Is Posttraumatic Stress Disorder in a Class of Its Own? Longitudinal Comparison to Other Conditions Following Trauma and Life Stress Exposure [manuscript]

Details

• Journal Article:
  Journal of Clinical Psychiatry
• Personal Author:
  Greene, Ashley L. ; Levin-Aspenson, Holly F. ; Feltman, Scott ; Long, Stephen ; Moore, Madeleine ; Ruggero, Camilo J. ; Clouston, Sean A. P. ; Bromet, Evelyn J. ; Luft, Benjamin J. ; Kotov, Roman
• Description:
  Objective: Posttraumatic stress disorder (PTSD) is defined by the assumption that qualifying traumatic events lead to a syndrome distinct from other internalizing disorders, while stressful life events play a prominent role in etiologic theories of major depressive disorder (MDD). We examined whether the environmental etiology of PTSD and MDD are distinct by evaluating the relative contributions of traumatic and stressful life events to both conditions. Harmful alcohol use and physical limitations served as noninternalizing comparators expected to show weaker associations with environmental factors. Methods: Longitudinal cohort study of World Trade Center disaster responders who completed annual assessments of mental health and physical functioning from July 1, 2002, to December 31, 2020. Psychiatric diagnoses were ascertained in clinical interviews. Multivariate regression and multilevel modeling quantified the percentage of variance in psychopathology and physical limitations attributable to trauma versus life stress. Results: 11,153 responders (mean age on September 11, 2001: 37.5 years; 91% male) completed 61,244 visits. The combined environmental effect of 9/11-trauma and life stress on PTSD and MDD was nearly identical (14.3% and 14.8% of between person variability), but much weaker for alcohol use and physical limitations (0.8% and 9.1%). Life stress explained the most variance in all diagnoses and symptoms across longitudinal and cross-sectional analytic strategies. Conclusions: In the longest study to date coexamining the environmental etiology of PTSD and MDD, trauma and life stress contributed to both conditions. Considering a spectrum of exposures from stressful life events to trauma and integrating knowledge across internalizing conditions may advance understanding and treatment of stress related psychopathology.
• Subjects:
  Occupational Health Safety September 11 Terrorist Attacks Stress Disorders, Post-Traumatic
• Keywords:
  PTSD; Post-traumatic stress disorder; Traumatic incident stress; World Trade Center; WTC; Mental health; Longitudinal study; Cohort studies; Stress-related illnesses; Psychological responses; First responders
• Source:
  J Clin Psychiatry 2025 May; 86(2):24m15591
• ISSN:
  0160-6689
• Document Type:
  Text
• Funding:
  Grant ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; Texas ; Florida ; New York City Region [OSHA] ; Dallas Region [OSHA] ; Atlanta Region [OSHA] ; Birmingham Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  9 pdf pages
• Volume:
  86
• Issue:
  2
• NIOSHTIC Number:
  nn:20071529
• Contact Point Address:
  Roman Kotov, PhD, Stony Brook University HSC, Level T-10, Room 060Z1, Stony Brook, NY 11794-8101
• Email:
  roman.kotov@stonybrook.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  State University of New York - Stony Brook
• Peer Reviewed:
  True
• Start Date:
  20230701
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d1a555e0159aab94701829f8ddef3a211123a76908b8767a1d08966218dbbdb8faabb94fb161ba27b99534804501687cb974371fbc79ce458ad84ab47522617c
• Download URL:
  https://stacks.cdc.gov/view/cdc/259125/cdc_259125_DS1.pdf
• File Type:
  [PDF - 1.85 MB ]