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Miori S, Sanna A, Lassola S, Cicolini E, Zanella R, Magnoni S, De Rosa S, Bellani G, Umbrello M. Incidence, Risk Factors, and Consequences of Post-Traumatic Stress Disorder Symptoms in Survivors of COVID-19-Related ARDS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085504. [PMID: 37107786 PMCID: PMC10138688 DOI: 10.3390/ijerph20085504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/28/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, prospective, observational study included all patients who were discharged from the ICU. Patients were administered the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire, the Short-Form Health Survey 36Version 2 (SF-36v2), a socioeconomic question set and the Impact of Event Scale-Revised (IES-R) to assess PTSD. Results: The multivariate logistic regression model found that an International Standard Classification of Education Score (ISCED) higher than 2 (OR 3.42 (95% CI 1.28-9.85)), monthly income less than EUR 1500 (OR 0.36 (95% CI 0.13-0.97)), and more than two comorbidities (OR 4.62 (95% CI 1.33-16.88)) are risk factors for developing PTSD symptoms. Patients with PTSD symptoms are more likely to present a worsening in their quality of life as assessed by EQ-5D-5L and SF-36 scales. Conclusion: The main factors associated with the development of PTSD-related symptoms were a higher education level, a lower monthly income, and more than two comorbidities. Patients who developed symptoms of PTSD reported a significantly lower Health-Related Quality of life as compared to patients without PTSD. Future research areas should be oriented toward recognizing potential psychosocial and psychopathological variables capable of influencing the quality of life of patients discharged from the intensive care unit to better recognize the prognosis and longtime effects of diseases.
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Affiliation(s)
- Sara Miori
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Andrea Sanna
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +0039-903687; Fax: +0039-902692
| | - Sergio Lassola
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Erica Cicolini
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Roberto Zanella
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy
| | - Giacomo Bellani
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy
| | - Michele Umbrello
- Department of Intensive Care Unit, San Carlo Borromeo University Hospital, 20142 Milan, Italy
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2
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Kehm RD, Li J, Takemoto E, Yung J, Qiao B, Farfel MR, Cone JE. Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer. Cancer Med 2022; 12:1829-1840. [PMID: 36107389 PMCID: PMC9883583 DOI: 10.1002/cam4.4992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While several studies have reported the association between 9/11 exposure and cancer risk, cancer survival has not been well studied in the World Trade Center (WTC) exposed population. We examined associations of 9/11-related exposures with mortality in WTC Health Registry enrollees diagnosed with cancer before and after 9/11/2001. PATIENTS AND METHODS This is a longitudinal cohort study of 5061 enrollees with a first-ever primary invasive cancer diagnosis between 1995 and 2015 and followed through 2016. Based on the timing of first cancer diagnosis, pre-9/11 (n = 634) and post-9/11 (n = 4427) cancer groups were examined separately. 9/11-related exposures included witnessing traumatic events, injury on 9/11, and 9/11-related post-traumatic stress disorder (PTSD). Associations of exposures with all-cause mortality were examined using Cox proportional hazards regression. In the post-9/11 group, cancer-specific mortality was evaluated by enrollee group (WTC rescue/recovery workers vs. non-workers) using Fine and Gray's proportional sub-distribution hazard models, adjusting for baseline covariates, tumor characteristics, and treatment. RESULTS In the pre-9/11 group, 9/11-related exposures were not associated with all-cause mortality. In the post-9/11 group, increased risk of all-cause mortality was associated with PTSD (adjusted HR = 1.35; 95% CI = 1.11-1.65), but not with injury or witnessing traumatic events. Cancer-specific mortality was not statistically significantly associated with 9/11-related exposures. In rescue/recovery workers, increased non-cancer mortality risk was associated with PTSD (aHR = 2.13, 95% CI = 1.13-4.00) and witnessing ≥3 traumatic events (aHR = 2.00, 95% CI = 1.13-3.55). CONCLUSIONS We did not observe associations between 9/11-related exposures and cancer-specific mortality. Similar to findings in the non-cancer WTC exposed population, PTSD was associated with increased risk of all-cause mortality in cancer patients.
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Affiliation(s)
- Rebecca D. Kehm
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA,Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew York CityNew YorkUSA
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Erin Takemoto
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Janette Yung
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
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3
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Kopańska M, Ochojska D, Mytych W, Lis MW, Banaś-Ząbczyk A. Development of a brain wave model based on the quantitative analysis of EEG and EEG biofeedback therapy in patients with panic attacks during the COVID-19 pandemic. Sci Rep 2022; 12:14908. [PMID: 36050377 PMCID: PMC9436169 DOI: 10.1038/s41598-022-19068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
The current global crisis facing the world is the COVID-19 pandemic. Infection from the SARS-CoV-2 virus leads to serious health complications and even death. As it turns out, COVID-19 not only physically assails the health of those infected, but also leads to serious mental illness regardless of the presence of the disease. Social isolation, fear, concern for oneself and one's loved ones, all of this occurs when a pandemic overloads people. People exhibit numerous neurological disorders that have never happened to them before. Patients are diagnosed with frequent panic attacks, the result of which can be seen in their Quantitative Electroencephalogram results. This test may be one of the main diagnostic tools of the COVID-19 pandemic. From the results obtained, it is possible to compare and draw conclusions. This method of testing effectively allows EEG biofeedback training and observes its effect on brain activity. The feedback received in this way gives us the opportunity to properly tailor a protocol for the patient and their conditions. Numerous studies support the effectiveness of EEG biofeedback for panic attacks and other psychiatric disorders. The purpose of our study was to show the effectiveness of EEG biofeedback with a Quantitative Electroencephalogram of the brainwave pattern after having COVID-19 and what symptoms may result.
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Affiliation(s)
- Marta Kopańska
- Department of Pathophysiology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.
| | - Danuta Ochojska
- Department of Psychology, Institute of Pedagogy, College of Social Sciences, University of Rzeszow, 35-959, Rzeszow, Poland
| | - Wiktoria Mytych
- Students Science Club "Reh-Tech", University of Rzeszow, Rzeszow, Poland
| | - Marcin W Lis
- Department of Zoology and Animal Welfare, Faculty of Animal Science, University of Agriculture in Cracow, 30-059, Cracow, Poland
| | - Agnieszka Banaś-Ząbczyk
- Department of Biology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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4
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Huber KA, Frazier PA, Alper HE, Brackbill RR. Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches. J Trauma Stress 2022; 35:508-520. [PMID: 34979044 DOI: 10.1002/jts.22763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/04/2021] [Accepted: 10/04/2021] [Indexed: 11/12/2022]
Abstract
Several studies have analyzed longitudinal data on posttraumatic stress symptoms (PTSS) from individuals who were proximal to the September 11, 2001, terrorist attacks (9/11) in an attempt to identify different trajectories of mental health in the years following mass trauma. The results of these studies have been heterogeneous, with researchers who used latent growth mixture modeling (LGMM) tending to identify four trajectories and those who used group-based trajectory modeling (GBTM) identifying five to seven trajectories. Given that no study has applied both GBTM and LGMM to their data, it remains unknown which modeling approach and what number of trajectories best fit post-9/11 PTSS data. The present study aimed to address that question by applying both LGMM and GBTM to data from the largest sample of survivors to date, comprising 37,545 New York City community members. When analyzing four waves of PTSS, reflecting participants' mental health up to 15 years post-9/11, LGMM fit the data better than GBTM. Our optimal solution consisted of four trajectories: low-stable (72.2% of the sample), decreasing (12.8%), increasing (9.5%), and high-stable (5.5%) symptoms. Covariate analyses indicated that economic factors (i.e., having a household income less than $25,000 and experiencing job loss due to 9/11) increased the odds of belonging to the high-stable symptom trajectory group to the greatest degree, ORs = 4.93-6.08. The results suggest that providing financial support, including affordable mental health care, could be an important intervention in the wake of future mass traumatic events.
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Affiliation(s)
- Kayla A Huber
- Department of Psychology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Patricia A Frazier
- Department of Psychology, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Howard E Alper
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Robert R Brackbill
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
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5
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Exposure to the World Trade Center disaster and test performance among New York City public school students over time, 1998–2003. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Liu SY, Li J, Leon LF, Schwarzer R, Cone JE. The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052604. [PMID: 35270297 PMCID: PMC8910094 DOI: 10.3390/ijerph19052604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003−2004) to Wave 4 (2015−2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations.
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Affiliation(s)
- Sze Yan Liu
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 10279, USA; (S.Y.L.); (L.F.L.); (J.E.C.)
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 10279, USA; (S.Y.L.); (L.F.L.); (J.E.C.)
- Correspondence: ; Tel.: +1-718-786-4412
| | - Lydia F. Leon
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 10279, USA; (S.Y.L.); (L.F.L.); (J.E.C.)
| | - Ralf Schwarzer
- Department of Psychology, Freie University of Berlin, 14195 Berlin, Germany;
- Department of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, NY 10279, USA; (S.Y.L.); (L.F.L.); (J.E.C.)
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7
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Song W, Zhao T, Huang E. How Does the COVID-19 Pandemic Affect People's Willingness to Pay for Health in the Short and Long Term? A Longitudinal Study during and after the COVID-19 Pandemic in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031568. [PMID: 35162590 PMCID: PMC8835082 DOI: 10.3390/ijerph19031568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has posed a substantial threat to people’s lives and aroused health concerns. This study aims at exploring the following questions. First, how does the COVID-19 pandemic affect people’s willingness to pay for health (WPH) in the short and long term? Second, what is the psychological mechanism underlying such an effect? Finally, what are the boundary conditions for this effect? To answer these questions, we conducted three longitudinal surveys. The first survey was launched in February 2020—the time of the most serious outbreak of COVID-19 in China. Data were obtained from 1548 participants through questionnaires on an online survey platform. The sample covered 297 prefecture-level cities in 31 provincial administrative regions. Subsequently, we conducted two follow-up surveys in August 2020 and July 2021. The samples of these surveys were randomly selected from the sample of the first survey. The findings showed that the pandemic promoted people’s WPH in the outbreak period. The fear of death and self-esteem mediated and moderated this effect, respectively. Moreover, the effect persisted for six months after the COVID-19 pandemic had been brought under control (August 2020). However, the effect disappeared after a year and a half (July 2021). These results indicate that the COVID-19 pandemic promoted people’s WPH and that this effect was sustained in the short term after the pandemic had been brought under control but not in the long term.
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Affiliation(s)
- Wei Song
- Yatai School of Business Management, Jilin University of Finance and Economics, Changchun 130117, China;
| | - Taiyang Zhao
- School of Philosophy and Sociology, Jilin University, Changchun 130012, China
- Correspondence: ; Tel.: +86-1332-154-1212
| | - Ershuai Huang
- School of Business Administration, Henan Polytechnic University, Jiaozuo 454003, China;
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8
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Wisnivesky JP, Becker JH, Ankam J, Markowitz SB, Doernberg M, Dickens B, Busse P, Crowley L, Federman A, Katz C, Weiss JJ, Gonzalez A. The Relationship Between Post-Traumatic Stress Disorder and Self-Management Behaviors in World Trade Center Workers with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:242-249. [PMID: 34534721 PMCID: PMC8973280 DOI: 10.1016/j.jaip.2021.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Comorbid posttraumatic stress disorder (PTSD) is highly prevalent and associated with increased morbidity among World Trade Center (WTC) rescue and recovery workers with asthma. However, the potential behavioral pathways underlying this relationship remain unclear. OBJECTIVE To evaluate whether PTSD is associated with lower adherence to asthma self-management behaviors among WTC workers with asthma. METHODS We used data from a prospective cohort of WTC workers with a physician diagnosis of asthma who were prescribed controller medications. Presence of comorbid PTSD was determined based on structured clinical interviews. Asthma self-management behaviors included medication adherence, inhaler technique, use of action plans, and trigger avoidance. We conducted unadjusted and multiple regression analyses to evaluate the association of PTSD with asthma self-management. RESULTS Overall, 30% of 276 WTC workers with asthma had comorbid PTSD. Posttraumatic stress disorder was associated with worse asthma control and poorer quality of life. However, PTSD was not significantly associated with medication adherence (odds ratio [OR] -0.15; 95% confidence interval [CI] -0.5 to 0.2), inhaler technique (OR -0.12; 95% CI -0.7 to 0.5), use of action plans (OR 0.8; 95% CI 0.4 to 1.8), or trigger avoidance (OR 0.9; 95% CI 0.4 to 1.8). CONCLUSIONS We did not find significant differences in key asthma self-management behaviors between WTC workers with and without PTSD. These results suggest that other mechanisms, such as differences in symptom perception or inflammatory pathways, may explain the association between PTSD and increased asthma morbidity.
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Affiliation(s)
- Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacqueline H. Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven B. Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Molly Doernberg
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brittany Dickens
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Paula Busse
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Crowley
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Gonzalez
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:608-620. [PMID: 36417219 PMCID: PMC9620943 DOI: 10.3390/epidemiologia2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022]
Abstract
Following exposures to traumatic events on 9/11, survivors have reported heightened levels of posttraumatic stress disorder (PTSD). Multiple factors contribute to both the exacerbation and amelioration of PTSD symptoms, including social integration and support. This cross-sectional study aimed to understand and identify associations of embeddedness and psychosocial risk factors by PTSD status for survivors and first responders of 9/11. Results indicate that those with chronic PTSD had the lowest prevalence of both social and emotional embeddedness and many who reported no PTSD symptoms following 9/11 reported moderate levels of social and emotional embeddedness. Overall, our findings suggest those individuals who reported little to no PTSD also reported the most social/emotional embeddedness; whereas those individuals who report greater or chronic PTSD report the least social/emotional embeddedness. As such, it may be beneficial for clinicians across multiple care disciplines and contexts to consider and address the social lives and needs of those individuals experiencing symptoms of PTSD to ensure their emotional and physical needs are truly being met.
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10
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Yung J, Takemoto E, Cone J, Li J. Change in 9/11-related post-traumatic stress symptoms following cancer diagnosis. Psychooncology 2021; 31:717-724. [PMID: 34866274 DOI: 10.1002/pon.5855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cancer can be a life-threatening stressor that may evoke pre-existing post-traumatic stress disorder (PTSD). We assessed change in 9/11-related PTSD symptoms following cancer diagnosis in a 9/11-exposed cohort, the World Trade Center Health Registry. METHODS We examined enrollees who had a first-time post-9/11 invasive cancer diagnosis and at least one pre- and two post-diagnosis 9/11-related PTSD assessments from enrolment through 2015. PTSD symptoms were measured using 17-item PTSD Checklist (PCL, range 17-85). Cancer was identified from New York State Cancer Registry and categorized as localized or advanced stage. We used piecewise spline linear mixed-effects models to examine rate of change in PCL scores from pre- to post-diagnosis periods, and whether the change differed by gender or stage, with time as fixed and random effects, adjusting for baseline age, race, and education. RESULTS 9/11-related PTSD symptoms were slightly increasing in the pre-diagnosis period, while this trend reversed in the post-diagnosis period (β: -0.38; 95% CI: -0.60, -0.15). This trend was driven by male rescue/recovery workers (RRW), among whom significant decrease in rate of change in PCL scores was observed for those with advanced stage (slope change difference [95% CI]: -1.81 [-2.73, -0.90]). No significant difference in rate of change was observed among non-RRW. Among females, PCL scores tended to decrease slightly, with no significant difference in rate of change between pre- and post-diagnosis periods. CONCLUSIONS We observed significant reduction in the rate of change in 9/11-related PTSD symptoms among male RRW. The underlying mechanism is unknown, necessitating future research.
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Affiliation(s)
- Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - James Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York, New York, USA
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11
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Rigutto C, Sapara AO, Agyapong VIO. Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature. Behav Sci (Basel) 2021; 11:bs11100140. [PMID: 34677233 PMCID: PMC8533613 DOI: 10.3390/bs11100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.
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12
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Yu S, Alper HE, Nguyen A, Maqsood J, Brackbill RM. Stroke hospitalizations, posttraumatic stress disorder, and 9/11-related dust exposure: Results from the World Trade Center Health Registry. Am J Ind Med 2021; 64:827-836. [PMID: 34558721 DOI: 10.1002/ajim.23271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies have examined the association between disaster-related factors and stroke by subtype or number. We investigated the association between 9/11-related posttraumatic stress disorder (PTSD), dust exposure, and stroke subtype as well as recurrent strokes. METHODS The study included 29,012 individuals enrolled in the World Trade Center Health Registry. Stroke cases were obtained by matching Registry enrollees to the New York State Department of Health's discharge records for inpatient visits between 2000 and 2016. Cox proportional hazards regression models were performed to examine the association between 9/11-related risk factors and stroke by subtype. Multinomial logistic regression models were conducted to assess the associations between the same risk factors and the number of stroke hospitalizations. RESULTS Having PTSD significantly increased the risk of developing ischemic and hemorrhagic stroke, with adjusted hazards ratios (AHRs) of 1.64 (95% confidence interval [CI]: 1.28-2.10) and 1.73 (95% CI: 1.10-2.71), respectively. The point estimate for dust cloud exposure, although not significant statistically, suggested an increased risk of ischemic stroke (AHR = 1.20, 95% CI: 0.96-1.50). PTSD was significantly associated with recurrent strokes with an adjusted odds ratio of 1.79 (95% CI: 1.09-2.95). CONCLUSIONS PTSD is a risk factor for both ischemic and hemorrhagic stroke and is associated with recurrent strokes. Dust exposure on 9/11 is a possible risk factor for ischemic stroke but not for hemorrhagic stroke, and was not associated with recurrent strokes. Our findings warrant additional research on stroke-morbidity and mortality associated with 9/11-related PTSD and dust exposure.
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Affiliation(s)
- Shengchao Yu
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Howard E. Alper
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Angela‐Maithy Nguyen
- Interdisciplinary Division, School of Public Health University of California‐Berkeley Berkeley California USA
| | - Junaid Maqsood
- New York City Department of Health and Mental Hygiene Long Island City New York USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene Long Island City New York USA
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Health Trends among 9/11 Responders from 2011-2021: A Review of World Trade Center Health Program Statistics. Prehosp Disaster Med 2021; 36:621-626. [PMID: 34550060 DOI: 10.1017/s1049023x21000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. METHODS The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. RESULTS A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. DISCUSSION Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. CONCLUSION Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.
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14
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Aranda J, Oriol I, Martín M, Feria L, Vázquez N, Rhyman N, Vall-Llosera E, Pallarés N, Coloma A, Pestaña M, Loureiro J, Güell E, Borjabad B, León E, Franz E, Domènech A, Pintado S, Contra A, Cortés MDS, Chivite I, Clivillé R, Vacas M, Ceresuela LM, Carratalà J. Long-term impact of COVID-19 associated acute respiratory distress syndrome. J Infect 2021; 83:581-588. [PMID: 34400219 PMCID: PMC8363182 DOI: 10.1016/j.jinf.2021.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/07/2021] [Indexed: 12/17/2022]
Abstract
Objectives To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis. Methods All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6 min walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied. Results Of 1295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score. Conclusion COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed.
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Affiliation(s)
- Judit Aranda
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.
| | - Isabel Oriol
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Clinical Science Department, Faculty of Medicine, University of Barcelona, Spain.
| | - Miguel Martín
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Lucía Feria
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Núria Vázquez
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Nicolás Rhyman
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Estel Vall-Llosera
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Natàlia Pallarés
- Statistics Advisory Service, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ana Coloma
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Melani Pestaña
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Jose Loureiro
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Elena Güell
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Beatriz Borjabad
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Elena León
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Elena Franz
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Anna Domènech
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Sara Pintado
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Anna Contra
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - María Del Señor Cortés
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Iván Chivite
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Raquel Clivillé
- Department or Microbiology of CLILAB Diagnòstics, Barcelona, Spain
| | - Montserrat Vacas
- Department of Psychiatry and Psychology, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Luis Miguel Ceresuela
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain; Clinical Science Department, Faculty of Medicine, University of Barcelona, Spain
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15
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Wisnivesky JP, Markowitz SB, James S, Stone K, Dickens B, Busse P, Crowley L, Federman A, Katz C, Gonzalez A. Comorbid posttraumatic stress disorder and major depressive disorder are associated with asthma morbidity among World Trade Center workers. Ann Allergy Asthma Immunol 2020; 126:278-283. [PMID: 33098982 DOI: 10.1016/j.anai.2020.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND World Trade Center (WTC) rescue and recovery workers have a high burden of asthma, comorbid posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). PTSD is associated with worse asthma outcomes. OBJECTIVE In this study, we evaluated whether the relationship between PTSD and asthma morbidity is modified by the presence of MDD. METHODS We used data from a cohort of WTC workers with asthma. Asthma control (asthma control questionnaire), resource utilization, and quality of life (asthma quality of life questionnaire) were evaluated. We used regression analyses to evaluate the adjusted association of PTSD and MDD with asthma control, resource utilization, and quality of life. RESULTS Of the study cohort of 293 WTC workers with asthma, 19% had PTSD alone, 2% had MDD alone, and 12% had PTSD and MDD. Adjusted mean differences (95% confidence interval) in asthma control questionnaire scores were 1.32 (0.85-1.80) for WTC workers with PTSD and MDD, 0.44 (0.03-0.84) for those with PTSD alone, and 0.50 (-0.38 to 1.38) for workers with MDD alone compared with those without MDD or PTSD. WTC workers with PTSD and MDD, PTSD alone, and MDD alone had mean (95% confidence interval) adjusted differences in asthma quality of life questionnaire scores of -1.67 (-2.22 to -1.12), -0.56 (-2.23 to -1.12), and -1.21 (-2.23 to -0.18), respectively, compared with workers without MDD or PTSD. Similar patterns were observed for acute resource utilization. CONCLUSION PTSD and MDD seem to have a synergistic effect that worsens asthma control and quality of life. Efforts to improve asthma outcomes in this population should address the negative impacts of these common mental health conditions.
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Affiliation(s)
- Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Steven B Markowitz
- Occupational-Environmental Medicine, Queens College, City University of New York, Flushing, New York
| | - Shynah James
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kim Stone
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brittany Dickens
- Occupational-Environmental Medicine, Queens College, City University of New York, Flushing, New York
| | - Paula Busse
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura Crowley
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Craig Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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