SBU Study: Long-Term PTSD Symptoms in WTC Responders Bear Watching

A study of nearly 13,000 World Trade Center (WTC) responders and their symptoms of post-traumatic stress disorder (PTSD) over a 20-year period (July 2002 to December 2022) shows that symptoms can change though remain for many responders, increase in a smaller portion of them, and can help predict their physical impairment and mental health many years after trauma.

Led by a team of researchers at Stony Brook Medicine, in affiliation with the World Trade Center Health and Wellness Program at Stony Brook University, the findings are published online in Nature Mental Health.

The findings and paper are a summation of more than 20 years of research and analysis by research scientists and clinicians working through the Stony Brook WTC Health and Wellness Program. Data included more than 81,000 clinical observations from 12,822 responders. The team found that symptoms were stable in the short term but changed significantly over two decades, peaked over a decade after exposure, and declined modestly thereafter.

 The median time before symptoms improved was between 8 and 10 years for confirmed PTSD cases. Most patients experienced improvement in symptoms after a decade post enrollment in the WTC Health and Wellness program. Yet approximately 10 percent reported elevated symptoms two decades after the trauma. Changes in symptoms also predicted higher functional impairments and mental health care utilization by the responders.

“Our findings highlight the enduring and long-term impact of PTSD among WTC responders, even with the substantial individual variability in PTSD symptom trajectories within the large sample,” said Frank Mann, lead author and senior research scientist in the Program in Public Health and in the Department of Medicine at the Renaissance School of Medicine (RSOM). Mann also led the analysis of the data.

All study participants are members of the Long Island WTC Health and Wellness Program, which is funded by the National Institute for Occupational Safety and Health (NIOSH). Responders who qualify for the program receive annual monitoring visits for WTC-related disorders, including PTSD.

“We believe that these findings, which have evolved and reflect many of our previous findings, are an important roadmap to the ongoing nature of PTSD in our WTC responders and potentially for others who have experienced mass trauma,” said co-author Benjamin Luft, MD, director of the Stony Brook WTC Health and Wellness Program, and the Edmund D. Pellegrino Professor of Medicine in the RSOM.

Luft added that the study uncovered an additional important finding: Non-professional responders, such as construction workers and general volunteers, in contrast to the professional first responders to Ground Zero, were significantly at greater risk for chronic PTSD symptoms. This finding, he notes, begins to identify the enormous financial consequences associated with developing chronic PTSD.

Mann, Luft and their colleagues emphasize several takeaways from their findings when analyzing PTSD in WTC responders over two decades: Think long-term, as symptom change is often slow but does occur; continual patient monitoring is key, as single-time point screenings miss late-emerging or relapsing PTSD cases; and continual care is necessary, as the most difficult PTSD cases have high rates of accompanying physical and mental impairment.