Psychological Medicine

  • Psychological Medicine / Volume 42 / Issue 05 / May 2012, pp 1069-1079
  • Copyright © Cambridge University Press 2011 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 18 November 2011

Original Articles

Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers

B. J. Lufta1, C. Schechtera2, R. Kotova3, J. Broihiera1, D. Reissmana4, K. Guerreraa1, I. Udasina5, J. Molinea6, D. Harrisona7, G. Friedman-Jimeneza7, R. H. Pietrzaka8a9, S. M. Southwicka8a9 and E. J. Brometa3 c1

a1 Department of Medicine, Stony Brook University, Stony Brook, NY, USA

a2 Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA

a3 Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA

a4 Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA

a5 Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA

a6 Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA

a7 Departments of Medicine and Environmental Medicine, New York University School of Medicine and Bellevue Hospital Center, New York, NY, USA

a8 Department of Psychiatry, Yale University School of Medicine, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA

a9 Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA


Background Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures.

Method Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC).

Results Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms.

Conclusions Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.

(Received August 03 2011)

(Revised October 02 2011)

(Accepted October 14 2011)

(Online publication November 18 2011)


c1 Address for correspondence: E. Bromet, Ph.D., Distinguished Professor, Departments of Psychiatry and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA. (Email: