Posttraumatic stress disorder and the risk of respiratory problems in world trade center responders: Longitudinal test of a pathway

Roman Kotov, Evelyn J. Bromet, Clyde B. Schechter, Julie Broihier, Adriana Feder, George Friedman-Jimenez, Adam Gonzalez, Kathryn Guerrera, Julia Kaplan, Jacqueline Moline, Robert H. Pietrzak, Dori Reissman, Camilo Ruggero, Steven M. Southwick, Iris Udasin, Michael Von Korff, Benjamin J. Luft

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity. Methods: 18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory. Results: In both groups of responders, initial PTSD (standardized regression coefficient: β = 0.20 and 0.23) and abnormal pulmonary function (β = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p <.0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset. Conclusions: These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.

Original languageEnglish (US)
Pages (from-to)438-448
Number of pages11
JournalPsychosomatic Medicine
Volume77
Issue number4
DOIs
StatePublished - May 15 2015

Fingerprint

Post-Traumatic Stress Disorders
Disasters
Lung
Pathway
World Trade Center
Medical Staff
Spirometry
Police
Comorbidity
Mental Health
Morbidity
Equipment and Supplies
Health

Keywords

  • 9/11
  • Disaster
  • Mental-physical comorbidity
  • Occupational medicine
  • PTSD
  • Pulmonary health

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology
  • Arts and Humanities (miscellaneous)
  • Developmental and Educational Psychology

Cite this

Posttraumatic stress disorder and the risk of respiratory problems in world trade center responders : Longitudinal test of a pathway. / Kotov, Roman; Bromet, Evelyn J.; Schechter, Clyde B.; Broihier, Julie; Feder, Adriana; Friedman-Jimenez, George; Gonzalez, Adam; Guerrera, Kathryn; Kaplan, Julia; Moline, Jacqueline; Pietrzak, Robert H.; Reissman, Dori; Ruggero, Camilo; Southwick, Steven M.; Udasin, Iris; Von Korff, Michael; Luft, Benjamin J.

In: Psychosomatic Medicine, Vol. 77, No. 4, 15.05.2015, p. 438-448.

Research output: Contribution to journalArticle

Kotov, R, Bromet, EJ, Schechter, CB, Broihier, J, Feder, A, Friedman-Jimenez, G, Gonzalez, A, Guerrera, K, Kaplan, J, Moline, J, Pietrzak, RH, Reissman, D, Ruggero, C, Southwick, SM, Udasin, I, Von Korff, M & Luft, BJ 2015, 'Posttraumatic stress disorder and the risk of respiratory problems in world trade center responders: Longitudinal test of a pathway', Psychosomatic Medicine, vol. 77, no. 4, pp. 438-448. https://doi.org/10.1097/PSY.0000000000000179
Kotov, Roman ; Bromet, Evelyn J. ; Schechter, Clyde B. ; Broihier, Julie ; Feder, Adriana ; Friedman-Jimenez, George ; Gonzalez, Adam ; Guerrera, Kathryn ; Kaplan, Julia ; Moline, Jacqueline ; Pietrzak, Robert H. ; Reissman, Dori ; Ruggero, Camilo ; Southwick, Steven M. ; Udasin, Iris ; Von Korff, Michael ; Luft, Benjamin J. / Posttraumatic stress disorder and the risk of respiratory problems in world trade center responders : Longitudinal test of a pathway. In: Psychosomatic Medicine. 2015 ; Vol. 77, No. 4. pp. 438-448.
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abstract = "Objective: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity. Methods: 18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory. Results: In both groups of responders, initial PTSD (standardized regression coefficient: β = 0.20 and 0.23) and abnormal pulmonary function (β = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p <.0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset. Conclusions: These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.",
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AU - Kotov, Roman

AU - Bromet, Evelyn J.

AU - Schechter, Clyde B.

AU - Broihier, Julie

AU - Feder, Adriana

AU - Friedman-Jimenez, George

AU - Gonzalez, Adam

AU - Guerrera, Kathryn

AU - Kaplan, Julia

AU - Moline, Jacqueline

AU - Pietrzak, Robert H.

AU - Reissman, Dori

AU - Ruggero, Camilo

AU - Southwick, Steven M.

AU - Udasin, Iris

AU - Von Korff, Michael

AU - Luft, Benjamin J.

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N2 - Objective: Posttraumatic stress disorder (PTSD) is associated with high medical morbidity, but the nature of this association remains unclear. Among responders to the World Trade Center (WTC) disaster, PTSD is highly comorbid with lower respiratory symptoms (LRS), which cannot be explained by exposure alone. We sought to examine this association longitudinally to establish the direction of the effects and evaluate potential pathways to comorbidity. Methods: 18,896 responders (8466 police and 10,430 nontraditional responders) participating in the WTC-Health Program were first evaluated between 2002 and 2010 and assessed again 2.5 years later. LRS were ascertained by medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory. Results: In both groups of responders, initial PTSD (standardized regression coefficient: β = 0.20 and 0.23) and abnormal pulmonary function (β = 0.12 and 0.12) predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times more likely and remission 1.8 times less likely in responders with initial PTSD than in responders without. Moreover, PTSD mediated, in part, the association between WTC exposures and development of LRS (p <.0001). Initial LRS and abnormal pulmonary function did not consistently predict PTSD onset. Conclusions: These analyses provide further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation associated with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.

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