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Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

Published online by Cambridge University Press:  02 December 2013

R. H. Pietrzak*
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. Feder
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
C. B. Schechter
Affiliation:
Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
R. Singh
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
L. Cancelmo
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
C. L. Katz
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
D. B. Reissman
Affiliation:
Office of the Director, National Institute for Occupational Safety and Health, Washington, DC, USA
F. Ozbay
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
V. Sharma
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
M. Crane
Affiliation:
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
D. Harrison
Affiliation:
Department of Environmental Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY, USA
R. Herbert
Affiliation:
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
S. M. Levin
Affiliation:
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
B. J. Luft
Affiliation:
Department of Medicine, Division of Infectious Diseases, Stony Brook University, Stony Brook, NY, USA
J. M. Moline
Affiliation:
Department of Population Health, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY, USA
J. M. Stellman
Affiliation:
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
I. G. Udasin
Affiliation:
Department of Environmental and Occupational Medicine, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA
R. El-Gabalawy
Affiliation:
Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
P. J. Landrigan
Affiliation:
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
S. M. Southwick
Affiliation:
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
*
* Address for correspondence: R. H. Pietrzak, Ph.D., M.P.H., National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue 151E, West Haven, CT, 06516, USA. (Email: robert.pietrzak@yale.edu)

Abstract

Background

Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations.

Method

Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11.

Results

CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time.

Conclusions

Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., text revision. American Psychiatric Press: Washington, DC.Google ScholarPubMed
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA. Google ScholarPubMed
Armour, C, Carragher, N, Elhai, JD (2013 a). Assessing the fit of the dysphoric arousal model across two nationally representative epidemiological surveys: The Australian NSMHWB and the United States NESARC. Journal of Anxiety Disorders 27, 109115.CrossRefGoogle ScholarPubMed
Armour, C, Elhai, JD, Richardson, D, Ractliffe, K, Wang, L, Elklit, A (2012). Assessing a five factor model of PTSD: is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression? Journal of Anxiety Disorders 26, 368376.CrossRefGoogle ScholarPubMed
Armour, C, Raudzah Ghazali, S, Elklit, A (2013 b). PTSD's latent structure in Malaysian tsunami victims: assessing the newly proposed dysphoric arousal model. Psychiatry Research 206, 2632.CrossRefGoogle ScholarPubMed
Berninger, A, Webber, MP, Cohen, HW, Gustave, J, Lee, R, Niles, JK, Chiu, S, Zeig-Owens, R, Soo, J, Kelly, K, Prezant, DJ (2010). Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001–2005. Public Health Reports 125, 556566.CrossRefGoogle ScholarPubMed
Bowler, RM, Han, H, Gocheva, V, Nakagawa, S, Alper, H, DiGrande, L, Cone, JE (2010). Gender differences in probable posttraumatic stress disorder among police responders to the 2001 World Trade Center terrorist attack. American Journal of Industrial Medicine 53, 11861196.CrossRefGoogle ScholarPubMed
Bremner, JD, Southwick, SM, Darnell, A, Charney, DS (1996). Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. American Journal Psychiatry 153, 369375.Google ScholarPubMed
Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, ML (2003). Acute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study. Journal of Traumatic Stress 16, 439443.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2004). Mental health status of World Trade Center rescue and recovery workers and volunteers – New York City, July 2002–August 2004. Morbidity and Mortality Weekly Report 53, 812815.Google Scholar
Creamer, M, Burgess, P, Pattison, P (1992). Reaction to trauma: a cognitive processing model. Journal of Abnormal Psychology 101, 452459.CrossRefGoogle ScholarPubMed
Cukor, J, Wyka, K, Jayasinghe, N, Weathers, F, Giosan, C, Leck, P, Roberts, J, Spielman, L, Crane, M, Difede, J (2011). Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001. Depression and Anxiety 28, 210217.CrossRefGoogle ScholarPubMed
Elhai, JD, Biehn, TL, Armour, C, Klopper, JJ, Frueh, BC, Palmieri, PA (2011). Evidence for a unique PTSD construct represented by PTSD's D1–D3 symptoms. Journal of Anxiety Disorders 25, 340345.CrossRefGoogle ScholarPubMed
Elhai, JD, Layne, CM, Steinberg, AM, Brymer, MJ, Briggs, EC, Ostrowski, SA, Pynoos, RS (2013). Psychometric properties of the UCLA PTSD reaction index. part II: investigating factor structure findings in a national clinic-referred youth sample. Journal of Traumatic Stress 26, 1018.CrossRefGoogle Scholar
Elhai, JD, Palmieri, PA (2011). The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. Journal of Anxiety Disorders 25, 849854.CrossRefGoogle ScholarPubMed
Fan, X, Sivo, SA (2009). Using goodness-of-fit indexes in assessing mean structure invariance. Structural Equation Modeling 16, 5467.CrossRefGoogle Scholar
Foa, EB, Riggs, DS, Gershuny, BA (1995). Arousal, numbing, and intrusion: symptom structure of PTSD following assault. American Journal of Psychiatry 152, 116120.Google ScholarPubMed
Herbert, R, Moline, J, Skloot, G, Metzger, K, Baron, S, Luft, B, Markowitz, S, Udasin, I, Harrison, D, Stein, D, Todd, A, Enright, P, Stellman, JM, Landrigan, PJ, Levin, SM (2006). The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program. Environmental Health Perspectives 114, 18531858.Google ScholarPubMed
Hinton, DE, Hofmann, SG, Pollack, MH, Otto, MW (2009). Mechanisms of efficacy of CBT for Cambodian refugees with PTSD: improvement in emotion regulation and orthostatic blood pressure response. CNS Neuroscience and Therapeutics 15, 255263.CrossRefGoogle ScholarPubMed
Hoge, EA, Worthington, JJ, Nagurney, JT, Chang, Y, Kay, EB, Feterowski, CM, Katzman, AR, Goetz, JM, Rosasco, ML, Lasko, NB, Zusman, RM, Pollack, MH, Orr, SP, Pitman, RK (2012). Effect of acute posttrauma propranolol on PTSD outcome and physiological responses during script-driven imagery. CNS Neuroscience and Therapeutics 18, 2127.CrossRefGoogle ScholarPubMed
Horowitz, MJ (2001). Stress Response Syndromes, 3rd edn. Jason Aronson: New York.Google Scholar
Hu, L, Bentler, PM (1998). Fit indices in covariance structural modeling: sensitivity to underparameterized model misspecification. Psychological Methods 3, 424453.CrossRefGoogle Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.CrossRefGoogle Scholar
Jöreskog, KG (1979). Statistical estimation of structural models in longitudinal developmental investigations. In Longitudinal Research in the Study of Behavior and Development (ed. Nesselroade, J. R. and Baltes, P. B.), pp. 303352. Academic Press: New York.Google Scholar
Keane, TM, Fairbank, JA, Caddell, RT, Zimering, RT, Bender, ME (1985). A behavioral approach to assessing and treating PTSD in Vietnam veterans. In Trauma and its Wake (ed. Figley, C. R.), pp. 257294. Brunner/Mazel: New York.Google Scholar
King, DW, Leskin, GA, King, LA, Weathers, FW (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment 10, 9096.CrossRefGoogle Scholar
Lawrence, JW, Fauerbach, J, Munster, A (1996). Early avoidance of traumatic stimuli predicts chronicity of intrusive thoughts following burn injury. Behaviour Research and Therapy 34, 643646.CrossRefGoogle Scholar
Leskin, GA, Kaloupek, DG, Keane, TM (1998). Treatment for traumatic memories: review and recommendations. Clinical Psychology Review 18, 9831001.CrossRefGoogle ScholarPubMed
Lucchini, RG, Crane, MA, Crowley, L, Globina, Y, Milek, DJ, Boffetta, P, Landrigan, PJ (2012). The World Trade Center Health Surveillance Program: results of the first 10 years and implications for prevention. Giomale Italiano di Medicina del Lavoro ed Ergonomia 34 (Suppl. 3), 529533.Google Scholar
Luft, BJ, Schechter, C, Kotov, R, Broihier, J, Reissman, D, Guerrera, K, Udasin, I, Moline, J, Harrison, D, Friedman-Jimenez, G, Pietrzak, RH, Southwick, SM, Bromet, EJ (2012). Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers. Psychological Medicine 42, 10691079.CrossRefGoogle ScholarPubMed
Macdonald, A, Monson, CM, Doron-Lamarca, S, Resick, PA, Palfai, TP (2011). Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Traumatic Stress 24, 268276.CrossRefGoogle ScholarPubMed
Malta, LS, Wyka, KE, Giosan, C, Jayasinghe, N, Difede, J (2009). Numbing symptoms as predictors of unremitting posttraumatic stress disorder. Journal of Anxiety Disorders 23, 223229.CrossRefGoogle ScholarPubMed
Marshall, GN, Schell, TL, Glynn, SM, Shetty, V (2006). The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury. Journal of Abnormal Psychology 115, 624628.CrossRefGoogle ScholarPubMed
Marshall, GN, Schell, TL, Miles, JNV (2013). A multi-sample confirmatory factor analysis of PTSD symptoms: what exactly is wrong with the DSM-IV structure? Clinical Psychology Review 33, 5466.CrossRefGoogle ScholarPubMed
Mayer, L, Carrol, S (1987). Testing for lagged, cotemporal and total dependence in cross-lagged panel analysis. Sociological Methods and Research 16, 187217.CrossRefGoogle Scholar
Muthén, B, Muthén, L (2002). MPlus: The Comprehensive Modeling Program for Applied Researchers. Muthén and Muthén: Los Angeles, CA.Google Scholar
Nixon, RDV, Nehmy, T, Seymour, M (2007). The effect of cognitive load and hyperarousal on negative intrusive memories. Behaviour Research and Therapy 45, 26522663.CrossRefGoogle ScholarPubMed
Perrin, MA, DiGrande, L, Wheeler, K, Thorpe, L, Farfel, M, Brackbill, R (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry 164, 13851394.CrossRefGoogle ScholarPubMed
Palmieri, PA, Weathers, FW, Difede, J, King, DW (2007). Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero. Journal of Abnormal Psychology 116, 329341.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Feder, A, Singh, R, Schechter, CB, Bromet, EJ, Katz, CL, Reissman, DB, Ozbay, F, Sharma, V, Crane, M, Harrison, D, Herbert, R, Levin, SM, Luft, BJ, Moline, JM, Stellman, JM, Udasin, IG, Landrigan, PJ, Southwick, SM (2013 a). Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study. Psychological Medicine. Published online: 3 04 2013 . doi:10.1017/S0033291713000597.Google ScholarPubMed
Pietrzak, RH, Galea, S, Southwick, SM, Gelernter, J (2013 b). Examining the relation between the serotonin transporter 5-HTTPLR genotype x trauma exposure interaction on a contemporary phenotypic model of posttraumatic stress symptomatology: a pilot study. Journal of Affective Disorders 148, 123128.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Gallezot, JD, Ding, YS, Henry, S, Potenza, MN, Southwick, SM, Krystal, JH, Carson, RE, Neumeister, A (2013 c). Association of posttraumatic stress disorder with reduced in vivo norepinephrine transporter density in locus coeruleus. JAMA Psychiatry 70, 11991205.CrossRefGoogle Scholar
Pietrzak, RH, Henry, S, Southwick, SM, Krystal, JH, Neumeister, A (2013 d). Linking in vivo brain serotonin type 1B receptor density to phenotypic heterogeneity of posttraumatic stress symptomatology. Molecular Psychiatry 18, 399401.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Schechter, CB, Bromet, EJ, Katz, CL, Reissman, DB, Ozbay, F, Sharma, V, Crane, M, Harrison, D, Herbert, R, Levin, SM, Luft, BJ, Moline, JM, Stellman, JM, Udasin, IG, Landrigan, PJ, Southwick, SM (2012 a). The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. Journal of Psychiatric Research 46, 835842.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Tsai, J, Harpaz-Rotem, I, Whealin, JM, Southwick, SM (2012 b). Support for a novel five-factor model of posttraumatic stress symptoms in three independent samples of Iraq/Afghanistan veterans: a confirmatory factor analytic study. Journal of Psychiatric Research 46, 317322.CrossRefGoogle ScholarPubMed
Pietrzak, RH, Van Ness, PH, Fried, TR, Galea, S, Norris, F (2012 c). Diagnostic utility and factor structure of the PTSD Checklist in older adults. International Psychogeriatrics 24, 16841696.CrossRefGoogle ScholarPubMed
Pitman, RK, Delahanty, DL (2005). Conceptually driven pharmacologic approaches to acute trauma. CNS Spectrums 10, 99106.CrossRefGoogle ScholarPubMed
Rabe, S, Dörfel, D, Zöllner, T, Maercker, A, Karl, A (2006). Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment. Applied Psychophysiology and Biofeedback 31, 315330.CrossRefGoogle ScholarPubMed
Raftery, AE (1995). Bayesian model selection in social research. Sociological Methodology 25, 111163.CrossRefGoogle Scholar
Reddy, MK, Anderson, BJ, Liebschutz, J, Stein, MD (2013). Factor structure of PTSD symptoms in opioid-dependent patients rating their overall trauma history. Drug and Alcohol Dependence 132, 597602.CrossRefGoogle ScholarPubMed
Ruggero, CJ, Kotov, R, Callahan, JL, Kilmer, JN, Luft, BJ, Bromet, EJ (2013). PTSD symptom dimensions and their relationship to functioning in World Trade Center responders. Psychiatry Research. Published online: 21 09 2013 . doi:10.1016/j.psychres.2013.08.052.CrossRefGoogle ScholarPubMed
Satorra, A, Bentler, PM (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika 66, 507514.CrossRefGoogle Scholar
Schell, TL, Marshall, GN, Jaycox, LH (2004). All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology 113, 189197.CrossRefGoogle Scholar
Schindel-Allon, I, Aderka, IM, Shahar, G, Stein, M, Gilboa-Schechtman, E (2010). Longitudinal associations between post-traumatic distress and depressive symptoms following a traumatic event: a test of three models. Psychological Medicine 40, 16691678.CrossRefGoogle ScholarPubMed
Schwarz, G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461464.CrossRefGoogle Scholar
Simms, LJ, Watson, D, Doebbeling, BN (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology 111, 637647.CrossRefGoogle ScholarPubMed
Solomon, Z, Horesh, D, Ein-Dor, T (2009). The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. Journal of Clinical Psychiatry 70, 837843.CrossRefGoogle ScholarPubMed
Soo, J, Webber, MP, Gustave, J, Lee, R, Hall, CB, Cohen, HW, Kelly, KJ, Prezant, DJ (2011). Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001–2010. Disaster Medicine and Public Health Preparedness 5 (Suppl. 2), S197S203.CrossRefGoogle ScholarPubMed
Stellman, JM, Smith, RP, Katz, CL, Sharma, V, Charney, DS, Herbert, R, Moline, J, Luft, BJ, Markowitz, S, Udasin, I, Harrison, D, Baron, S, Landrigan, PJ, Levin, SM, Southwick, S (2008). Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster. Environmental Health Perspectives 116, 12481253.CrossRefGoogle ScholarPubMed
Strawn, JR, Geracioti, TDJ (2008). Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depression and Anxiety 25, 260271.CrossRefGoogle ScholarPubMed
Thompson, KE, Vasterling, JJ, Benotsch, EG, Brailey, K, Constans, J, Uddo, M, Sutker, PB (2004). Early symptom predictors of chronic distress in Gulf War veterans. Journal of Nervous and Mental Disease 192, 146152.CrossRefGoogle ScholarPubMed
Vaiva, G, Ducrocq, F, Jezequel, K, Averland, B, Lestavel, P, Brunet, A, Marmar, CR (2003). Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biological Psychiatry 54, 947949.CrossRefGoogle ScholarPubMed
Wang, L, Li, Z, Shi, Z, Zhang, J, Zhang, K, Liu, Z, Elhai, JD (2011 a). Testing the dimensionality of posttraumatic stress responses in young Chinese adult earthquake survivors: further evidence for ‘dysphoric arousal’ as a unique PTSD construct. Depression and Anxiety 28, 10971104.CrossRefGoogle Scholar
Wang, L, Zhang, J, Shi, Z, Zhou, M, Li, Z, Zhang, K, Liu, Z, Elhai, JD (2011 b). Comparing alternative factor models of PTSD symptoms across earthquake victims and violent riot witnesses in China: evidence for a five-factor model proposed by Elhai et al (2011). Journal of Anxiety Disorders 25, 771776.CrossRefGoogle Scholar
Wang, M, Armour, C, Li, X, Dai, X, Zhu, X, Yao, S (2013 a). The factorial invariance across gender of three well-supported models: further evidence for a five-factor model of posttraumatic stress disorder. Journal of Nervous and Mental Disease 201, 145152.CrossRefGoogle ScholarPubMed
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629640.CrossRefGoogle ScholarPubMed
Wang, R, Wang, L, Li, Z, Cao, C, Shi, Z, Zhang, J (2013 b). Latent structure of posttraumatic stress disorder symptoms in an adolescent sample one month after an earthquake. Journal of Adolescence 36, 717725.CrossRefGoogle Scholar
Watson, D (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522536.CrossRefGoogle ScholarPubMed
Weathers, F, Litz, B, Herman, D, Huska, J, Keane, T (1993). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX (http://www.pdhealth.mil/library/downloads/pcl_sychometrics.doc). Accessed November 2013.Google Scholar
Webber, MP, Glaser, MS, Weakley, J, Soo, J, Ye, F, Zeig-Owens, R, Weiden, MD, Nolan, A, Aldrich, TK, Kelly, K, Prezant, D (2013). Physician-diagnosed respiratory conditions and mental health symptoms 7–9 years following the World Trade Center disaster. American Journal of Industrial Medicine 54, 661671.CrossRefGoogle Scholar
Wisnivesky, JP, Teitelbaum, S, Todd, A, Boffetta, P, Crane, M, Dellenbaugh, C, Harrison, D, Herbert, R, Jeon, Y, Kaplan, J, Levin, S, Luft, B, Markowitz, S, Moline, J, Pietrzak, RH, Shapiro, M, Southwick, SM, Stevenson, L, Udasin, I, Wallenstein, S, Landrigan, P (2011). Long persistence of multiple illnesses in September 11 responders. Lancet 378, 888897.CrossRefGoogle Scholar
Yufik, T, Simms, LJ (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology 119, 764776.CrossRefGoogle ScholarPubMed
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