Risk, coping and PTSD symptom trajectories in World Trade Center responders. (November 2016)

• Record Type: Journal Article
• Authors: Feder, Adriana; Mota, Natalie; Salim, Ryan; Rodriguez, Janice; Singh, Ritika; Schaffer, Jamie; Schechter, Clyde B.; Cancelmo, Leo M.; Bromet, Evelyn J.; Katz, Craig L.; Reissman, Dori B.; Ozbay, Fatih; Kotov, Roman; Crane, Michael; Harrison, Denise J.; Herbert, Robin; Levin, Stephen M.; Luft, Benjamin J.; Moline, Jacqueline M.; Stellman, Jeanne M.; Udasin, Iris G.; Landrigan, Philip J.; Zvolensky, Michael J.; Yehuda, Rachel; Southwick, Steven M.; Pietrzak, Robert H.
• Is Part Of: Journal of psychiatric research. Volume 82(2016:Nov.)
• Page Start: 68
• Page End: 79
• Publication Date: 2016-11
• Subjects: Posttraumatic stress disorder -- World Trade Center -- Responders -- Trajectories -- Risk -- Coping; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2016.07.003
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. Findings in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders.