Trends in elevated PTSD risk in firefighters exposed to the World Trade Center Disaster: 2001-2005

Objectives: To describe trends in elevated risk of Post-Traumatic Stress Disorder (PTSD) as determined by the PTSD Checklist in World Trade Center (WTC)-exposed firefighters, and examine symptom progression in the cohort that completed both year-one and year-three or four (follow-up) questionnaires.

Methods: We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from 9/12/01 to 9/11/05, defining exposure based on arrival time and duration of work at the WTC site. Additionally, we modeled outcomes of elevated PTSD risk in the cohort of 5,817.

Results: In cross-sectional analyses, the prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p<0.0001). Risk was greatest in firefighters who arrived earliest (OR 2.8; 95% CI 2.5-3.2), worked longest at the WTC site (OR 2.0; 95% CI 1.8-2.3), retired due to a WTC-related disability (OR 1.5; 95% CI 1.3-1.8), experienced more coworker deaths in their firehouse (OR 1.8; 95% CI 1.0-3.3), or supervised without previous supervisory experience (OR 4.5; 95% CI 3.1-6.7). Of those ever displaying symptoms of elevated PTSD risk 27.0% were persistent at follow-up, 44.5% were delayed in onset and only presented at follow-up, and 28.5% remitted by follow-up. Elevated PTSD risk correlated with difficulty functioning at year one (OR 16.6; 95% CI 13.5-20.1) and at follow-up (OR 21.2; 95% CI 17.6-25.7).

Conclusions: Elevated PTSD risk is associated with functional impairment and remains largely unabated three-to-four years post disaster. Risk identification is the first step towards counseling and reductions in disease prevalence, severity and progression.