Clinician Supported Mobile App to Reduce Mental Health Symptoms Among World Trade Center Responders in Florida

INTRODUCTION, BACKGROUND AND SIGNIFICANCE. The September 11, 2001 terrorist attacks on the World Trade Center (WTC) have had long-lasting impacts on the mental health of responders involved in rescue and recovery efforts. The World Trade Center Health Program (WTCHP) was established to monitor and treat health conditions related to the WTC disaster. This study addresses the mental health (MH) treatment needs of WTC responders, particularly those who have relocated to Florida after retirement and now represent an older WTCHP subgroup with a higher percentage of Latinos. The research evaluates a clinician-supported mobile application, Clinician Supported (CS) PTSD Coach, for reducing symptoms of Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and sleep disturbances. The study also emphasizes inclusion of Spanish-speaking Hispanic responders to advance health equity through use of the Spanish version of the app and a Spanish adaptation of the intervention manual.

Background. Since its inception in 2011, the WTCHP, funded by CDC/NIOSH, has monitored and treated more than 120,000 responders and survivors with WTC-related conditions. Mental health conditions such as PTSD, anxiety, depression, substance abuse, and sleep disturbances are highly prevalent. PTSD is the most commonly certified psychiatric condition, with prevalence ranging from 3.8% to 29.6%. Despite the chronic nature of these conditions, there are few controlled studies of effective treatments. Most existing interventions are in-person and focus on highly exposed individuals. There have been virtually no controlled studies of app-based remote interventions for the large number of General Responders (GRs) with full or subthreshold PTSD, and none have focused on Spanish-speaking Hispanic GRs. This study addresses these gaps by testing a clinician-supported MH mobile application (CS PTSD Coach) among WTC GRs.

Florida Sub-Cohort. Florida has more than 5,496 registered WTC responders. This group is older, more often retired, and includes a higher proportion of Hispanic individuals compared with responders in other regions. The study focuses on this sub-cohort because of its unique vulnerabilities, including exposure to extreme climate events such as hurricanes that may exacerbate PTSD symptoms. Relocation of WTC responders from the New York Metropolitan Area to Florida is part of a broader migration trend, resulting in a growing number of WTCHP members in Florida and an urgent need for accessible MH services.

Preliminary data indicate that approximately 40% of Florida WTC responders show probable PTSD. There is interest in remotely delivered MH services, supporting the feasibility of the proposed intervention. The older age, higher retirement rates, and larger proportion of Hispanic individuals make this sub-cohort particularly relevant for studying the long-term MH effects of 9/11 exposure and the overlapping impact of aging.

Clinician Supported PTSD Coach Mobile App. The Clinician Supported (CS) PTSD Coach combines the self-managed PTSD Coach app with four 20-30 minute psychotherapy sessions delivered by a clinician over eight weeks. The app includes modules on psychoeducation about PTSD, self-assessment, symptom management, and accessing support. Preliminary studies with Veterans show that CS PTSD Coach can reduce PTSD and depression symptoms.