Trajectories of PTSD risk and resilience in World Trade Center responders: An 8-year prospective cohort study

R. H. Pietrzak, A. Feder, R. Singh, Clyde B. Schechter, 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, P. J. Landrigan, S. M. Southwick

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)205-219
Number of pages15
JournalPsychological Medicine
Volume44
Issue number1
DOIs
StatePublished - Jan 2014

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Post-Traumatic Stress Disorders
Cohort Studies
Prospective Studies
Police
Psychiatry
Wounds and Injuries
Disasters
Hispanic Americans
Morbidity
Education
Health
Protective Factors
Therapeutics

Keywords

  • Disaster
  • latent modeling
  • longitudinal data
  • post-traumatic stress disorder
  • responders
  • risk factors

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

Trajectories of PTSD risk and resilience in World Trade Center responders : An 8-year prospective cohort study. / Pietrzak, R. H.; Feder, A.; Singh, R.; Schechter, Clyde B.; 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.; Landrigan, P. J.; Southwick, S. M.

In: Psychological Medicine, Vol. 44, No. 1, 01.2014, p. 205-219.

Research output: Contribution to journalArticle

Pietrzak, RH, Feder, A, Singh, R, 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 2014, 'Trajectories of PTSD risk and resilience in World Trade Center responders: An 8-year prospective cohort study', Psychological Medicine, vol. 44, no. 1, pp. 205-219. https://doi.org/10.1017/S0033291713000597
Pietrzak, R. H. ; Feder, A. ; Singh, R. ; Schechter, Clyde B. ; 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. ; Landrigan, P. J. ; Southwick, S. M. / Trajectories of PTSD risk and resilience in World Trade Center responders : An 8-year prospective cohort study. In: Psychological Medicine. 2014 ; Vol. 44, No. 1. pp. 205-219.
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abstract = "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.",
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T2 - An 8-year prospective cohort study

AU - Pietrzak, R. H.

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AU - Singh, R.

AU - Schechter, Clyde 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.

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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.

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