MOUNT SINAI JOURNAL OF MEDICINE 75:115–127, 2008 115 Mental Health of Workers and Volunteers Responding to Events of 9/11: Review of the Literature Corey B. Bills, BA, 1 Nancy A. S. Levy, BA, 2 Vansh Sharma, MD, 3 Dennis S. Charney, MD, 3 Robin Herbert, MD, 3 Jacqueline Moline, MD, MSc 3 and Craig L. Katz, MD 3 1 Pritzker School of Medicine, University of Chicago and Mailman School of Public Health, Columbia University, New York, NY, USA 2 New York University and Mailman School of Public Health, Columbia University, New York, NY, USA 3 The Mount Sinai School of Medicine, Department of Psychiatry and Department of Community & Preventive Medicine New York, NY, USA ABSTRACT Background: Disaster workers responding to the events of September 11th were exposed to traumatic events. No study has systematically investigated the diverse mental health status and needs of the heterogeneous population of disaster workers responding to the events of September 11th. Methods: Using PubMed and Medline and the search terms of ‘‘September 11, 2001’’ or ‘‘September 11’’ or ‘‘9/11’’or ‘‘WTC’’ or ‘‘World Trade Center’’, the authors reviewed all articles that examined the mental health outcomes of workers at one of the three September 11th crash sites or the Fresh Kills landfill in New York City. Results: In total, 25 articles met study inclusion criteria, often using different methodologies. The articles described varying degrees of mental health symptomatology, risk factors for adverse mental health outcomes, and utilization of mental health services. Conclusions: The mental health needs of workers exposed to the events of September 11th ranged from little to no care to pharmacotherapy. A range of risk factors, including exposures at the WTC site and occupational activities, impacted on Address Correspondence to: Craig L. Katz Mount Sinai School of Medicine Department of Psychiatry New York, NY, USA Email: craig.katz@mssm.edu these needs but the role of specific mental health interventions was less clear. These findings suggest the need for a future program for disaster workers consisting of an accessible mental health treatment service supported by comprehensive postdisaster surveillance and emphasis on pre-disaster mental wellness. A number of areas for further consideration and study were identified, including the need for a more diverse exploration of involved responder populations as well as investigation of potential mental health outcomes beyond post-traumatic stress disorder (PTSD). Mt Sinai J Med 75:115–127, 2008.  2008 Mount Sinai School of Medicine Key Words: September 11th, disaster, mental health, first responders, disaster workers, review. The September 11th, 2001 attacks on the World Trade Center (WTC) and Pentagon, as well as the plane crash in Shanksville, Pennsylvania, have had a profound effect on the health of Americans. 1 There has also been a good deal of attention paid to those who were directly exposed to the attacks: people who worked in the WTC or the Pentagon, those who live or work in downtown Manhattan, those who lost a loved one in the attacks, and first responders who assisted in the rescue and recovery efforts. Extensive literature dating back many decades has consistently documented that both manmade and natural disasters are associated with psychopathology of varying frequency, duration, and nature in people exposed to these events. 2–4 Typically, the psycho- logical aftermath of a disaster is conceptualized as arising out of a combination of the exposure itself combined with other factors such as prior psychiatric history and extent of postdisaster psychosocial sup- port. Common psychopathological outcomes include Published online in Wiley InterScience (www.interscience.wiley.com). DOI:10.1002/msj.20026  2008 Mount Sinai School of Medicine