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Mental and Behavioral Health Publications

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2026

  • Factors associated with resilience in the context of multiple consecutive disasters: A qualitative study of survivors of world trade Center, hurricane Sandy, and COVID-19 disasters
    • A study looked at how people recovered after 9/11, Hurricane Sandy, and COVID-19. Researchers interviewed 24 people who had lived through at least two of these disasters. They found three patterns of recovery: staying strong, recovering after a hard time, and having long-term struggles. Support from family, friends, communities, and services helped people recover. People who had strong support were better able to cope. The study shows that disaster recovery needs both personal and community support.
    • Dhanya, A. S., Metzler, J., Brackbill, R. M., & Gershon, R. R. (2026). Factors associated with resilience in the context of multiple consecutive disasters: A qualitative study of survivors of World Trade Center, Hurricane Sandy, and COVID-19 disasters. Progress in Disaster Science, 30, 100545. https://doi.org/10.1016/j.pdisas.2026.100545

2025

  • Longitudinal study of smoking cessation among World Trade Center Health Registry enrollees, 2003-2021.
    • A study looked at whether PTSD affects people’s ability to quit smoking after 9/11. Researchers followed smokers in the World Trade Center Health Registry from 2003 to 2021. About 31% of people quit smoking by the next survey. People with PTSD were 8% less likely to quit than those without PTSD. The findings suggest that smoking programs for people affected by 9/11 should also address mental health to better support quitting.
    • Sirbu, L., Sisti, J. S., & Cone, J. E. (2026). Longitudinal study of smoking cessation among World Trade Center Health Registry enrollees, 2003–2021. Drug and Alcohol Dependence, 278, 113010. https://doi.org/10.1016/j.drugalcdep.2025.113010
  • Adverse childhood experiences, exposure to the World Trade Center attacks, and chronic symptoms of depression, PTSD, and unhealthy drinking.
    • This study followed over 26,000 adults in the World Trade Center Health Registry to see how past trauma affects mental health after 9/11. Researchers found that people who experienced trauma as children were more likely to have lasting PTSD, depression, and unhealthy drinking as adults after 9/11. Childhood trauma made these mental health problems more severe and long-lasting. The findings suggest that asking about trauma across a person’s life can help identify those who may need extra mental health support after disasters.
    • Parcesepe, A. M., Sanborn, J., Sisti, J. S., & Metzler, J. (2026). Adverse childhood experiences, exposure to the World Trade Center attacks, and chronic symptoms of depression, PTSD, and unhealthy drinking. Journal of Affective Disorders, 395, 120671. https://doi.org/10.1016/j.jad.2025.120671
  • Long COVID symptoms and loneliness: findings from the World Trade Center Health Registry.
    • A study looked at whether long COVID symptoms were linked to loneliness among 5,692 people in the World Trade Center Health Registry. About 61% reported feeling lonely. People with long COVID symptoms were 19% more likely to report loneliness than those without symptoms. They were also more likely to feel emotionally lonely. The study suggests that long COVID may affect people’s social and emotional well-being, and that addressing loneliness could help improve quality of life.
    • Sisti, J. S., Packard, S. E., & Metzler, J. (2025). Long COVID symptoms and loneliness: findings from the World Trade Center Health Registry. BMC Public Health, 26(1), 392. https://doi.org/10.1186/s12889-025-26006-8
  • Exposure to the World Trade Center Disaster, Health, and Health-Related Quality of Life Nearly 20 Years After 9/11
    • Nearly 20 years after 9/11, many people exposed to the World Trade Center disaster still face serious health problems. Using data from nearly 27,000 adults in the WTC Health Registry, researchers found high rates of breathing problems, digestive issues, PTSD, depression, and poor quality of life. These conditions were more common than in the general population. The findings show the need for continued health monitoring and support for those affected.
    • Sisti, J. S., Dhanya, A., Alper, H. E., Millet, N., Ahmadi, A., & Brackbill, R. M. (2025). Exposure to the World Trade Center Disaster, Health, and Health‐Related Quality of Life Nearly 20 Years After 9/11. American Journal of Industrial Medicine, 68(5), 413–427. https://doi.org/10.1002/ajim.23706
  • Longitudinal trajectories of binge and heavy drinking pattern among World Trade Center Health Registry enrollees, 2006–2021: A dual trajectory modeling approach
    • This study followed more than 18,000 World Trade Center Health Registry enrollees for 15 years to understand patterns of binge and heavy drinking. Most people reported low, stable drinking over time. However, some groups showed higher or increasing drinking levels. Older age, being male, lack of social support, and 9/11-related PTSD were linked to riskier drinking patterns. These findings can help guide targeted prevention and counseling efforts for people exposed to 9/11.
    • Dhanya, A. S., Welch, A. E., Alper, H. E., Locke, S., & Brackbill, R. M. (2025). Longitudinal trajectories of binge and heavy drinking pattern among World Trade Center Health Registry enrollees, 2006–2021: A dual trajectory modeling approach. Drug and Alcohol Dependence, 276, 112912. https://doi.org/10.1016/j.drugalcdep.2025.112912
  • Trajectories of post-traumatic stress disorder symptoms and subsequent risk of long COVID in the World Trade Center Health Registry
    • Researchers studied people exposed to the 9/11 World Trade Center disaster to see if past stress symptoms affected long COVID risk. Among those who had COVID-19, 41% reported long COVID symptoms. People with a history of post-traumatic stress symptoms—including those whose symptoms improved over time—were more likely to have long COVID than those with little or no stress symptoms. The findings suggest that people with past trauma may need extra screening and support for long COVID.
    • Sisti, J. S., Packard, S. E., Yung, J., & Metzler, J. (2025). Trajectories of post-traumatic stress disorder symptoms and subsequent risk of long COVID in the World Trade Center Health Registry. Journal of Affective Disorders, 390, 119814. https://doi.org/10.1016/j.jad.2025.119814
  • Probable posttraumatic stress disorder related to the September 11, 2001, terrorist attacks and self‐inflicted injury–related hospitalizations and emergency department visits.
    • This study looked at whether 9/11-related PTSD is linked to self-inflicted injuries among more than 50,000 people in the World Trade Center Health Registry. Over approximately 11 years, researchers tracked hospital and emergency room visits for self-harm. People with PTSD were more than twice as likely to have a self-inflicted injury than those without PTSD. The findings show that screening for PTSD after disasters may help identify people who need early support and prevention services.
    • Locke, S., Sisti, J., Takemoto, E., Seil, K., Pollari, C., Cone, J. E., & Li, J. (2026). Probable posttraumatic stress disorder related to the September 11, 2001, terrorist attacks and self‐inflicted injury–related hospitalizations and emergency department visits. Journal of Traumatic Stress, 39(1), 110–118. https://doi.org/10.1002/jts.70023

2023

  • Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees
    • In 2021, almost 220 people died from opioid overdoses daily in the US. Research saw a link between post-traumatic stress disorder (PTSD) and increased opioid misuse. We found that in the 13-years after 9/11, people with PTSD had a much higher risk of going to the hospital for opioid misuse. Improved treatment and increased screenings for PTSD may reduce the chances of opioid misuse.
    • Garrey, S. K., Locke, S., Pollari, C., Li, J., & Takemoto, E. (2023). Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees. Psychiatry Research, 328, 115462. https://doi.org/10.1016/j.psychres.2023.115462
  • Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees
    • A WTC Health Registry study suggests that enrollees who have multiple mental health conditions are at greater risk of developing confusion or memory loss. Doctors treating patients with mental health conditions should be aware of this possible condition.
    • Seil, K., Alper, H., Yu, S., Brackbill, R., & Millien, L. (2023). Association of PTSD history with confusion or memory loss among World Trade Center Health Registry enrollees. Journal of Affective Disorders Reports, 14, 100655. https://doi.org/10.1016/j.jadr.2023.100655
  • Association of Rheumatoid Arthritis with Opioid Pain Medication Overuse among Persons Exposed to the 9/11 World Trade Center Disaster
    • Opioid pain medication is often used to treat Rheumatoid Arthritis (RA). This is a new health issue for people exposed to the 9/11 disaster. This study found that people with RA use more opioids than people without RA. It also found that for someone who has RA, PTSD has no effect on taking more opioids or not. It is essential to evaluate the risk and use of opioid medication to lower the chance of overuse by RA patients exposed to the 9/11 disaster.
    • Dhanya, A. S., Yung, J., Cone, J. E., & Li, J. (2023). Association of Rheumatoid Arthritis with Opioid Pain Medication Overuse among Persons Exposed to the 9/11 World Trade Center Disaster. International Journal of Environmental Research and Public Health, 20(5), 4166. https://doi.org/10.3390/ijerph20054166

2022

  • Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14-15 years after the September 11, 2001, terrorist attacks
    • One of the most common 9/11-health-related conditions is post-traumatic stress disorder (PTSD). People with PTSD have disturbing memories of 9/11. PTSD can cause people to have difficulty working, home life, and socializing. This study found that those with more social support and did physical exercise with multiple PTSD symptoms had no impairment. Those with low PTSD symptoms who reported poor health had low social support and no exercise to have difficulty working, home life, and socializing.
    • Trivedi, N. U., Gargano, L. M., Brackbill, R. M., & Jacobson, M. H. (2023). Posttraumatic stress disorder and functional impairment among World Trade Center Health Registry enrollees 14–15 years after the September 11, 2001, terrorist attacks. Journal of Traumatic Stress, 36(1), 44–58. https://doi.org/10.1002/jts.22887
  • The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis
    • This study looked at whether PTSD symptoms would lead to having less social support. Those with 9/11-related PTSD symptoms were more likely to report less social support, and vice versa. Our findings show the importance of having a strong social support network to help protect mental health after a disaster, and over time.
    • Liu, S. Y., Li, J., Leon, L. F., Schwarzer, R., & Cone, J. E. (2022). The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis. International Journal of Environmental Research and Public Health, 19(5), 2604. https://doi.org/10.3390/ijerph19052604
  • Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016
    • Enrollees exposed to 9/11 continued to have poor control of their asthma despite treatment. This study looked at the relationships among asthma, mental health, and quality of life. Results suggest that a study of simultaneous treatment of asthma and mental illness are needed to improve this situation.
    • Friedman, S. M., Alper, H., De La Hoz, R. E., Osahan, S., Farfel, M. R., & Cone, J. (2022). Change in Asthma Is Associated with Change in PTSD in World Trade Center Health Registrants, 2011 to 2016. International Journal of Environmental Research and Public Health, 19(13), 7795. https://doi.org/10.3390/ijerph19137795

2021

  • Trajectories of Psychological Distress Among Individuals Exposed to the 9/11 World Trade Center Disaster
    • Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster likely suffered from psychological distress. People have different experiences of distress over time. This study showed five different ways of having psychological distress over time. These include no distress, low distress that did not change, distress that increased over time, distress that decreased over time, and always high level of distress. 78% were in the no distress group. Women, young at the time of 9/11, lower education had more distress than no distress group. Non-rescue/recovery workers with a lot of traumatic exposure were also more likely to be more distressed over time.
    • Ko, T. M., Alper, H. E., Brackbill, R. H., & Jacobson, M. H. (2022). Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster. Psychological Medicine, 52(14), 2950–2961. https://doi.org/10.1017/S0033291720004912
  • Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees
    • This study looked at enrollees who lived in New York State during 2001-2016 and were World Trade Center responders and people who lived in the community. Those with more exposure to 9/11 were more likely to be hospitalized for a condition caused by drinking alcohol than other people with less 9/11 exposure. We also saw a link between having 9/11-related post-traumatic stress disorder symptoms and hospitalization due to excessive alcohol drinking. Our findings show effects on physical and mental health after a disaster and over time.
    • Takemoto, E., Giesinger, I., Russell, J. S., & Li, J. (2021). Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees. Drug and Alcohol Dependence, 221, 108656. https://doi.org/10.1016/j.drugalcdep.2021.108656
  • A mixed methods study after multiple disasters: September 11, 2001 World Trade Center terrorist attacks and Hurricane Sandy
    • The study looked at a group of people who had a direct experience with both 9/11 and Hurricane Sandy. Those who felt they were not prepared for the storm or had a financial loss reported higher levels of stress. Those who had a feeling gratefulness or patriotism in relation to their experience reported lower levels of stress.
    • Garrey, S. K., Ogunyemi, A. A., & Gargano, L. M. (2022). A Mixed-Methods Study After Multiple Disasters: September 11, 2001, World Trade Center Terrorist Attacks and Hurricane Sandy. Disaster Medicine and Public Health Preparedness, 16(2), 698–705. https://doi.org/10.1017/dmp.2020.465
  • Exploratory case study of suicide among a sample of 9/11 survivors
    • In this recent case study, we used medical examiner information to learn more about 9/11-related suicides among World Trade Center Health Registry enrollees. We identified 35 enrollee suicides that happened in New York City during 2004-2018. Most of the cases were non-Hispanic white (66%), male (83%), rescue/recovery workers (54%), and middle-aged (median 58 years). Sixty percent of the cases had depression mentioned in the files, but none mentioned PTSD. Rescue/recovery workers may be at extra risk for suicide. Mental health screening and treatment must be prioritized for the 9/11-exposed population.
    • Seil, K., Takemoto, E., Farfel, M. R., Huynh, M., & Li, J. (2021). Exploratory Case Study of Suicide among a Sample of 9/11 Survivors. International Journal of Environmental Research and Public Health, 19(1), 57. https://doi.org/10.3390/ijerph19010057
  • Dynamic Residential Movement and Depression among World Trade Center Health Registry Enrollees
    • The study looked at frequent moving and the chance of depression with adults exposed to the 9/11 disaster. We also looked at how relationships were affected. We found that most enrollees did not move in 2007–2014. However, frequent moving was associated with a risk of depression compared to not moving. We also found that keeping social networks could help ease the chance of depression with the enrollees who moved most.
    • Lim, S., Liu, S. Y., Brite, J., Crossa, A., Locke, S., Pollari, C., & Baquero, M. (2022). Dynamic residential movement and depression among the World Trade Center Health Registry enrollees. Social Psychiatry and Psychiatric Epidemiology, 57(6), 1157–1165. https://doi.org/10.1007/s00127-021-02192-9

2020

  • Change in binge drinking behavior after Hurricane Sandy among persons exposed to the 9/11 World Trade Center disaster
    • Previous work found that people who were affected by the 9/11 terrorist attacks in NYC tended to binge drink more. This study looked at drinking behavior among WTC Health Registry enrollees before and after Hurricane Sandy struck in October/Nov 2012. Binge drinking was defined as drinking five or more alcohol drinks on one occasion for men and four or more drinks for women. We found that those without 9/11-related PTSD who had Sandy-related PTSD were more likely to start and continue binge drinking after Sandy. Those with 9/11-related PTSD did not change their binge drinking behavior after Sandy. Future disaster responses should plan for treatment of alcohol use and PTSD at the same time.
    • Locke, S., Nguyen, A.-M., Friedman, L., & Gargano, L. M. (2020). Change in binge drinking behavior after Hurricane Sandy among persons exposed to the 9/11 World Trade Center disaster. Preventive Medicine Reports, 19, 101144. https://doi.org/10.1016/j.pmedr.2020.101144
  • World Trade Center Exposure and Posttraumatic Growth: Assessing Positive Psychological Change 15 Years after 9/11
    • The adverse physical and mental health effects of the 9/11 World Trade Center attacks have been well documented. Posttraumatic growth (PTG) is also important and necessary to monitor since positive outcomes and attributes of well-being are an important part of one’s health. The presence of PTG was assessed among 4,934 people who completed the WTC Health Registry’s survey on Health and Quality of Life 15 years after 9/11. PTG refers to the positive psychological change following a traumatic event that results in improved -level of functioning. Unlike resilience, PTG allows individuals to surpass pre-trauma functioning and not simply return to their baseline level of functioning. Some (~34%) participants experienced moderate-to-high level of PTG. Having a very high level of 9/11-related exposure and greater levels of social integration, social support, and self-efficacy was associated with a slight increase in PTG. Trauma treatment for 9/11 victims should consider PTG and the extent it can aid patients facing adversity.
    • Pollari, C. D., Brite, J., Brackbill, R. M., Gargano, L. M., Adams, S. W., Russo-Netzer, P., Davidov, J., Banyard, V., & Cone, J. E. (2020). World Trade Center Exposure and Posttraumatic Growth: Assessing Positive Psychological Change 15 Years after 9/11. International Journal of Environmental Research and Public Health, 18(1), 104. https://doi.org/10.3390/ijerph18010104
  • “Post-traumatic stress disorder and risk of prescription opioid use, over-use, and misuse among World Trade Center Health Registry enrollees, 2015-2016
    • A study examined whether PTSD after the September 11 attacks was linked to prescription opioid use among 26,840 people. Researchers found that people with current PTSD had the highest rates of opioid use, overuse, and misuse. Those with past PTSD also had higher risks than people who never had PTSD. The findings suggest that people with 9/11-related PTSD may be more likely to use prescription opioids and may benefit from closer screening and support.
    • Takemoto, E., Brackbill, R., Martins, S., Farfel, M., & Jacobson, M. (2020). Post-traumatic stress disorder and risk of prescription opioid use, over-use, and misuse among World Trade Center Health Registry enrollees, 2015–2016. Drug and Alcohol Dependence, 210, 107959. https://doi.org/10.1016/j.drugalcdep.2020.107959
  • The intentional self-medication of 9/11-related PTSD symptoms with alcohol:15 years after the disaster
    • Post-traumatic stress disorder (PTSD) was the most common mental health condition associated with the 9/11 terror attacks. This study found that the risk of self-medication with alcohol increased as the number of PTSD symptoms increased. Many of the people exposed to 9/11 continue to have PTSD symptoms and may use alcohol to feel better. Repeated check-ups for alcohol use among survivors of mass-traumas with PTSD symptoms is important for public health.
    • Garrey, S. K., Welch, A. E., Jacobson, M. H., Brackbill, R. M., & Gargano, L. M. (2020). The Intentional Self-Medication of 9/11-Related PTSD Symptoms with Alcohol: 15 Years after the Disaster. International Journal of Environmental Research and Public Health, 17(15), 5327. https://doi.org/10.3390/ijerph17155327
  • Probable posttraumatic stress disorder and lower respiratory symptoms among rescue/recovery workers and community members after the 9/11 World Trade Center attacks - A longitudinal mediation analysis
    • The study looked at the link between posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) among survivors of 9/11. The study used the results from a previous test of World Trade Center rescue/recovery workers and exposed community members. The results were that PTSD and LRS each mediated the other. A diagnosis of either should be a sign to see if the other condition exists.
    • Wyka, K., Friedman, S. M., & Jordan, H. T. (2020). Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks—A Longitudinal Mediation Analysis. Psychosomatic Medicine, 82(1), 115–124. https://doi.org/10.1097/PSY.0000000000000731
  • Post-traumatic stress disorder and the association with overweight, obesity, and weight change among individuals exposed to the World Trade Center disaster, 2003-2016
    • Post-traumatic stress disorder affects weight. This study showed that people exposed to WTC disaster and who had PTSD gained weight over time. Obesity was most common among the people with chronic PTSD (39.5%) and not every time PTSD (36.6%), compared to those with no PTSD (29.3%). Also people with a history of PTSD after 9/11 were more likely to have obesity and weigh more over time. These findings confirm the need for a focus on both physical and mental health to improve health outcomes.
    • Takemoto, E., Van Oss, K. R., Chamany, S., Brite, J., & Brackbill, R. (2021). Post-traumatic stress disorder and the association with overweight, obesity, and weight change among individuals exposed to the World Trade Center disaster, 2003–2016. Psychological Medicine, 51(15), 2647–2656. https://doi.org/10.1017/S0033291720001208

2019

  • Exposure to multiple disasters: The long-term effect of Hurricane Sandy (October 29, 2012) on NYC survivors of the September 11, 2001 World Trade Center attack
    • The study found that enrollees with 9/11-related PTSD who then experienced Hurricane Sandy increased their chances of future 9/11-related PTSD. Those with lower optimism after Sandy had a higher risk for 9/11-related PTSD. This shows the need to explore mental health for this group.
    • Gargano, L. M., Li, J., Millien, L., Alper, H., & Brackbill, R. M. (2019). Exposure to multiple disasters: The long-term effect of Hurricane Sandy (October 29, 2012) on NYC survivors of the September 11, 2001 World Trade Center attack. Psychiatry Research, 273, 719–724. https://doi.org/10.1016/j.psychres.2019.01.090
  • PTSD and Comorbid Depression: Social Support and Self-Efficacy in World Trade Center Tower Survivors 14-15 Years After 9/11
    • Following the World Trade Center (WTC) terrorist attack in New York City, the rates of post-traumatic stress disorder (PTSD) and depression remain high. Social support and self-efficacy have been associated with PTSD. However, little is known about their effect on PTSD and depressive comorbidity. Findings indicate that self-efficacy may be more important than social support.
    • Adams, S. W., Bowler, R. M., Russell, K., Brackbill, R. M., Li, J., & Cone, J. E. (2019). PTSD and comorbid depression: Social support and self-efficacy in World Trade Center tower survivors 14–15 years after 9/11. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 156–164. https://doi.org/10.1037/tra0000404
  • Comorbid posttraumatic stress disorder and lower respiratory symptoms in disaster survivors: Qualitative results of a 17-year follow-up of World Trade Center disaster survivors
    • The study wanted to learn more about how people who survived a disaster and have post-traumatic stress disorder (PTSD) along with other serious medical problems are coping. The focus was to understand how PTSD is related to breathing problems. To find out what factors affect how people take care of themselves and get treatment and to see how both of these problems at the same time having affects a person's quality of life. They hoped this information would help make treatments better and lessen the strain on public health and healthcare.
    • Gargano, L. M., Gershon, R. R., Ogunyemi, A., Dorlette, D., Petrsoric, L. J., & Cone, J. E. (2019). Comorbid posttraumatic stress disorder and lower respiratory symptoms in disaster survivors: Qualitative results of a 17-year follow-up of World Trade Center disaster survivors. Progress in Disaster Science, 4, 100050. https://doi.org/10.1016/j.pdisas.2019.100050
  • Examining Associations Between Hurricane Sandy Exposure and Posttraumatic Stress Disorder by Community of Residence
    • The study examined how exposure to 2012's Hurricane Sandy differed by community across New York City and nearby Long Island, and the differential impact of exposure on mental health. This study emphasized the differential impact of hurricane exposure on subsequent PTSD symptoms in three communities affected by Hurricane Sandy. Future preparedness and recovery efforts must understand community correlates of mental health concerns to promote resilience in vulnerable communities.
    • Schwartz, R. M., Rasul, R., Gargano, L. M., Lieberman‐Cribbin, W., Brackbill, R. M., & Taioli, E. (2019). Examining Associations Between Hurricane Sandy Exposure and Posttraumatic Stress Disorder by Community of Residence. Journal of Traumatic Stress, 32(5), 677–687. https://doi.org/10.1002/jts.22445
  • Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster
    • Exposure to the events on 9/11 is associated with greater incidence of poor mental health, asthma diagnosis, and poor asthma control. Prior research has shown mental health conditions, such as anxiety, depression, and PTSD, are associated with poor adherence to asthma medication protocols. To examine these complicated relationships, this study used self-reported long-term medication adherence data see if non-adherence explained part of the relationship between diminished mental health and less asthma control. The study population was composed of participants of the World Trade Center Health Registry Cohort who identified themselves as asthmatic after the disaster and who were currently prescribed a long-term asthma control medication. Contrary to the original hypothesis, this study found that enrollees with mental health conditions who were better at adhering to their medication regimen had slightly worse control of their asthma than those with poor medication adherence. This finding suggests that in this population, the relationship between poor mental health and worse asthma control may not be explained medication adherence. There are a few possible explanations for these paradoxical results. For example, severe asthmatics may adhere better to their prescribed medication protocols because they are highly symptomatic and stick closely to their regimen to reduce symptoms. Therefore, the association between adherence and asthma control among the WTC-exposed population may have once been positive (that is greater adherence was associated with greater asthma control), but at some point, reversed. Over the several years of the study period (2002-2016), patients who were more responsive to treatment improved, whereas other patients, whose symptoms were less responsive to treatment, did not. The persistence of symptoms more than a decade after the event also raises questions about the physiology of WTC-related asthma and whether corticosteroid-based therapy, medication that is used to treat severe asthma, may be incompletely effective in the population we studied. Asthma can be caused by a variety of inflammatory pathways. Air-born irritant-induced asthma, such as the WTC-related asthma, may likely be a new and ill-defined asthma type, and not responsive to current therapies. There is also the possibility that because symptoms are often non-specific and potentially misdiagnosed, that some enrollees are being treated for, but do not, in fact, have asthma. Asthma is a complex condition and may be an overly broad term that describes related but separate diseases.
    • Brite, J., Friedman, S., De La Hoz, R. E., Reibman, J., & Cone, J. (2020). Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster. Journal of Asthma, 57(11), 1253–1262. https://doi.org/10.1080/02770903.2019.1672722

2018

  • Longitudinal determinants of depression among World Trade Center Health Registry enrollees, 14-15 years after the 9/11 attacks
    • A study of more than 21,000 people exposed to 9/11 followed their mental health for 14 years. About 18.6% developed depression, and it was much more common among people who had PTSD. Low income, unemployment, poor social support, later traumatic events, and long-term physical illness were linked to a higher risk of depression. These same factors also made recovery harder. The findings show the lasting mental health effects of 9/11 and the need for long-term support.
    • Jacobson, M. H., Norman, C., Nguyen, A., & Brackbill, R. M. (2018). Longitudinal determinants of depression among World Trade Center Health Registry enrollees, 14–15 years after the 9/11 attacks. Journal of Affective Disorders, 229, 483–490. https://doi.org/10.1016/j.jad.2017.12.105
  • Re-experiencing 9/11-Related PTSD Symptoms Following Exposure to Hurricane Sandy
    • A study examined how Hurricane Sandy affected people who had previously experienced the September 11 attacks. Sandy caused severe flooding, damage, and displacement in areas also affected by 9/11. Researchers found that people with PTSD from 9/11 were much more likely to develop PTSD symptoms after Sandy. However, even people without earlier PTSD may have been affected. The findings suggest that later disasters can bring back memories of past trauma and increase mental health risks.
    • Li, J., E. Alper, H., M. Gargano, L., B. Maslow, C., & M. Brackbill, R. (2018). Re-experiencing 9/11-Related PTSD Symptoms Following Exposure to Hurricane Sandy. International Journal of Emergency Mental Health and Human Resilience, 20(3). https://doi.org/10.4172/1522-4821.1000404
  • Post-9/11 Drug-and-Alcohol-Related Hospitalizations among World Trade Center Health Registry Enrollees, 2003-2010
    • A study of more than 41,000 people exposed to 9/11 examined hospital stays related to alcohol and drug use. About 1.5% had at least one such hospitalization. People who witnessed three or more traumatic events during the attacks had a higher risk of drug-related hospitalization. People with PTSD had higher risks of both drug- and alcohol-related hospital stays. The findings suggest that people with PTSD or severe trauma may benefit from early support and treatment for substance use.
    • Hirst, A., Miller-Archie, S. A., Welch, A. E., Li, J., & Brackbill, R. M. (2018). Post-9/11 drug- and alcohol- related hospitalizations among World Trade Center Health Registry enrollees, 2003–2010. Drug and Alcohol Dependence, 187, 55–60. https://doi.org/10.1016/j.drugalcdep.2018.01.028

2017

  • Intensity of binge drinking a decade after the September 11th terror attacks among exposed persons
    • Some people who directly experienced the September 11 attacks in NYC are still suffering from serious mental health problems, including PTSD and excessive alcohol consumption. Data from a 2015-2016 study conducted on over 28,000 WTC Registry enrollees over the age of 18 showed that 25% reported binge drinking in the past month. This is 1.5 times greater than the proportion of NYC adults reporting binge drinking. Of those who said they had engaged in binge drinking, more than one-third reported high intensity binge drinking which means they had more than eight drinks on one occasion. People with PTSD were two times more likely to binge drink with high intensity than to not binge drink at all compared to people without PTSD. In this study, certain groups were more likely to report high intensity binge drinking: People with PTSD, those who participated in rescue and recovery work, and those with 9/11-related injuries and other traumatic exposures. It is important therapy addresses both PTSD symptoms and excessive alcohol use. Policy strategies aimed at reducing access to and the consumption of alcohol are other ways to help reduce binge drinking. Improving access to treatment of PTSD and alcohol use will help people who binge drink and have PTSD lead happier and healthier lives.
    • Welch, A. E., Caramanica Zweig, K., McAteer, J. M., & Brackbill, R. M. (2017). Intensity of Binge Drinking a Decade After the September 11th Terror Attacks Among Exposed Individuals. American Journal of Preventive Medicine, 52(2), 192–198. https://doi.org/10.1016/j.amepre.2016.10.034
  • Resilience to post-traumatic stress among World Trade Center survivors: a mixed-methods study
    • A study interviewed 29 people who escaped the World Trade Center on September 11 to learn what factors affected PTSD risk. Five showed signs of likely PTSD. People were less likely to develop PTSD when they had emergency training, stayed with others, took action quickly, or felt able to lead. Risk was higher among those with poor physical health, injuries, limited communication, confusion, or traumatic experiences. The findings suggest that emergency training and social support may help protect mental health.
    • Gargano, PhD, L. M., Hosakote, Ms, S., Zhi, Mph, Q., Qureshi, PhD, K. A., & Gershon, DrPH, R. R. (2017). Resilience to post-traumatic stress among World Trade Center survivors: A mixed-methods study. Journal of Emergency Management, 15(5), 275–284. https://doi.org/10.5055/jem.2017.0336
  • Posttraumatic Stress Disorder, Gender, and Risk Factors: World Trade Center Tower Survivors 10 to 11 Years After the September 11, 2001 Attacks
    • A study of 1,755 people who escaped the World Trade Center found that PTSD remained common 10–11 years after 9/11. About 13.7% of men and 24.1% of women had signs of PTSD. However, gender alone did not explain the difference. Younger age, unemployment, less education, greater exposure, unmet mental health needs, and less social support were linked to more severe symptoms. The findings suggest that social and economic factors play an important role in long-term PTSD.
    • Bowler, R. M., Adams, S. W., Gocheva, V. V., Li, J., Mergler, D., Brackbill, R., & Cone, J. E. (2017). Posttraumatic Stress Disorder, Gender, and Risk Factors: World Trade Center Tower Survivors 10 to 11 Years After the September 11, 2001 Attacks. Journal of Traumatic Stress, 30(6), 564–570. https://doi.org/10.1002/jts.22232

2016

  • Police Officers Who Responded to 9/11: Comorbidity of PTSD, Depression, and Anxiety 10-11 Years Later
    • We examined comorbidity of PTSD, depression, and/or anxiety among police enrollees (N=1,884) from the WTC Health Registry. Categorized into four groups based on comorbidity of PTSD, depression, and anxiety. DSM-IV diagnostic criteria for PTSD were used. Depression (PHQ-8) and anxiety (GAD-7) were assessed with standardized psychometric inventories. Multinomial logistic regression was used to identify putative risk factors associated with comorbidity of PTSD. Of 243 (12.9% of total) police with probable PTSD, 21.8% had probable PTSD without comorbidity, 24.7% had depression, 5.8% had anxiety, and 47.7% had comorbid depression and anxiety. Risk factors for comorbid PTSD, depression, and anxiety include being Hispanic, decrease in income, experiencing physical injury on 9/11, experiencing stressful/traumatic events since 9/11, and being unemployed/retired. Nearly half of police with probable PTSD had comorbid depression and anxiety.
    • Bowler, R. M., Kornblith, E. S., Li, J., Adams, S. W., Gocheva, V. V., Schwarzer, R., & Cone, J. E. (2016). Police officers who responded to 9/11: Comorbidity of PTSD, depression, and anxiety 10–11 years later. American Journal of Industrial Medicine, 59(6), 425–436. https://doi.org/10.1002/ajim.22588
  • Trajectories of PTSD among Lower Manhattan Residents and Area Workers following the 2001 World Trade Center Disaster, 2003-2012
    • The majority of the hundreds of thousands of people directly exposed to the September 11th terror attacks in NYC were civilians and were not involved in rescue/recovery work. Because earlier studies showed that PTSD was one of the most common health conditions up to 6 years after 9/11, we examined longer-term patterns of PTSD symptoms over a nine year period among 17,000 civilians enrolled in the WTC Health Registry. Most civilians had few or no PTSD symptoms; however, one in four had PTSD at some point during the study period. Some people with PTSD had symptoms that improved, however most had symptoms that either persisted or got worse over time. PTSD that persisted or worsened was more common among enrollees with low education and social support, or who had high WTC exposure, were unemployed or were unable to get the mental health care they needed.
    • Welch, A. E., Caramanica, K., Maslow, C. B., Brackbill, R. M., Stellman, S. D., & Farfel, M. R. (2016). Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003–2012. Journal of Traumatic Stress, 29(2), 158–166. https://doi.org/10.1002/jts.22090
  • Mental health status of World Trade Center tower survivors compared to other survivors a decade after the September 11, 2001 terrorist attacks
    • This study compared the current mental health status of persons who were in the World Trade Center (WTC) towers, other surrounding buildings, or on the street the morning of the September 11th terrorist attacks. Those in the WTC towers were at increased risk for post-traumatic stress disorder (PTSD) and frequent binge drinking. Infrastructure and behavioral barriers experienced during evacuation were significantly associated with PTSD. Understanding the effects of disaster-related evacuation barriers on the long-term mental health status of survivors can help in the planning of continuing post-disaster treatment.
    • Gargano, L. M., Nguyen, A., DiGrande, L., & Brackbill, R. M. (2016). Mental health status of World Trade Center tower survivors compared to other survivors a decade after the September 11, 2001 terrorist attacks. American Journal of Industrial Medicine, 59(9), 742–751. https://doi.org/10.1002/ajim.22636
  • A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: a growth curve analysis
    • This paper examined the relationship between initial exposure levels, long-term PTSD symptoms, and subsequent emotional support among police responders. The study population included police responders who had reported their 9/11 exposure levels at Wave 1 (2003/4), provided three waves of data on PTSD symptoms using the 17-item PCL scale, and rated their received emotional support at Wave 3 (N=2,204, 1,908 men, 296 women, mean age: 38 years at exposure). A second-order growth curve reflected a PTSD symptom trajectory which was embedded in a structural equation model, with exposure level specified as an exogenous predictor, and emotional support specified as an endogenous outcome. Exposure had a main effect on mean symptom levels (intercept) across three waves but it made no difference in changes in symptoms (slope), and no difference in emotional support. The symptom trajectory, on the other hand, had an effect on emotional support. Its intercept and slope were both related to support, indicating that changes in symptoms affected later emotional support. Initial trauma exposure levels can have a long-term effect on mean symptom levels. Emotional support is lower in police responders when PTSD symptoms persist over seven years, but becomes higher when reduction in symptoms occurs.
    • Schwarzer, R., Cone, J. E., Li, J., & Bowler, R. M. (2016). A PTSD symptoms trajectory mediates between exposure levels and emotional support in police responders to 9/11: A growth curve analysis. BMC Psychiatry, 16(1), 201. https://doi.org/10.1186/s12888-016-0907-5

2015

  • Trajectories of scores on a screening instrument for PTSD among World Trade Center rescue, recovery, and clean-up workers
    • This study described the course of PTSD symptoms in a cohort of 9/11 responders by identifying five distinct subgroups on the basis of trajectories of scores on the Posttraumatic Disorder Checklist, administered three times over an 8-9 year period. It identified several 9/11-related exposures associated with high likelihood of following specific trajectories, and assessed the impact of changing life circumstances on the course of each trajectory. Responders with higher levels of exposure were more likely to follow less favorable trajectories than were responders with less exposure. Within trajectory groups, responders who endured more adverse personal circumstances during the study period had higher scores than did those with more favorable circumstances. This study highlights the need for immediate and continued periodic screening for both mental health effects of disasters and circumstances that may affect the course of those effects.
    • Maslow, C. B., Caramanica, K., Welch, A. E., Stellman, S. D., Brackbill, R. M., & Farfel, M. R. (2015). Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean‐Up Workers. Journal of Traumatic Stress, 28(3), 198–205. https://doi.org/10.1002/jts.22011
  • Posttraumatic stress disorder after Hurricane Sandy among persons exposed to the 9/11 disaster
    • The Registry provided a sampling pool for a survey of the experiences and physical and mental health of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012; a total of 4,558 Hurricane Sandy surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events.
    • Caramanica, K. (2015). Posttraumatic Stress Disorder after Hurricane Sandy among Persons Exposed to the 9/11 Disaster. International Journal of Emergency Mental Health and Human Resilience, 17(1). https://doi.org/10.4172/1522-4821.1000173
  • Cigarette Smoking and 9/11-Related Posttraumatic Stress Disorder among World Trade Center Health Registry Enrollees, 2003-12
    • A study of more than 34,000 adults exposed to the September 11 attacks examined smoking and PTSD over eight years. Smoking rates fell from 12.6% to 9.2% during the study. However, people with PTSD were more likely to smoke and had a harder time quitting. Smokers with PTSD were 25% to 39% less likely to quit than smokers without PTSD. The findings suggest that people with PTSD may need extra support to stop smoking after a disaster.
    • Welch, A. E., Jasek, J. P., Caramanica, K., Chiles, M. C., & Johns, M. (2015). Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003–12. Preventive Medicine, 73, 94–99. https://doi.org/10.1016/j.ypmed.2015.01.023

2014

  • Comorbidity of 9/11-Related Posttraumatic Stress Disorder and Depression in the World Trade Center Health Registry 10 to 11 Years Post-Disaster
    • A study of 29,486 adult Registry enrollees conducted 10-11 years post-9/11 found that 15.2% screened positive for probable PTSD at Wave 3, 14.9% for depression, and 10.1% for both. Comorbid PTSD and depression was associated with high 9/11 exposures, low social integration, unemployment for health reasons, and experiencing more than one traumatic life event since 9/11. Comorbid persons experienced poorer outcomes on all PTSD-related impairment measures and symptom duration, life satisfaction, overall health, and perceived unmet mental health care need compared to those with PTSD or depression only.
    • Caramanica, K., Brackbill, R. M., Liao, T., & Stellman, S. D. (2014). Comorbidity of 9/11‐Related PTSD and Depression in the World Trade Center Health Registry 10–11 Years Postdisaster. Journal of Traumatic Stress, 27(6), 680–688. https://doi.org/10.1002/jts.21972
  • Chronic probable posttraumatic stress disorder among police registrants in the World Trade Centre Health Registry ten years after 9/11/01
    • A study of police officers exposed to the September 11 attacks found that 12.9% still showed signs of PTSD more than 10 years later. About 2.6% had ongoing PTSD symptoms over the long term. Officers who witnessed more stressful events on 9/11 or faced several stressful events later had a higher risk. Unmet mental health needs also increased risk. Strong social support and having close friends or family were linked to a lower risk of lasting PTSD.
    • Cone, J., Bowler, R., Li, J., Kornblith, E., Shaikh, A., & Gocheva, V. (2014). 0429 Chronic Probable Posttraumatic Stress Disorder among Police Registrants in the World Trade Centre Health Registry Ten Years after 9/11/01. Occupational and Environmental Medicine, 71(Suppl 1), A55.3-A56. https://doi.org/10.1136/oemed-2014-102362.172
  • Frequent binge drinking five to six years after exposure to 9/11: Findings from the World Trade Center Health Registry
    • Many of our Registry enrollees and other exposed persons developed PTSD after 9/11 and as a consequence may be drinking excessively. We looked at the survey responses from about 41,000 Registry enrollees, to examine the relationship between PTSD, extent of exposure to the 9/11 disaster, and frequent binge drinking, which was defined as having five or more drinks on a single occasion on five or more days of the past month. Frequent binge drinking was reported by fifteen percent of those suffering from PTSD, and only six percent of those without PTSD. People with higher levels of exposure to the 9/11 disaster were more likely to report frequent binge drinking than people with lower exposures. We now have a better understanding of the impact of PTSD and different levels of 9/11 exposure on how often people engage in binge drinking.
    • Welch, A. E., Caramanica, K., Maslow, C. B., Cone, J. E., Farfel, M. R., Keyes, K. M., Stellman, S. D., & Hasin, D. S. (2014). Frequent binge drinking five to six years after exposure to 9/11: Findings from the World Trade Center Health Registry. Drug and Alcohol Dependence, 140, 1–7. https://doi.org/10.1016/j.drugalcdep.2014.04.013

2013

  • Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5-6 years post-9/11 in responders enrolled in the World Trade Center Health Registry
    • A study of 14,388 rescue and recovery workers five to six years after 9/11 found that 40% of those with lower respiratory symptoms and 57 percent of those with likely posttraumatic stress disorder (PTSD) had both types of symptoms. Rescue and recovery workers with this combination, or comorbidity, had more severe illness than responders with respiratory symptoms alone or probable PTSD alone. Responders who were comorbid were about three times more likely to report fair or poor general health, and twice as likely to report being unable to perform usual activities for 14 or more days in the month before completing their 2006-2007 survey. Given the comorbidity of respiratory and probable PTSD symptoms, health care providers are strongly encouraged to address both mental and physical health outcomes among persons exposed to a disaster, such as the 9/11 disaster.
    • Friedman, S. M., Farfel, M. R., Maslow, C. B., Cone, J. E., Brackbill, R. M., & Stellman, S. D. (2013). Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5–6 years post‐9/11 in responders enrolled in the World Trade Center Health Registry. American Journal of Industrial Medicine, 56(11), 1251–1261. https://doi.org/10.1002/ajim.22217
  • Social integration buffers stress in New York police after the 9/11 terrorist attack
    • Being socially integrated is regarded as a protective factor enabling people to cope with adversity. This study, based on 2943 police officers, examines Posttraumatic Stress Disorder (PTSD) among officers who responded to the 9/11 terrorist attack on the World Trade Center. A model was specified that uses 9/11 horrific event exposure as a predictor, earlier (Wave 1 WPTSD) response as a mediator, and later (Wave 2 PTSD) response as an outcome, and social integration as a moderator of this relationship. We found a multiplicative relationship between exposure levels and social integration: The higher the exposure level, the more stress responses occur, but this effect was buffered by a high level of social integration. Wave 1 PTSD interacted with social integration on Wave 2 PTSD: The more the police officers were socially integrated, the lower the Wave 2 PTSD score. The findings contribute to the understanding of mediating and moderating mechanisms that result in health outcomes such as posttraumatic stress disorder or resilience.
    • Schwarzer, R., Bowler, R. M., & Cone, J. E. (2014). Social integration buffers stress in New York police after the 9/11 terrorist attack. Anxiety, Stress, & Coping, 27(1), 18–26. https://doi.org/10.1080/10615806.2013.806652

2012

  • Co-occurring lower respiratory symptoms and posttraumatic stress disorder 5 to 6 years after the World Trade Center terrorist attack
    • More than 25% of residents, office workers, and passers-by enrolled in the Registry who had either lower respiratory symptoms or probable post-traumatic stress disorder (PTSD) had both conditions five to six years after 9/11. Also, enrollees who had both conditions were much more likely to report 14 days of activity lost in the 30 days before being surveyed than enrollees with one of these conditions.
    • Nair, H. P., Ekenga, C. C., Cone, J. E., Brackbill, R. M., Farfel, M. R., & Stellman, S. D. (2012). Co-occurring Lower Respiratory Symptoms and Posttraumatic Stress Disorder 5 to 6 Years After the World Trade Center Terrorist Attack. American Journal of Public Health, 102(10), 1964–1973. https://doi.org/10.2105/AJPH.2012.300690

2011

  • Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry
    • A study of nearly 5,000 volunteers who helped after the September 11 attacks found that volunteers without professional training had higher rates of health problems. Compared with trained volunteers, they were more likely to experience the dust cloud, injuries, and traumatic events. They also had higher rates of PTSD, asthma, and breathing problems. The findings show the need for better protection, health checks, and support for volunteers during and after disasters.
    • Debchoudhury, I., Welch, A. E., Fairclough, M. A., Cone, J. E., Brackbill, R. M., Stellman, S. D., & Farfel, M. R. (2011). Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry. Preventive Medicine, 53(6), 359–363. https://doi.org/10.1016/j.ypmed.2011.08.034
  • Longitudinal mental health impact among police responders to the 9/11 terrorist attack
    • A longitudinal study of nearly 3,000 police responders found that PTSD prevalence doubled from 7.8% in 2003-04 to 16.5% in 2006-7. Female police were significantly more likely than male police to report PTSD symptoms in the first survey, but this gender difference disappeared by the second survey. PTSD risk factors included post 9/11 unemployment and disability.
    • Bowler, R. M., Harris, M., Li, J., Gocheva, V., Stellman, S. D., Wilson, K., Alper, H., Schwarzer, R., & Cone, J. E. (2012). Longitudinal mental health impact among police responders to the 9/11 terrorist attack. American Journal of Industrial Medicine, 55(4), 297–312. https://doi.org/10.1002/ajim.22000

2010

  • Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center
    • A study of 3,271 people who escaped the World Trade Center towers found that 15% likely had PTSD two to three years after the September 11 attacks. Nearly all survivors reported at least one stress symptom. People who were on higher floors, left the towers late, were caught in the dust cloud, saw horrific events, or were injured had a higher risk of PTSD. Lower income and working for an employer with deaths also increased the risk.
    • DiGrande, L., Neria, Y., Brackbill, R. M., Pulliam, P., & Galea, S. (2011). Long-term Posttraumatic Stress Symptoms Among 3,271 Civilian Survivors of the September 11, 2001, Terrorist Attacks on the World Trade Center. American Journal of Epidemiology, 173(3), 271–281. https://doi.org/10.1093/aje/kwq372
  • Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack
    • A study of 4,017 police responders found that 8.3% had signs of PTSD two to three years after the September 11 attacks. PTSD was more common among female officers (13.9%) than male officers (7.4%). Being injured during the attacks and older age increased the risk of PTSD, showing the importance of mental health support for first responders after major disasters.
    • Bowler, R. M., Han, H., Gocheva, V., Nakagawa, S., Alper, H., DiGrande, L., & Cone, J. E. (2010). Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. American Journal of Industrial Medicine, 53(12), 1186–1196. https://doi.org/10.1002/ajim.20876

2009

  • Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack
    • A long-term study of 46,322 adults in the World Trade Center Health Registry found that 10.2% developed asthma and 23.8% experienced PTSD symptoms 5 to 6 years after the September 11 attacks. Exposure to the dust cloud, longer time spent at the disaster site, and major personal losses increased the risk of lasting health problems. The study shows that both breathing problems and mental health effects continued years after the disaster.
    • Brackbill, R. M. (2009). Asthma and Posttraumatic Stress Symptoms 5 to 6 Years Following Exposure to the World Trade Center Terrorist Attack. JAMA, 302(5), 502. https://doi.org/10.1001/jama.2009.1121

2008

  • Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks
    • A study of 11,037 adults living near the World Trade Center found that 12.6% had signs of PTSD two to three years after the September 11 attacks. People who were injured, saw traumatic events, or were exposed to the dust cloud had a higher risk of developing long-term PTSD. The study also found that lower income, less education, and taking part in evacuation or rescue efforts increased this risk. These findings show the need for long-term mental health support, especially for vulnerable communities.
    • DiGrande, L., Perrin, M. A., Thorpe, L. E., Thalji, L., Murphy, J., Wu, D., Farfel, M., & Brackbill, R. M. (2008). Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2–3 years after the September 11, 2001 terrorist attacks. Journal of Traumatic Stress, 21(3), 264–273. https://doi.org/10.1002/jts.20345

2007

  • Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers
    • A study of nearly 29,000 rescue and recovery workers found that 12.4% had signs of PTSD two to three years after the September 11 attacks. Volunteers and workers without disaster training had the highest rates of PTSD, while police workers had the lowest rates. Those who started work earlier and spent more time at the World Trade Center site had a higher risk of developing PTSD. These findings show the importance of disaster training and limiting time spent at disaster sites.
    • Perrin, M. A., Digrande, L., Wheeler, K., Thorpe, L., Farfe, M., & Brackbil, R. (2007). Differences in PTSD prevalence and associated risk factors among world trade center disaster rescue and recovery workers. The American Journal of Psychiatry, 164(9), 1385–1394. https://doi.org/10.1176/appi.ajp.2007.06101645

2006

  • Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings
    • Survivors and rescue recovery workers exposed to the September 11 attacks faced serious dangers, including injuries, polluted air, and traumatic experiences. A health study found that many survivors were caught in the dust and debris cloud, were injured, or developed new health problems. More than half reported breathing problems, while others had heartburn, severe headaches, or skin and hearing problems. Some survivors also experienced depression, anxiety, or other serious emotional distress. Overall, the study showed that survivors had lasting physical and mental health problems two to three years after the attacks. The researchers recommended continuing to monitor their health, especially for people who were exposed to the dust cloud.
    • Brackbill, R. M., Thorpe, L. E., DiGrande, L., Perrin, M., Sapp, J. H., Wu, D., Campolucci, S., Walker, D. J., Cone, J., Pulliam, P., Thalji, L., Farfel, M. R., & Thomas, P. (2006). Surveillance for World Trade Center Disaster Health Effects Among Survivors of Collapsed and Damaged Buildings: (506912006-001) [Dataset]. https://doi.org/10.1037/e506912006-001