BACKGROUND: Posttraumatic stress disorder (PTSD) is one of the most common mental health sequelae of the 9/11 terrorist attacks on the World Trade Center (WTC). Enrollees in the World Trade Center Health Registry (Registry) were also affected by Hurricane Sandy (Sandy), which struck the New York City metropolitan area in late October 2012. Previous research has shown that 9/11-related PTSD predicted Sandy-related PTSD among Registry enrollees. This study evaluated the impact of Sandy-related PTSD on the trajectory of 9/11-related PTSD symptoms among Registry enrollees.
METHODS: The study population included 3,199 adult Registry enrollees who completed surveys at Wave 1 (2003-4), Wave 2 (2006-7), and Wave 3 (2011-12), and Wave 4 (2015-16) and post-Hurricane Sandy (2013). At Waves 1-4, 9/11-related PTSD was assessed using the PTSD Checklist (PCL). Latent class growth analysis was used to identify groups of enrollees who shared a similar trajectory of change in PCL score from Wave 1 to Wave 3. We compared enrollees in each trajectory group with and without Sandy-related PTSD to assess its impact on 9/11-related PTSD status at Wave 4 (Wave 4 PTSD) using bivariate analyses and multivariable logistic regression.
RESULTS: A model with five groups best described PTSD symptoms from Wave 1 to Wave 3: low-stable (49.7%), moderate-stable (29.8%), moderate-increasing (7.3%), high-decreasing (9.1%), and high-stable (4.1%). Almost all enrollees in the low-stable and moderate-stable groups did not have Wave 4 PTSD, regardless of Sandy-related PTSD status. Conversely, over 80% of enrollees in the high-stable group had Wave 4 PTSD, irrespective of Sandy PTSD status. Of enrollees in the moderate-increasing group, 75% of those with Sandy-related PTSD also had Wave 4 PTSD compared to 47% of those without Sandy-related PTSD. Among enrollees in the high-deceasing group, 55% of those with Sandy-related PTSD also had Wave 4 PTSD, compared to 26% of those without Sandy-related PTSD. In adjusted analyses, among enrollees in the high-decreasing group Sandy-related PTSD and Wave 4 unmet healthcare needs were significantly associated with Wave 4 PTSD; however, Sandy-related exposures, post-Sandy unmet mental healthcare needs and seeking counseling were not.
CONCLUSIONS: The large proportion of enrollees with Sandy-related PTSD in the high-decreasing group who subsequently screened positive for Wave 4 PTSD—seemingly a reversal in their trajectory—suggests that for a certain sub-group of enrollees Hurricane Sandy may have exacerbated previously resolved symptoms of 9/11-related PTSD. This indicates a need to assess and address mental health sequelae from previous traumatic exposures.