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Resilience to post-traumatic stress among World Trade Center survivors: A mixed-methods study

Lisa M. Gargano, PhD, Sindhushree Hosakote, MS, Qi Zhi, MPH, Kristine A. Qureshi, PhD, Robyn R. Gershon, DrPH

Abstract


The purpose of this study was to identify individual characteristics, behaviors, and psychosocial factors associated with symptoms of post-traumatic stress disorder (PTSD) among World Trade Center (WTC) disaster evacuation survivors. The study utilized a mixed-method design. In-depth interviews were conducted using a prepared script. PTSD was assessed using the PTSD checklist-civilian (PCL-C; a score ≥ 50 indicates probable PTSD). Thematic analysis was conducted to identify factors associated with PTSD. A purposive sample of 29 WTC evacuees was recruited using a multimodal recruitment strategy. Eligibility included: history of evacuation from the WTC (Tower 1 and/or Tower 2) on September 11, 2001, and decisional capacity for informed consent. Five participants had PCL-C scores ≥ 50. Thematic analysis identified resiliency factors (protective for PTSD), including leadership, taking action based on “gut” feelings (to evacuate), social support (staying in a group), going on “automatic survival” mode, and previous training on emergency response. Risk factors for PTSD included lack of emergency response training, lack of sense of urgency, poor physical condition, lack of communication skills, lack of direction, peri-event physical injury, peri-event traumatic exposure (horror), and moral injury (guilt and remorse). Several modifiable factors that may confer resilience were identified. In particular, the role of emergency response training in preventing disaster-related mental illness should be explored as a possible strategy for enhancing resilience to disaster events.


Keywords


September 11, 2001, 9/11, World Trade Center, post-traumatic stress disorder, resilience, in-depth interviews, mixed methods

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References


National Institute of Standards and Technology: Final Reports from the NIST Investigation of the World Trade Center Disaster. 2005. Available at https://www.nist.gov/engineering-laboratory/final-reports-nist-world-trade-center-disaster-investigation. Accessed August 24, 2016.

Galea S, Ahern J, Resnick H, et al.: Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002; 346(13): 982-987.

Caramanica K, Brackbill RM, Liao T, et al.: Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster. J Trauma Stress. 2014; 27(6): 680-688.

DiGrande L, Perrin MA, Thorpe LE, et al.: Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress. 2008; 21(3): 264-273.

Farfel M, DiGrande L, Brackbill R, et al.: An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health. 2008; 85(6): 880-909.

Maslow CB, Caramanica K, Welch AE, et al.: Trajectories of scores on a screening instrument for PTSD among World Trade Center rescue, recovery, and clean-up workers. J Trauma Stress. 2015; 28(3): 198-205.

Welch AE, Caramanica K, Maslow CB, et al.: Trajectories of PTSD among Lower Manhattan residents and area workers following the 2001 World Trade Center Disaster, 2003-2012. J Trauma Stress. 2016; 29(2): 158-166.

Brackbill RM, Hadler JL, DiGrande L, et al.: Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA. 2009; 302(5): 502-516.

Shing EZ, Jayawickreme E, Waugh CE: Contextual positive coping as a factor contributing to resilience after disasters. J Clin Psychol. 2016; 72(12): 1287-1306.

Weisaeth L: Vulnerability and protective factors for posttraumatic stress disorder. Psychiatry Clin Neurosci. 1998; 52: S43-S48.

Gershon RR, Magda LA, Riley HEM, et al.: The World Trade Center evacuation study: Factors associated with initiation and length of time for evacuation. Fire Materials. 2012; 36(5-6): 481-500.

Gershon RR, Qureshi KA, Rubin MS, et al.: Factors associated with high-rise evacuation: Qualitative results from the World Trade Center Evacuation Study. Prehosp Disaster Med. 2007; 22(3): 165-173.

Blanchard EB, Jones-Alexander J, Buckley TC, et al.: Psychometric properties of the PTSD Checklist (PCL). Behav Res Therapy. 1996; 34(8): 669-673.

Neria Y, Gross R, Olfson M, et al.: Posttraumatic stress disorder in primary care one year after the 9/11 attacks. Gen Hosp Psychiatry. 2006; 28(3): 213-222.

Weathers FW, Litz BT, Herman DS, et al.: The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at: Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX, 1993.

Wilkins KC, Lang AJ, Norman SB: Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011; 28(7): 596-606.

Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, Thalji L, Dennis JM, Fairbank JA, Kulka RA. Psychological reactions to terrorist attacks: findings from the National Study of Americans’ Reactions to September 11. JAMA. 2002 Aug 7; 288(5): 581-8.

Sherman MF, Gershon RR, Riley HEM, et al.: Emergency preparedness safety climate and other factors associated with mental health outcomes among world trade center disaster evacuees. Disaster Med Public Health Prep. 2017; 11(3): 326-336.

Blumer H: Symbolic Interactionism: Perspective and Method. Englewood Cliffs, NJ: Prentice-Hall Inc., 1969.

Shrout PE, Fleiss JL: Intraclass correlations: Uses in assessing rater reliability. Psychol Bull. 1979; 86(2): 420-428.

Benight CC, Bandura A: Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behav Res Therapy. 2004; 42(10): 1129-1148.

Ozbay F, Johnson DC, Dimoulas E, et al.: Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry (Edgmont). 2007; 4(5): 35-40.

Galea S, Ahern J, Resnick H, et al.: Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med. 2002; 346(13): 982-987.

UDoV Affairs: PTSD: National Center for PTSD. 2016. Available at http://www.ptsd.va.gov/. Accessed August 24, 2016.

Litz BT, Stein N, Delaney E, et al.: Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clin Psychol Rev. 2009; 29(8): 695-706.

Nash WP, Marino Carper TL, Mills MA, et al.: Psychometric evaluation of the Moral Injury Events Scale. Military Med. 2013; 178(6): 646-652.

Nash WP, Litz BT: Moral injury: A mechanism for war-related psychological trauma in military family members. Clin Child Family Psychol Rev. 2013; 16(4): 365-375.

Welch AE, Caramanica K, Debchoudhury I, et al.: A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees. BMC Public Health. 2012; 12: 721.

Slone LB: Prevalence of PTSD in primary care settings. PTSD Res Quart. 2006; 17(2): 1-8.

Gargano LM, Gershon RR, Brackbill RM: Quality of life of persons injured on 9/11: Qualitative analysis from the World Trade Center Health Registry. PLoS Curr. 2016; 8.

Southwick SM, Bonanno GA, Masten AS, et al.: Resilience definitions, theory, and challenges: Interdisciplinary perspectives. Eur J Psychotraumatol. 2014; 5.




DOI: https://doi.org/10.5055/jem.2017.0336

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