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French LM, Brickell TA, Lippa SM, Rogers AA, Cristaudo KE, Walker TT, Higgins M, Bailie JM, Kennedy J, Hungerford L, Lange RT. Clinical relevance of subthreshold PTSD versus full criteria PTSD following traumatic brain injury in U.S. service members and veterans. J Affect Disord 2024; 358:408-415. [PMID: 38705525 DOI: 10.1016/j.jad.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). METHODS Participants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). RESULTS There was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e. , MTBI Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). LIMITATIONS Limitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. CONCLUSION PTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself.
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Affiliation(s)
- Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alicia A Rogers
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Kendal E Cristaudo
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Thomas T Walker
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; CICONIX, Annapolis, MD, USA
| | - Molly Higgins
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; University of Colorado, Colorado Springs, CO, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; 33 Area Branch Clinic Camp Pendleton, CA, USA
| | - Jan Kennedy
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Brooke Army Medical Center, Joint Base San Antonio, TX, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; Naval Medical Center San Diego, CA, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA; National Intrepid Center of Excellence, Bethesda, MD, USA; Contractor, General Dynamics Information Technology, Silver Spring, MD, USA; University of British Columbia, Vancouver, BC, Canada; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Feder A, Kowalchyk ML, Brinkman HR, Cahn L, Aaronson CJ, Böttche M, Presseau C, Fred-Torres S, Markowitz JC, Litz BT, Yehuda R, Knaevelsrud C, Pietrzak RH. Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms. Psychiatry Res 2024; 336:115885. [PMID: 38603979 DOI: 10.1016/j.psychres.2024.115885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average "large" effect size improvement, d = 1.49). Significant and "moderate-to-large" main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62-1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.
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Affiliation(s)
- Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mary L Kowalchyk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah R Brinkman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah Cahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy J Aaronson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Böttche
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Candice Presseau
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Veterans' Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Sharely Fred-Torres
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute, Department of Clinical Therapeutics, New York, NY, USA; Columbia University, Department of Psychiatry, New York, NY, USA
| | - Brett T Litz
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA; Boston University, Boston, Department of Psychological and Brain Sciences, MA, USA; Veterans' Administration Boston Healthcare System, Epidemiological Research and Information Center, Boston, MA, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Neuroscience, New York, NY, USA; James J. Peters Veterans' Administration Medical Center, Bronx, New York, USA
| | - Christine Knaevelsrud
- Freie Universität Berlin, Department of Clinical Psychological Intervention, Berlin, Germany
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
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Contractor AA, Almeida IM, Fentem A, Griffith EL, Kaur G, Slavish DC. Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1468-1483. [PMID: 37427484 DOI: 10.1177/15248380231184207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).
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Pacella BJ, Cowlishaw S, Gibbs L, Bryant RA, Brady K, Gallagher C, Molyneaux R, Gibson K, Block K, Harms L, Forbes D, O'Donnell ML. Trajectory of adjustment difficulties following disaster: 10-year longitudinal cohort study. BJPsych Open 2024; 10:e57. [PMID: 38433588 PMCID: PMC10951843 DOI: 10.1192/bjo.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events. AIMS This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure. METHOD The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3-4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode). RESULTS Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3-4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors. CONCLUSIONS Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.
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Affiliation(s)
- Belinda J. Pacella
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Sean Cowlishaw
- Turner Institute for Brain and Mental Health, Monash School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lisa Gibbs
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kate Brady
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Colin Gallagher
- Centre for Transformative Innovation, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
| | - Robyn Molyneaux
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kari Gibson
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Karen Block
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louise Harms
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan L. O'Donnell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Posttraumatic stress disorder in Belgian police officers: prevalence and the effects of exposure to traumatic events. Eur J Psychotraumatol 2023; 14:2156558. [PMID: 37052090 PMCID: PMC9869988 DOI: 10.1080/20008066.2022.2156558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Police officers are at considerable risk of developing posttraumatic symptoms because they frequently encounter violent or emotionally disturbing incidents. We investigate experiences with potentially traumatic events (PTE), traumatic exposure, and the prevalence of probable posttraumatic stress disorder (PTSD), complex PTSD and subclinical PTSD in a sample of Belgian police officers.Methods: In total, 1,465 police officers from 15 Belgian Local Police zones participated in a web-based survey, consisting of three segments: evaluating experiences with a list of 29 PTE, assessing if any of these PTE accounted for traumatic exposure, and evaluating 1-month probable PTSD, complex PTSD and subclinical PTSD prevalence using the International Trauma Questionnaire (ITQ).Results: Police officers frequently experience a wide range of PTE. A large majority of 93.0% reports traumatic exposure. Assessment with ITQ shows a 1-month prevalence of 5.87% for probable PTSD and 1.50% for probable complex PTSD, while an additional 7.58% report subclinical PTSD. No demographic variables influenced PTSD prevalence. Cumulative PTE experiences in itself did not predict PTSD, while the characteristics of certain PTE did entail a higher prevalence of probable PTSD and subclinical PTSD.Discussion: This study is the first to evaluate experiences with PTE, traumatic exposure and 1-month prevalence of probable PTSD, complex PTSD, and subclinical PTSD in Belgian police officers. Police officers are frequently confronted with a broad variety of PTE, and a large majority reports traumatic exposure. The 1-month prevalence of probable PTSD is significantly higher compared to previous international research in the general population, but lower than in similar international research involving police officers. In this study, cumulative PTE experiences in itself did not reliably predict PTSD, while the characteristics of certain PTE did. Posttraumatic symptoms are an important mental health challenge in Belgian police.
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Lowe SM, Haugen PT, Rosen R, Werth AS. World Trade Center psychological exposures and trauma related disorders: PTSD and adjustment disorders. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023:1-6. [PMID: 36927280 DOI: 10.1080/19338244.2023.2188153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The relationship between exposure to the World Trade Center (WTC) disaster and elevated rates of trauma related psychiatric illnesses in 9/11 responders and survivors has been well documented. This paper is part of a series to promote the practice of evidence-based medicine when managing persons with WTC-related conditions and focuses on "Trauma and Stressor Related Disorders," a diagnostic category that includes posttraumatic stress disorder (PTSD) and adjustment disorder. It offers background on 9/11-related trauma exposure, a summary of research findings from this cohort, and is followed by brief diagnostic and treatment information from selected clinical practice guidelines.
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Affiliation(s)
- Sandra M Lowe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- World Trade Center Health Program, Icahn School of Medicine at Mount Sinai Clinical Center of Excellence, New York, NY, USA
| | - Peter T Haugen
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca Rosen
- NYU Grossman School of Medicine, New York, NY, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY, USA
| | - Aditi S Werth
- NYU Grossman School of Medicine World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
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Kowalchyk M, Chernoff E, Brinkman HR, Brown AD, Pietrzak RH, Feder A. Perceived social support moderates the relation between forward-focused coping and PTSD symptoms in World Trade Center trauma survivors. J Psychiatr Res 2023; 159:130-134. [PMID: 36708637 DOI: 10.1016/j.jpsychires.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Social support and perceived ability to cope with trauma have been linked to severity of PTSD symptoms. While previous literature has highlighted the influence of trauma coping style on PTSD severity, data are lacking regarding factors that may moderate this association. Such information may help inform more personalized treatments for PTSD. Toward this end, we analyzed data from 100 treatment-seeking WTC responders and survivors with full or subthreshold World Trade Center (WTC)-related PTSD who completed measures of perceived ability to cope with trauma and perceived social support prior to treatment initiation. Correlation analyses revealed that higher forward-focused perceived ability to cope (r = -0.24) and perceived social support (r = -0.32) were each associated with lower severity of PTSD symptoms. In a multivariable regression analysis, perceived social support emerged as a significant moderator of the relation between forward-focused coping and overall PTSD symptom severity (β = -0.36). Specifically, among individuals with higher forward-focused coping, those with higher social support had lower severity of symptoms than those with lower social support. Results suggest that interventions to bolster social support among trauma survivors with a forward-focusing coping style may help mitigate severity of PTSD symptoms in treatment-seeking trauma survivors with PTSD symptoms.
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Affiliation(s)
- Mary Kowalchyk
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eva Chernoff
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah R Brinkman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam D Brown
- Department of Psychology, The New School for Social Research, New York, NY, USA; Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Lu D, Sapkota Y, Valdimarsdóttir UA, Koenen KC, Li N, Leisenring WM, Gibson T, Wilson CL, Robison LL, Hudson MM, Armstrong GT, Krull KR, Yasui Y, Bhatia S, Recklitis CJ. Genome-wide association study of posttraumatic stress disorder among childhood cancer survivors: results from the Childhood Cancer Survivor Study and the St. Jude Lifetime Cohort. Transl Psychiatry 2022; 12:342. [PMID: 35999196 PMCID: PMC9399128 DOI: 10.1038/s41398-022-02110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
Genetic influence shapes who develops posttraumatic stress disorder (PTSD) after traumatic events. However, the genetic variants identified for PTSD may in fact be associated with traumatic exposures (e.g., interpersonal violence), which appear heritable as well. Childhood cancer survivors (CCS) are at risk for PTSD, but genetic influences affecting cancer are unlikely to overlap with those affecting PTSD. This offers a unique opportunity to identify variants specific to PTSD risk. In a genome-wide association study (GWAS), 3984 5-year survivors of childhood cancer of European-ancestry from the Childhood Cancer Survivor Study (CCSS) were evaluated for discovery and 1467 survivors from the St. Jude Lifetime (SJLIFE) cohort for replication. Childhood cancer-related PTSD symptoms were assessed using the Posttraumatic Stress Diagnostic Scale in CCSS. GWAS was performed in CCSS using logistic regression and lead markers were replicated/meta-analyzed using SJLIFE. Cross-associations of identified loci were examined between CCS and the general population. PTSD criteria were met for 671 participants in CCSS and 161 in SJLIFE. Locus 10q26.3 was significantly associated with PTSD (rs34713356, functionally mapped to ECHS1, P = 1.36 × 10-8, OR 1.57), and was replicated in SJLIFE (P = 0.047, OR 1.37). Variants in locus 6q24.3-q25.1 reached marginal significance (rs9390543, SASH1, P = 3.56 × 10-6, OR 0.75) in CCSS and significance when meta-analyzing with SJLIFE (P = 2.02 × 10-8, OR 0.75). Both loci were exclusively associated with PTSD in CCS rather than PTSD/stress-related disorders in general population (P-for-heterogeneity < 5 × 10-6). Our CCS findings support the role of genetic variation in PTSD development and may provide implications for understanding PTSD heterogeneity.
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Affiliation(s)
- Donghao Lu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177, Stockholm, Sweden. .,Perini Family Survivors' Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, 02115, US.
| | - Yadav Sapkota
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Unnur A. Valdimarsdóttir
- grid.4714.60000 0004 1937 0626Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden ,grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 US ,grid.14013.370000 0004 0640 0021Center of Public Health Sciences, Faculty of Medicine, University of Iceland, 101 Reykjavík, Iceland
| | - Karestan C. Koenen
- grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 US ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Research Unit, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Nan Li
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Wendy M. Leisenring
- grid.270240.30000 0001 2180 1622Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Todd Gibson
- grid.94365.3d0000 0001 2297 5165Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, 20892 MD US
| | - Carmen L. Wilson
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Leslie L. Robison
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Melissa M. Hudson
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA ,grid.240871.80000 0001 0224 711XDepartment of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Gregory T. Armstrong
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Kevin R. Krull
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA ,grid.240871.80000 0001 0224 711XDepartment of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Yutaka Yasui
- grid.240871.80000 0001 0224 711XDepartment of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Smita Bhatia
- grid.265892.20000000106344187Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Christopher J. Recklitis
- grid.38142.3c000000041936754XPerini Family Survivors’ Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215 USA
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Wesemann U, Applewhite B, Himmerich H. Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review. BJPsych Open 2022; 8:e107. [PMID: 35656574 PMCID: PMC9230690 DOI: 10.1192/bjo.2022.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions. AIMS The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors. METHOD A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the 'Guidance on the Conduct of Narrative Synthesis in Systematic Reviews'. RESULTS Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation. CONCLUSIONS The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Germany
| | - Briana Applewhite
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Baker LD, Stroman JC, Kalantar EA, Bock RC, Berghoff CR. Indirect Associations Between Posttraumatic Stress Symptoms and Other Psychiatric Symptoms, Alcohol Use, and Well-being via Psychological Flexibility Among Police Officers. J Trauma Stress 2022; 35:55-65. [PMID: 33821526 DOI: 10.1002/jts.22677] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 11/08/2022]
Abstract
Police officers experience a high number of potentially traumatic events (PTEs) often associated with elevated posttraumatic stress symptoms (PTSS). In addition, PTSS are related to co-occurring psychiatric symptoms (e.g., anxiety, depression), alcohol misuse, and low perceived well-being. Yet, behavioral processes that may account for the associations between PTSS and unfavorable outcomes remain unspecified. Psychological flexibility, or one's response to private experiences (e.g., PTE-related memories) with an open, aware, and active approach, may be one such process. The present study aimed to evaluate psychological flexibility as both a mediator and moderator of PTSS and commonly co-occurring psychiatric symptoms, alcohol use, and general well-being, using cross-sectional data provided by a sample of police officers (N = 459) recruited from three regionally distributed U.S. police agencies. Structural equation modeling indicated a well-fitting model wherein psychological flexibility indirectly accounted for associations among PTSS and endogenous outcomes, χ2 (107, N = 457) = 225.33, p < .001, CFI = .99, TLI = .98, RMSEA = .05, 90% CI [.04, .06], SRMR = .03. Psychological flexibility also moderated associations between PTSS and psychiatric symptoms, B = 1.58 (SE = 0.22), p < .001; and well-being, B = -3.84 (SE = 0.46), p < .001. Although additional research is needed, these preliminary results suggest psychological flexibility may be a behavioral process that accounts for negative outcomes associated with PTSS and a productive intervention target in the context of PTSS and generalized distress. Further research regarding the role of psychological flexibility in PTSS-related outcomes for police officers appears warranted.
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Affiliation(s)
- Lucas D Baker
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Joel C Stroman
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Emily A Kalantar
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
| | - Rachel C Bock
- Department of Psychology, University of South Dakota, Vermillion, South Dakota, USA
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11
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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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12
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Litz BT, Cummings MH, Grunthal B, McLean CL. A Public Health Framework for Preventing Mental Disorders in the Context of Pandemics. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:519-531. [PMID: 34629840 PMCID: PMC8488184 DOI: 10.1016/j.cbpra.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/21/2020] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems.
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Affiliation(s)
- Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
- Boston University School of Medicine
| | - Mackenzie H Cummings
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
| | - Breanna Grunthal
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
| | - Caitlin L McLean
- VA San Diego Healthcare System
- University of California San Diego
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13
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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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Xu Y, Vandeleur C, Müller M, Seifritz E, Kleim B, von Känel R, Wagner EYN, Strippoli MPF, Castelao E, Gholamrezaee MM, Preisig M, Ajdacic-Gross V. Retrospectively assessed trajectories of PTSD symptoms and their subsequent comorbidities. J Psychiatr Res 2021; 136:71-79. [PMID: 33578109 DOI: 10.1016/j.jpsychires.2021.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dynamic trajectories of psychopathology, such as post-traumatic stress disorder (PTSD) provide a key to understanding human adjustment processes after trauma exposure. Recent studies have suggested more heterogeneous mental health outcomes than the initially identified four adjustment trajectories. To explore this heterogeneity, we investigated the after-trauma adjustment patterns of psychopathology based on retrospective lifetime data. This was first carried out on the PTSD symptoms (PTSS, including no symptoms, few symptoms, partial and full PTSD), and secondly together with their post-trauma comorbidities. METHODS Data of trauma and the post-trauma mental disorders were collected for a large and randomly selected community sample, resulting in a N = 960 trauma-exposed subsample. Pattern recognition as carried out by latent class analysis (LCA) was implemented on this subsample. LCA was first exploited to identify the potential trajectory patterns of PTSS and next to explore the patterns of mental adjustments when additional post-trauma comorbid disorders, such as anxiety, mood and substance use disorders, were assessed. RESULTS Four PTSS trajectory patterns were found, namely resilient, chronic, recovered, and delayed onset, consistent with findings from longitudinal PTSD studies. When post-trauma comorbidities were evaluated, other than the trajectory pattern of delayed onset which retained a low comorbidity profile, the other three split respectively and paired up with either low, moderate or high comorbidity profile. CONCLUSIONS Mental health outcomes after trauma exposure were considerably more complex than the four previously established adjustment trajectories. Here, we uncovered additional and more heterogeneous adjustment patterns comprised of PTSS trajectories and post-trauma comorbidity profiles.
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Affiliation(s)
- Yanhua Xu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - Caroline Vandeleur
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - En-Young N Wagner
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marie-Pierre F Strippoli
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mehdi M Gholamrezaee
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Center for Research in Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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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: 7] [Impact Index Per Article: 1.8] [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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