Reissman, D. B.

AU - Ozbay, F.

AU - Sharma, V.

AU - Crane, M.

AU - Harrison, D.

AU - Herbert, R.

AU - Levin, S. M.

AU - Luft, B. J.

AU - Moline, J. M.

AU - Stellman, J. M.

AU - Udasin, I. G.

AU - El-Gabalawy, R.

AU - Landrigan, P. J.

AU - Southwick, S. M.

PY - 2014

Y1 - 2014

N2 - Background Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. Method Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. Results CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. Conclusions Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

AB - Background Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. Method Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. Results CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. Conclusions Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

KW - Confirmatory factor analysis

KW - Disaster

KW - Post-traumatic stress disorder

UR - http://www.scopus.com/inward/record.url?scp=84899685801&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899685801&partnerID=8YFLogxK

U2 - 10.1017/S0033291713002924

DO - 10.1017/S0033291713002924

M3 - Article

VL - 44

SP - 2085

EP - 2098

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 10

ER -