Posttraumatic stress disorder and the risk of respiratory problems in World Trade Center responders: longitudinal test of a pathway

Details

• Personal Author:
  Broihier J ; Bromet EJ ; Feder A ; Friedman-Jimenez G ; Gonzalez A ; Guerrera K ; Kaplan J ; Kotov R ; Luft BJ ; Moline J ; Pietrzak RH ; Reissman D ; Ruggero C ; Schechter C ; Southwick SM ; Udasin I ; Von Korff M
• Description:
  Objective: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity. Methods: 18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory. Results: In both groups of responders, initial PTSD (standardized regression coefficient: beta = 0.20 and 0.23) and abnormal pulmonary function (beta = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p < .0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset. Conclusions: These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders. [Description provided by NIOSH]
• Subjects:
  Diagnosis Emergency Responders Health Care Facilities Workforce And Services Health Promotion Law Enforcement Lung Mental Health Morbidity Occupational Exposure Occupational Health Respiratory Function Tests Respiratory System Respiratory Tract Diseases Risk Assessment Risk Factors Safety Stress, Psychological

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• Keywords:
  9/11 Author Keywords: Pulmonary Health Clinical-diagnosis Disaster Emergency-responders Employee-exposure Health-programs Long-term-study Lung-function Medical-monitoring Mental-physical Comorbidity Mental-stress Morbidity-rates Occupational-medicine Occupational Medicine Physiological-effects Physiological-response Police-officers Psychological-stress PTSD Pulmonary-function Rescue-workers Respiratory-system-disorders Risk-factors Spirometry Statistical-analysis Surveillance-programs

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• ISSN:
  0033-3174
• Document Type:
  Text
• Funding:
  Contract ; Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; District of Columbia ; New Jersey ; New York ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 6 ; Texas ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OD - Office of the Director ; WTCHP - World Trade Center Health Program
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  438-448
• Volume:
  77
• Issue:
  4
• NIOSHTIC Number:
  nn:20046156
• Citation:
  Psychosom Med 2015 May; 77(4):438-448
• Contact Point Address:
  Roman Kotov, PhD, Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794
• Email:
  roman.kotov@stonybrook.edu
• Federal Fiscal Year:
  2015
• Performing Organization:
  Mount Sinai School of Medicine - New York
• Peer Reviewed:
  True
• Start Date:
  20040601
• Source Full Name:
  Psychosomatic Medicine
• End Date:
  20100531
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:406dabd0f887a78ebe9cece815c6033aa70c69fd45677351ac6120c8ef336315918a684cf3f9f96966d8f78a8e79ce422c247e8270c1a67020d3efb86757e3af
• Download URL:
  https://stacks.cdc.gov/view/cdc/201289/cdc_201289_DS1.pdf
• File Type:
  [PDF - 316.00 KB ]