The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis.

Sze Yan Liu,Jiehui Li,James E Cone,Lydia F Leon,Ralf Schwarzer

doi:10.3390/ijerph19052604

Abstract

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.

Highlights

IntroductionThe terrorist attacks on the World Trade Center (WTC) on 11 September 2001 were unprecedented in mental health impact
Published: 24 February 2022The terrorist attacks on the World Trade Center (WTC) on 11 September 2001 were unprecedented in mental health impact
Of the 27,959 enrollees who participated in all four waves, as mentioned above, we excluded those with incomplete data on social support (n = 1661) and PTSD Checklist (PCL) (n = 2948), and those with pre-9/11-diagnosed posttraumatic stress disorder (PTSD) (n = 185), leaving a sample of 23,165 for the data analysis

Summary

Introduction

The terrorist attacks on the World Trade Center (WTC) on 11 September 2001 were unprecedented in mental health impact. Large-scale traumatic events, such as the 9/11 attacks, lead to an increase in posttraumatic stress disorder (PTSD). PTSD has varied from 3.8% to 29.6%, depending on populations and time periods [1]. Previous studies found that exposure to the 9/11 terrorist attack was associated with elevated. PTSD levels among a cohort of WTC-exposed adults years after the disaster [2,3,4]. While the prevalence of PTSD among WTC survivors has decreased over time, elevated levels of PTSD have persisted for a substantial subgroup.

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