Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site

OBJECTIVE: We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site. METHODS: A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques. RESULTS: Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced. CONCLUSIONS: These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly.     

Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster

BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. OBJECTIVES: Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. METHODS: Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. RESULTS: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. CONCLUSIONS: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.     

PTSD and depression among displaced Chinese workers after the world trade center attack: A follow-up study

We conducted a follow-up assessment to assess the development of Posttraumatic Stress Disorder (PTSD) and depression among Chinese immigrants after the World Trade Center attack. Sixty-five Chinese displaced workers who were originally interviewed in May 2002 were re-interviewed in March 2003. Whereas depression scores decreased over time, avergae PTSD scores remained unchanged. The trajectory of posttraumatic stress symptoms was more complex, with an increasing number of individuals who show no or little emotional health problems and another increasing group of individuals with exacerbated posttraumatic stress symptoms. Although the mean values of the re-experiencing and hypervigilance cluster did not change over time, the mean value of the avoidance/numbing cluster increased significantly from time 1 (M=4.60, SD=4.98) to time 2 (M=6.34, SD=4.24), (F_1.61=5.69, P=.02). A higher proportion of subjects met diagnostic criteria of PTSD at time 2 (27%) than at time 1 (21%). The study highlights the importance of ongoing mental health surveillance of diverse cultural and linguistic groups after a major traumatic event. The time of the study, Dr. Thiel de Bocanegra was vice president for Research and Evaluation at Safe Horizon