Mental and physical health outcomes of World Trade Center disaster volunteers

Background: Volunteers are universally present at man-made and natural disasters and may share experiences and exposures with victims, yet little is known of their health outcomes.

Objectives: To compare mental and physical health outcomes among 4,974 volunteers who performed World Trade Center (WTC)-related rescue/recovery work.

Methods: We studied adults who completed the WTC Health Registry 2006-07 survey and reported volunteering between 9/11/01 and 6/30/02. We examined associations between volunteer type (affiliated with an organization [n=3702], spontaneous [n=1272]) and probable posttraumatic stress disorder (PTSD); new/worsening lower respiratory symptoms; post-9/11 first diagnosis of anxiety disorder, depression, and/or PTSD; and asthma/reactive airway dysfunction syndrome (RADS). Odds ratios adjusted for select demographic characteristics (ORadj) were calculated using multinomial regression.

Results: Spontaneous volunteers were more likely than affiliated volunteers to have been present in lower Manhattan (77.4% vs. 25.8%), worked at the WTC site (34.8% vs. 11.9%), witnessed horror (90.9% vs. 85.6%), and sustained injury (25.1% vs. 16.8%) on 9/11/01. They had greater odds of having an early post-911 mental health diagnosis (ORadj 1.6; 95% CI: 1.3-1.8), chronic probable PTSD (2.2; 1.7-2.8), late-onset probable PTSD (1.9; 1,5-2.5), new/worsening lower respiratory symptoms (2.0; 1.8-2.4), and early post-9/11 asthma/RADS (1.8; 1.2-2.7) and were more likely to report unmet healthcare needs than affiliated volunteers (29.8% vs. 16.1%).

Conclusion: These findings may reflect more intense exposure to physical and psychological hazards among spontaneous volunteers due to their earlier arrival. This suggests all volunteers need protection during and after disasters, including timely screening and mental and physical healthcare.