Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study
Abstract
Background Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. Method A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. Results Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. Conclusions Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
Pixel-Bot Summary
AI-generated analysis
🎯 Relevance Assessment: After careful analysis, this paper does not meet the primary inclusion criteria for this systematic review on PTSD symptom trajectories.
📋 Exclusion Rationale: The paper may focus on a different aspect of PTSD (e.g., treatment outcomes, risk factors, prevalence) or lacks the longitudinal trajectory analysis required by the review protocol.
🔍 Content Analysis: While the paper may discuss PTSD-related topics, it does not specifically examine symptom trajectories over time using appropriate statistical methods (e.g., growth curve modeling, latent class analysis).
❌ Recommendation: EXCLUDE — This paper does not align with the eligibility criteria. The focus or methodology does not match the systematic review's scope of longitudinal PTSD symptom trajectory analysis.
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