摘要：Objectives. We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health–related medical leave over the first 2.5 years after the attack. Methods. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and “loss of a co-worker while working at the collapse.” We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision , and a sensitivity-specificity analysis. Results. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health–related medical leave. Exposure–response gradients were significant for all outcomes. Conclusions. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources. The September 11, 2001, terrorist attacks on the World Trade Center (WTC) killed 2749 people. A vast, dangerous urban disaster site was created for thousands of rescue workers exposed to numerous physical, chemical, and psychological hazards, 1 – 3 resulting in well-documented physical health consequences. 4 – 9 The Fire Department of the City of New York (FDNY) is the largest fire department in the world, with an annual workforce averaging 11 500 firefighters. On September 11, 2001, FDNY personnel were first-responders and victims, suffering a devastating number of fatalities, injuries, respiratory illnesses, and psychological injuries. During the collapse of the towers, 341 FDNY firefighters and 2 FDNY paramedics lost their lives. Nearly every FDNY firefighter worked at the WTC for varying time periods between September 11, 2001, and July 25, 2002. Among the many WTC rescue and recovery workers, FDNY firefighters arguably suffered the greatest exposures to the injured, the dying, the dead, human remains (many from their own colleagues), and potential life-threatening situations. Studies of firefighters' mental health after rescue and recovery efforts are few in number and small in sample size. 10 – 13 After the Oklahoma City bombing in 1995, posttraumatic stress disorder (PTSD) was diagnosed for 34% of survivors 13 , 14 and 13% of firefighters. 10 After the WTC attack, an elevated PTSD risk, referred to as “probable PTSD,” 15 – 17 was reported for 37% of evacuees 15 and, depending on scoring methods, for 12% to 17% of FDNY firefighters and non-FDNY firefighters included in the WTC Registry, 16 as well as the 11% to 20% of non-FDNY rescue-recovery workers included in the Mt Sinai Coordinated WTC Medical Monitoring and Treatment Program. 17 We present new data on the psychological impact of exposure to the WTC disaster among the FDNY WTC firefighter cohort over the first 2.5 years after the attack. First, we described the cohort's psychological response as determined by a computerized self-administered questionnaire, use of the FDNY Counseling Services Unit (CSU), and verified, rather than self-reported, functional impairment as assessed by CSU-assigned mental health–related medical leave. Second, we determined whether psychological symptom scores reported within the first 6 months after September 11 were associated with elevated PTSD risk, CSU use, or CSU-assigned mental health–related medical leave. Third, we determined whether exposure–response gradients were significant for these outcomes.
