Thousands of World Trade Center rescue and recovery workers were still suffering serious mental health effects three years after the disaster, the Health Department reported today. New findings released from the World Trade Center Health Registry show that one in eight rescue and recovery workers (12.4%) likely had post-traumatic stress disorder when they were interviewed in 2003 and 2004. The findings were published today in the American Journal of Psychiatry, available online at www.ajp.psychiatryonline.org (direct link: http://ajp.
The new data come from the World Trade Center Health Registry's initial survey of nearly 30,000 rescue and recovery workers. The respondents ranged from police officers and firefighters to clergy and construction workers. The prevalence of post-traumatic stress disorder (PTSD) varied significantly by occupation, with rates ranging from 6.2% among police officers to 21.2% among unaffiliated volunteers (those who were not working with an organization such as the Red Cross). The prevalence of PTSD in the U.S. population is roughly 4% at any given time.
Like the unaffiliated volunteers, workers from non-emergency occupations such as construction, engineering and sanitation also suffered particularly high rates of PTSD. It is unlikely that these workers had gone through disaster preparedness training or had experience with previous emergencies, both of which can help buffer psychological trauma.
People who started work on or soon after 9/11, or who worked for longer periods, were also more vulnerable to PTSD. For all occupations except police, the risk of PTSD was greatest among those who worked at the site for more than three months. The finding suggests that shortening work periods, and limiting exposure of those who have less prior exposure to trauma, might help reduce PTSD rates in future emergencies.
"Post-traumatic stress disorder can be devastating, affecting people's families and work lives," said Dr. Thomas R. Frieden, New York City Health Commissioner. "People with PTSD are also more likely to suffer from depression and substance abuse. The Registry helps us gauge the persistence of these problems over time. It also helps us inform the public and the medical community about the health effects of 9/11, so that people can get the best possible care."
The survey found that firefighters developed PTSD at nearly twice the rate of police officers (12.2% versus 6.2%), a finding consistent with past research. The discrepancy is not well understood, but the authors offer several possible explanations. It may reflect the rigorous screening that police recruits undergo, but it could also reflect under-reporting by police officers who fear being judged unfit for duty. In addition, firefighters lost six times as many comrades as police officers, suggesting that grief may have compounded the trauma and the risk of PTSD.
Sustaining an injury, or having to evacuate a building, raised the risk of PTSD in nearly all of the groups surveyed. But other risk factors affected only certain types of workers. Performing search and rescue work raised the risk of PTSD for engineering and sanitation workers, but civilian volunteers were more likely to suffer if they engaged in firefighting or light construction work. This suggests again that working outside of one's area of expertise can place people at risk for developing PTSD.
The new findings highlight the value of disaster preparedness and training for all types of emergency responders, and point to concrete steps that could help minimize PTSD in future disasters:
• Use shift rotations to reduce workers' and volunteers' duration of service at emergency sites.
• Establish mental-health services to address the needs of rescue and recovery workers who have received less disaster training than police and fire staff.
The Health Department has linked all survey participants with mental-health issues to LifeNet, a 24-hour hotline operated by the Mental Health Association of New York City. LifeNet provides an assessment, information and referrals and assists the caller in determining an appropriate place for care. When a person is in crisis, LifeNet will refer to a Mobile Crisis Team and will follow up to ensure contact is made. If you or someone you know is suffering with PTSD, or any other emotional or substance abuse problem, call 311 and ask for LifeNet. Services are available in multiple languages.
Update on Efforts to Learn More about WTC-Related Illness
The World Trade Center Health Registry, the largest public health registry in U.S. history, was launched in 2003 to track the health of people exposed to the collapse of the World Trade Center and those who worked at the WTC site. The registry is a collaborative effort involving the Health Department, the CDC's Agency for Toxic Substances and Disease Registry (ATSDR), with funding from the Federal Emergency Management Agency (FEMA).
The Health Department is now re-surveying all 71,000 registrants to learn more about their current health status. So far, nearly 60% of registrants have responded. The re-survey will help determine whether respiratory and mental health conditions have persisted five to six years after the disaster. Because of its size, the registry can illuminate patterns that would elude individual physicians and provide valuable guidance to affected groups. Previous findings from the WTC Health Registry can be found at www.nyc.gov/html/doh/html/wtc/materials.html.
The Health Department is also conducting a separate study of respiratory health among registrant and analyzing records to see whether the disaster has had affected cancer incidence. The Health Department - along with the Fire Department, Mount Sinai Medical Center and Bellevue Hospital - is also updating guidelines for treating adults with WTC-related illness. The same group is developing guidelines for treating affected children.
PTSD is an anxiety disorder that can result from experiences marked by intense fear, hopelessness or horror. The common causes include war, terrorism and personal assault. Symptoms include avoiding situations reminiscent of the event, reliving the event when reminded of it, feeling emotionally numb, or feeling hyper-alert. Many people recover with counseling or medication, but PTSD can be very disruptive to those who suffer from it, leading to family and work problems, as well as drug and alcohol abuse.