Comorbidity amplifies the effects of post-9/11 posttraumatic stress disorder trajectories on health-related quality of life

Supporting young people through the COVID-19 pandemic and beyond: a multi-site qualitative longitudinal study

BACKGROUND

Throughout the COVID-19 pandemic, youth have experienced substantial stress due to abrupt changes in education, finances, and social life, compounding pre-existing stressors. With youth (ages 15-26) often at critical points in development, they are vulnerable to long-term mental health challenges brought on by pandemic trauma.

METHODS

To identify youth experiences throughout the pandemic and examine changes over time, we conducted semi-structured interviews among n = 141 youth in two Canadian provinces (Ontario and British Columbia) and across the country of Ireland at three time points over the course of more than one year (August 2020-October 2021). We conducted a qualitative longitudinal analysis using an inductive content approach.

RESULTS

Categories identified were (1) coping with hardship; (2) opportunities for growth; (3) adapting to new ways of accessing services; (4) mixed views on the pandemic: attitudes, behaviour, and perception of policy response; (5) navigating COVID-19 information; (6) transitioning to life after the pandemic; and (7) youth-led recommendations for government and service response. The findings also reveal trends in health and wellness in accordance with prolonged periods of lockdown, changes in weather, and return to normalcy after the availability of COVID-19 vaccines. Key recommendations from youth include incorporating youth voice into decision making, communicating public health information effectively to youth, enhancing service delivery post-pandemic, and planning for future pandemics.

CONCLUSIONS

These results provide insights into the extensive longitudinal impacts of the COVID-19 pandemic on young people across three geographical locations. Actively involving youth in decision making roles for future pandemics or public health emergencies is critical.

A history of PTSD changes the way people express themselves during the COVID-19 pandemic

Background: The words people use in everyday life tell us about their emotions, their mental state and allow us to understand how people process and interpret an event. Previous research has established a link between the content analysis of narrative texts and the psychopathology of people who have experienced trauma.Objectives: This study examines whether the development of PTSD following exposure to a previous traumatic event alters the way people express themselves in the context of an anxiety-provoking event, the COVID-19 pandemic.Methods: This study is based on semi-structured interviews conducted during the first lockdown period in France (23 April-16 May 2020) with people exposed to the 13 November 2015 attacks (N = 31) and nonexposed people (N = 57).Results: People with PTSD had longer narratives and used more first-person singular pronouns, lower first-person plural pronouns, more words related to negative emotions and anxiety compared to the nonexposed group. Within the PTSD group, there was no significant difference between the use of words related to the attacks and the pandemic. Conversely, the nonexposed group used more words related to the COVID-19 pandemic compared to words related to the attacks.Conclusion: These results confirm, as have other studies, that a history of PTSD can specifically modify the style and narrative of past experiences. They underline the importance of including linguistic analyses in psychological assessments of PTSD.

Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study

BACKGROUND

The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD).

METHODS

Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ² and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40).

CONCLUSIONS

The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.

Mortality after the 9/11 terrorist attacks among world trade center health registry enrollees with cancer

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.

Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members

Exposure to World Trade Center (WTC) dust/fumes and traumas on 11 September 2001 has been reported as a risk factor for post-traumatic stress disorder (PTSD) and other mental/physical health symptoms in WTC-affected populations. Increased systemic inflammation and oxidative stress from the exposure and subsequent illnesses have been proposed as contributors to the underlying biological processes. Many blood-based biomarkers of systemic inflammation, including C-reactive protein (CRP), are useful for non-invasive diagnostic and monitoring of disease process, and also potential targets for therapeutic interventions. Twenty years after 9/11, however, the relationships between WTC exposure, chronic PTSD, and systemic inflammation are only beginning to be systematically investigated in the WTC-affected civilian population despite the fact that symptoms of PTSD and systemic inflammation are still common and persistent. This paper aims to address this knowledge gap, using enrollees of the WTC Environmental Health Center (EHC), a federally designated treatment and surveillance program for community members (WTC Survivors) exposed to the 9/11 terrorist attack. We conducted a mediation analysis to investigate the association between acute WTC dust cloud traumatic exposure (WDCTE) on 9/11, chronic PTSD symptoms, and levels of systemic inflammation. The data indicate that the chronic PTSD symptoms and some specific symptom clusters of PTSD significantly mediate the WDCTE on systemic inflammation, as reflected by the CRP levels. As both chronic PTSD and systemic inflammation are long-term risk factors for neurodegeneration and cognitive decline, further research on the implications of this finding is warranted.

Prevalence of Posttraumatic Stress Disorder Following the Earthquake in Iran and Pakistan: A Systematic Review and Meta-Analysis

Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after the earthquake in Iran and Pakistan. The review includes all articles published from inception to March 2019. The pooled prevalence for overall PTSD was 55.6% (95% CI: 49.9-61.3). It was 60.2% (95% CI: 54.1-66.3) and 49.2% (95% CI: 39.4-59) for Iranian and Pakistani survivors, respectively. Women experienced higher incidence of PTSD than men. The variation of PTSD based on the clinical interview was lower than the self-report approach. The interval time between the earthquakes and the assessment showed that the prevalence of PTSD decreased over time. The prevalence of PTSD in Iran and Pakistan was higher than the global average, and the rate of the disorder in Iran was higher than in Pakistan. Sex, method of assessment, and time lag between the occurrence of disaster and assessment of PTSD affect the prevalence.

PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak

Background:

Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic.

Objective:

To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes.

Methods:

74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression).

Results:

A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group.

Conclusion:

Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.

Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees

BACKGROUND

We examined both the impact of 9/11-related exposures and repeated assessments of post-traumatic stress disorder (PTSD) on the risk of alcohol-related hospitalizations (ARH) among individuals exposed to the World Trade Center (WTC) disaster.

METHODS

9/11-related exposures (witnessing traumatic events, physical injuries, or both) were measured at baseline and PTSD symptoms were assessed at four time points (2003-2016) using the PTSD Checklist-17 among 53,174 enrollees in the WTC Health Registry. ICD-9-CM and ICD-10-CM codes were used to identify ARHs (2003-2016) through linked administrative data. For the effect of 9/11-related exposures on ARH, Cox proportional-hazards regression estimated hazard ratios (HR) and 95 % confidence intervals (CI); for time-varying PTSD, extended Cox proportional-hazards regression was used. Models were adjusted fora priori confounders and stratified by enrollee group (uniformed rescue and recovery worker (RRW), non-uniformed RRW, and community members). Person-time was calculated from baseline or 9/12/2001 to the earliest of ARH, withdrawal, death, or end of follow-up (12/31/2016).

RESULTS

Across all 9/11-related exposures, community members and non-uniformed RRWs were at increased risk of ARHs; uniformed RRWs were not. In adjusted models, PTSD was associated with an increased risk of hospitalization across all groups [HR, (95 % CI): uniformed RRWs: 2.6, (1.9, 3.6); non-uniformed RRWs: 2.1, (1.7, 2.7); and community members: 2.6, (2.1, 3.2)].

CONCLUSIONS

Among certain enrollee groups, 9/11-related exposures are associated with an increased risk of ARH and that PTSD is strongly associated with ARHs among all enrollee groups. Findings may assist the clinical audience in improving screening and treatment.

Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland

Background

Even though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context.

Methods

The BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches.

Results

Issues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance—resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity.

Conclusions

As a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.

Association Between Posttraumatic Stress Disorder and Mortality Among Responders and Civilians Following the September 11, 2001, Disaster

IMPORTANCE

Posttraumatic stress disorder (PTSD) has been associated with increased mortality, primarily in studies of veterans. The World Trade Center Health Registry (Registry) provides a unique opportunity to study the association between PTSD and mortality among a population exposed to the World Trade Center attacks in New York, New York, on September 11, 2001 (9/11).

OBJECTIVES

To assess whether 9/11-related probable PTSD (PTSD) is associated with increased mortality risk, as well as whether this association differs when including repeated measures of PTSD over time vs a single baseline assessment.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal cohort study of 63 666 Registry enrollees (29 270 responders and 34 396 civilians) was conducted from September 5, 2003, to December 31, 2016, with PTSD assessments at baseline (wave 1: 2003-2004) and 3 follow-up time points (wave 2: 2006-2007, wave 3: 2011-2012, wave 4: 2015-2016). Data analyses were conducted from December 4, 2018, to May 20, 2019.

EXPOSURES

Posttraumatic stress disorder was defined using the 17-item PTSD Checklist-Specific (PCL-S) self-report measure (score ≥50) at each wave (waves 1-4). Baseline PTSD was defined using wave 1 PCL-S, and time-varying PTSD was defined using the PCL-S assessments from all 4 waves.

MAIN OUTCOMES AND MEASURES

Mortality outcomes were ascertained through National Death Index linkage from 2003 to 2016 and defined as all-cause, cardiovascular, and external-cause mortality.

RESULTS

Of 63 666 enrollees (38 883 men [61.1%]; mean [SD] age at 9/11, 40.4 [10.4] years), 6689 (10.8%) had PTSD at baseline (responders: 2702 [9.5%]; civilians: 3987 [12.0%]). Participants who were middle aged (2022 [12.5%]), female (3299 [13.8%]), non-Latino black (1295 [17.0%]), or Latino (1835 [22.2%]) were more likely to have PTSD. During follow-up, 2349 enrollees died (including 230 external-cause deaths and 487 cardiovascular deaths). Among all enrollees in time-varying analyses, PTSD was associated with all-cause, cardiovascular, and external-cause mortality, with adjusted hazard ratios (AHRs) of greater magnitude compared with analyses examining baseline PTSD. Among responders, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.91; 95% CI, 1.58-2.32), cardiovascular (AHR, 1.95; 95% CI, 1.25-3.04), and external-cause (AHR, 2.40; 95% CI, 1.47-3.91) mortality. Among civilians, time-varying PTSD was significantly associated with increased risk of all-cause (AHR, 1.54; 95% CI, 1.28-1.85), cardiovascular (AHR, 1.72; 95% CI, 1.15-2.58), and external-cause (AHR, 2.11; 95% CI, 1.06-4.19) mortality.

CONCLUSIONS AND RELEVANCE

The risk of mortality differed in examination of baseline PTSD vs repeated measures of PTSD over time, suggesting that longitudinal data should be used where possible. Comparable findings between responders and civilians suggest that 9/11-related PTSD is associated with an increased mortality risk.

Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015

During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.

Longitudinal Change of PTSD Symptoms in Community Members after the World Trade Center Destruction

The World Trade Center (WTC) Environmental Health Center (EHC) is a treatment program for community members with exposure to the 9/11 terrorist attack and its physical and emotional aftermath. Compared to the general responders program, the WTC EHC is diverse with equal gender distribution, representation of many races and ethnicities, and a wide range of social economic status. Patients in the WTC EHC were initially enrolled for physical symptoms, most of which were respiratory, however a large portion of the enrollees scored positive for probable posttraumatic stress disorder (PTSD). In this paper we identify patient characteristics associated with probable PTSD. We also determine the characteristics associated with the longitudinal change of PTSD symptoms, including persistence and remittance, using the widely used Posttraumatic Check List-17 (PCL) cut-off value of 44, as well as changes in PCL total score and symptom cluster scores in patients of Low and High PTSD symptom severity. Few patients with elevated scores achieved a score below 44. However, longitudinal improvement in PCL score at follow-up was identified for patients with High PTSD scores (PCL > 57.5). Changes in PCL symptom clusters differed between those with High and Low PCL scores. These data suggest improvement over time in PCL score that differs depending on the severity of the score and variable responses in the PCL symptom clusters.

Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort

Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003–2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1–5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0–10.4), compared to those with low exposure. A test for exposure—response trend was statistically significant (P_trend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.

Persistent mental and physical health impact of exposure to the September 11, 2001 World Trade Center terrorist attacks

BACKGROUND

Asthma, gastroesophageal reflux disease (GERD), posttraumatic stress disorder (PTSD) and depression have each been linked to exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We described the prevalence and patterns of these conditions and associated health-related quality of life (HRQOL) fifteen years after the attacks.

METHODS

We studied 36,897 participants in the WTC Health Registry, a cohort of exposed rescue/recovery workers and community members, who completed baseline (2003-2004) and follow-up (2015-16) questionnaires. Lower respiratory symptoms (LRS; cough, dyspnea, or wheeze), gastroesophageal reflux symptoms (GERS) and self-reported clinician-diagnosed asthma and GERD history were obtained from surveys. PTSD was defined as a score > 44 on the PTSD checklist, and depression as a score > 10 on the Patient Health Questionnaire (PHQ). Poor HRQOL was defined as reporting limited usual daily activities for > 14 days during the month preceding the survey.

RESULTS

In 2015-16, 47.8% of participants had ≥1 of the conditions studied. Among participants without pre-existing asthma, 15.4% reported asthma diagnosed after 9/11; of these, 76.5% had LRS at follow up. Among those without pre-9/11 GERD, 22.3% reported being diagnosed with GERD after 9/11; 72.2% had GERS at follow-up. The prevalence of PTSD was 14.2%, and of depression was 15.3%. HRQOL declined as the number of comorbidities increased, and was particularly low among participants with mental health conditions. Over one quarter of participants with PTSD or depression reported unmet need for mental health care in the preceding year.

CONCLUSIONS

Nearly half of participants reported having developed at least one of the physical or mental health conditions studied by 2015-2016; comorbidity among conditions was common. Poor HRQOL and unmet need for health were frequently reported, particularly among those with post-9/11 PTSD or depression. Comprehensive physical and mental health care are essential for survivors of complex environmental disasters, and continued efforts to connect 9/11-exposed persons to needed resources are critical.

Combat Posttraumatic Stress Disorder and Quality of Life: Do Somatic Comorbidities Matter?

A vast number of veterans with posttraumatic stress disorder (PTSD) have chronic somatic comorbidities. However, their relationship with quality of life (QoL) has received little attention. We aimed to compare QoL of veterans with similar intensity of PTSD but different number of chronic somatic disorders. Of 129 veterans, 78% had at least one somatic disorder, and they reported lower QoL across all domains than veterans without somatic comorbidities. The greatest effect size was observed on social relationship (d = 0.65), it was notable on environment (d = 0.4) and psychological health (d = 0.38), and it was not relevant on physical health (d = 0.05). There was a negative correlation between the number of somatic disorders and scores on psychological health (rs = -0.217, p = 0.014), social relationships (rs = -0.248, p = 0.005), and environment (rs = -0.279, p = 0.001). The QoL of war veterans decreases significantly with the number of comorbid somatic conditions, particularly on the nonphysical domains of QoL.

Re-experiencing 9/11-Related PTSD Symptoms Following Exposure to Hurricane Sandy

Background

Understanding Pre-Existing Posttraumatic Stress Disorder (PTSD) symptoms and risk of PTSD following Hurricane Sandy (Sandy) has important implications for PTSD screening of persons exposed to multiple traumas. This study assessed the association between Sandy exposure and a subset of PTSD symptoms related to re-experiencing trauma from the events of the September 11, 2001 (9/11).

Methods

We studied 4,220 respondents from a random 8,870 person sample of adult World Trade Center Health Registry enrollees who completed a post-Sandy survey between March 28 and November 7, 2013. The symptom cluster of re-experiencing 9/11 was defined using 3 out of 5 questions in the intrusion domain of the PTSD Checklist. Multivariable logistic regression, adjusting for socio-demographics, social support and any post-9/11 life threatening events prior to Sandy, was performed separately in those symptomatic and non-symptomatic of re-experiencing 9/11 prior to Sandy.

Results

A total of 688 enrollees (16.3%) reported re-experiencing 9/11 symptoms after Sandy (58.8% in those symptomatic prior to Sandy, and 8.7% in those non-symptomatic). A significant association between Sandy exposure and re-experiencing 9/11 was observed only among those non symptomatic prior to Sandy (adjusted odds ratio (AOR)=1.7, 95% confidence interval=1.2-2.3 for moderate Sandy exposure; AOR=2.8, 2.0-4.0 for high Sandy exposure).

Conclusions

Individuals with a history of trauma should be considered for early screening and counseling for mental health after a subsequent traumatic event, regardless of PTSD status, especially in 9/11 exposed populations.