The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort

Robert H. Pietrzak, Clyde B. Schechter, Evelyn J. Bromet, Craig L. Katz, Dori B. Reissman, Fatih Ozbay, Vansh Sharma, Michael Crane, Denise Harrison, Robin Herbert, Stephen M. Levin, Benjamin J. Luft, Jacqueline M. Moline, Jeanne M. Stellman, Iris G. Udasin, Philip J. Landrigan, Steven M. Southwick

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort. Methods: A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001. Results: The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4% and 15.4%, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs] = 1.56-1.86), pre-9/11 stressors (ORs = 1.30-1.50), family support (ORs = 0.83-0.94), and union membership (ORs = 0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR = 1.36), performing search and rescue work (OR = 1.29), and work support (OR = 0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs = 3.82-41.74), and somatic symptoms and functional difficulties (ORs = 1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs = 2.93-7.02; and ORs = 1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1% and 19.8%, respectively, versus 6.8% in trauma controls). Conclusions: These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel.

Original languageEnglish (US)
Pages (from-to)835-842
Number of pages8
JournalJournal of Psychiatric Research
Volume46
Issue number7
DOIs
StatePublished - Jul 2012

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Police
Post-Traumatic Stress Disorders
Odds Ratio
Disasters
Rescue Work
Recovery
Burden
World Trade Center
Rescue
Delivery of Health Care
Panic Disorder
Dust
Psychiatry
Cross-Sectional Studies
Alcohols
Interviews
Depression
Psychology

Keywords

  • Depression
  • Healthcare needs
  • Police
  • Posttraumatic stress disorder
  • World Trade Center

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Arts and Humanities (miscellaneous)

Cite this

The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. / Pietrzak, Robert H.; Schechter, Clyde B.; Bromet, Evelyn J.; Katz, Craig L.; Reissman, Dori B.; Ozbay, Fatih; Sharma, Vansh; Crane, Michael; Harrison, Denise; Herbert, Robin; Levin, Stephen M.; Luft, Benjamin J.; Moline, Jacqueline M.; Stellman, Jeanne M.; Udasin, Iris G.; Landrigan, Philip J.; Southwick, Steven M.

In: Journal of Psychiatric Research, Vol. 46, No. 7, 07.2012, p. 835-842.

Research output: Contribution to journalArticle

Pietrzak, RH, Schechter, CB, 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, Landrigan, PJ & Southwick, SM 2012, 'The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort', Journal of Psychiatric Research, vol. 46, no. 7, pp. 835-842. https://doi.org/10.1016/j.jpsychires.2012.03.011
Pietrzak, Robert H. ; Schechter, Clyde B. ; Bromet, Evelyn J. ; Katz, Craig L. ; Reissman, Dori B. ; Ozbay, Fatih ; Sharma, Vansh ; Crane, Michael ; Harrison, Denise ; Herbert, Robin ; Levin, Stephen M. ; Luft, Benjamin J. ; Moline, Jacqueline M. ; Stellman, Jeanne M. ; Udasin, Iris G. ; Landrigan, Philip J. ; Southwick, Steven M. / The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. In: Journal of Psychiatric Research. 2012 ; Vol. 46, No. 7. pp. 835-842.
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abstract = "Background: This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort. Methods: A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001. Results: The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4{\%} and 15.4{\%}, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs] = 1.56-1.86), pre-9/11 stressors (ORs = 1.30-1.50), family support (ORs = 0.83-0.94), and union membership (ORs = 0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR = 1.36), performing search and rescue work (OR = 1.29), and work support (OR = 0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs = 3.82-41.74), and somatic symptoms and functional difficulties (ORs = 1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs = 2.93-7.02; and ORs = 1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1{\%} and 19.8{\%}, respectively, versus 6.8{\%} in trauma controls). Conclusions: These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel.",
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AU - Katz, Craig L.

AU - Reissman, Dori B.

AU - Ozbay, Fatih

AU - Sharma, Vansh

AU - Crane, Michael

AU - Harrison, Denise

AU - Herbert, Robin

AU - Levin, Stephen M.

AU - Luft, Benjamin J.

AU - Moline, Jacqueline M.

AU - Stellman, Jeanne M.

AU - Udasin, Iris G.

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N2 - Background: This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort. Methods: A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001. Results: The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4% and 15.4%, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs] = 1.56-1.86), pre-9/11 stressors (ORs = 1.30-1.50), family support (ORs = 0.83-0.94), and union membership (ORs = 0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR = 1.36), performing search and rescue work (OR = 1.29), and work support (OR = 0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs = 3.82-41.74), and somatic symptoms and functional difficulties (ORs = 1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs = 2.93-7.02; and ORs = 1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1% and 19.8%, respectively, versus 6.8% in trauma controls). Conclusions: These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel.

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KW - Depression

KW - Healthcare needs

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KW - World Trade Center

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