TY - JOUR
T1 - Trajectories of PTSD risk and resilience in World Trade Center responders
T2 - An 8-year prospective cohort study
AU - Pietrzak, R. H.
AU - Feder, A.
AU - Singh, R.
AU - Schechter, C. B.
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 - Landrigan, P. J.
AU - Southwick, S. M.
PY - 2014/1
Y1 - 2014/1
N2 - Background Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri-and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. Method A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. Results Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. Conclusions Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri-and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
AB - Background Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri-and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. Method A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. Results Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. Conclusions Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri-and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
KW - Disaster
KW - latent modeling
KW - longitudinal data
KW - post-traumatic stress disorder
KW - responders
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=84889787866&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84889787866&partnerID=8YFLogxK
U2 - 10.1017/S0033291713000597
DO - 10.1017/S0033291713000597
M3 - Article
C2 - 23551932
AN - SCOPUS:84889787866
SN - 0033-2917
VL - 44
SP - 205
EP - 219
JO - Psychological Medicine
JF - Psychological Medicine
IS - 1
ER -
