Psychiatr News September 7, 2007
Volume 42, Number 17, page 1
© 2007 American Psychiatric Association
Job-Related Variations Found in Rescue Workers' PTSD Rates
Aaron Levin
A study published on the sixth anniversary of 9/11 reports that the
prevalence rate of current probable PTSD among nearly 29,000 workers at the
World Trade Center averages 12.4 percent.
Training and experience go a long way in reducing the aftereffects of
traumatic stress, according to a study of thousands of workers who toiled at
the World Trade Center site in Manhattan in the nine months following the
September 11, 2001, terror attacks.
Two to three years after the event, police officers had the lowest
prevalence of posttraumatic stress disorder (PTSD) among the eight
occupational groups represented among the workers, wrote Megan Perrin, M.P.H.,
of the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, N.Y.,
and colleagues in the September American Journal of Psychiatry. The
researchers used both the PTSD Checklist–Civilian Version and
DSM-IV diagnostic criteria to evaluate PTSD.
The prevalence of current probable PTSD among the 28,962 workers enrolled
in the World Trade Center Health Registry averaged 12.4 percent. Police
officers showed a rate of 6.2 percent, while firefighters, emergency medical
or disaster personnel, and other employees of government agencies were twice
as likely to have PTSD.
Construction or engineering crew members (17.8 percent) and unaffiliated
volunteers (21.2 percent) recorded the highest rates of PTSD. The latter
category included people such as clergy, white-collar workers, and others who
reported occupations not directly related to rescue and recovery work.
Probability of PTSD rose for all occupations other than police as the time
they worked on the site increased. Not surprisingly, probabilities were higher
for those who began work in the first week after the attack than among those
who started after September 18.
Stepping outside of one's usual job boundaries added measurable stress,
too, wrote Perrin. PTSD risk increased for firefighters doing light
construction work, for sanitation workers doing search and rescue work, and
for police and emergency medical personnel fighting fires.
"Novelty does add a degree of stress," said emergency room
psychiatrist Anthony Ng, M.D., who was medical director of Disaster Psychiatry
Outreach in New York at the time of the terror attacks. He is also a member
and former chair of APA's Committee on Psychiatric Dimensions of Disasters.
"In simulations of job tasks, people show more stress if they're asked
to do something different."
"Prior training or experience may protect against the psychological
distress associated with disaster work," wrote Perrin, echoing results
of previous research by others.
However, that did not explain all the disparity between the police and
other first responders, she said. After Hurricane Katrina, for instance, the
prevalence of PTSD among New Orleans police officers was 19 percent, close to
the 22 percent reported for firefighters, although local conditions may have
influenced those outcomes.
Another factor that may account for some of the difference is that police
may underreport symptoms, fearing career repercussions, Perrin speculated. Or
perhaps the police force may have more rigorous pre-employment screening that
may produce more resilience than workers in other categories.
In addition, firefighters and paramedics, who lost 343 of their comrades
when the towers collapsed, may well have identified with the lost victims or
felt bereaved, adding to their psychological burden, she added. (Fires burned
at the site for 99 days after the attacks.)
Police and firefighters also have different cultures and working styles,
which may explain some variation in their response to stress, said Ng. Police
officers rely on authority and force to do their job, while firefighters and
medics rely on personality and persuasion, he said. That may increase the
stress on their psychological resources.
"Cops work alone or with a partner, while firefighters work in groups
and live together on the job," he suggested. "That might increase
their camaraderie and the hurt they felt after September 11."
Other workers may not have received the organizational support, mental
health services, or the public recognition that are available to police and
firefighters, all of which may have increased their distress.
Interventions targeted at specific occupational groups who work at major
disasters might alleviate the psychological burden that comes with their
participation, wrote Perrin and colleagues. "Disaster preparedness
training and shift rotations to enable a shorter duration of service at the
site may reduce PTSD among workers and volunteers in future
disasters."
Preparation does provide some buffer for future events, agreed Ng.
"But that means ongoing training, not practicing once a year,"
he said. "You have to know what to expect and not be surprised, even
when things are at their most chaotic."
"Differences in PTSD Prevalence and Associated Risk Factors
Among World Trade Center Disaster Rescue and Recovery Workers" is posted
at
<ajp.psychiatryonline.org>
under the September issue. 
Get information about faster international access.
Privacy Policy
Copyright © 2007
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
