Statistical findings from longitudinal studies of mental health among 9/11 witnesses and first responders.
September 11, 2001, changed the lives of thousands of Americans, including survivors, witnesses, and first responders. What have we learned about the psychiatric sequelae? These study findings shed light on their illnesses, comorbid conditions, and overall mental health.
In what was heralded as “the largest and longest longitudinal face-to-face study of individuals exposed to the 9/11 attack as children,” investigators compared children who witnessed the attack (N=844) to children who saw it on television (N=491).1 Based on his findings, the study’s lead author, Lawrence Amsel, MD, recommended that clinicians who treat patients with trauma check in with them about long-term effects, which could last for decades.
In their paper on first responders’ self-reported mental health needs, Diab et al analyzed data from 16,170 study participants, which included police responders (N=8881) and non-traditional responders (eg, construction workers) (N=7289). All participants completed an annual health monitoring visit with the WTC Health Program.2 Participants desired a variety of services, including psychotherapy, psychiatric medication, and stress management counseling. The authors hoped that their findings could aid outreach and monitoring efforts in the future.
The study of stigma and barriers to care by DePierro et al3 included police officers (N=6777) and non-traditional responders (N=6272). Police officers and non-traditional responders who reported PTSD symptoms were also more likely to endorse the idea that stigma was associated with care.
Chen et al4 studied WTC responders (N=4196) who were monitored by the WTC Health Program between 2012 and 2014. During that time, responders completed a web-based survey that gathered information on WTC exposure, demographics, and mental health services use.
For this study, Garrey et al5 used data from the WTC Health Registry (N = 28,935). Based on the high levels of ISMA in WTC survivors, the authors concluded that “repeated screenings for self-medicative alcohol use among survivors of mass traumas with PTSD symptoms is of public health importance.”
Diminich et al6 looked at data from a cross-sectional sample of WTC first responders (N=4815) from a 2015 to 2018 monitoring program. The most common comorbid conditions were reduced hand-grip strength and chair-rise speed, which the researchers noted were well “beyond age-expected impairment.” Despite some study limitations (most participants were white, male, and in law enforcement), the authors still suggested that their results may contain the seeds of future research: "these results may suggest that investigators interested in understanding the risk of PTSD with co-morbid [cognitive/physical impairment] may need to better understand the extent to which neurodegeneration is evidence in prodromal” physical impairment.
Even as the 20th anniversary passes, many witnesses and first responders will still struggle with psychiatric illnesses. To learn more about their conditions, and about how September 11th has affected the United States as a whole, read a collection of articles and videos from Psychiatric TimesTM.
1. Caffrey M. Study of children of 9/11 reveals long-term effects of childhood trauma. AJMC. May 20, 2019. Accessed September 7, 2021. https://www.ajmc.com/view/study-of-children-of-911-reveals-longterm-effects-of-childhood-trauma
2. Diab O, DePierro J, Cancelmo L, et al. Mental healthcare needs in World Trade Center responders: results from a large, population-based health monitoring cohort. Adm Policy Ment Health. 2020;47(3):427-434.
3. DePierro J, Lowe SM, Haugen PT, et al. Mental health stigma and barriers to care in World Trade Center responders: Results from a large, population-based health monitoring cohort. Am J Ind Med. 2021;64(3):208-216.
4. Chen C, Salim R, Rodriguez J, Singh R, et al. The burden of subthreshold posttraumatic stress disorder in World Trade Center responders in the second decade after 9/11. J Clin Psychiatry. 2020;81(1):19m12881.
5. Garrey SK, Welch AE, Jacobson MH, et al. The intentional self-medication of 9/11-related PTSD symptoms with alcohol: 15 years after the disaster. Int J Environ Res Public Health. 2020;17(15):5327.
6. Diminich ED, Clouston SAP, Kranidis A, et al Chronic posttraumatic stress disorder and comorbid cognitive and physical impairments in World Trade Center responders. J Trauma Stress. 2021;34(3):616-627.