More than a decade after 9/11, the "FirstView" section online in Psychological Medicine published results of a study in which the association between two signature health problems amongst WTC first responders was examined, namely respiratory illness and post-traumatic stress disorder (PTSD).

The study was led by Benjamin J. Luft, M.D., an Edmund D. Pellegrino Professor of Medicine, and Medical Director of Stony Brook's World Trade Center Health Program together with Evelyn Bromet, Ph.D., Distinguished Professor at the Departments of Psychiatry and Behavioral Science, and Preventive Medicine at Stony Brook University School of Medicine and their team.

Thousands of rescue and recovery workers who worked in the area surrounding the World Trade Center in the wake of the terrorist attacks were simultaneously exposed to extreme mental trauma coupled with an extraordinary environmental disaster. This combination of horrendous physical hazards in terms of exposure to the combustion of jet fuel and smoldering debris fire, the emotional trauma of witnessing events of heavy death tolls and massive destruction has caused two persistent health problems, i.e. respiratory illness and PTSD, amongst those involved in the rescue and recovery mission.

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."


For their study, titled "Exposure, Probable PTSD and Lower Respiratory Illness Among World Trade Center Rescue, Recovery and Clean-Up Workers," Dr. Luft and his team at Stony Brook and other WTC clinics examined 8,508 traditional responders and 12,333 non-traditional responders between July 16, 2002, and September 11, 2008. Primary responders consisted primarily of police offers, whilst non-traditional responders included maintenance and transportation workers. The examinations were conducted at WTC Health Program clinics, a network in the New York Metro area established by the National Institute for Occupational Safety and Health (NIOSH).

The researchers investigated linked patterns between WTC exposures, WTC-related PTSD, health risk factors like obesity and smoking, as well as respiratory symptoms diagnosed by physicians that occurred after 9/11 and still existed at examination, together with abnormal pulmonary functioning measured by low forced vital capacity.

They discovered an extraordinary association between respiratory symptoms and PTSD, together with evidence that PTSD could potentially play a resolving role in the relationship between exposure and symptoms.

The findings revealed that the probable PTSD rate amongst traditional responders was lower, i.e. 5.9% compared with 23% of non-traditional responders, and that less (22.5%) traditional responders suffered from respiratory symptoms compared with 28.4% of non-traditional responders although pulmonary function test results proved similar in both groups.

After performing statistical analyses, the researchers established that PTSD and respiratory symptoms were moderately linked. The analysis also demonstrated that in both groups, PTSD was likely to mediate the connection between WTC exposure and respiratory symptoms.

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

"The results are indicative that PTSD appears to 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. Bromet and Dr. Luft, the findings highlight the need for screening WTC responders for mental health, saying it is just as vital as screening the responders for respiratory symptoms. They also believe that preventative interventions should also be made available for non-traditional responders, who volunteer to work in disaster-related activities, given that the study revealed that non-traditional WTC responders reported substantially higher rates of probable PTSD compared to traditional responders. The study's results also highlight the need for scientists to recognize PTSD's role and its subsequent risk for long-term disability in WTC responders.

According to Dr. Luft, further research and long-term data are necessary to clarify the association between PTSD and respiratory symptoms in WTC responders as well as for measuring the impact this association has on the extent of disability in WTC responders.

He concludes:

"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 Petra Rattue