Disaster Medicine and Public Health Preparedness

Research Article

Trends in Probable PTSD in Firefighters Exposed to the World Trade Center Disaster, 2001–2010

Jackie Soo, Mayris P. Webber c1, Jackson Gustave, Roy Lee, Charles B. Hall, Hillel W. Cohen, Kerry J. Kelly and David J. Prezant


Objective: We present the longest follow-up, to date, of probable posttraumatic stress disorder (PTSD) after the 2001 terrorist attacks on the World Trade Center (WTC) in New York City firefighters who participated in the rescue/recovery effort.

Methods: We examined data from 11 006 WTC-exposed firefighters who completed 40 672 questionnaires and reported estimates of probable PTSD by year from serial cross-sectional analyses. In longitudinal analyses, we used separate Cox models with data beginning from October 2, 2001, to identify variables associated with recovery from or delayed onset of probable PTSD.

Results: The prevalence of probable PTSD was 7.4% by September 11, 2010, and continued to be associated with early arrival at the WTC towers during every year of analysis. An increasing number of aerodigestive symptoms (hazard ratio [HR] 0.89 per symptom, 95% confidence interval [CI] 0.86-.93) and reporting a decrease in exercise, whether the result of health (HR 0.56 vs no change in exercise, 95% CI 0.41-.78) or other reasons (HR 0.76 vs no change in exercise, 95% CI 0.63-.92), were associated with a lower likelihood of recovery from probable PTSD. Arriving early at the WTC (HR 1.38 vs later WTC arrival, 95% CI 1.12-1.70), an increasing number of aerodigestive symptoms (HR 1.45 per symptom, 95% CI 1.40–1.51), and reporting an increase in alcohol intake since September 11, 2001 (HR 3.43 vs no increase in alcohol intake, 95% CI 2.67-4.43) were associated with delayed onset of probable PTSD.

Conclusions: Probable PTSD continues to be associated with early WTC arrival even 9 years after the terrorist attacks. Concurrent conditions and behaviors, such as respiratory symptoms, exercise, and alcohol use also play important roles in contributing to PTSD symptoms.

(Disaster Med Public Health Preparedness. 2011;5:S197-S203)

(Received May 31 2011)

(Accepted July 08 2011)

Key Words:

  • World Trade Center;
  • mental health;
  • psychological symptoms;
  • firefighters;
  • stress disorders, post-traumatic;
  • occupational health;
  • September 11 terrorist attacks;
  • New York City;
  • terrorism;
  • disaster response


c1 Correspondence: Address correspondence and reprint requests to Dr Mayris Webber, New York City Fire Department, Bureau of Health Services, 9 Metrotech Center, Brooklyn, NY 11201 (e-mail: webberm@fdny.nyc.gov).

Author Affiliations: Ms Soo and Dr Prezant are with the Department of Medicine, and Drs Webber, Hall, and Cohen are with the Department of Epidemiology and Population Health, Montefiore Medical Center. Mr Gustave, Mr Lee, and Dr Kelly are with the Bureau of Health Services, Fire Department of the City of New York.

This work was supported by National Institute for Occupational Safety and Health (NIOSH) grant RO1-OH07350.