Resilience to post-traumatic stress among World Trade Center survivors: A mixed-methods study

Lisa M. Gargano, PhD; Sindhushree Hosakote, MS; Qi Zhi, MPH; Kristine A. Qureshi, PhD; Robyn R. Gershon, DrPH

doi:10.5055/jem.2017.0336

Authors

Lisa M. Gargano, PhD
Sindhushree Hosakote, MS
Qi Zhi, MPH
Kristine A. Qureshi, PhD
Robyn R. Gershon, DrPH

DOI:

https://doi.org/10.5055/jem.2017.0336

Keywords:

September 11, 2001, 9/11, World Trade Center, post-traumatic stress disorder, resilience, in-depth interviews, mixed methods

Abstract

The purpose of this study was to identify individual characteristics, behaviors, and psychosocial factors associated with symptoms of post-traumatic stress disorder (PTSD) among World Trade Center (WTC) disaster evacuation survivors. The study utilized a mixed-method design. In-depth interviews were conducted using a prepared script. PTSD was assessed using the PTSD checklist-civilian (PCL-C; a score ≥ 50 indicates probable PTSD). Thematic analysis was conducted to identify factors associated with PTSD. A purposive sample of 29 WTC evacuees was recruited using a multimodal recruitment strategy. Eligibility included: history of evacuation from the WTC (Tower 1 and/or Tower 2) on September 11, 2001, and decisional capacity for informed consent. Five participants had PCL-C scores ≥ 50. Thematic analysis identified resiliency factors (protective for PTSD), including leadership, taking action based on “gut” feelings (to evacuate), social support (staying in a group), going on “automatic survival” mode, and previous training on emergency response. Risk factors for PTSD included lack of emergency response training, lack of sense of urgency, poor physical condition, lack of communication skills, lack of direction, peri-event physical injury, peri-event traumatic exposure (horror), and moral injury (guilt and remorse). Several modifiable factors that may confer resilience were identified. In particular, the role of emergency response training in preventing disaster-related mental illness should be explored as a possible strategy for enhancing resilience to disaster events.

Author Biographies

Lisa M. Gargano, PhD

World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York

Sindhushree Hosakote, MS

Graduate Division, Department of Global Health Sciences, University of California—San Francisco, San Francisco, California

Qi Zhi, MPH

Institute for Health Policy Studies, School of Medicine, University of California—San Francisco, San Francisco, California

Kristine A. Qureshi, PhD

Global Health Nursing Program, School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii

Robyn R. Gershon, DrPH

Department of Environmental Public Health, The College of Global Public Health, New York University, New York, New York

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