Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders

Purpose: While severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship. Methods: We analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual’s trait resilience level (Connor-Davidson Resilience Scale, CD-RISC). Results: For both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = − 0.24, S.E. = 0.017, z = − 14.29, p < 0.001) and anxiety symptoms (β = − 0.17, S. E. = 0.016, z = − 10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β = 5.08, S.E. = 0.36, p < 0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders. Conclusion: Our findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.