State Level Policies on First Responder Mental Health in the U.S.: A Scoping Review.

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

Mental health treatment for first responders: An assessment of mental health provider needs.

First responders experience mental health conditions at a higher rate than the general population. To improve treatment and enhance quality of care, it is important to understand the needs of those who provide mental health treatment to this population. The purpose of this study was to explore the needs of mental health providers with experience working with first responders to better understand how first responders differ from community patients, and what training and supports providers need to enhance treatment. Semistructured qualitative interviews were conducted via videocalls with 12 mental health providers who provide mental health care to Australian first responders. The interviews were transcribed verbatim and interpretative phenomenological analysis was performed. The findings highlighted the importance of identity and culture among first responders, and the need for cultural awareness and understanding among mental health providers working with this population. Various training opportunities which could enhance treatment capacities were identified, including training in accurate assessment and differential diagnosis, evidence-based trauma-focused treatments, transdiagnostic treatments, and working with specific first responder treatment characteristics (e.g., emotional detachment, rigid cognitive styles, and preferences toward structure and order). Ways in which mental health providers can be supported included facilitating professional networks between providers and connection with first responder organizations. The insights gathered from this study provide a foundation from which to consider training and support development for mental health providers working with first responders. Service level implications and directions are outlined to assist future decision making on this topic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental health stigma and barriers to care in World Trade Center responders: Results from a large, population-based health monitoring cohort.

BACKGROUND: Nearly 20 years after the terrorist attacks of September 11, 2001, multiple studies have documented the adverse mental consequences among World Trade Center (WTC) rescue, recovery, and clean-up workers. However, scarce research has examined mental health stigma and barriers to care in WTC-exposed individuals, and no known study has examined whether rates of endorsement may differ between police and "nontraditional" responders, the latter comprising a heterogeneous group of workers and volunteers. OBJECTIVE: To identify the prevalence and correlates of mental health stigma and barriers to care in WTC responders. METHODS: Mental health stigma and barriers to care and their correlates were examined in 6,777 police and 6,272 nontraditional WTC responders. RESULTS: Nontraditional responders endorsed more stigma or barriers to care concerns than police responders. Within a subsample who screened positive for a psychiatric disorder, police were more likely than nontraditional responders to endorse "concerns that negative job consequences might result" (17.9% vs. 9.1%), while nontraditional responders were more likely to endorse "I don't know where to go to find counseling services" (18.4% vs.6.6%). Within this subsample, mental health service need and more severe WTC-related posttraumatic stress disorder symptoms were associated with increased likelihood of endorsing stigma or barriers; pre-9/11 psychiatric history and non-Hispanic Black race/ethnicity were associated with lower likelihood of endorsing stigma or barriers. CONCLUSIONS: Results of this study underscore the burden of mental health stigma and barriers to care in WTC responders, and highlight the need for targeted interventions to address these concerns and promote mental healthcare utilization in this population.

Impact of COVID -19 on children: special focus on the psychosocial aspect.

Although medical literature shows that children are minimally susceptible to 2019-Corona virus disease (COVID-19), they are hit the hardest by psychosocial impact of this pandemic. Being quarantined in homes and institutions may impose greater psychological burden than the physical sufferings caused by the virus. School closure, lack of outdoor activity, aberrant dietary and sleeping habits are likely to disrupt children's usual lifestyle and can potentially promote monotony, distress, impatience, annoyance and varied neuropsychiatric manifestations. Incidences of domestic violence, child abuse, adulterated online contents are on the rise. Children of single parent and frontline workers suffer unique problems. The children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic, such as child labor, child trafficking, child marriage, sexual exploitation and death etc. Parents, pediatricians, psychologists, social workers, hospital authorities, government and non-governmental organizations have important roles to play to mitigate the psychosocial ill-effects of COVID-19 on children and adolescents. To provide the basic amenities, social security, medical care, and to minimize the educational inequities among the children of the different strata of the society are foremost priorities.

"Playing the system": Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel.

There are growing concerns about the impact of public safety work on the mental health of public safety personnel; as such, we explored systemic and individual factors that might dissuade public safety personnel from seeking care. Public safety personnel barriers to care-seeking include the stigma associated with mental disorders and frequent reports of insufficient access to care. To better understand barriers to care-seeking, we thematically analyzed the optional open-ended final comments provided by over 828 Canadian public safety personnel as part of a larger online survey designed to assess the prevalence of mental disorders among public safety personnel. Our results indicated that systematic processes may have (1) shaped public safety personnel decisions for care-seeking, (2) influenced how care-seekers were viewed by their colleagues, and (3) encouraged under-awareness of personal mental health needs. We described how public safety personnel who do seek care may be viewed by others; in particular, we identified widespread participant suspicion that coworkers who took the time to address their mental health needs were "abusing the system." We explored what constitutes "abusing the system" and how organizational structures-systematic processes within different public safety organizations-might facilitate such notions of abuse. We found that understaffing may increase scrutiny of injured public safety personnel by those left to manage the additional burden; in addition, cynicism and unacknowledged structural stigma may emerge, preventing the other public safety personnel from identifying their mental health needs and seeking help. Finally, we discuss how system-level stigma can be potentiated by fiscal constraints when public safety personnel take any leave of absence, inadvertently contributing to an organizational culture wherein help-seeking for employment-related mental health concerns becomes unacceptable. Implications for public safety personnel training and future research needs are discussed.

A mixed-methods assessment of the impact of the opioid epidemic on first responder burnout.

BACKGROUND: First responders have demanding jobs and report experiencing burnout. The opioid epidemic has added to first responder workloads, which could contribute to increased burnout. This mixed-methods study examined burnout among first responders by: 1) describing burnout among first responders specifically related to workload demands associated with the opioid epidemic; 2) exploring first responder perspectives on how the opioid epidemic has affected their profession; and 3) conducting exploratory analyses to examine how burnout and perspectives on the effect of the opioid epidemic differ across first responder professions. METHODS: First responders completed an online survey (n = 196), including a burnout questionnaire, as part of a county-wide opioid misuse resource and needs assessment. A subset completed qualitative interviews (n = 12). In both the survey and interviews, participants were asked their perspectives on how the opioid epidemic impacted their profession. RESULTS: One-third (33%; n = 179) of survey respondents reported high burnout scores. The majority saw community opioid misuse as a significant problem (98%; n = 188) that has affected their profession (95%; n = 188). Qualitative analyses supported survey findings with participants expressing increased workloads and emotional effects related to the opioid epidemic. CONCLUSIONS: First responders reported experiencing burnout, increased workloads, and negative emotional effects related to their role in responding to the opioid epidemic. Despite this, first responders view responding to community opioid misuse as part of their professional role for which they have received specialized training. Future research should continue to explore the impact of the opioid epidemic on first responders, including how to prevent or address burnout.

A Quality Improvement Assessment of the Delivery of Mental Health Services among WTC Responders Treated in the Community.

The World Trade Center Health Program (WTCHP) provides mental health services through diverse service delivery mechanisms, however there are no current benchmarks to evaluate utilization or quality. This quality improvement (QI) initiative sought to examine the delivery and effectiveness of WTCHP mental health services for World Trade Center (WTC) responders who receive care through the Northwell Health Clinical Center of Excellence (CCE), and to characterize the delivery of evidence-based treatments (EBT) for mental health (MH) difficulties in this population. Methods include an analysis of QI data from the Northwell CCE, and annual WTCHP monitoring data for all responders certified for mental health treatment. Nearly 48.9% of enrolled responders with a WTC-certified diagnosis utilized treatment. The majority of treatment delivered was focused on WTC-related conditions. There was significant disagreement between provider-reported EBT use and independently-evaluated delivery of EBT (95.6% vs. 54.8%, p ≤ 0.001). EBT delivery was associated with a small decrease in Posttraumatic Stress Disorder (PTSD) symptoms over time. Providers engaged in the process of data collection, but there were challenges with adherence to outcome monitoring and goal setting. Data from this report can inform continued QI efforts in the WTCHP, as well as the implementation and evaluation of EBT.

Analysis of Emergency Health Care Workforce and Service Readiness for a Mass Casualty Event in the Republic of Ireland.

OBJECTIVE: Ultimately, a country's capacity for a large-scale major emergency response will be directly related to the competence of its health care provider (HCP) workforce and communication between emergency responders and hospitals. The purpose of this study was to assess HCP preparedness and service readiness for a major emergency involving mass casualties (mass casualty event or MCE) in Ireland. METHODS: A cross-sectional study using a 53-item survey was administered to a purposive sample of emergency responders and HCPs in the Republic of Ireland. Data collection was achieved using the Qualtrics® Research Suite. Descriptive statistics and appropriate tests of comparison between professional disciplines were conducted using Stata 13. RESULTS: A total of 385 respondents, registered nurses (43.4%), paramedics (37.9%), medical doctors (10.1%), and administrators/managers (8.6%), participated in the study. In general, a level of knowledge of MCEs and knowledge of clinical response activities and self-assessed clinical competence varied drastically across many aspects of the survey. Knowledge and confidence also varied across professional disciplines (P<0.05) with nurses, in general, reporting the least knowledge and/or confidence. CONCLUSIONS: The results demonstrate that serious deficits exist in HCP knowledge, skills, and self-perceived abilities to participate in a large-scale MCE. Results also suggest a poor knowledge base of existing major emergency response plans. (Disaster Med Public Health Preparedness. 2019;13:243-255).

Experiencing External Workplace Violence: Differences in Indicators Between Three Types of Emergency Responders.

Police officers, firefighters, and emergency medical workers are at a relatively high risk of experiencing external workplace violence (EWPV), that is, violence initiated by people outside the organization. Based on criminal opportunities theories, the aim of this research was to study to what extent socio-demographic and work characteristics are related to experiencing EWPV. In addition, the aim was to explore how these relations differ between the three types of emergency responders. Data from a workplace violence survey of the Ministry of the Interior and Kingdom Relations of the Netherlands was used, from which emergency medical workers ( n = 264), firefighters ( n = 255), and police officers ( n = 296) were selected. Results indicated that police officers experienced most and firefighters experienced least EWPV. Younger professionals and professionals who have more frequent and risky contact experienced more EWPV. The expectations that males and those with less skills or experience to avoid EWPV experience more EWPV were not convincingly supported. The relationships between characteristics and EWPV, and the explanatory power of the models, differed between types of emergency responders. The studied characteristics best explained variations in EWPV of police officers, and therefore prevention of EWPV by addressing these characteristics will be most successful for police officers. The prediction of EWPV should be improved, for example, by studying the relationship with "attractiveness" or "vulnerability" of the possible victim, such as psychological characteristics of professionals. The study showed that research about indicators and prevention of EWPV should be aimed at separate professions.

Prevalence and correlates of psychiatric symptoms among first responders in a Southern State.

First responders (FRs) respond to critical incidents as an expectation of their profession, and after years of service, exposure to trauma can accumulate and potentially lead to mental health problems, such as posttraumatic stress disorder (PTSD). A gap persists in the research regarding duty-related risk factors and prevalence of mental health problems among FRs. Guided by existing evidence and in partnerships with the state's FR community, this study assessed the mental health needs of FRs, risk factors that may contribute to these problems, and the associations therein. A convenience sample of firefighters and emergency medical technicians/paramedics (n = 220) were recruited from across Arkansas to complete an online survey. This survey incorporated brief assessment tools to measure various mental health problems, and captured other data regarding possible risk factors. Results found that 14% reported moderate-severe and severe depressive symptoms, 28% reported moderate-severe and severe anxiety symptoms, 26% reported significant symptoms of PTSD, 31% reported harmful/hazardous alcohol use and dependence, 93% reported significant sleep disturbances, and 34% indicated high risk for suicide. Significant group differences were found across measures and gender (female), shift-structure (48 h or more), department setting (rural), relationship status (non-partnered), and having a medical history of hypertension. These findings pose significant implications for mental healthcare providers, as well as other healthcare providers and FR organizations. Findings will guide future research that will address the need for changes in decision-making, funding, and policy regarding FRs' MH and MH services available to them.

Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues.

First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.

Presenteeism among emergency health care staff. / Presentismo en profesionales sanitarios de los servicios de urgencias y emergencias.

OBJECTIVES: To estimate the prevalence of presenteeism among different categories of hospital and pre-hospital emergency health care professionals in the Principality of Asturias, Spain, and to define the sociodemographic characteristics and workplace factors associated with presenteeism in all categories. MATERIAL AND METHODS: Cross-sectional descriptive study carried out during the last half of 2014 and first half of 2015. A self-administered questionnaire was used to collecta data on sociodemographic and work-related variables and perception of work as stressful. The respondents, who answered voluntarily and anonymously, assessed themselves on the Stanford Presenteeism Scale-6 adapted for use in Spain. RESULTS: The prevalence of presenteeism was 52.9% among the 323 respondents. Presenteeism was associated with stress (P<.01), place of work (P=.004), and bearing responsibility for dependent persons (P=.034) in the group overall. The association between stress and presenteeism was clearly present in emergency physicians (P=.049) and in nurses with dependents under their care (P=.016). CONCLUSION: The prevalence of presenteeism is high among emergency staff in the Principality of Asturias. Presenteeism is associated with diverse factors.

OBJETIVO: Conocer la prevalencia de presentismo en las diferentes categorías profesionales del personal asistencial sanitario de los servicios de urgencias (SU) hospitalarios y extrahospitalarios del Servicio de Salud del Principado de Asturias, así como definir las características sociodemográficas y los factores laborales que se asocian con el mismo en las diferentes categorías profesionales. METODO: Estudio descriptivo transversal llevado a cabo durante el último semestre del año 2014 y primero del 2015. Mediante cuestionario anónimo y voluntario se recogieron variables sociodemográficas y relacionadas con el trabajo, la percepción del trabajo como estresante y, de forma autoaplicada, la escala de presentismo Standford Presenteeism Scale-6 adaptada a población española. RESULTADOS: Sobre 323 profesionales se observó una prevalencia de presentismo del 52,9%. Se comprobó la existencia de relación entre estrés y presentismo (p < 0,01), el presentismo en función del centro de trabajo (p = 0,004) y el hecho de tener personas dependientes al cargo (p = 0,034). También se encontró asociación con el estrés en personal médico (p = 0,049) y personal de enfermería con personas dependientes a su cargo (p = 0,016). CONCLUSIONES: Existe una elevada prevalencia de presentismo en el personal sanitario de los SU del Principado de Asturias, hallándose relaciones estadísticamente significativas con múltiples variables.

Interprofessional Mass Casualty Incident Simulation Design Protocol to Prepare Prelicensure Nursing Students to Respond to a Disaster.

Nurses need to be prepared to respond to mass casualty incidents. Simulation is an ideal teaching intervention that can be used to prepare nursing students to effectively triage patients and allocate limited resources. This article describes a detailed interprofessional mass casualty simulation of a bus crash with 32 victims. Nursing students trained with emergency responders with students acting as charge nurses throughout the simulation. The details of the simulation are provided for faculty to replicate.

Psychological Sequelae of the 2013 Super Typhoon Haiyan Among Survivor-Responders.

OBJECTIVE: Super Typhoon Haiyan (known as Yolanda in the Philippines), one of the strongest tropical cyclones recorded in history, made landfall in the Philippines in November 2013. This cross-sectional study examined the psychological impact of the typhoon and its aftermath, as well as the impact of individual typhoon-related stressors among a group of survivor-responders. METHOD: A total of 192 Filipino adult survivors who were also disaster-relief responders and 45 unaffected disaster-relief responders (N = 237) completed a questionnaire that assessed their general psychological distress (GPD), symptoms of posttraumatic stress (PTS), and disaster experiences 1.5 to 4 months after the event. RESULTS: The disaster-exposed group was more distressed and suffered from more symptoms of PTS, but the prevalence of posttraumatic stress disorder (PTSD) was not statistically different between the two groups (7.9% versus 9.4%). Regression analysis revealed that financial instability (ß = .52), physical injury (ß = .21), and perceived life threat (ß = .17) were associated with GPD. Physical injury (ß = .20) and perceived life threat (ß = .20) were also associated with PTS symptoms. CONCLUSIONS: Although a marked difference in PTSD was not noted, the psychological impact of Super Typhoon Haiyan on survivor-responders in terms of nonspecific psychological distress and symptoms of PTS was considerable. Some typhoon-related stressors, including financial instability, physical injury, and perceived life threat, appear to be more detrimental to mental health than other stressors.

Assessment of private security guards by Suicide Probability Scale and Brief Symptom Inventory.

AIM: The aim of the present study was to investigate the influence of suicide probability and relevant sociodemographic features and to provide information for preventing suicide in private security guards working under the stressful conditions and continuous exposure to the negative and traumatic life events. METHODS: 200 private security guards and 200 personnels of Ankara University participated in the study. A sociodemographic information questionnaire, the Suicide Probability Scale (SPS) and the Brief Symptom Inventory (BSI) were used to collect the data. RESULTS: Gender, marital status, income, religious beliefs, experiencing a life-threatening situation, history of a suicide attempt, smoking and not having a chronic disease caused statistically significant differences in the scores for SPS between the private security guards group and the controls. Moreover there was a statistically significant positive correlation between the total scores of the subscales of SPS and the total scores of BSI. CONCLUSIONS: Like police officers and gendarmes, private security guards are at high risk of committing and attempting suicide because of being at stressful work settings and also suffering from secondary trauma. It is required that they should be aware of their tendency to commit suicide and have regular psychiatric screenings.

Assessment of provider attitudes toward #naloxone on Twitter.

BACKGROUND: As opioid overdose rates continue to pose a major public health crisis, the need for naloxone treatment by emergency first responders is critical. Little is known about the views of those who administer naloxone. The current study examines attitudes of health professionals on the social media platform Twitter to better understand their perceptions of opioid users, the role of naloxone, and potential training needs. METHODS: Public comments on Twitter regarding naloxone were collected for a period of 3 consecutive months. The occupations of individuals who posted tweets were identified through Twitter profiles or hashtags. Categories of emergency service first responders and medical personnel were created. Qualitative analysis using a grounded theory approach was used to produce thematic content. The relationships between occupation and each theme were analyzed using Pearson chi-square statistics and post hoc analyses. RESULTS: A total of 368 individuals posted 467 naloxone-related tweets. Occupations consisted of professional first responders such as emergency medical technicians (EMTs), firefighters, and paramedics (n = 122); law enforcement officers (n = 70); nurses (n = 62); physicians (n = 48); other health professionals including pharmacists, pharmacy technicians, counselors, and social workers (n = 31); naloxone-trained individuals (n = 12); and students (n = 23). Primary themes included burnout, education and training, information seeking, news updates, optimism, policy and economics, stigma, and treatment. The highest levels of burnout, fatigue, and stigma regarding naloxone and opioid overdose were among nurses, EMTs, other health care providers, and physicians. In contrast, individuals who self-identified as "naloxone-trained" had the highest optimism and the lowest amount of burnout and stigma. CONCLUSIONS: Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.

Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department.

BACKGROUND: Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence. METHODS: A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders. RESULTS: Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters (OR 14.4, 95%CI: 9.2-22.2, P < 0.001). Females reported increased odds of patient-initiated violence injuries compared to males (OR = 6.25, 95%CI 3.8-10.2), but this relationship was entirely mediated through occupation (AOR = 1.64, 95%CI 0.94-2.85). Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention. CONCLUSIONS: Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.

The hidden price and possible benefit of repeated traumatic exposure.

There is a growing evidence showing that first-responders who are frequently exposed to traumatic events as part of their occupational routine may pay a hidden price. Although they display low to moderate levels of post-traumatic stress disorder (PTSD) symptoms, similar to individuals with full-blown PTSD, they show impaired ability to process and react according to contextual demands. We aimed to test whether this impairment affects performance on simple unrelated tasks and its association with cumulative traumatic exposure and level of PTSD symptoms. Thirty-nine trauma-exposed criminal scene investigator police and 35 unexposed civilians matched for age, gender, and education performed a simple discrimination task in the presence of aversive pictures with low or high intensity. We predicted and found that trauma-exposed individuals failed to modify their behavior in accordance with levels of negative intensity. Hence they were equally distracted in both low and high negative intensity conditions, compared to unexposed controls who showed improved performance in low intensity conditions. Importantly, performance of trauma-exposed individuals on conditions of low intensity negatively correlated with their levels of PTSD symptoms. These results highlight the maladaptive tendency of individuals with repeated traumatic exposure to maintain the same behavior in low-intensity contextual conditions when it is no longer adequate. Interestingly however, in high-intensity conditions trauma-exposed individuals outperformed unexposed controls. Specifically, when completing simple tasks in high intensity conditions. The results suggest that repeated traumatic exposure has both positive and negative consequences on the way individuals interpret and react to their environment.

Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11.

BACKGROUND: Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. METHODS: Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. RESULTS: Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. CONCLUSION: Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed.