Maslow Carey B, Caramanica Kimberly, Welch Alice E, Stellman Steven D, Brackbill Robert M, Farfel Mark R
New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
J Trauma Stress. 2015 Jun;28(3):198-205. doi: 10.1002/jts.22011. Epub 2015 May 19.
The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.
在16488名参与2001年9月11日（9·11）世贸中心（纽约市）事件救援与恢复工作并登记在世贸中心健康登记处的工作人员中，研究了创伤后应激障碍（PTSD）长达8 - 9年的纵向病程。潜在类别增长分析确定了5组救援与恢复工作人员，他们在创伤后应激障碍检查表（PCL）的3次施测中具有相似的分数轨迹：低稳定组（53.3%）、中度稳定组（28.7%）、中度增加组（6.4%）、高下降组（7.7%）和高稳定组（4.0%）。相对于低稳定组，较高风险组的成员与9·11相关暴露有关，包括在世贸中心工作的时长，调整后的优势比范围为1.3至2.0，目睹恐怖事件（范围 = 1.3至2.1）、受伤（范围 = 1.4至2.3）、感知到生命或安全受到威胁（范围 = 2.2至5.2）、亲人丧亡（范围 = 1.6至4.8）以及因9·11事件失业（范围 = 2.4至15.8）。在各风险组内，较高的PCL分数与不良社会环境有关，包括社会支持较低，B系数范围为0.2至0.6、离婚、分居或丧偶（范围 = 0.4 - 0.7）以及失业（范围 = 0.4 - 0.5）。鉴于影响PTSD不同轨迹的基线、暴露相关和背景因素，应在灾难后立即并定期对PTSD和不良环境进行筛查。
