World Trade Center Disaster Exposure-Related Probable Posttraumatic Stress Disorder among Responders and Civilians: A Meta-Analysis

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Probable posttraumatic stress disorder (PTSD) stands out as one of the major syndromes that appears to have endured over the decade following the World Trade Center (WTC) disaster in New York Metropolitan area. One could hypothesize that the risk of having PTSD might be higher in responders than civilian populations. Differences in the PTSD risks were attributable to diverse exposure classifications and cohort types, as well as other moderators such as data sources, PTSD assessment instrument/criteria, and lapse time since 9/11. Because all the PTSD assessments from the studies were based on self-report and not clinical diagnostics, the PTSD referred to in this study is probable PTSD. The results from the pooled data of ten primary studies comprising of either civilains alone, respondents alone or a mixed population yieled a range of associations. For example, the associations between exposure and probable PTSD were weaker in responders than civilians, and this difference was more pronounced for physical compared to psychosocial exposure types. On one hand, the responders faced unprecedented, treacherous working conditions at the site and were potentially under more intense physical and psychological stress.

The World Trade Center (WTC) disaster on September 11th 2001 (9/11) was an unprecedented traumatic event to the responders and civilians in the New York metropolitan area and beyond. The study objective was to conduct a meta-analysis of WTC- related studies to evaluate and compare the probable PTSD risk associated with specific exposures among adults in the greater New York area, and to examine whether discrepancies in aspects of study design such as WTC exposure classification and cohort type (i.e. responders vs. civilians) affected PTSD risk. Although the study demonstrates significant positive associations between the WTC exposure and probable PTSD, there remains a need for high quality primary studies utilising psychosocial surveillance techniques such as questionnaires that are able to distinguish between the nature and severity of exposure types. Furthermore, future studies of WTC responders and civilians should provide more specific information on exposure and mental health outcomes so that meta-analyses of long-term effects can encompass a broader array of studies in order to develop and modify existing response and recovery plans, and to prepare and mitigate for future disasters.

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