Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002–2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.

Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003–2004) to Wave 4 (2015–2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations.

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The purpose of this study was to evaluate and compare the effectiveness of two interventions—a mailed brochure and a structured phone call—for increasing emergency preparedness knowledge among this population. We conducted a two-arm parallel group trial between February 2019 and August 2020. Participants were Registry enrollees who completed the Wave 4 Registry (2015–2016) survey, whose primary language was English or Spanish, who lived in New York City, and who did not report being a rescue and recovery worker affiliated with FDNY or NYPD. Enrollees were randomized to receive either a brochure by mail summarizing the components of emergency preparedness or a 15 min phone call describing the same. The primary outcome measure was the number of “yes” responses to the ten-item CDC CASPER emergency preparedness questionnaire, measured at baseline and post-intervention. Enrollees were sequentially alternatively assigned to either the brochure or phone call groups. In total, 705 enrollees were assigned to the brochure (n = 353) or phone call (n = 352) groups, and a total of 702 enrollees were analyzed. The Incident Rate Ratio (IRR) for the effect of time was 1.17 (95% CI = (1.14, 1.20)) and for intervention was 1.00 (95% CI = (0.95, 1.05)) Both the brochure and phone call interventions improved knowledge of emergency preparedness from baseline to post-intervention assessment, and to the same extent.