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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. Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders. Psychol Med 2014; 44:2085-2098. [PMID: 24289878 DOI: 10.1017/s0033291713002924] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- R H Pietrzak
- National Center for Posttraumatic Stress Disorder,VA Connecticut Healthcare System,West Haven, CT,USA
| | - A Feder
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - C B Schechter
- Department of Family and Social Medicine,Albert Einstein College of Medicine of Yeshiva University,Bronx, NY,USA
| | - R Singh
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - L Cancelmo
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - E J Bromet
- Department of Psychiatry,Stony Brook University,Stony Brook, NY,USA
| | - C L Katz
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - D B Reissman
- Office of the Director,National Institute for Occupational Safety and Health,Washington, DC,USA
| | - F Ozbay
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - V Sharma
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - M Crane
- Department of Preventive Medicine,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - D Harrison
- Department of Environmental Medicine,Bellevue Hospital Center/New York University School of Medicine,New York, NY,USA
| | - R Herbert
- Department of Preventive Medicine,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - S M Levin
- Department of Preventive Medicine,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - B J Luft
- Department of Medicine, Division of Infectious Diseases,Stony Brook University,Stony Brook, NY,USA
| | - J M Moline
- Department of Population Health,Hofstra North Shore-Long Island Jewish School of Medicine,Great Neck, NY,USA
| | - J M Stellman
- Department of Health Policy and Management,Mailman School of Public Health, Columbia University,New York, NY,USA
| | - I G Udasin
- Department of Environmental and Occupational Medicine,UMDNJ-Robert Wood Johnson Medical School,Piscataway, NJ,USA
| | - R El-Gabalawy
- Departments of Psychology and Psychiatry,University of Manitoba,Winnipeg, Manitoba,Canada
| | - P J Landrigan
- Department of Preventive Medicine,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - S M Southwick
- National Center for Posttraumatic Stress Disorder,VA Connecticut Healthcare System,West Haven, CT,USA
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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. Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study. Psychol Med 2014; 44:205-219. [PMID: 23551932 DOI: 10.1017/s0033291713000597] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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Affiliation(s)
- R H Pietrzak
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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Reissman DB, Staley F, Curtis GB, Kaufmann RB. Use of geographic information system technology to aid Health Department decision making about childhood lead poisoning prevention activities. Environ Health Perspect 2001; 109:89-94. [PMID: 11171530 PMCID: PMC1242056 DOI: 10.1289/ehp.0110989] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Centers for Disease Control and Prevention recommend that local public health agencies use local data to identify children at risk for lead exposure to ensure that they receive preventive services. The objective of this study was to demonstrate the usefulness of a geographic information system (GIS) in identifying children at risk for lead exposure. We conducted a descriptive study, using GIS technology, of the blood lead (BPb) levels and residential location of at-risk children screened for lead exposure. "At-risk children" were defined as those children living in housing built before 1950 or in an area with a high proportion of older housing. The study was conducted in Jefferson County, Kentucky, USA. Participants were the cohort of children born in 1995 and screened from 1996 through 1997, and children younger than age 7 years who were screened from 1994 through 1998. Outcome measures were the BPb level and residential location (address or target zone) of at-risk children screened from 1996 through 1997, and the number and location of homes where more than one child had been poisoned by lead from 1994 through 1998. The proportion of children screened who live within zones targeted for universal screening varied from 48% to 53%, while only 50% of the at-risk children in the entire county were screened. Between 1994 and 1998, 79 homes housed 35% of the 524 children with lead poisoning. These housing units were prioritized for lead-hazard remediation. Significant numbers of at-risk children throughout the county were not being tested for lead exposure, even in prioritized areas. GIS can be very useful to health departments in planning lead exposure screening strategies and measuring program performance.
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Affiliation(s)
- D B Reissman
- Lead Poisoning Prevention Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
This is a cross-sectional study consisting of self-administered survey instruments to measure psychological distress and stress-inducing work demands after 6 months of rumors about an upcoming corporate downsizing event. The workforce consisted predominantly of white males who were married, college-educated, and nonsmokers. Higher stress levels were seen among older, more educated workers, who had longer company tenure. Role boundary problems, noxious physical environments, and company tenure were retained in the final multivariable model predicting distress level. The ongoing time delay for management to implement the threatened layoff and peer rankings for a new job performance appraisal contributed to a decline in worker solidarity because of concerns about career and job security. These uncertainties reduced worker productivity and effective teamwork.
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Affiliation(s)
- D B Reissman
- Great Lakes Center for Occupational and Environmental Safety and Health, School of Public Health, University of Illinois at Chicago, USA
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