For most 9/11 first responders, post-traumatic stress disorder (PTSD) symptoms didn’t improve until nearly a decade later, and about 10 per cent of those with the condition experienced worsening symptoms 20 years on. The finding underscores just how persistent PTSD can be and highlights the need for more effective treatments.
at Stony Brook University in New York and his colleagues tracked PTSD symptoms in 12,822 emergency workers who responded to the 11 September 2001 terrorist attacks on the World Trade Center in New York City. Using a standardised questionnaire, the researchers measured PTSD symptoms on a scale of 17 to 85, with higher scores indicating greater severity. Participants could complete the survey once a year between July 2002 – a month after response efforts ended – and December 2022. On average, they did so six times over the roughly 20-year period.
PTSD symptoms remained largely stable across all participants, but for those officially diagnosed with the condition, symptoms changed significantly over time. In this group, symptoms tended to worsen during the first 10 years of the study before gradually improving in the subsequent 10. The median time before symptoms improved – defined as a decrease of at least 10 points – was nearly nine years in those with PTSD.
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“I think this hump of worsening was a little surprising,” says at Duke University in North Carolina. Why symptoms worsened before improving isn’t clear. Resick thinks it may have to do with first responders retiring.
“Avoidance is the main way people cope with PTSD symptoms”, and some people use work to suppress traumatic memories, she says. “So, when they retire, suddenly they’ve got all this time on their hands and the PTSD symptoms just come roaring back.”
This may propel them to finally seek treatment, which is why symptoms then improve. It is also possible therapists have become more effective at treating PTSD in the decades since 9/11, says Resick.
By the 20-year mark, 76 per cent of those with PTSD finally saw symptoms improve. But roughly 10 per cent still experienced worsening symptoms, highlighting the need to make treatments even more widely available.
“It is never too late to get therapy,” says Resick. “There are enough people who have PTSD that we still need to go back and focus on them. Just because it happened a long time ago, we shouldn’t be forgetting about them.”
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Nature Mental Health
