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Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort


Nearly two decades after the 9/11 attacks on the World Trade Center (WTC), the prevalence of mental disorders remains elevated among traditional (e.g., police) and non-traditional (e.g., construction workers) responders who were involved in the WTC rescue, recovery, and clean-up efforts. To date, however, scarce research has examined factors associated with perceived need for mental health care, which is critical to promoting engagement in mental health treatment in this population. Data were analyzed from 16,170 WTC responders, including 8881 police responders and 7289 non-traditional responders, who completed their first annual health monitoring visit with the WTC Health Program an average of 6.5 years after September 11, 2001. Predisposing, enabling, and need-based factors associated with perceived need for mental health care were examined using multivariable logistic regression analyses. Nearly half (48.7%) of non-traditional responders and a fifth (20.6%) of police responders reported a need for mental health care. The most common perceived needs were for psychotropic medication, individual psychotherapy, and stress management counseling. Predisposing (e.g., female gender) and need-based factors (e.g., WTC-related posttraumatic stress disorder) predicted perceived need for mental health care in both groups. Among non-traditional responders, Hispanic ethnicity and current suicidal ideation were additionally associated with this outcome. Non-traditional WTC responders are substantially more likely than police WTC responders to perceive a need for mental health treatment. Characterization of factors associated with perceived need for treatment can help inform population-based outreach and monitoring efforts designed to promote engagement in mental health treatment in WTC responders.

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This study was supported by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (Research Contracts 200-2011-41919 and 200-2017-93325). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC/NIOSH. This funding source had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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Correspondence to Jonathan DePierro.

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Dr. Feder (co-inventor) and Mount Sinai have been named on a use patent application of ketamine for the treatment of posttraumatic stress disorder; patent is currently pending. Dr. Schechter has received consulting fees from Accolade, Inc., for analysis of claims data in evaluation of the effectiveness of their services and for technical support provided to in-house statistical staff. Dr. Pietrzak is a scientific consultant to CogState Ltd. Drs. DePierro, Crane, Harrison, Luft, Moline, and Southwick and Ms. Diab, Ms. Schaffer and Mr. Cancelmo report no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Mount Sinai Program for the Protection of Human Subjects, HS#: 11-01635) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Diab, O., DePierro, J., Cancelmo, L. et al. Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort. Adm Policy Ment Health 47, 427–434 (2020).

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  • Mental health service needs
  • World Trade Center responders
  • Perceived needs
  • Community services