Co-Morbid Trends in Physical and Mental Health Symptoms in World Trade Center-Exposed Firefighters

Objective: To evaluate co-morbidity of World Trade Center (WTC)-related physical health symptoms and Post-Traumatic Stress Disorder (PTSD) in Fire Department, City of New York (FDNY) firefighters.

Methods: Firefighters were enrolled in the FDNY-WTC-Monitoring Program, which includes pulmonary function tests (PFTs) and health questionnaires. FDNY-defined PTSD required endorsement of both >9 of 14 symptoms and all DSM-IV-TRŪ domains (arousal, avoidance and re-experiencing). We evaluated WTC-related physical health symptoms in firefighters with and without PTSD and the relationship between endorsement of each DSM-IV-TRŪ PTSD domain and presence in the top quartile of physical symptom counts (TQ-PSC).

Results: 8.6% of 5,280 firefighters met our definition of PTSD within 1 year of 9/11; 10.3% did so 2-4 years later. In multivariable analysis, > 2 lower respiratory and >2 gastrointestinal symptoms were independently associated with PTSD (ORs 1.9 and 3.1, respectively). Endorsement of individual domains including arousal, avoidance and re-experiencing was associated with TQ-PSC (ORs 2.8, 2.0 and 1.6, respectively). Better pulmonary function was protective against TQ-PSC (OR 0.87).

Conclusions: We found concordance between PTSD and post-WTC physical symptoms at both time points. Because PTSD and physical symptoms were measured simultaneously, we could not determine directionality. However, PFT results were only associated with physical symptoms.