Coping Responses and Psychological Outcomes in Latino World Trade Center (WTC) Responders

Background:Upwards of 50,000 people are estimated to have participated in the rescue and recovery efforts at the World Trade Center (WTC) site. These responders endured unprecedented hazardous working conditions and psychological stressors while working at Ground Zero and/or the Staten Island landfill.  Our study aimed to characterize longitudinal trajectories of PTSD symptoms in WTC responders.  Further, little is known about how Latino responders are coping since 9/11 and how their coping influences their psychological wellbeing.

Methods:We analyzed data from a cohort of 10,835 WTC responders, including 4,035 police first responders and 6,800 non-traditional responders who attended monitoring visits at the Mount Sinai WTC Health Program (WTC-HP) an average of 3, 6, and 8 years post-9/11.  We used latent growth mixture modeling (LGMM) to characterize longitudinal trajectories of WTC-related PTSD symptoms in rescue and recovery workers. Multinomial logistic regression analyses were then conducted to assess determinants of the WTC-related PTSD symptom trajectories. Additionally, we are presently conducting a Web-based survey of over 3,000 WTC responders, focusing on coping, social support and other potentially protective factors, with a particular interest in Latino responders. The Web-based survey includes the Posttraumatic Growth Inventory-Short Form (PTGI-SF), Response to Stressful Experiences Scale (RSES), Trait Positive and Negative Affect Schedule (PANAS), Quality of Life Enjoyment and Satisfaction Scale-Short Form (Q-LES-Q-SF), and Medical Outcomes Study Social Support Survey (MOS-SSS), among other scales. Participant responses to the survey scales and three open-ended questions will be used in mixed method-data analyses.

Results:We found that a 4-class solution best characterized longitudinal PTSD symptoms in police WTC responders: resistant (77.8%), delayed-onset (8.5%), recovering (8.4%), and severe chronic (5.3%). In non-traditional WTC responders, a 6-class solution was optimal: resistant (58.0%), recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%), and moderate chronic (6.2%). In both police and non-traditional responders, prior psychiatric history, Hispanic ethnicity, severity of WTC exposure, and WTC-related medical conditions were strongly associated with symptomatic PTSD trajectories. Conversely, greater education, and family and work support while working at the WTC site were protective against the more symptomatic trajectories.  Given the association we and others have found between Hispanic ethnicity and higher PTSD symptom levels in responders, we will focus on potentially protective factors and coping in Latino responders in analyses of our ongoing Web-based survey data.

Conclusion: This study identified heterogeneous PTSD symptom trajectories in WTC responders. While police responders were less likely than non-traditional responders to have elevated PTSD symptom levels, Hispanic ethnicity was among the risk factors for symptomatic PTSD trajectories in both groups, in addition to exposure severity and pre-9/11 psychiatric history. Additional findings from our ongoing Web-based survey on coping and other potentially protective factors among Latino responders will be presented, of importance for prevention and treatment efforts in this population.