Results of an investigation analyzing the association between the two signature health problems – post-traumatic stress disorder (PTSD) and respiratory illness – among recovery workers who responded first at the World Trade Center (WTC), have been revealed after more than a decade following the terrorist attacks on the WTC. The study was led by Benjamin J. Luft, M.D., the Edmund D. Pellegrino Professor of Medicine, and Medical Director of Stony Brook’s World Trade Center Health Program, and Evelyn Bromet, Ph.D., Distinguished Professor, Departments of Psychiatry and Behavioral Science, and Preventive Medicine, Stony Brook University School of Medicine, and published in the “FirstView” section online in Psychological Medicine.

Recovery workers who responded first to the WTC site were exposed to both extreme mental trauma and to an extraordinary environmental disaster. The attacks on the WTC have led to two persistent health problems among the rescue workers – PTSD and respiratory ailments – due to the extreme emotional trauma of witnessing such enormous destruction and deaths, as well as the unprecedented physical hazards, such as exposure to the explosion of jet fuel and the smoldering debris fire.

Dr. Luft explains:

“This study illustrates the integral relationship between mental health and physical diseases that WTC responders suffer. The analysis not only shows that relationship but also connects PTSD as a possible co-factor in responders’ diseases, which reinforces our view at Stony Brook’s WTC Health Program that the illnesses suffered by 9/11 responders are a compilation of problems that often present as an entire syndrome of diseases and conditions.”

In “Exposure, Probable PTSD and Lower Respiratory Illness Among World Trade Center Rescue, Recovery and Clean-Up Workers,” Dr. Luft and his team, as well as additional WTC clinics revealed data from 12,333 non-traditional responders, including transportation and maintenance workers, and 8,508 traditional responders, mainly police officers. Between July 16, 2002, and Sep. 11, 2008, the responders were analyzed at WTC Health Program clinics – a network in the New York Metro area set up by the National Institute for Occupational Safety and Health (NIOSH).

The team discovered a prominent association between respiratory symptoms and post-traumatic stress disorder. In addition, they found evidence that PTSD may play a mediating role in the exposure-symptom association.

The researchers investigated patterns of relationships among exposures from the world trade center, post-traumatic stress disorder associated to the WTC, health risk factors, such as smoking and obesity, abnormal pulmonary functioning defined by low forced vital capacity, in addition to physician-assessed respiratory symptoms that occurred following 9/11.

They discovered that fewer police (22.5%) experienced respiratory symptoms compared to non-traditional respondents (28.4%), and that police had lower rates of probable PTSD (5.9%) compared with non-traditional responders (23%). However, in both groups pulmonary function tests were comparable. According to statistical examinations, PTSD and respiratory symptoms were fairly associated. In both groups, PTSD was possibly mediating the association between respiratory symptoms and WTC exposure.

Dr. Bromet, a world famous expert in psychiatric epidemiology and disaster research, explained:

“The results are indicative that PTSD appears to a have a major and complex role in relation to respiratory illnesses in this patient population. Our findings mirror research results found in several veterans’ populations and in patients in primary care settings around the world. Mental and physical health are integrally linked. It is not always obvious which one is the driver, but in the end, what matters is that both mental and physical health are recognized and treated with equal care and respect.”

According to Dr. Luft and Dr. Bromet, the discoveries highlight the theory that mental health screenings of responders to the WTC, is equally as vital as screening for respiratory symptoms. In addition, they believe that as the investigation revealed that non-traditional WTC responders reported considerably higher rates of probable PTSD than police, preventative interventions should be in place for non-traditional responders. Findings from the investigation also highlight the need to identify the role PTSD plays as well as its consequent risk for long-term disability in those who responded at the world trade center.

Dr. Luft warns that further studies and long-term data are required in order to better define the association between respiratory symptoms and PTSD in WTC responders and to measure the impact of this association on the extend of disability in those who responded.

Dr. Luft explains:

“The results are a first step in nailing down the exact relationship between PTSD and respiratory illness. We need to continue to study the relationship and its implications to help us to better treat responders who suffer from multiple mental and physical conditions.”

Written by Grace Rattue