Mental health of workers and volunteers responding to events of 9/11: Review of the literature

Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine (Impact Factor: 1.62). 03/2008; 75(2):115-27. DOI: 10.1002/msj.20026
Source: PubMed


Disaster workers responding to the events of September 11th were exposed to traumatic events. No study has systematically investigated the diverse mental health status and needs of the heterogeneous population of disaster workers responding to the events of September 11th.
Using PubMed and Medline and the search terms of "September 11, 2001" or "September 11" or "9/11"or "WTC" or "World Trade Center", the authors reviewed all articles that examined the mental health outcomes of workers at one of the three September 11th crash sites or the Fresh Kills landfill in New York City.
In total, 25 articles met study inclusion criteria, often using different methodologies. The articles described varying degrees of mental health symptomatology, risk factors for adverse mental health outcomes, and utilization of mental health services.
The mental health needs of workers exposed to the events of September 11th ranged from little to no care to pharmacotherapy. A range of risk factors, including exposures at the WTC site and occupational activities, impacted on these needs but the role of specific mental health interventions was less clear. These findings suggest the need for a future program for disaster workers consisting of an accessible mental health treatment service supported by comprehensive postdisaster surveillance and emphasis on pre-disaster mental wellness. A number of areas for further consideration and study were identified, including the need for a more diverse exploration of involved responder populations as well as investigation of potential mental health outcomes beyond post-traumatic stress disorder (PTSD).

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    • "An example of acute and subchronic massive exposures was the World Trade Center 9/11-related environmental disaster (Bills et al., 2008; Jordan et al., 2013; Ozbay et al., 2013). Massive exposure to a complex mixture of inhalable fine PM, nanoparticles (NPs) and toxic chemicals, resulted in persistent mental detrimental effects and evolution toward unknown brain health outcomes beyond posttraumatic stress disorder (Bills et al., 2008; Jordan et al., 2013; Ozbay et al., 2013). The olfactory bulb (OB) pathology needs special attention because large segments of the world population inhale toxic substances on daily basis that have the potential for harming the olfactory system and penetrating the brain via the olfactory epithelium (Calderón-Garcidueñas et al., 2010). "
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    ABSTRACT: Research links air pollution mostly to respiratory and cardiovascular disease. The effects of air pollution on the central nervous system (CNS) are not broadly recognized. Urban outdoor pollution is a global public health problem particularly severe in megacities and in underdeveloped countries, but large and small cities in the United States and the United Kingom are not spared. Fine and ultrafine particulate matter (UFPM) defined by aerodynamic diameter (<2.5-μm fine particles, PM 2.5 , and <100-nm UFPM) pose a special interest for the brain effects given the capability of very small particles to reach the brain. In adults, ambient pollution is associated to stroke and depression, whereas the emerging picture in children show significant systemic inflammation, immunodysregulation at systemic, intratechal and brain levels, neuroinflammation and brain oxidative stress, along with the main hallmarks of Alzheimer and Parkinson’s diseases: hyperphosphorilated tau, amyloid plaques and misfolded α -synuclein. Animal models exposed to particulate matter components show markers of both neuroinflammation and neurodegeneration. Epidemiological, cognitive, behavioral and mechanistic studies into the association between air pollution exposures and the development of CNS damage particularly in children are of pressing importance for public health and quality of life. Primary health providers have to include a complete prenatal and postnatal environmental and occupational history to indoor and outdoor toxic hazards and measures should be taken to prevent or reduce further exposures.
    Primary Health Care Research & Development 09/2014; Prim Health Care Res Dev. 2014 Sep 26:1-17(04). DOI:10.1017/S146342361400036X
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    • "Aldrich et al. 2010). High rates of probable PTSD assessed with selfreport measures such as the PTSD Checklist (PCL) have also been reported for responder cohorts (Perrin et al. 2007 ; Bills et al. 2008 ; Farfel et al. 2008 ; Stellman et al. 2008 ; Brackbill et al. 2009 ; Berninger et al. 2010 ; Niles et al. 2011 ; Wisnivesky et al. 2011). For example, a study of firefighters found annual rates for the first 4 years after 9/11 of about 10 % per year (Berninger et al. 2010). "
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    ABSTRACT: Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
    Psychological Medicine 05/2012; 42(5):1069-79. DOI:10.1017/S003329171100256X · 5.94 Impact Factor
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    • "Additionally , disaster workers who perceived their lives were in danger were more likely to report PTSD symptoms (Cukor et al., 2011). Studies investigating the mental health outcomes of disaster workers and volunteers who responded to 9/11 have found varying results (Bills et al., 2008). Perrin et al. (2007) conducted an analysis of almost 29,000 rescue and recovery workers from various professional and volunteer organizations who enrolled in the WTC Health Registry using the PTSD Checklist (PCL; Weathers , Litz, Herman, Huska, & Keane, 1993) and found an overall PTSD prevalence of 12.4% for workers 2 to 3 years after 9/11, ranging from 6.2% for police to 21.2% for volunteers unaffiliated with organizations working at the site. "
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    ABSTRACT: This study examined the long-term mental health outcomes of 2,960 nonrescue disaster workers deployed to the World Trade Center site in New York City following the September 11, 2001 (9/11) terrorist attacks. Semistructured interviews and standardized self-report measures were used to assess the prevalence of posttraumatic stress disorder (PTSD) and other psychopathology 4 and 6 years after the attacks. Clinician-measured rates of PTSD and partial PTSD 4-years posttrauma were 8.4% and 8.9%, respectively, in a subsample of 727 individuals. Rates decreased to 5.8% and 7.7% for full and partial PTSD 6 years posttrauma. For the larger sample, self-report scores revealed probable PTSD and partial PTSD prevalence to be 4.8% and 3.6% at 4 years, and 2.4% and 1.8% at 6 years. Approximately 70% of workers never met criteria for PTSD. Although PTSD rates decreased significantly over time, many workers remained symptomatic, with others showing delayed-onset PTSD. The strongest predictors of ongoing PTSD 6 years following 9/11 were trauma history (odds ratio (OR) = 2.27, 95% confidence interval (CI) [1.06, 4.85]); the presence of major depressive disorder 1-2 years following the trauma (OR = 2.80, 95% CI [1.17, 6.71]); and extent of occupational exposure (OR = 1.31, 95% CI [1.13, 1.51]). The implications of the findings for both screening and treatment of disaster workers are discussed.
    Journal of Traumatic Stress 10/2011; 24(5):506-14. DOI:10.1002/jts.20672 · 2.72 Impact Factor
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