Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks-A Longitudinal Mediation Analysis

Details

• Personal Author:
  Friedman SM ; Jordan HT ; Wyka K
• Description:
  Objective: Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up. Methods: Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003-2004, 2006-2007, and 2011-2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score >/=44. Results: Probable PTSD predicted LRS (R/R workers: β = 0.88-0.98, p < .001; community members: β = 0.67-0.86, p < .001) and LRS predicted PTSD (R/R workers: β = 0.83-0.91, p < .001; community members: β = 0.68-0.75, p < .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p = .001-.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p = .001-.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)-LRS relationship (indirect effect, p < .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p = .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p < .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p = .001). Conclusions: Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Mental Health Occupational Health Respiratory System Respiratory Tract Diseases Safety September 11 Terrorist Attacks
• Keywords:
  9/11 Disaster Author Keywords: PTSD Emergency Responders First Responders Lower Respiratory Symptoms Occupational Medicine Post-traumatic Stress Disorder Psychological Effects PTSD Rescue Workers Respiratory Diseases World Trade Center WTC

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• ISSN:
  0033-3174
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  115-124
• Volume:
  82
• Issue:
  1
• NIOSHTIC Number:
  nn:20059263
• Citation:
  Psychosom Med 2020 Jan; 82(1):115-124
• Contact Point Address:
  Katarzyna Wyka, PhD, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th St, New York, NY 10027
• Email:
  kwyka@sph.cuny.edu
• Federal Fiscal Year:
  2020
• Performing Organization:
  New York City Health/Mental Hygiene
• Peer Reviewed:
  True
• Start Date:
  20090430
• Source Full Name:
  Psychosomatic Medicine
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f866ea23e5d6e762b49773c1d295ac586757e7782072f9d49e18dbf64e269c549dc0d1a1c4374207124310ed444ce109e7c734e2bb5b3afceb2e174b0be0d62a
• Download URL:
  https://stacks.cdc.gov/view/cdc/223542/cdc_223542_DS1.pdf
• File Type:
  [PDF - 397.53 KB ]