TY  - JOUR
PY  - 2016//
TI  - Risk, coping and PTSD symptom trajectories in World Trade Center responders
JO  - Journal of psychiatric research
A1  - Feder, Adriana
A1  - Mota, Natalie
A1  - Salim, Ryan
A1  - Rodriguez, Janice
A1  - Singh, Ritika
A1  - Schaffer, Jamie
A1  - Schechter, Clyde B.
A1  - Cancelmo, Leo M.
A1  - Bromet, Evelyn J.
A1  - Katz, Craig L.
A1  - Reissman, Dori B.
A1  - Ozbay, Fatih
A1  - Kotov, Roman
A1  - Crane, Michael
A1  - Harrison, Denise J.
A1  - Herbert, Robin
A1  - Levin, Stephen M.
A1  - Luft, Benjamin J.
A1  - Moline, Jacqueline M.
A1  - Stellman, Jeanne M.
A1  - Udasin, Iris G.
A1  - Landrigan, Philip J.
A1  - Zvolensky, Michael J.
A1  - Yehuda, Rachel
A1  - Southwick, Steven M.
A1  - Pietrzak, Robert H.
SP  - 68
EP  - 79
VL  - 82
IS  - 
N2  - Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. <br><br>FINDINGS in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders.<br><br>Copyright © 2016 Elsevier Ltd. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0022-3956
UR  - http://dx.doi.org/10.1016/j.jpsychires.2016.07.003
ID  - ref1
ER  -