Ptsd and depressive symptoms as potential mediators of the association between world trade center exposure and subjective cognitive concerns in rescue/recovery workers

Ankura Singh, Rachel Zeig-Owens, Laura Rabin, Theresa Schwartz, Mayris P. Webber, David Appel, David J. Prezant, Charles B. Hall

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

We observed that World Trade Center (WTC) exposure, post-traumatic stress disorder (PTSD) symptoms and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers. This follow-up study examined whether PTSD symptoms and/or depressive symptoms mediate the observed association between WTC exposure and subjective cognitive concerns. We included WTC-exposed FDNY workers who completed the Cognitive Function Instrument (CFI), measuring self-perceived cognitive decline (N = 9516). PTSD symptoms and depressive symptoms were assessed using the PCL-S and CES-D, respectively. Multivariable linear regression estimated the association between WTC exposure and CFI score, adjusting for confounders. Mediation analyses followed the methods of Vanderweele (2014). Participants’ average age at CFI assessment was 56.6 ± 7.6 years. Higher-intensity WTC exposure was associated with worse CFI score, an effect that was entirely mediated by PTSD symptoms (%mediated: 110.9%; 95%CI: 83.1–138.9). When substituting depressive symptoms for PTSD symptoms, the WTC exposure–CFI association was largely mediated (%mediated: 82.1%; 95%CI: 60.6–103.7). Our findings that PTSD symptoms and depressive symptoms mediate the association between WTC exposure and subjective cognitive concerns indicate that in the absence of these symptoms, WTC exposure in rescue/recovery workers would not be associated with subjective cognition. Interventions targeting PTSD and depression may have additional value in mitigating cognitive decline in WTC-exposed populations.

Original languageEnglish (US)
Article number5683
Pages (from-to)1-13
Number of pages13
JournalInternational journal of environmental research and public health
Volume17
Issue number16
DOIs
StatePublished - Aug 2 2020

Keywords

  • Cognitive dysfunction
  • Epidemiological studies
  • Mental health
  • Occupational exposure
  • Post-traumatic
  • Stress disorders

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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