Chief Leader - September 28, 2016by SARAH DORSEY
The emotional fallout from the Sept. 11 attacks continues to deeply affect first-responders and survivors, and may influence physical health in ways we don’t yet fully understand, several top researchers said at a recent conference on the Upper East Side. The World Trade Center Health Program, which monitors and treats 9/11 victims, held the event at the New York Academy of Medicine to mark the 15th anniversary of the assaults on New York and the Pentagon.
9/11 Dust Fallout
Scientists also shared new research potentially linking disease to 9/11 dust exposure, and discussed biological markers that could indicate more-aggressive illness in survivors.
Just three weeks after the World Trade Center was attacked, clinicians performed their first monitoring exam of first-responders, Dr. David Prezant noted last week. He is the Chief Medical Officer for the Fire Department and co-directs its medical-monitoring program. He has led several key studies that showed increased risks for certain types of cancer among firefighters who performed the rescue and recovery work.
Today, with funding allocated by Congress through the James Zadroga Act, nearly 75,000 people are enrolled to receive free health care and monitoring through the World Trade Center Health Program, including nearly 16,000 FDNY members and retirees.
The need for vigilance is clear. Ninety percent of those responding to the attacks didn’t wear an effective respirator at all, or rarely wore one, on the day of the towers’ collapse, Dr. Prezant noted. Even in the months that followed, from October 2001 through July 2002, just 45 percent of responders wore an effective respirator most of the time.
Breathed Toxic Mix
And they breathed a powerful mix of chemicals—some over several months and some all at once, when they were engulfed in the cloud from the fallen towers.
Up to three percent of the dust was made of asbestos fibers, according to measurements that weren’t taken until at least Sept. 14, 2001, long after the initial cloud had settled. When it’s airborne, no level of asbestos is considered safe for humans. Glass fibers, lead and other heavy metals were also ground into the dust. Survivors breathed cement dust, PCBs, and the toxic products of the burning jet fuel, including dioxins, diesel fumes, benzene, and other volatile organic compounds.
About 90,000 people are thought to have responded to the 9/11 disaster, and were exposed to those dangers alongside tens of thousands of residents, volunteers and nearby workers. Today, nearly 5,500 people have been certified to have 9/11-related cancer, 86 percent of them responders. Thousands more have chronic respiratory or digestive problems.
But researchers are increasingly coming to understand the long-term emotional effects of the disaster, as well, and the strong impact it has on the body.
“Mental and physical health, as you’ve been hearing all day, are really intimate partners,” said Dr. Evelyn Bromet, the Director of the Epidemiology Research Group at Stony Brook University. “Another way of thinking about it is that they are opposite sides of the same coin.”
Post-traumatic stress disorder is perhaps the best-known mental-health effect of a disaster, and many 9/11 responders are still feeling the symptoms, said Dr. Adriana Feder, a psychiatry professor at the Icahn School of Medicine at Mt. Sinai Medical Center.
She conducted a survey of nearly 4,500 police officers and non-uniformed responders, including construction workers, volunteers, asbestos handlers, utility and transportation workers.
Twelve years after 9/11, about a quarter of the police officers still reported significant symptoms of PTSD, and 12 percent said their symptoms were worsening. Among the non-traditional responders, the rates were even worse: nearly half the respondents still had significant symptoms. A full quarter of them were getting worse.
Hispanics Hit Hardest
Dr. Feder stressed that PTSD can seriously impair a person’s well-being and ability to participate in life. Common symptoms include suddenly feeling as though the disaster were happening all over again; losing interest in things that you used to enjoy; having angry outbursts; being unable to have loving feelings toward those close to you; and feeling as though bad things will happen to you or that your future will be foreshortened.
Dr. Feder and her colleagues found that those with PTSD symptoms were more likely to be Hispanic. They were more likely to have had mental-health issues before the attacks, and were much more likely to cope with their pain in less-healthy ways, including substance abuse and trying to avoid the subject.
Those who had more positive ways of coping tended to have fewer PTSD symptoms. They may have come to a feeling of acceptance about their 9/11 losses or their physical illness, and may have focused on a positive outcome from the attacks. They may have realized that they were stronger than they believed or noticed that they developed a strong bond with other survivors. Those who were prepared for rescue and recovery work, having done it before or having been trained to handle disasters, were also less likely to have PTSD.
Such associations are becoming better-understood through 9/11 research. The World Trade Center collapse marked the first time that mental health was included in an official surveillance program for disaster survivors, Dr. Bromet said. When she asked Dr. Prezant why it was included, he quickly answered, “Because we cared.”
Unlike previous disasters, Dr. Prezant explained, “‘We were at Ground Zero with the responders. So there wasn’t a ‘we/they’ attitude. It was an ‘us’ situation. There was a complete understanding of everything that didn’t happen before,’” Dr. Bromet recalled.
Emotional Physical Link
Several researchers noted that emotional health and physical health are increasingly thought to be closely linked, and many are studying how they affect each other.
And PTSD is hardly the only mental-health fallout of 9/11. Depression is becoming a major focus for Sept. 11 researchers, Dr. Bromet said. Prolonged grief, substance abuse, and anxiety about one’s health have also continued to be major problems. Some survivors continue to have severe headaches or other physical symptoms that are triggered by their emotional struggles.
First-responders were generally less likely to suffer PTSD than civilians, except for firefighters who were caught in the tower collapse. Dr. Prezant said that among firefighters, depression has become the most significant mental-health issue resulting from the attacks, with 17 percent of respondents reporting it. Problem alcohol use and PTSD were found in just 9 percent and 8 percent of participants.
The all-day conference featured many other speakers whose talks are posted online at https://goo.gl/Hq2QVL.
Among the findings:
* PTSD and respiratory ailments appear to be strongly linked, though it’s not totally clear which condition drives the other, according to Stony Brook University researchers.
* PTSD is also strongly linked to ailments like diabetes, respiratory symptoms, and autoimmune diseases.
* Some studies have found that as many as 60 percent of 9/11 responders continue to have at least some symptoms of PTSD and respiratory illness.
* Among 9/11 responders studied by Stony Brook University, PTSD was also linked to cognitive problems.
* Mt. Sinai researchers led by Dr. Mary Ann McLaughlin found that a large number of 9/11 responders had stiffening of the heart muscle despite being younger than 50, not being obese, and having blood pressure within the normal range. These and other findings may indicate a link between Sept. 11 dust exposure and heart disease.
* Several scientists are looking for special biological markers that can predict whether certain diseases progress more rapidly in 9/11 responders.