ABSTRACT
BACKGROUND: Symptoms of post-traumatic stress disorder (PTSD) have been reported even years after the terrorist attacks of September 11, 2001 (9/11). METHODS: We used screening tools to assess the prevalence of probable PTSD in 9/11-exposed firefighters at two time points, within 6 months of 9/11 (baseline) and 3-4 years post-disaster (follow-up). RESULTS: Five thousand six hundred fifty-six individuals completed assessments at both times. 15.5% reported probable PTSD post-9/11, 8.6% at baseline and 11.1% at follow-up, on average 2.9 (SD 0.5) years later. Analyses revealed that nearly half of all probable PTSD occurred as delayed onset (absent baseline, present follow-up). Compared with the resilient group (no probable PTSD at either time), probable PTSD at baseline, and delayed onset at follow-up were each associated with concomitant functional impairment (OR 19.5 and 18.9), respectively. CONCLUSION: Similar percentages of firefighters met criteria for baseline and delayed onset probable PTSD at follow-up, years later. Both were associated with substantial functional impairment. Early risk identification could provide opportunities for mental health interventions before symptoms compromise work and social relationships.
Subject(s)
Fires/statistics & numerical data , Occupational Diseases/psychology , Occupational Exposure/adverse effects , September 11 Terrorist Attacks/statistics & numerical data , Stress Disorders, Post-Traumatic/psychology , Adult , Alcoholism , Confidence Intervals , Disease Progression , Female , Humans , Logistic Models , Longitudinal Studies , Male , Mental Health , Middle Aged , Multivariate Analysis , New York City/epidemiology , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Odds Ratio , Prevalence , Psychometrics , Risk Assessment , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires , Time Factors , Young AdultABSTRACT
OBJECTIVES: We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health-related medical leave over the first 2.5 years after the attack. METHODS: Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis. RESULTS: Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health-related medical leave. Exposure-response gradients were significant for all outcomes. CONCLUSIONS: This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.
Subject(s)
Fires , Occupational Exposure/adverse effects , September 11 Terrorist Attacks , Stress Disorders, Post-Traumatic/epidemiology , Surveys and Questionnaires , User-Computer Interface , Adult , Humans , Male , Mass Screening , Middle Aged , New York City/epidemiology , Rescue Work , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/physiopathology , Workforce , Young AdultABSTRACT
INTRODUCTION: A large number of firefighters retired after 11 September 2001. These retirees were confronted with multiple challenges, including grief, trauma-related physical injuries and psychological distress, difficulties related to the transition of their roles, and deterioration of social support. OBJECTIVE: The Fire Department of New York (FDNY) Counseling Service Unit's "Stay Connected" Program designed and implemented after 11 September 2001 is described in this report. This unique program was designed to use a combination of peer outreach and professional counseling to address the mental health needs of retiring firefighters and their families. METHODS: Descriptive information about the intervention program was gathered through semi-structured interviews with Counseling Service Unit staff. Client satisfaction surveys were collected during three six-week periods. RESULTS: Quantitative data indicate that clients rated their overall satisfaction with the clerical and counseling staff a perfect 4 out of 4. The report of their overall satisfaction with the services also was nearly at ceiling (3.99 out 4). The perceived helpfulness of the services in resolving the problems experienced by the clients increased significantly over time. Qualitative data indicate that peer involvement and intensive community outreach, i.e., social events, wellness activities, and classes, were integral to the success of the intervention. CONCLUSIONS: This project provided valuable lessons about how to develop and implement a "culturally competent"intervention program for public safety workers retiring after a disaster. Creative, proactive, non-traditional outreach efforts and leveraging peers for credibility and support were particularly important.
