They retrieved body parts, wallets, personal papers. They picked their way through seared steel, toxic dust and filthy debris, sometimes fearing for their own safety and often under chaotic conditions. Their devotion had a price.
The Sept. 11, 2001, attack on the World Trade Center has exacted a toll on the thousands of rescue, recovery and reclamation specialists who labored for months in the ruins. Many have been left with chronic mental health problems and a dysfunctional social life, as well as psychological distress levels that "greatly exceed the population norms," according to a large-scale, five-year study released Wednesday by medical and psychiatric researchers from the Centers for Disease Control and Prevention, Yale Medical School, Mount Sinai School of Medicine and six other institutions.
The study evaluated the mental state of more than 10,000 disaster response workers and revealed that two-thirds of them met criteria for "substantial stress reactions" years after their experiences. A third felt abnormally "watchful" or were troubled with disturbing memories, sleep problems and anger issues. Eleven percent had post-traumatic stress disorder (PTSD) more akin to a war zone than a recovery effort.
"Prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population," the study said.
Another quarter of the respondents had difficulty concentrating, many avoided talking or even thinking about what they had witnessed while 20 percent were easily startled. Seventeen percent had problems with alcohol abuse, 15 percent had disturbing dreams or felt their future had been "cut short," one-out-of-10 experienced flashbacks of their experiences while 9 percent had clinical depression. Five percent were left with panic disorders.
Some Sept. 11 responders had a very personal stake in their work — more than 500 had lost a family member, a third had lost one friend or more. Even their children were affected. More than 2,000 reported that their children were "more fearful" while 1,500 said their children were "more clingy" because of their parents' involvement at the site.
The researchers pointed out that all U.S. troops returning home are routinely monitored for psychological well-being after combat. Yet few medical protocols are in place to monitor disaster workers.
"Taken together, our findings indicate that a substantial public mental health burden exists in the responder population, which puts them at risk for a variety of adverse health and social consequences," the study said.
The findings are based on the evaluations of 10,132 workers conducted since 2002. Yet this substantial number is only a fraction of the estimated number of people who helped in recovery efforts.
According to estimates from the World Trade Center Health Registry maintained by the Department of Health and Human Services and the City of New York, more than 92,000 men and women were involved in the rescue and restoration of the site after the attacks.
"Long-term provision of accessible mental health services for rescue and recovery workers likely should still constitute part of future disaster planning," the study said, advising that environmental disasters would pose similar challenges.
The study was published in Environmental Health Perspectives, an academic journal.