Race/Ethnic Differences in Prevalence and Correlates of Posttraumatic Stress Disorder in World Trade Center Responders: Results From a Population-Based, Health Monitoring Cohort

Clinical Impact Statement The relatively high rates of WTC-related PTSD found in Latino/a WTC responders are likely due to the social and economic stressors Latino/a subgroups more commonly face. Vulnerability factors, such as low socioeconomic status, having a psychiatric disorder, low social support from family and workplace and additional life stressors following the event contributed to higher rates of WTC-related PTSD regardless of racial/ethnic group. These results underscore the importance of implementing interventions that address the unique contextual conditions facing vulnerable subgroups, such as improved education and income, and mitigation of ongoing stressors. Objective: This study evaluated race/ethnic differences in the prevalence and correlates of World Trade Center (WTC) related posttraumatic stress disorder (PTSD) in WTC responders. Method: Data were analyzed from a population-based, health monitoring cohort of 15,440 nontraditional (i.e., construction workers) and 13,403 police WTC responders. Results: Among nontraditional responders, the prevalence of WTC-related PTSD was highest in Latino/a (40.4%) versus Black (27.3%) and White (26.5%) responders; among police responders, Latino/a (10.4%) responders also had higher prevalence of PTSD relative to Black (9.8%) and White (8.7%) responders. However, multivariable analyses revealed that prior psychiatric diagnosis, greater severity of WTC-related exposures, post-9/11 stressful life events, (in police responders only) older age, and (in nontraditional responders only) lower income and education levels accounted for substantially higher prevalence of WTC-related PTSD across ethnic/racial groups. Additionally, among nontraditional responders, subgroups with added risk included responders who were: Latino/a or White had high post-911 stressful events; Latino/a or Black and had pre-9/11 psychiatric history; and Latinas. Among police responders, subgroups with added risk were Latino/a or Black police with a low annual income. Conclusions: Collectively, results of this study underscore the burden of differential vulnerability that can contribute to higher prevalence of PTSD in certain cultural subgroups following large magnitude traumatic events.