In 2011-2012, the Registry launched its third survey (Wave 3) to gain an understanding of enrollees’ health status 10 years after the events of 9/11. More than 43,000 people responded to this survey, providing information on post-traumatic stress disorder, depression, respiratory health, economic impacts, unmet health care needs and other medical conditions and health care needs.
The Registry has published numerous findings based on updates from this survey and other resources. Some of the findings are highlighted below.
Prevalence of PTSD and depression
Among approximately 30,000 adult enrollees who completed all three Registry surveys, over 15% reported having PTSD, nearly 15% reported symptoms of depression, and 10% reported suffering from both conditions. Risk factors for having both PTSD and depression include increased number of 9/11 exposures, lack of social integration, and experiencing a traumatic life event after 9/11. (Caramanica et al.; Journal of Traumatic Stress, 2014)
Course of PTSD over time among rescue and recovery workers
The course of PTSD symptoms was examined among 16,488 rescue and recovery workers by looking at scores on the PTSD checklist instrument (PCL) over a period of 9 years. Five common patterns (or trajectories) of PCL scores were identified: 1) low, stable 2) moderate, stable, 3) moderate, increasing 4) high, decreasing and 5) high, stable. Membership in groups with higher scores (more severe symptoms of PTSD) was associated with higher levels of 9/11-related exposures. Findings from this study suggest a greater need for comprehensive and continuous screenings for this survivor group. (Maslow et al.; Journal of Traumatic Stress, 2015)
PTSD comorbidity and early retirement and job loss
The association between chronic 9/11 related health conditions and premature exit from the labor force was examined among 7,662 non-uniformed rescue and recovery workers under the age of 60. This study focused on early retirement and health-related job loss as two major modes of premature labor force exit. Workers with chronic medical conditions were more likely to experience early retirement and job loss, particularly when PTSD was also present. These findings suggest that future evaluations of the impact of disasters should assess the long-term effects on labor force outcomes. (Yu et al.; American Journal of Industrial Medicine, 2016)
PTSD and unmet health care needs
In a study of 9,803 adult enrollees with probable PTSD or depression, over a third of participants reported an unmet mental health care need at Wave 3. More severe mental health symptoms and lower social support were each associated with unmet mental health care needs. Barriers to adequate care included cost and access, particularly among those with low social support. These findings are being used to inform efforts to address unmet mental health care needs among those exposed to the 9/11 attacks. (Ghuman et al.; BMC Public Health, 2014)
Persistent lower respiratory symptoms 10 years after 9/11
Among 18,913 Registry enrollees who completed the first three Registry surveys, 15% reported persistent lower respiratory symptoms (cough, wheeze, dyspnea, or inhaler use in the 30 days prior to the survey) in 2011-2012. Half of those with persistent lower respiratory symptoms also had PTSD, depression, or generalized anxiety disorder. The co-occurrence of lower respiratory symptoms and mental illness continue to persist 10 years after 9/11. Future studies are needed to assess the interrelationship between respiratory health and mental illness. (Friedman et al; Occupational and Environmental Medicine, 2016)
Poor control of 9/11-related asthma among adults
Among 2,445 enrollees who were diagnosed with asthma between 9/12/2001 and 12/31/2003, more than a third continue to experience asthma symptoms that interfered with their daily lives 10 years after the attacks. Factors that were closely tied to poor control of asthma symptoms were co-existing mental health conditions, including PTSD and depression. Co-existing gastroesophageal reflux and obstructive sleep apnea were also associated with worse asthma symptoms. These findings emphasize the importance of integrating care for physical and mental health conditions. (Jordan et al; Journal of Asthma, 2015)
During the follow-up period of 2007 through 2011, 685 first life-time primary cancer cases were diagnosed among 24,863 rescue/recovery workers, and 992 among 35,476 civilian survivors. There were 8% to 11% more cancer cases occurring in our study population than expected compared to the New York State population. Excess cancers include skin melanoma and prostate cancer in both populations, thyroid cancers among rescue/recovery workers, and female breast cancer, non-Hodgkin’s lymphoma among civilian survivors. Additional follow up studies are needed to understand the magnitude and risk of cancers among this population.
Substance use in adolescents
In looking at substance use among adolescents ten years after exposure to the events of 9/11, 11% of adolescents reported ever smoking cigarettes, 18% have ever drinking alcohol, and 10% having ever using marijuana. Adolescents who witnessed a disturbing event on 9/11 were twice as likely to report ever drinking and almost three times as likely to have ever used marijuana. Among those ≥5 years of age on 9/11, fear for personal safety on 9/11 was significantly associated with having ever smoked cigarettes, ever drank, and ever used marijuana. (Gargano et al; Journal of Child and Adolescent Substance Abuse. 2016)