Treatment Online

Risk for Workers at Ground Zero Varies by Training and Task
> 9/7/2007 1:40:21 PM

Those who bravely help with rescue and recovery after a disaster should be honored not only for putting themselves in the line of physical danger but for putting themselves at high risk for post-traumatic stress disorder. While only 4% of the general U.S. population has PTSD, studies have documented numbers from 5% to 32% for rescue and recovery workers. A study conducted by Dr. R. P. Smith found that 13% of workers on the World Trade Center site still showed PTSD symptoms a year after the attack. Just as these workers pulled survivors from the wreckage, scientists are trying to pull valuable information from the tragedy.

Dr. Megan Perrin felt that there was a trove of more detailed information behind the simple 13% statistic. In a study published in this month’s American Journal of Psychiatry, she broke the numbers down by profession and task performed, looking for any significant differences in PTSD prevalence. Using the World Trade Center Health Registry, an extensive database that the majority of workers voluntarily joined, Dr. Perrin found PTSD rates as low as 6.2% (police) and as high as 21.2% (unaffiliated volunteers).

The police were remarkable not only for their low rates of PTSD but also for the fact that they alone did not have a linearly increasing relationship between length of work and rates of PTSD. The authors use peculiar data like this to learn more about the general causes of PTSD. They speculate that police are less traumatized than other groups because they are exposed to violence and death as a regular part of their job. This can explain why firefighters also very low rates, but not why they had higher rates than policemen. The answer may be that firefighters suffered greater grief because they lost more of their comrades.

Sanitation workers and unaffiliated volunteers had particularly high rates of PTSD. This may illuminate two other principles for predicting who will be scarred by trauma. Sanitation workers received little recognition for their efforts, lost in the shadow of praise for firefighters and police, and so may have been more likely to dwell on negative emotions.�� Unaffiliated volunteers did not have the support structures that other groups could rely on. Not only did they not have standardized mental health treatment, but they did not have as robust of an informal support network from coworkers.

Another dimension that Dr. Perrin investigated was the task that workers performed. Interestingly, it was less important what task was done than whether that task was something that the worker was trained for. Police who had to fight fires or clear wreckage had much higher rates of PTSD than police who kept order. This effect is probably a result of both past experience and feelings of efficacy. Those who perform tasks they are familiar with and skilled at are less likely to feel shocked and hopeless.

The detailed statistics uncovered in this study help us understand why some are scarred by a terrible event and others are able to move on. If we are able to identify which rescue and recovery workers are at highest risk for developing PTSD, then we can try to minimize their exposure to dangerous factors and make sure that they have easy access to therapy.

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