Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes

The 2004 Florida hurricane season was unprecedented. Within a period of 7 weeks, 4 hurricanes and 1 tropical storm made landfall.1,2 The $4.85 billion in costs incurred for hurricane relief accounted for nearly 88% of the total disaster aid in 2004.3 State and local public health workers played a critical role as first responders in this and other disasters. Concern for public health response to natural disasters has increased during the past decade in the aftermath of 9/11, the tsunamis in Asia and Japan, Hurricane Katrina, and the Haiti earthquakes. Public health and disaster workers experience acute and longer term posttraumatic stress disorder (PTSD) and health risk behaviors such as increased alcohol and increased tobacco use.4 However, few studies have addressed large populations regarding these important components of our emergency public health response. Work-related exposure to disasters has been associated with PTSD and depression in disaster workers.5 A meta-analysis of 38 studies of rescue workers (N = 20 000) found that the worldwide pooled prevalence of PTSD was 10%.6 The prevalence of PTSD in rescue workers enrolled in the World Trade Center health registry was 12.4% (range, 6.2% for police to 21.2% for volunteers).7 Firefighters and mortuary workers have high levels of PTSD symptoms.8–10 In an epidemiological study of first responders, symptoms of PTSD and depression increased with the number of critical work-related exposures.11 Firefighters working at the Oklahoma City bombing were more likely to have PTSD if they had longer exposure to the bomb site.10 Symptoms of major depression were reported by 27% of firefighters 13 weeks after responding to Hurricane Katrina.12 Few studies have examined the risk factors for increased alcohol and tobacco use in disaster workers. Almost half of the disaster workers reported drinking more alcohol than usual during the time that they worked at the World Trade Center, and about one-third continued increased use.13 Smoking in ambulance personnel following the fireworks disaster in Enschede, the Netherlands, predicted symptoms of PTSD and depression 18 months after the disaster.14 Increased tobacco use has been reported in 29% of disaster workers following 9/11, and 23% of former smokers resumed cigarette smoking.15 The 2004 hurricane season provided a unique opportunity to examine public health workers of the Florida Department of Health (FDOH) who experienced repeated deployments, high work demand, and both work and family stressors in responding to the hurricanes. Specifically, we examined the relationship of probable PTSD, probable depression, and increased alcohol and tobacco use 9 months posthurricanes to disaster exposure and work demand in public health workers.