The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort

Background: This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort. Methods: A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001. Results: The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4% and 15.4%, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs] = 1.56-1.86), pre-9/11 stressors (ORs = 1.30-1.50), family support (ORs = 0.83-0.94), and union membership (ORs = 0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR = 1.36), performing search and rescue work (OR = 1.29), and work support (OR = 0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs = 3.82-41.74), and somatic symptoms and functional difficulties (ORs = 1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs = 2.93-7.02; and ORs = 1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1% and 19.8%, respectively, versus 6.8% in trauma controls). Conclusions: These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel. Published by Elsevier Ltd.