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Malachy Corrigan, RN, Rita McWilliams, PhD, MPH, Kerry J. Kelly, MD, Justin Niles, MA, Claire Cammarata, PhD, Kristina Jones, MD, Daniel Wartenberg, PhD, William K. Hallman, PhD, Howard M. Kipen, MD, MPH, Lara Glass, MPH, John K. Schorr, PhD, Ira Feirstein, MD and David J. Prezant, MD

At the time of the study, Malachy Corrigan, Kerry J. Kelly, Justin Niles, Claire Cammarata, Kristina Jones, Lara Glass, Ira Feirstein, and David J. Prezant were with the Fire Department of the City of New York, New York. Rita McWilliams, Daniel Wartenberg, and Howard M. Kipen were with Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry at New Jersey, New Brunswick. William K. Hallman was with Rutgers University, New Brunswick, NJ. John K. Schorr was with the Stetson Institute for Social Research, Stetson University, Deland, FL.

Correspondence: Correspondence should be sent to David J. Prezant, MD, Fire Department of the City of New York, Office of Medical Affairs, Room 4w-1, 9 Metrotech Center, Brooklyn, NY 11201 (e-mail: prezand{at}fdny.nyc.gov). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We sought to determine the frequency of psychological symptoms and elevated posttraumatic stress disorder (PTSD) risk among New York City firefighters after the World Trade Center (WTC) attack and whether these measures were associated with Counseling Services Unit (CSU) use or mental health–related medical leave over the first 2.5 years after the attack.

Methods. Shortly after the WTC attack, a computerized, binary-response screening questionnaire was administered. Exposure assessment included WTC arrival time and "loss of a co-worker while working at the collapse." We determined elevated PTSD risk using thresholds derived from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a sensitivity-specificity analysis.

Results. Of 8487 participants, 76% reported at least 1 symptom, 1016 (12%) met criteria for elevated PTSD risk, and 2389 (28%) self-referred to the CSU, a 5-fold increase from before the attack. Higher scores were associated with CSU use, functional job impairment, and mental health–related medical leave. Exposure–response gradients were significant for all outcomes.

Conclusions. This screening tool effectively identified elevated PTSD risk, higher CSU use, and functional impairment among firefighters and therefore may be useful in allocating scarce postdisaster mental health resources.