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

Authors

Jeanne Mager Stellman, Mount Sinai School of Medicine
Rebecca P. Smith, Mount Sinai School of Medicine
Craig L. Katz, Mount Sinai School of Medicine
Vansh Sharma, Mount Sinai School of Medicine
Dennis S. Charney, Mount Sinai School of Medicine
Robin Herbert, Mount Sinai School of Medicine
Jacqueline Moline, Mount Sinai School of Medicine
Benjamin J. Luft, SUNY-Stony Brook
Steven Markowitz, CUNY Queens College
Iris Udasin, University of Medicine and Dentistry of New Jersey
Denise Harrison, New York University
Sherry Baron, Centers for Disease Control
Philip J. Landrigan, Mount Sinai School of Medicine
Stephen M. Levin, Mount Sinai School of Medicine
Steven Southwick, Mount Sinai School of Medicine

Document Type

Article

Publication Date

September 2008

Abstract

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.

Comments

This work was originally published in Environmental Health Perspectives, available at doi:10.1289/ehp.11164.