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Thompson HM, Thanik E, Sabra A, Ko F, Hung WW, Colicino E, Lucchini RG, Bello G, Crane M, Teitelbaum SL, Ornstein KA. A pilot study to identify factors associated with frailty within the World Trade Center general responder cohort. Am J Ind Med 2024; 67:582-591. [PMID: 38735862 DOI: 10.1002/ajim.23590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Given the significant exposures experienced by the World Trade Center (WTC) general responders, there is increasing interest in understanding the effect of these exposures on aging in this population. We aim to identify factors that may be associated with frailty, a clinical syndrome characterized by a decrease in one's reserve that has been linked to poor health outcomes. METHODS WTC general responders enrolled in the WTC Health Program aged 50 and older provided informed consent. Validated frailty assessments, the Frailty Phenotype (with the Johns Hopkins Frailty Assessment Calculator) along with the FRAIL scale, categorized nonfrail from prefrail/frail. Fall risk, functional status, and cognition were also assessed. WTC variables, including an identified WTC-certified condition, were utilized. The risk of frailty was estimated using log binomial regression analysis. A 95% confidence interval (CI) was used to estimate the prevalence ratio (PR). RESULTS One hundred and six participants were included; 38 (35.8%) were classified as pre-frail or frail. More of the pre-frail/frail group were obese (57.9% vs. 25%; p = 0.004) and had a WTC-certified condition (78.9% vs. 58.8%; p = 0.036). Obesity (PR = 2.43, 95% CI = 1.31, 4.53), a WTC-certified condition (PR = 1.77, 95% CI = 1.09, 2.89), and risk of falling (PR = 1.97, 95% CI = 1.01, 3.84) were independently associated with frailty. CONCLUSIONS Obesity and having a WTC-certified condition were found to be risk factors for frailty in our pilot study. Future work may focus on further identifying risk factors for frailty in the larger WTC general responder population.
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Affiliation(s)
- Hannah M Thompson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmad Sabra
- General Responder Data Center, Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - William W Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Geriatric, Research, Education and Clinical Center, Icahn School of Medicine at Mount Sinai, James J Peters VA Medical Center, New York, New York, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, School of Public Health, Florida International University, Miami, Florida, USA
| | - Ghalib Bello
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, 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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Sowan W, Baziliansky S. Acute Stress Symptoms, Intolerance of Uncertainty and Coping Strategies in Reaction to the October 7 War. Clin Psychol Psychother 2024; 31:e3021. [PMID: 38894501 DOI: 10.1002/cpp.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/01/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND On 7 October 2023, hundreds of armed Hamas fighters breached the security border fence and entered Israel from the Gaza Strip. More than 1400 Israeli citizens were murdered, and 239 individuals were kidnapped. Many Israeli citizens experienced these occurrences as psychologically traumatic events that caused stress and uncertainty. OBJECTIVES The present study aimed to examine the relationship between exposure to war (in more distant circles), intolerance of uncertainty (IU) and disengaged coping on acute stress symptoms (ASS). First, we examined whether exposure to war and IU were directly associated with ASS. Second, we tested the mediating role of disengaged coping in the relationship among war exposure, IU and ASS. METHODS This cross-sectional study involved 393 Israeli citizens. Participants answered questionnaires on exposure to war, IU, coping strategies and ASS. RESULTS The study results indicate that higher exposure and higher levels of IU were directly associated with more intensive ASS, and this association was partially mediated by higher use of disengaged coping strategies. CONCLUSIONS Individuals during wartime are at risk of experiencing high levels of ASS and developing ASD. However, degree of exposure to war alone was not associated with ASS, but it was related to personal resources and coping strategies.
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Affiliation(s)
- Wafaa Sowan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Svetlana Baziliansky
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Muysewinkel E, Vesentini L, Van Deynse H, Stene LE, Bilsen J, Van Overmeire R. The psychosocial aid response after the 22/03/2016 attacks in Belgium: a community case study. Front Public Health 2024; 12:1362021. [PMID: 38525333 PMCID: PMC10957622 DOI: 10.3389/fpubh.2024.1362021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction After the terrorist attacks, early psychosocial care is provided to people considered at risk of developing mental health issues due to the attacks. Despite the clear importance of such early intervention, there is very few data on how this is registered, who is targeted, and whether target-recipients accept such aid. Methods Using registry data from the Centre General Wellbeingwork (CAW), a collection of centers in the regions Brussels and Flanders that provide psychosocial care, we examined the early psychosocial care response after the terrorist attacks of 22/03/2016 in Belgium. Results In total, 327 people were listed to be contacted by the CAW, while only 205 were reached out to (62.7%). Most were contacted within a month (84.9%), and were victims of the attacks (69.8%). Overall, the majority was female (55.6%). Conclusion Overall, target recipients were witnesses and survivors of the attacks, though a large proportion of people were not reached by the early outreach.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Public Health Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Public Health Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
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Stiltner B, Fischer IC, Duek O, Polimanti R, Harpaz-Rotem I, Pietrzak RH. Functional correlates of a novel 8-factor model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2024; 171:69-74. [PMID: 38244335 DOI: 10.1016/j.jpsychires.2024.01.017] [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: 10/03/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
Emerging evidence indicates that more nuanced models of posttraumatic stress disorder (PTSD) may better capture the condition's symptom structure. Recent theoretical and empirical work suggest that an 8-factor model of PTSD with separate internally- (e.g. flashbacks) and externally- (e.g. trauma-cue related physiological reactivity) generated intrusive symptom clusters may advance understanding of PTSD and its treatment and course. However, the model's functional and clinical significance still requires evaluation. To this end, we analyzed data from the National Health and Resilience in Veterans Study, a nationally representative sample of 3847 trauma-exposed U.S. military veterans. Multivariable regressions were performed to assess the relationship between the 8 PTSD symptom clusters, assessed using the PTSD Checklist for DSM-5, and clinical and functional measures. Results revealed that externally-generated intrusions were associated with higher odds of current depression and anxiety and worse mental, cognitive, and psychosocial functioning. Anhedonia (e.g., loss of interest in enjoyable activities) symptoms were associated with all the correlates tested, while negative affect (e.g., having strong negative feelings such as fear) symptoms were associated with all measures except depression. Avoidance symptoms were associated with lower odds of current anxiety while externalizing behavior symptoms were linked to higher odds of suicidal ideation. Anxious arousal symptoms were associated with lower odds of suicidal ideation but higher odds of PTSD-related impairment/distress, while dysphoric arousal symptoms were associated with higher odds of current depression, PTSD-related impairment/distress and worse mental and cognitive functioning. Results suggest that a more nuanced 8-factor model of PTSD symptoms may help inform understanding of the clinical and functional correlates of this multi-faceted disorder.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale 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
| | - Or Duek
- Department of Psychiatry, Yale 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; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Israel
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale 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
| | - Robert H Pietrzak
- Department of Psychiatry, Yale 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; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
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Arcan C, Hou W, Hoffman K, Reichardt A, Yang X, Clouston SAP, Bromet EJ, Luft B. Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial. Obes Sci Pract 2024; 10:e725. [PMID: 38263989 PMCID: PMC10804354 DOI: 10.1002/osp4.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
Objective Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). Methods WTC Health Program members (N = 62), 45-65 years, males 87%, body mass index (BMI) 27-45 kg/m2 randomized to MedDiet (n = 31) or usual nutrition counseling (n = 31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. Results A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17) kg, BMI 33.20 (27.50-41.75) kg/m2, and Waist circumference (WC) 109.22 (90.17-150.62) cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p = 0.0002; Control: -1% (-13%-4%), p = 0.008 and at follow-up MedDiet: -2% (-14%-12%), p = 0.07; Control: -2% (-20%-3%), p = 0.006. The overall BMI was reduced by -0.68 kg/m2 (-4.61-2.09) kg/m2 p < 0.0001 at post-intervention and by -0.60 kg/m2 (-6.91-3.39) kg/m2, p < 0.0009 at follow-up. Overall, median WC was reduced (p < 0.0001); post-intervention -3.81 cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p = 0.019) and serum ω6/ω3 (p = 0.029) at post-intervention. Conclusion Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.
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Affiliation(s)
- Chrisa Arcan
- Department of EpidemiologySchool of Population HealthVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Wei Hou
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
- Vertex Pharmaceuticals IncorporatedBostonMassachusettsUSA
| | - Kathryn Hoffman
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Amanda Reichardt
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Xiaohua Yang
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
| | - Sean A. P. Clouston
- Department of FamilyPopulation and Preventive MedicineRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Evelyn J. Bromet
- Neurosciences InstituteRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Benjamin Luft
- Stony Brook World Trade Center Health Plan and Wellness ProgramRenaissance School of MedicineStony Brook UniversityCommackNew YorkUSA
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7
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Johnstad PG. Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use. Front Public Health 2024; 11:1268339. [PMID: 38249418 PMCID: PMC10797041 DOI: 10.3389/fpubh.2023.1268339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however. Objective The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons. Methods Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency. Results From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses. Conclusion This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.
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8
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Slavish DC, Ruggero CJ, Schuler K, Schwartz JE, Luft B, Kotov R. Effects of Daily Posttraumatic Stress Disorder Symptoms on Heart Rate Variability. Psychosom Med 2024; 86:30-36. [PMID: 37982540 PMCID: PMC10841862 DOI: 10.1097/psy.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with an increased risk of health problems, including cardiovascular disease. PTSD is related to poor autonomic function indicated by reduced heart rate variability (HRV). However, very little work has tested the timescale or direction of these effects, given that most evidence comes from cross-sectional studies. Documentation of when effects occur and in what direction can shed light on mechanisms of cardiovascular disease risk and inform treatment. The present study of 169 World Trade Center responders, oversampled for PTSD, tested how daily PTSD symptoms were associated with autonomic function as reflected through HRV. METHODS Participants ( N = 169) completed surveys of PTSD symptoms three times a day at 5-hour intervals for 4 days while also wearing ambulatory monitors to record electrocardiograms to derive HRV (i.e., mean absolute value of successive differences between beat-to-beat intervals). RESULTS HRV did not predict PTSD symptoms. However, PTSD symptoms during a 5-hour interval predicted reduced HRV at the next 5-hour interval ( β = -0.09, 95% confidence interval = -0.16 to -0.02, p = .008). Results held adjusting for baseline age, current heart problems, and current PTSD diagnosis. CONCLUSIONS Findings underscore growing awareness that PTSD symptoms are not static. Even their short-term fluctuations may affect cardiovascular functioning, which could have more severe impacts if disruption accumulates over time. Research is needed to determine if momentary interventions can halt increases in PTSD symptoms or mitigate their impact on cardiovascular health.
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Affiliation(s)
| | | | - Keke Schuler
- Uniformed Services University of the Health Sciences, Department of Military & Emergency Medicine
| | | | | | - Roman Kotov
- Stony Brook University, Department of Psychiatry
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Flannery RB, Flannery GJ. Public Works Employees and Posttruamatic Stress Disorder: an At-Risk Population. Psychiatr Q 2023; 94:531-540. [PMID: 36808046 DOI: 10.1007/s11126-023-10014-1] [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] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
Although not widely known, public works employees in the United States were designated as emergency providers during critical incidents in 2003 and have provided these public works services, when activated. These public works employees may be either employees of a specific government entity or, more recently, privately contracted employees who provide similar services for a government entity. First responders working critical incidents are at risk for psychological trauma and posttraumatic stress disorder (PTSD). It is less clear, however, whether government/contracted public works employees working the same critical incidents are subject to the same risk of onset. This paper reviewed 24 empirical studies assessing this possible association from 1980 to 2020. These studies included 94,302 government/contracted employees. Psychological trauma/PTSD was reported in all 24 manuscripts assessing PTSD. Three of these studies additionally reporting serious somatic health problems. Public works employees are at risk for onset and this is a worldwide issue. Study findings and treatment implications are presented.
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Affiliation(s)
- Raymond B Flannery
- The University of Massachusetts Chan Medical School, Worcester, MA, USA.
- , Newton, MA, USA.
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Invernizzi A, Rechtman E, Curtin P, Papazaharias DM, Jalees M, Pellecchia AC, Santiago-Michels S, Bromet EJ, Lucchini RG, Luft BJ, Clouston SA, Tang CY, Horton MK. Functional changes in neural mechanisms underlying post-traumatic stress disorder in World Trade Center responders. Transl Psychiatry 2023; 13:239. [PMID: 37429850 DOI: 10.1038/s41398-023-02526-y] [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] [Received: 09/28/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/12/2023] Open
Abstract
World Trade Center (WTC) responders exposed to traumatic and environmental stressors during rescue and recovery efforts have a high prevalence of chronic WTC-related post-traumatic stress disorder (WTC-PTSD). We investigated neural mechanisms underlying WTC-PTSD by applying eigenvector centrality (EC) metrics and data-driven methods on resting state functional magnetic resonance (fMRI). We identified how EC differences relate to WTC-exposure and behavioral symptoms. We found that connectivity differentiated significantly between WTC-PTSD and non-PTSD responders in nine brain regions, as these differences allowed an effective discrimination of PTSD and non-PTSD responders based solely on analysis of resting state data. Further, we found that WTC exposure duration (months on site) moderates the association between PTSD and EC values in two of the nine brain regions; the right anterior parahippocampal gyrus and the left amygdala (p = 0.010; p = 0.005, respectively, adjusted for multiple comparisons). Within WTC-PTSD, a dimensional measure of symptom severity was positively associated with EC values in the right anterior parahippocampal gyrus and brainstem. Functional neuroimaging can provide effective tools to identify neural correlates of diagnostic and dimensional indicators of PTSD.
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Affiliation(s)
- Azzurra Invernizzi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elza Rechtman
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Demetrios M Papazaharias
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maryam Jalees
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison C Pellecchia
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Santiago-Michels
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
- Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Cheuk Y Tang
- Department of Radiology and Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Natale G, Kritikos M, Kuan PF, Carr MA, Yang X, Yang Y, Kotov R, Bromet EJ, Clouston SA, Luft BJ. Glial suppression and post-traumatic stress disorder: A cross-sectional study of 1,520 world trade center responders. Brain Behav Immun Health 2023; 30:100631. [PMID: 37251545 PMCID: PMC10209702 DOI: 10.1016/j.bbih.2023.100631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Background Chronically re-experiencing the memory of a traumatic event might cause a glial response. This study examined whether glial activation would be associated with PTSD in a study of responders present after the 9/11 World Trade Center attacks without comorbid cerebrovascular disease. Methods Plasma was retrieved from 1,520 WTC responders and stored for a cross-sectional sample of responders of varying levels of exposure and PTSD. Plasma levels (pg/ml) of glial fibrillary acidic protein (GFAP) were assayed. Because stroke and other cerebrovascular diseases cause distributional shifts in GFAP levels, multivariable-adjusted finite mixture models analyzed GFAP distributions in responders with and without possible cerebrovascular disease. Results Responders were aged 56.3 years and primarily male; 11.07% (n = 154) had chronic PTSD. Older age was associated with increased GFAP, whereas higher body mass was associated with decreased GFAP. Multivariable-adjusted finite mixture models revealed that severe re-experiencing trauma from 9/11 was associated with lower GFAP (B = -0.558, p = 0.003). Conclusion This study presents evidence of reduced plasma GFAP levels among WTC responders with PTSD. Results suggest re-experiencing traumatic events might cause glial suppression.
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Affiliation(s)
- Ginny Natale
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11794
| | - Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11794
| | - Pei-Fen Kuan
- Department of Applied Mathematics, Stony Brook University, Stony Brook, NY, USA, 11794
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11725
| | - Xiaohua Yang
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA, 11794
| | - Yuan Yang
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11794
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA, 11794
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA, 11794
| | - Sean A.P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11794
| | - Benjamin J. Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 11725
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA, 11794
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North CS, McDonald K. A Prospective Post-disaster Longitudinal Follow-up Study of Emotional and Psychosocial Outcomes of the Oklahoma City Bombing Rescue and Recovery Workers During the First Quarter Century Afterward. Disaster Med Public Health Prep 2023; 17:e331. [PMID: 36815364 DOI: 10.1017/dmp.2022.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Little prospectively assessed post-disaster longitudinal research has been done on mental health (MH) outcomes of disaster rescue and recovery workers. This longitudinal prospective study, which is examining first responders to a terrorist bombing in Oklahoma City after nearly a quarter century, was conducted to investigate their long-term MH outcomes using full diagnostic assessments. This will most accurately inform planning for longitudinal MH care needs. METHODS Longitudinal follow-up interviews of 124 rescue and recovery workers, from an original volunteer sample of 181 volunteer workers, were completed 3 years after the bombing, and reassessed 23 years after using consistent research methods. Structured diagnostic interviews were conducted at both assessments, but these were limited to posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) with additional questions about alcohol use, problems, and major psychosocial problems of life at follow up. RESULTS Initially, the rescue and recovery workers had a lower prevalence of post-disaster PTSD and MDD than directly exposed survivors. They also showed higher rates of PTSD than MDD. However, over time, PTSD increased a little while MDD increased 4-fold though fewer than 50% of the cases were remitted. CONCLUSION Low remission and increasing MDD provide incentives for surveillance and availability of treatment for decades after disaster, regardless of whether they were pre-existing conditions or disaster related.
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Affiliation(s)
- Carol S North
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, Texas, USA
- The Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Katy McDonald
- The Altshuler Center for Education and Research, Metrocare Services, Dallas, Texas, USA
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Son Y, Clouston SAP, Kotov R, Eichstaedt JC, Bromet EJ, Luft BJ, Schwartz HA. World Trade Center responders in their own words: predicting PTSD symptom trajectories with AI-based language analyses of interviews. Psychol Med 2023; 53:918-926. [PMID: 34154682 PMCID: PMC8692489 DOI: 10.1017/s0033291721002294] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Oral histories from 9/11 responders to the World Trade Center (WTC) attacks provide rich narratives about distress and resilience. Artificial Intelligence (AI) models promise to detect psychopathology in natural language, but they have been evaluated primarily in non-clinical settings using social media. This study sought to test the ability of AI-based language assessments to predict PTSD symptom trajectories among responders. METHODS Participants were 124 responders whose health was monitored at the Stony Brook WTC Health and Wellness Program who completed oral history interviews about their initial WTC experiences. PTSD symptom severity was measured longitudinally using the PTSD Checklist (PCL) for up to 7 years post-interview. AI-based indicators were computed for depression, anxiety, neuroticism, and extraversion along with dictionary-based measures of linguistic and interpersonal style. Linear regression and multilevel models estimated associations of AI indicators with concurrent and subsequent PTSD symptom severity (significance adjusted by false discovery rate). RESULTS Cross-sectionally, greater depressive language (β = 0.32; p = 0.049) and first-person singular usage (β = 0.31; p = 0.049) were associated with increased symptom severity. Longitudinally, anxious language predicted future worsening in PCL scores (β = 0.30; p = 0.049), whereas first-person plural usage (β = -0.36; p = 0.014) and longer words usage (β = -0.35; p = 0.014) predicted improvement. CONCLUSIONS This is the first study to demonstrate the value of AI in understanding PTSD in a vulnerable population. Future studies should extend this application to other trauma exposures and to other demographic groups, especially under-represented minorities.
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Affiliation(s)
- Youngseo Son
- Department of Computer Science, Stony Brook University, New York, USA
| | - Sean A. P. Clouston
- Program in Public Health, Stony Brook University, New York, USA
- Department of Family, Population and Preventive Medicine, Stony Brook University, New York, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, New York, USA
| | - Johannes C. Eichstaedt
- Department of Psychology & Institute for Human-Centered A.I., Stanford University, Stanford, California, USA
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14
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Waszczuk MA, Kuan PF, Yang X, Miao J, Kotov R, Luft BJ. Discovery and replication of blood-based proteomic signature of PTSD in 9/11 responders. Transl Psychiatry 2023; 13:8. [PMID: 36631443 PMCID: PMC9834302 DOI: 10.1038/s41398-022-02302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Proteomics provides an opportunity to develop biomarkers for the early detection and monitoring of post-traumatic stress disorder (PTSD). However, research to date has been limited by small sample sizes and a lack of replication. This study performed Olink Proseek Multiplex Platform profiling of 81 proteins involved in neurological processes in 936 responders to the 9/11 disaster (mean age at blood draw = 55.41 years (SD = 7.93), 94.1% white, all men). Bivariate correlations and elastic net regressions were used in a discovery subsample to identify concurrent associations between PTSD symptom severity and the profiled proteins, and to create a multiprotein composite score. In hold-out subsamples, nine bivariate associations between PTSD symptoms and differentially expressed proteins were replicated: SKR3, NCAN, BCAN, MSR1, PVR, TNFRSF21, DRAXIN, CLM6, and SCARB2 (|r| = 0.08-0.17, p < 0.05). There were three replicated bivariate associations between lifetime PTSD diagnosis and differentially expressed proteins: SKR3, SIGLEC, and CPM (OR = 1.38-1.50, p < 0.05). The multiprotein composite score retained 38 proteins, including 10/11 proteins that replicated in bivariate tests. The composite score was significantly associated with PTSD symptom severity (β = 0.27, p < 0.001) and PTSD diagnosis (OR = 1.60, 95% CI: 1.17-2.19, p = 0.003) in the hold-out subsample. Overall, these findings suggest that PTSD is characterized by altered expression of several proteins implicated in neurological processes. Replicated associations with TNFRSF21, CLM6, and PVR support the neuroinflammatory signature of PTSD. The multiprotein composite score substantially increased associations with PTSD symptom severity over individual proteins. If generalizable to other populations, the current findings may inform the development of PTSD biomarkers.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Xiaohua Yang
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jiaju Miao
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
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15
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Huang C, Kritikos M, Sosa MS, Hagan T, Domkan A, Meliker J, Pellecchia AC, Santiago-Michels S, Carr MA, Kotov R, Horton M, Gandy S, Sano M, Bromet EJ, Lucchini RG, Clouston SAP, Luft BJ. World Trade Center Site Exposure Duration Is Associated with Hippocampal and Cerebral White Matter Neuroinflammation. Mol Neurobiol 2023; 60:160-170. [PMID: 36242735 PMCID: PMC9758101 DOI: 10.1007/s12035-022-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022]
Abstract
Responders to the World Trade Center (WTC) attacks on 9/11/2001 inhaled toxic dust and experienced severe trauma for a prolonged period. Studies report that WTC site exposure duration is associated with peripheral inflammation and risk for developing early-onset dementia (EOD). Free Water Fraction (FWF) can serve as a biomarker for neuroinflammation by measuring in vivo movement of free water across neurons. The present case-controlled study aimed to examine associations between WTC site exposure duration as well as EOD status with increased hippocampal and cerebral neuroinflammation. Ninety-nine WTC responders (mean age of 56) were recruited between 2017 and 2019 (N = 48 with EOD and 51 cognitively unimpaired). Participants were matched on age, sex, occupation, race, education, and post-traumatic stress disorder (PTSD) status. Participants underwent neuroimaging using diffusion tensor imaging protocols for FWF extraction. Region of interest (ROI) analysis and correlational tractography explored topographical distributions of FWF associations. Apolipoprotein-e4 allele (APOEε4) status was available for most responders (N = 91). Hippocampal FWF was significantly associated with WTC site exposure duration (r = 0.30, p = 0.003), as was cerebral white matter FWF (r = 0.20, p = 0.044). ROI analysis and correlational tractography identified regions within the limbic, frontal, and temporal lobes. Hippocampal FWF and its association with WTC exposure duration were highest when the APOEε4 allele was present (r = 0.48, p = 0.039). Our findings demonstrate that prolonged WTC site exposure is associated with increased hippocampal and cerebral white matter neuroinflammation in WTC responders, possibly exacerbated by possession of the APOEε4 allele.
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Affiliation(s)
- Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA
| | - Mario Serrano Sosa
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Thomas Hagan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Alan Domkan
- Department of Physiology and Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Jaymie Meliker
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA
| | - Alison C Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Melissa A Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Sam Gandy
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, 101 Nichols Rd#3-071, Stony Brook, NY, 11794, USA.
| | - Benjamin J Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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16
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Coêlho BM, Santana GL, de Souza Dantas H, Viana MC, Andrade LH, Wang YP. Correlates and prevalence of post-traumatic stress disorders in the São Paulo metropolitan area, Brazil. J Psychiatr Res 2022; 156:168-176. [PMID: 36252346 DOI: 10.1016/j.jpsychires.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/15/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors. METHODS Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas. RESULTS Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to "interpersonal violence" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38). CONCLUSION Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.
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Affiliation(s)
- Bruno Mendonça Coêlho
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Geilson Lima Santana
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Maria Carmen Viana
- Department of Social Medicine Post-Graduate Program in Public Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Ko TM, Alper HE, Brackbill RH, Jacobson MH. Trajectories of psychological distress among individuals exposed to the 9/11 World Trade Center disaster. Psychol Med 2022; 52:2950-2961. [PMID: 33823957 PMCID: PMC9693657 DOI: 10.1017/s0033291720004912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/01/2020] [Accepted: 11/29/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Individuals present in lower Manhattan during the 9/11 World Trade Center (WTC) disaster suffered from significant physical and psychological trauma. Studies of longitudinal psychological distress among those exposed to trauma have been limited to relatively short durations of follow-up among smaller samples. METHODS The current study longitudinally assessed heterogeneity in trajectories of psychological distress among WTC Health Registry enrollees - a prospective cohort health study of responders, students, employees, passersby, and residents in the affected area (N = 30 839) - throughout a 15-year period following the WTC disaster. Rescue/recovery status and exposure to traumatic events of 9/11, as well as sociodemographic factors and health status, were assessed as risk factors for trajectories of psychological distress. RESULTS Five psychological distress trajectory groups were found: none-stable, low-stable, moderate-increasing, moderate-decreasing, and high-stable. Of the study sample, 78.2% were classified as belonging to the none-stable or low-stable groups. Female sex, being younger at the time of 9/11, lower education and income were associated with a higher probability of being in a greater distress trajectory group relative to the none-stable group. Greater exposure to traumatic events of 9/11 was associated with a higher probability of a greater distress trajectory, and community members (passerby, residents, and employees) were more likely to be in greater distress trajectory groups - especially in the moderate-increasing [odds ratios (OR) 2.31 (1.97-2.72)] and high-stable groups [OR 2.37 (1.81-3.09)] - compared to the none-stable group. CONCLUSIONS The current study illustrated the heterogeneity in psychological distress trajectories following the 9/11 WTC disaster, and identified potential avenues for intervention in future disasters.
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Affiliation(s)
- Tomohiro M. Ko
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA
| | - Howard E. Alper
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
| | - Robert H. Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
| | - Melanie H. Jacobson
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
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Development of an Evidence-Informed Solution to Emotional Distress in Public Safety Personnel and Healthcare Workers: The Social Support, Tracking Distress, Education, and Discussion CommunitY (STEADY) Program. Healthcare (Basel) 2022; 10:healthcare10091777. [PMID: 36141388 PMCID: PMC9498760 DOI: 10.3390/healthcare10091777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023] Open
Abstract
Public safety personnel (PSP) and healthcare workers (HCWs) are frequently exposed to traumatic events and experience an increased rate of adverse mental health outcomes compared to the public. Some organizations have implemented wellness programming to mitigate this issue. To our knowledge, no programs were developed collaboratively by researchers and knowledge users considering knowledge translation and implementation science frameworks to include all evidence-informed elements of posttraumatic stress prevention. The Social Support, Tracking Distress, Education, and Discussion Community (STEADY) Program was developed to fill this gap. It includes (1) peer partnering; (2) distress tracking; (3) psychoeducation; (4) peer support groups and voluntary psychological debriefing following critical incidents; (5) community-building activities. This paper reports on the narrative literature review that framed the development of the STEADY framework and introduces its key elements. If successful, STEADY has the potential to improve the mental well-being of PSP and HCWs across Canada and internationally.
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Zhang Y, Rosen R, Reibman J, Shao Y. Posttraumatic Stress Disorder Mediates the Association between Traumatic World Trade Center Dust Cloud Exposure and Ongoing Systemic Inflammation in Community Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148622. [PMID: 35886474 PMCID: PMC9322679 DOI: 10.3390/ijerph19148622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Yian Zhang
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
| | - Rebecca Rosen
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Psychiatry, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Joan Reibman
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA;
- HHC World Trade Center Environmental Health Center, 462 First Avenue, New York, NY 10016, USA;
- NYU Alzheimer Disease Research Center, 145 E 32 Street, New York, NY 10016, USA
- Correspondence: (J.R.); (Y.S.)
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20
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Waszczuk MA, Hopwood CJ, Luft BJ, Morey LC, Perlman G, Ruggero CJ, Skodol AE, Kotov R. The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning. Clin Psychol Sci 2022; 10:734-751. [PMID: 35967764 PMCID: PMC9366938 DOI: 10.1177/21677026211056596] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | | | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
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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: 6] [Impact Index Per Article: 3.0] [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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22
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Clouston SAP, Hall CB, Kritikos M, Bennett DA, DeKosky S, Edwards J, Finch C, Kreisl WC, Mielke M, Peskind ER, Raskind M, Richards M, Sloan RP, Spiro A, Vasdev N, Brackbill R, Farfel M, Horton M, Lowe S, Lucchini RG, Prezant D, Reibman J, Rosen R, Seil K, Zeig-Owens R, Deri Y, Diminich ED, Fausto BA, Gandy S, Sano M, Bromet EJ, Luft BJ. Cognitive impairment and World Trade Centre-related exposures. Nat Rev Neurol 2022; 18:103-116. [PMID: 34795448 PMCID: PMC8938977 DOI: 10.1038/s41582-021-00576-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 02/03/2023]
Abstract
On 11 September 2001 the World Trade Center (WTC) in New York was attacked by terrorists, causing the collapse of multiple buildings including the iconic 110-story 'Twin Towers'. Thousands of people died that day from the collapse of the buildings, fires, falling from the buildings, falling debris, or other related accidents. Survivors of the attacks, those who worked in search and rescue during and after the buildings collapsed, and those working in recovery and clean-up operations were exposed to severe psychological stressors. Concurrently, these 'WTC-affected' individuals breathed and ingested a mixture of organic and particulate neurotoxins and pro-inflammogens generated as a result of the attack and building collapse. Twenty years later, researchers have documented neurocognitive and motor dysfunctions that resemble the typical features of neurodegenerative disease in some WTC responders at midlife. Cortical atrophy, which usually manifests later in life, has also been observed in this population. Evidence indicates that neurocognitive symptoms and corresponding brain atrophy are associated with both physical exposures at the WTC and chronic post-traumatic stress disorder, including regularly re-experiencing traumatic memories of the events while awake or during sleep. Despite these findings, little is understood about the long-term effects of these physical and mental exposures on the brain health of WTC-affected individuals, and the potential for neurocognitive disorders. Here, we review the existing evidence concerning neurological outcomes in WTC-affected individuals, with the aim of contextualizing this research for policymakers, researchers and clinicians and educating WTC-affected individuals and their friends and families. We conclude by providing a rationale and recommendations for monitoring the neurological health of WTC-affected individuals.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Charles B Hall
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Minos Kritikos
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, USA
| | - Steven DeKosky
- Evelyn F. and William L. McKnight Brain Institute and Florida Alzheimer's Disease Research Center, Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Jerri Edwards
- Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Caleb Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - William C Kreisl
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University, New York, NY, USA
| | - Michelle Mielke
- Specialized Center of Research Excellence on Sex Differences, Department of Neurology, Department of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Elaine R Peskind
- Veteran's Association VISN 20 Northwest Mental Illness Research, Education, and Clinical Center, Veteran's Affairs Puget Sound Health Care System, Seattle, WA, USA
- Alzheimer's Disease Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Murray Raskind
- Veteran's Association VISN 20 Northwest Mental Illness Research, Education, and Clinical Center, Veteran's Affairs Puget Sound Health Care System, Seattle, WA, USA
- Alzheimer's Disease Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Marcus Richards
- Medical Research Council Unit for Lifelong Health and Ageing, Population Health Sciences, University College London, London, UK
| | - Richard P Sloan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Avron Spiro
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Department of Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Neil Vasdev
- Azrieli Centre for Neuro-Radiochemistry, Brain Health Imaging Center, Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert Brackbill
- World Trade Center Health Registry, New York Department of Health and Mental Hygiene, New York, NY, USA
| | - Mark Farfel
- World Trade Center Health Registry, New York Department of Health and Mental Hygiene, New York, NY, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sandra Lowe
- The World Trade Center Mental Health Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - David Prezant
- World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joan Reibman
- Department of Environmental Medicine, New York University Langone Health, New York, NY, USA
| | - Rebecca Rosen
- World Trade Center Environmental Health Center, Department of Psychiatry, New York University, New York, NY, USA
| | - Kacie Seil
- World Trade Center Health Registry, New York Department of Health and Mental Hygiene, New York, NY, USA
| | - Rachel Zeig-Owens
- World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yael Deri
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Erica D Diminich
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Bernadette A Fausto
- Center for Molecular & Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Sam Gandy
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Mount Sinai Alzheimer's Disease Research Center and Ronald M. Loeb Center for Alzheimer's Disease, Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Mary Sano
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, USA
- Mount Sinai Alzheimer's Disease Research Center and Ronald M. Loeb Center for Alzheimer's Disease, Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Oltmanns JR, Ruggero C, Miao J, Waszczuk M, Yang Y, Clouston SAP, Bromet EJ, Luft BJ, Kotov R. The Role of Personality in the Mental and Physical Health of World Trade Center Responders: Self- versus Informant-Reports. Clin Psychol Sci 2022; 1:10.31234/osf.io/c4gbf. [PMID: 36407479 PMCID: PMC9670015 DOI: 10.31234/osf.io/c4gbf] [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] [Indexed: 06/16/2023]
Abstract
Personality is linked to important health outcomes, but most prior studies have relied on self-reports, making it possible that shared-method variance explains the associations. The present study examined self- versus informant-reports of personality and multi-method outcomes. World Trade Center (WTC) responders and informants, 283 pairs, completed five-factor model personality measures and multi-method assessments of stressful events, functioning, mental disorders, 9/11-related treatment costs, BMI, and daily activity across three years. Self-reports were uniquely related to stressful events and functioning. Both self-reports and informant-reports showed incremental validity over one another for mental disorder diagnoses and treatment costs. For objective outcomes daily activity and BMI, informant-reports showed incremental validity over self-reports, accounting for all self-report variance and more. The findings suggest that informant-reports of personality provide better validity for objective health outcomes, which has implications for understanding personality and its role in mental and physical health.
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24
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Kritikos M, Huang C, Clouston SAP, Pellecchia AC, Mejia-Santiago S, Carr MA, Hagan T, Kotov R, Gandy S, Sano M, Horton M, Bromet EJ, Lucchini RG, Luft BJ. DTI Connectometry Analysis Reveals White Matter Changes in Cognitively Impaired World Trade Center Responders at Midlife. J Alzheimers Dis 2022; 89:1075-1089. [PMID: 35964183 PMCID: PMC9730899 DOI: 10.3233/jad-220255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND More than 8% of responders who participated in the search and rescue efforts at the World Trade Center (WTC) following 9/11 developed early-onset cognitive impairment (CI). Approximately 23% were also diagnosed with chronic post-traumatic stress disorder (PTSD). OBJECTIVE To shed light on the pathophysiology of these WTC-related conditions, we examined diffusion connectometry to identify altered white matter tracts in WTC responders with CI and/or PTSD compared to unaffected responders. METHODS 99 WTC responders (mean age 56 years) consisting of CI-/PTSD- (n = 27), CI+/PTSD- (n = 25), CI-/PTSD+ (n = 24), and CI+/PTSD+ (n = 23) were matched on age, sex, occupation, race, and education. Cognitive status was determined using the Montreal Cognitive Assessment and PTSD status was determined using the DSM-IV SCID. Diffusion tensor imaging was acquired on a 3T Siemens Biograph mMR scanner. Connectometry analysis was used to examine whole-brain tract-level differences in white matter integrity as reflected by fractional anisotropy (FA) values after adjusting for confounders. RESULTS Analyses identified that FA was negatively correlated with CI and PTSD status in the fornix, cingulum, forceps minor of the corpus callosum and the right uncinate fasciculus. Furthermore, FA was negatively correlated with PTSD status, regardless of CI status in the superior thalamic radiation and the cerebellum. CONCLUSION This is the first connectometry study to examine altered white matter tracts in a sample of WTC responders with CI and/or PTSD. Results from this study suggest that WTC responders with early-onset CI may be experiencing an early neurodegenerative process characterized by decreased FA in white matter tracts.
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Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY
| | - Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Mejia-Santiago
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Thomas Hagan
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sam Gandy
- James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx NY, 10468
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Cognitive Health and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinair, New York, NY, USA
| | - Benjamin J. Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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25
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Kritikos M, Clouston SAP, Huang C, Pellecchia AC, Mejia-Santiago S, Carr MA, Kotov R, Lucchini RG, Gandy SE, Bromet EJ, Luft BJ. Cortical complexity in world trade center responders with chronic posttraumatic stress disorder. Transl Psychiatry 2021; 11:597. [PMID: 34815383 PMCID: PMC8611009 DOI: 10.1038/s41398-021-01719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
Approximately 23% of World Trade Center (WTC) responders are experiencing chronic posttraumatic stress disorder (PTSD) associated with their exposures at the WTC following the terrorist attacks of 9/11/2001, which has been demonstrated to be a risk factor for cognitive impairment raising concerns regarding their brain health. Cortical complexity, as measured by analyzing Fractal Dimension (FD) from T1 MRI brain images, has been reported to be reduced in a variety of psychiatric and neurological conditions. In this report, we hypothesized that FD would be also reduced in a case-control sample of 99 WTC responders as a result of WTC-related PTSD. The results of our surface-based morphometry cluster analysis found alterations in vertex clusters of complexity in WTC responders with PTSD, with marked reductions in regions within the frontal, parietal, and temporal cortices, in addition to whole-brain absolute bilateral and unilateral complexity. Furthermore, region of interest analysis identified that the magnitude of changes in regional FD severity was associated with increased PTSD symptoms (reexperiencing, avoidance, hyperarousal, negative affect) severity. This study confirms prior findings on FD and psychiatric disorders and extends our understanding of FD associations with posttraumatic symptom severity. The complex and traumatic experiences that led to WTC-related PTSD were associated with reductions in cortical complexity. Future work is needed to determine whether reduced cortical complexity arose prior to, or concurrently with, onset of PTSD.
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Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alison C Pellecchia
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Mejia-Santiago
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Melissa A Carr
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
| | - Samuel E Gandy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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26
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Oltmanns JR, Schwartz HA, Ruggero C, Son Y, Miao J, Waszczuk M, Clouston SAP, Bromet EJ, Luft BJ, Kotov R. Artificial intelligence language predictors of two-year trauma-related outcomes. J Psychiatr Res 2021; 143:239-245. [PMID: 34509091 PMCID: PMC8935804 DOI: 10.1016/j.jpsychires.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/29/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent research on artificial intelligence has demonstrated that natural language can be used to provide valid indicators of psychopathology. The present study examined artificial intelligence-based language predictors (ALPs) of seven trauma-related mental and physical health outcomes in responders to the World Trade Center disaster. METHODS The responders (N = 174, Mage = 55.4 years) provided daily voicemail updates over 14 days. Algorithms developed using machine learning in large social media discovery samples were applied to the voicemail transcriptions to derive ALP scores for several risk factors (depressivity, anxiousness, anger proneness, stress, and personality). Responders also completed self-report assessments of these risk factors at baseline and trauma-related mental and physical health outcomes at two-year follow-up (including symptoms of depression, posttraumatic stress disorder, sleep disturbance, respiratory problems, and GERD). RESULTS Voicemail ALPs were significantly associated with a majority of the trauma-related outcomes at two-year follow-up, over and above corresponding baseline self-reports. ALPs showed significant convergence with corresponding self-report scales, but also considerable uniqueness from each other and from self-report scales. LIMITATIONS The study has a relatively short follow-up period relative to trauma occurrence and a limited sample size. CONCLUSIONS This study shows evidence that ALPs may provide a novel, objective, and clinically useful approach to forecasting, and may in the future help to identify individuals at risk for negative health outcomes.
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27
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Koraishy FM, Coca SG, Cohen BE, Scherrer JF, Mann F, Kuan PF, Luft BJ, Clouston S. The Association of Posttraumatic Stress Disorder With Longitudinal Change in Glomerular Filtration Rate in World Trade Center Responders. Psychosom Med 2021; 83:978-986. [PMID: 34297009 PMCID: PMC8578353 DOI: 10.1097/psy.0000000000000968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High levels of psychological distress increase the risk of a wide range of medical diseases. In this study, we investigated the association between posttraumatic stress disorder (PTSD) and kidney disease. METHODS World Trade Center (WTC) responders were included if they had two or more measures of estimated glomerular filtration rate (eGFR). The PTSD Checklist (PCL) was used to define no PTSD (PCL < 40), "mild" PTSD (40 ≤ PCL <50), and "severe" PTSD (PCL ≥50). Subtypes of PTSD by symptom clusters were analyzed. Multinomial logistic regression was used to estimate the association of PTSD with two GFR change outcomes (decline or increase) compared with the stable GFR outcome. RESULTS In 2266 participants, the mean age was 53.1 years, 8.2% were female, and 89.1% were White. Individuals with PTSD (n = 373; 16.5%) did not differ in mean baseline GFR from individuals without PTSD (89.73 versus 90.56 mL min-1 1.73 m-2; p = .29). During a 2.01-year mean follow-up, a mean GFR decline of -1.51 mL min-1 1.73 m-2 per year was noted. In multivariable-adjusted models, PTSD was associated with GFR decline (adjusted relative risk [aRR] = 1.74 [1.32-2.30], p < .001) compared with stable GFR, with "hyperarousal" symptoms showing the strongest association (aRR =2.11 [1.40-3.19]; p < .001). Dose-response effects were evident when comparing mild with severe PTSD and comparing PTSD with versus without depression. PTSD was also associated with GFR rise (aRR = 1.47 [1.10-1.97], p < .009). The association between PTSD and GFR change was stronger in participants older than 50 years. CONCLUSIONS PTSD may be a novel risk factor for exaggerated longitudinal GFR change in young, healthy adults. These findings need to be validated in other cohorts.
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Affiliation(s)
- Farrukh M. Koraishy
- Department of Medicine, Division of Nephrology, Stony Brook University
- Stony Brook WTC Wellness Program
| | - Steven G. Coca
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai
| | - Beth E. Cohen
- Department of Medicine, University of California, San Francisco
| | | | - Frank Mann
- Department of Family, Population, and Preventative Medicine, Program in Public Health, Stony Brook University
| | - Pei-Fen Kuan
- Stony Brook WTC Wellness Program
- Department of Applied Mathematics and Statistics, Stony Brook University
| | - Benjamin J. Luft
- Stony Brook WTC Wellness Program
- Department of Medicine, Division of Infectious Diseases, Stony Brook University
| | - Sean Clouston
- Stony Brook WTC Wellness Program
- Department of Family, Population, and Preventative Medicine, Program in Public Health, Stony Brook University
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28
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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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29
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Deri Y, Clouston SAP, DeLorenzo C, Gardus JD, Bartlett EA, Santiago-Michels S, Bangiyev L, Kreisl WC, Kotov R, Huang C, Slifstein M, Parsey RV, Luft BJ. Neuroinflammation in World Trade Center responders at midlife: A pilot study using [ 18F]-FEPPA PET imaging. Brain Behav Immun Health 2021; 16:100287. [PMID: 34589784 PMCID: PMC8474562 DOI: 10.1016/j.bbih.2021.100287] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background Neuroinflammation has long been theorized to arise from exposures to fine particulate matter and to be modulated when individuals experience chronic stress, both of which are also though to cause cognitive decline in part as a result of neuroinflammation. Objectives Hypothesizing that neuroinflammation might be linked to experiences at the World Trade Center (WTC) events, this study explored associations between glial activation and neuropsychological measures including post-traumatic stress disorder (PTSD) symptom severity and WTC exposure duration. Methods Translocator protein 18-kDa (TSPO) is overexpressed by activated glial cells, predominantly microglia and astrocytes, making TSPO distribution a putative biomarker for neuroinflammation. Twenty WTC responders completed neuropsychological assessments and in vivo PET brain scan with [18F]-FEPPA. Generalized linear modeling was used to test associations between PTSD, and WTC exposure duratiioni as the predictor and both global and regional [18F]-FEPPA total distribution volumes as the outcomes. Result Responders were 56.0 ± 4.7 years-old, and 75% were police officers on 9/11/2001, and all had at least a high school education. Higher PTSD symptom severity was associated with global and regional elevations in [18F]-FEPPA binding predominantly in the hippocampus (d = 0.72, P = 0.001) and frontal cortex (d = 0.64, P = 0.004). Longer exposure duration to WTC sites was associated with higher [18F]-FEPPA binding in the parietal cortex. Conclusion Findings from this study of WTC responders at midlife suggest that glial activation is associated with PTSD symptoms, and WTC exposure duration. Future investigation is needed to understand the important role of neuroinflammation in highly exposed WTC responders. We examined the theory that glial activation is associated with 9/11 exposures. TSPO-Vt was examined using PET in 20 responders adjusting for TSPO genotype. Responders with PTSD had increased TSPO distribution volume in the hippocampus. Heavily exposed responders had increased TSPO distribution in the parietal cortex.
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Affiliation(s)
- Yael Deri
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Christine DeLorenzo
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - John D Gardus
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Elizabeth A Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lev Bangiyev
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - William C Kreisl
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Chuan Huang
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Mark Slifstein
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ramin V Parsey
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Daniels RD, Kubale TL, Reissman DB, Howard J. The World Trade Center Health Program: Twenty years of health effects research. Am J Ind Med 2021; 64:797-802. [PMID: 34558722 PMCID: PMC9631716 DOI: 10.1002/ajim.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
It has been 20 years since the devastating terrorist attacks on September 11, 2001. Thousands were injured or killed during the attacks and many more are at risk of adverse health stemming from physical, psychological, and emotional stressors born out of the attacks. Private, federal, state, and local resources were gathered soon after the attacks to address impacts to the community, including the health and well-being of both responders and survivors. Many of these efforts are now largely consolidated under the federally mandated World Trade Center (WTC) Health Program. This program provides medical monitoring and treatment of qualifying conditions among the 9/11-exposed population and supports related physical and mental health research. In this commentary, we describe the WTC Health Program, with emphasis on the health-effects research it has funded since inception in 2011. We describe sentinel research publications, and how science has impacted the program. We provide examples relating studies in this special issue to important roles in the WTC Health Program research agenda. Finally, we provide a perspective on future research needs.
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Affiliation(s)
- Robert D. Daniels
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Travis L. Kubale
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - Dori B. Reissman
- World Trade Center Health Program (WTCHP), Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
| | - John Howard
- Office of the Director National Institute for Occupational Safety and Health (NIOSH) Washington District Columbia USA
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Amanda AR, Hidajah AC, Wahyuni CU. The Effect of Post-Traumatic Stress Disorder on Women After The Earthquake in Central Sulawesi. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i32021.303-309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a psychological disorder caused by uncommon occurrences such as threats or catastrophic events. Women are particularly susceptible to developing PTSD, as they have a range of threat perceptions. Purpose: The aim of this study was to examine the effect of PTSD on women survivor of the earthquake in the Sigi Biromaru sub-district of Central Sulawesi. Methods: This was a descriptive study conducted using a cross-sectional design. The population for this study were housewives who have been displaced by the earthquake and are currently residing in temporary shelters (Huntara) in a village located in the Sigi Biromaru sub-district. The instrument used in this study was the PTSD measurement questionnaire sheet. It was conducted from March to April 2020 and included a total of 115 participants. Univariate analysis was used to determine the respondents’ characteristics, including their age, education, occupation, income, and a description of the PTSD condition. Results: The results show that the majority of respondents experienced severe PTSD (70.43%). Most of the respondents (35.65%) were between the ages of 37 and 46, were senior high school graduates (40%), were unemployed (74%), and had earnings of < 2,500,000 (85.22%). Three variables that affect PTSD are education with a p-value of 0.03 < 0.05, job/occupation with a p-value of 0.02 < 0.05, and income with a p-value of 0.03 < 0.05. Conclusion: Women who are elderly, have a low level of education, are unemployed, and have low income are more vulnerable to experiencing PTSD.
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Chen APF, Clouston SAP, Kritikos M, Richmond L, Meliker J, Mann F, Santiago-Michels S, Pellecchia AC, Carr MA, Kuan PF, Bromet EJ, Luft BJ. A deep learning approach for monitoring parietal-dominant Alzheimer's disease in World Trade Center responders at midlife. Brain Commun 2021; 3:fcab145. [PMID: 34396105 PMCID: PMC8361422 DOI: 10.1093/braincomms/fcab145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Little is known about the characteristics and causes of early-onset cognitive impairment. Responders to the 2001 New York World Trade Center disaster represent an ageing population that was recently shown to have an excess prevalence of cognitive impairment. Neuroimaging and molecular data demonstrate that a subgroup of affected responders may have a unique form of parietal-dominant Alzheimer's Disease. Recent neuropsychological testing and artificial intelligence approaches have emerged as methods that can be used to identify and monitor subtypes of cognitive impairment. We utilized data from World Trade Center responders participating in a health monitoring program and applied a deep learning approach to evaluate neuropsychological and neuroimaging data to generate a cortical atrophy risk score. We examined risk factors associated with the prevalence and incidence of high risk for brain atrophy in responders who are now at midlife. Training was conducted in a randomly selected two-thirds sample (N = 99) enrolled using of the results of a structural neuroimaging study. Testing accuracy was estimated for each training cycle in the remaining third subsample. After training was completed, the scoring methodology that was generated was applied to longitudinal data from 1441 World Trade Center responders. The artificial neural network provided accurate classifications of these responders in both the testing (Area Under the Receiver Operating Curve, 0.91) and validation samples (Area Under the Receiver Operating Curve, 0.87). At baseline and follow-up, responders identified as having a high risk of atrophy (n = 378) showed poorer cognitive functioning, most notably in domains that included memory, throughput, and variability as compared to their counterparts at low risk for atrophy (n = 1063). Factors associated with atrophy risk included older age [adjusted hazard ratio, 1.045 (95% confidence interval = 1.027-1.065)], increased duration of exposure at the WTC site [adjusted hazard ratio, 2.815 (1.781-4.449)], and a higher prevalence of post-traumatic stress disorder [aHR, 2.072 (1.408-3.050)]. High atrophy risk was associated with an increased risk of all-cause mortality [adjusted risk ratio, 3.19 (1.13-9.00)]. In sum, the high atrophy risk group displayed higher levels of previously identified risk factors and characteristics of cognitive impairment, including advanced age, symptoms of post-traumatic stress disorder, and prolonged duration of exposure to particulate matter. Thus, this study suggests that a high risk of brain atrophy may be accurately monitored using cognitive data.
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Affiliation(s)
- Allen P F Chen
- Medical Scientist Training Program, Department of Neurobiology and Behavior, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Sean A P Clouston
- Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
- Program in Public Health, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
| | - Minos Kritikos
- Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
- Program in Public Health, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
| | - Lauren Richmond
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Jaymie Meliker
- Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
- Program in Public Health, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
| | - Frank Mann
- Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
- Program in Public Health, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11794, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11725, USA
| | - Alison C Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11725, USA
| | - Melissa A Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11725, USA
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY 11794, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Benjamin J Luft
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY 11725, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
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33
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Diminich ED, Clouston SAP, Kranidis A, Kritikos M, Kotov R, Kuan P, Carr M, Bromet EJ, Luft BJ. Chronic Posttraumatic Stress Disorder and Comorbid Cognitive and Physical Impairments in World Trade Center Responders. J Trauma Stress 2021; 34:616-627. [PMID: 33219599 PMCID: PMC8137717 DOI: 10.1002/jts.22631] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/26/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to increased prevalence and incidence of cognitive and physical impairment. When comorbid, these conditions may be associated with poor long-term outcomes. We examined associations between chronic PTSD and symptom domains with cognitive and physical functioning in World Trade Center (WTC) responders nearly 20 years after the September 11, 2001, terrorist attacks. Participants included a cross-sectional sample of 4,815 responders who attended a monitoring program in 2015-2018. Montreal Cognitive Assessment scores less than 23 indicated cognitive impairment (CogI); Short Physical Performance Battery scores 9 or lower on a hand-grip test indicated physical impairment (PhysI). Comorbid cognitive/physical impairment (Cog/PhysI) was defined as having cognitive impairment with at least one objective PhysI indicator. Clinical chart review provided PTSD diagnoses; symptom domains were assessed using the PTSD Checklist. Participants were on average 53.05 years (SD = 8.01); 13.44% had PTSD, 7.8% had CogI, 24.8% had PhysI, and 5.92% had comorbid Cog/PhysI. Multivariable-adjusted multinomial logistic regression demonstrated that Responders with PTSD have more than three times the risk of Cog/PhysI (adjusted RR = 3.29, 95% CI 2.44- 4.44). Domain-specific analyses revealed that emotional numbing symptoms predicted an increased risk of PhysI (adjusted RR = 1.57, 95% CI 1.08-2.28), whereas reexperiencing symptoms were associated with comorbid Cog/PhysI (adjusted RR = 3.96, 95% CI, 2.33-6.74). These results suggest that responders with chronic PTSD may have increased risk of deficits beyond age-expected impairment characterized by the emergence of comorbid Cog/PhysI at midlife.
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Affiliation(s)
- Erica D. Diminich
- Program in Public HealthRenaissance School of Medicine at Stony Brook University Stony BrookNew YorkUSA
| | - Sean A. P. Clouston
- Program in Public HealthRenaissance School of Medicine at Stony Brook University Stony BrookNew YorkUSA
| | | | - Minos Kritikos
- Program in Public HealthRenaissance School of Medicine at Stony Brook University Stony BrookNew YorkUSA
| | - Roman Kotov
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Peifen Kuan
- Department of Applied Mathematics and StatisticsStony Brook UniversityStony BrookNew YorkUSA
| | - Melissa Carr
- World Trade Center Responder Health and Wellness ProgramDepartment of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNYUSA
| | - Evelyn J. Bromet
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Benjamin J. Luft
- World Trade Center Responder Health and Wellness ProgramDepartment of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNYUSA
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34
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Ruggero CJ, Schuler K, Waszczuk MA, Callahan JL, Contractor AA, Bennett CB, Luft BJ, Kotov R. Posttraumatic stress disorder in daily life among World Trade Center responders: Temporal symptom cascades. J Psychiatr Res 2021; 138:240-245. [PMID: 33866052 DOI: 10.1016/j.jpsychires.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms are common in the immediate aftermath of a trauma, but it is their persistence over time that leads to a diagnosis. This pattern highlights the critical role of symptom maintenance to understanding and treating the disorder. Relatively few studies have explored whether PTSD symptoms may be interacting or triggering one another to worsen and maintain the disorder, a dynamic we refer to as "symptom cascades." Additionally, little work has tested in real-time how other maintenance factors, such as stress, contribute to such events in daily life. METHODS The present study in a group (N = 202) of World Trade Center (WTC) responders oversampled for PTSD tested day-to-day temporal associations among PTSD symptom dimensions (i.e., intrusions, avoidance, numbing, and hyperarousal) and stress across one week. RESULTS Longitudinal models found hyperarousal on a given day predicted increased PTSD symptoms the next day, with the effect sizes almost double compared to other symptom dimensions or daily stress. Intrusions, in contrast, showed little prospective predictive effects, but instead were most susceptible to the effects from other symptoms the day before. Avoidance and numbing showed weaker bidirectional effects. LIMITATIONS Findings are from a unique population and based on naturalistic observation. CONCLUSIONS Results are consistent with the idea of symptom cascades, they underscore hyperarousal's strong role in forecasting short-term increases in PTSD (even more than stress per se) and they raise the prospect of highly specific ecological momentary interventions to potentially disrupt PTSD maintenance in daily life.
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Affiliation(s)
| | - Keke Schuler
- National Center for Disaster Medicine and Public Health, The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, USA
| | - Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
| | | | | | | | | | - Roman Kotov
- Department of Psychiatry, Stony Brook University, USA
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Kuan PF, Ren X, Clouston S, Yang X, Jonas K, Kotov R, Bromet E, Luft BJ. PTSD is associated with accelerated transcriptional aging in World Trade Center responders. Transl Psychiatry 2021; 11:311. [PMID: 34031357 PMCID: PMC8144188 DOI: 10.1038/s41398-021-01437-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/09/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with shortened lifespan and healthspan, which suggests accelerated aging. Emerging evidence suggests that methylation age may be accelerated in PTSD. It is important to examine whether transcriptional age is also accelerated because transcriptome is highly dynamic, associated with age-related outcomes, and may offer greater insight into the premature aging in PTSD. This study is the first reported investigation of the relationship between transcriptional age and PTSD. Using RNA-Seq data from our previous study on 324 World Trade Center responders (201 never had PTSD, 81 with current PTSD, and 42 with past PTSD), as well as a transcriptional age calculator (RNAAgeCalc) recently developed by our group, we found that responders with current PTSD, compared with responders without a PTSD diagnosis, showed accelerated transcriptional aging (p = 0.0077) after adjustment for chronological age and race. We compared our results to the epigenetic aging results computed from several epigenetic clock calculators on matching DNA methylation data. GrimAge methylation age acceleration was also associated with PTSD diagnosis (p = 0.0097), and the results remained significant after adjustment for the proportions of immune cell types. PhenoAge, Hannum, and Horvath methylation age acceleration were not reliably related to PTSD. Both epigenetic and transcriptional aging may provide biological insights into the mechanisms underpinning aging in PTSD.
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Affiliation(s)
- Pei-Fen Kuan
- grid.36425.360000 0001 2216 9681Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY USA
| | - Xu Ren
- grid.36425.360000 0001 2216 9681Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY USA
| | - Sean Clouston
- Department of Family and Preventive Medicine, Stony Book University, Stony Brook, NY USA
| | - Xiaohua Yang
- grid.36425.360000 0001 2216 9681Department of Medicine, Stony Brook University, Stony Brook, NY USA
| | - Katherine Jonas
- Department of Psychiatry, Stony Book University, Stony Brook, NY USA
| | - Roman Kotov
- Department of Psychiatry, Stony Book University, Stony Brook, NY USA
| | - Evelyn Bromet
- Department of Psychiatry, Stony Book University, Stony Brook, NY USA
| | - Benjamin J. Luft
- grid.36425.360000 0001 2216 9681Department of Medicine, Stony Brook University, Stony Brook, NY USA
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36
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Guilaran J, De Terte I, Kaniasty K, Stephens C. Received Social Support and Post-Traumatic Stress Symptoms in New Zealand and Philippine Emergency Responders. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Emergency responders are at risk of post-traumatic stress symptoms (PTSS). This study investigates the relationship between the different components of received social support (RSS) and PTSS in these occupations. Method: This cross-sectional study involved emergency responders from New Zealand and the Philippines (n=223). Participants answered an online questionnaire measuring social support and PTSS. Results: High amount of total received support was significantly associated with lower levels of PTSS. Analyses of RSS components revealed that co-worker, emotional, and tangible support exhibited salutary main effects on PTSS. Furthermore, high amounts of RSS from supervisors were found to be associated with low levels of PTSS only among participants who reported low trauma exposure. Discussion: Findings were congruent with the main effects model of RSS. Results also underscored the importance of investigating varied manifestations of social support as they may differentially influence the strength of effects of receiving social support by emergency responders.
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Affiliation(s)
| | | | - Krzysztof Kaniasty
- Indiana University of Pennsylvania & Polish Academy of Sciences, Warsaw, Poland
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Takemoto E, Giesinger I, Russell JS, Li J. Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees. Drug Alcohol Depend 2021; 221:108656. [PMID: 33689968 DOI: 10.1016/j.drugalcdep.2021.108656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA
| | - Ingrid Giesinger
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA
| | - Jonathan S Russell
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA.
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Jellestad L, Vital NA, Malamud J, Taeymans J, Mueller-Pfeiffer C. Functional impairment in Posttraumatic Stress Disorder: A systematic review and meta-analysis. J Psychiatr Res 2021; 136:14-22. [PMID: 33548826 DOI: 10.1016/j.jpsychires.2021.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) is a serious and debilitating condition often associated with significant impairments in daily functioning. To date, research on the complexity of functional impairment in individuals with PTSD is scarce and only limited. Yet, a quantitative synthesis and comprehensive review of existing evidence is needed to better characterize the magnitude of functional impairment in PTSD in distinct domains. We conducted a systematic literature search including observational studies comparing functioning of individuals with and without PTSD. Random effects meta-analyses were performed for the different functional domains according to the WHO International Classification of Functioning, Disability and Health (ICF). The protocol followed the MOOSE guidelines for systematic reviews. A total of thirty-four studies comprising 14 206 participants were included in the study. Compared to healthy individuals, subjects with PTSD showed significant (ps < 0.001) impairments with large to very large effect sizes (ds > 1) in all domains. Subjects with, compared to without, PTSD showed significant (ps < 0.001) impairments with medium to large effect sizes (ds > 0.5) in the domains General Tasks and Demands, Mobility, Self Care, Domestic Life, Interpersonal Interactions and Relationships, Major Life Areas and Community, Social and Civic Life. Significant impairments with small to medium effect sizes in the same domains were observed comparing PTSD to other mental disorders. In conclusion, PTSD has a significant impact on most areas of daily functioning as conceptualized in the International Classification of Functioning, Disability and Health (ICF) of the WHO. Early detection and targeted treatment of functional deficits is warranted in this patient population.
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Affiliation(s)
- Lena Jellestad
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Nicolà A Vital
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jolanda Malamud
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Taeymans
- Department of Health, Bern University of Applied Sciences, Berne, Switzerland; Vrije Universiteit Brussel, Faculty of Sports- and Rehabilitation Sciences, Brussels, Belgium
| | - Christoph Mueller-Pfeiffer
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lamb D, Withnall RD. A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel. Stress Health 2021; 37:364-377. [PMID: 33112039 DOI: 10.1002/smi.3001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Abstract
The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.
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Affiliation(s)
- Di Lamb
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rich Dj Withnall
- Royal Centre for Defence Medicine, Research & Clinical Innovation, Birmingham, UK
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40
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Huang C, Kritikos M, Clouston SAP, Deri Y, Serrano-Sosa M, Bangiyev L, Santiago-Michels S, Gandy S, Sano M, Bromet EJ, Luft BJ. White Matter Connectivity in Incident Mild Cognitive Impairment: A Diffusion Spectrum Imaging Study of World Trade Center Responders at Midlife. J Alzheimers Dis 2021; 80:1209-1219. [PMID: 33646156 PMCID: PMC8150516 DOI: 10.3233/jad-201237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Individuals who participated in response efforts at the World Trade Center (WTC) following 9/11/2001 are experiencing elevated incidence of mild cognitive impairment (MCI) at midlife. Objective: We hypothesized that white matter connectivity measured using diffusion spectrum imaging (DSI) would be restructured in WTC responders with MCI versus cognitively unimpaired responders. Methods: Twenty responders (mean age 56; 10 MCI/10 unimpaired) recruited from an epidemiological study were characterized using NIA-AA criteria alongside controls matched on demographics (age/sex/occupation/race/education). Axial DSI was acquired on a 3T Siemen’s Biograph mMR scanner (12-channel head coil) using a multi-band diffusion sequence. Connectometry examined whole-brain tract-level differences in white matter integrity. Fractional anisotropy (FA), mean diffusivity (MD), and quantified anisotropy were extracted for region of interest (ROI) analyses using the Desikan-Killiany atlas. Results: Connectometry identified both increased and decreased connectivity within regions of the brains of responders with MCI identified in the corticothalamic pathway and cortico-striatal pathway that survived adjustment for multiple comparisons. MCI was also associated with higher FA values in five ROIs including in the rostral anterior cingulate; lower MD values in four ROIs including the left rostral anterior cingulate; and higher MD values in the right inferior circular insula. Analyses by cognitive domain revealed nominal associations in domains of response speed, verbal learning, verbal retention, and visuospatial learning. Conclusions: WTC responders with MCI at midlife showed early signs of neurodegeneration characterized by both increased and decreased white matter diffusivity in regions commonly affected by early-onset Alzheimer’s disease.
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Affiliation(s)
- Chuan Huang
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Minos Kritikos
- Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Yael Deri
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, NY, USA
| | - Mario Serrano-Sosa
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Lev Bangiyev
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Santiago-Michels
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, NY, USA
| | - Sam Gandy
- Center for Cognitive Health and NFL Neurological Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Sano
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.,Center for Cognitive Health and NFL Neurological Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,World Trade Center Health and Wellness Program, Stony Brook University, Stony Brook, NY, USA
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Kuan P, Clouston S, Yang X, Che C, Gandy S, Kotov R, Bromet E, Luft BJ. Single-cell transcriptomics analysis of mild cognitive impairment in World Trade Center disaster responders. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12154. [PMID: 33665344 PMCID: PMC7896635 DOI: 10.1002/dad2.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Recent research has found that World Trade Center (WTC) responders in their mid-50s have an elevated prevalence of mild cognitive impairment (MCI) that is associated with neural degeneration and subcortical thinning. This article extends our understanding of the molecular complexity of MCI through gene expression profiling of blood. METHODS The transcriptomics of 40 male WTC responders were profiled across two cohorts (discovery: nine MCI and nine controls; replication: 11 MCI and 11 controls) using CITE-Seq at single-cell resolution in blood. RESULTS Comparing the transcriptomic signatures across seven major cell subpopulations, the largest differences were observed in monocytes in which 226 genes were differentially expressed. Pathway analysis on the genes unique to monocytes identified processes associated with cerebral immune response. DISCUSSION Our findings suggested monocytes may constitute a key cell type to target in blood-based biomarker studies for early detection of risk of MCI and development of new interventions.
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Affiliation(s)
- Pei‐Fen Kuan
- Department of Applied Mathematics and StatisticsStony Brook UniversityStony BrookNew YorkUSA
| | - Sean Clouston
- Department of Family and Preventive MedicineStony Book UniversityStony BrookNew YorkUSA
| | - Xiaohua Yang
- Department of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Chang Che
- Department of Applied Mathematics and StatisticsStony Brook UniversityStony BrookNew YorkUSA
| | - Samuel Gandy
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roman Kotov
- Department of PsychiatryStony Book UniversityStony BrookNew YorkUSA
| | - Evelyn Bromet
- Department of PsychiatryStony Book UniversityStony BrookNew YorkUSA
| | - Benjamin J. Luft
- Department of MedicineStony Brook UniversityStony BrookNew YorkUSA
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Mental Healthcare Needs in World Trade Center Responders: Results from a Large, Population-Based Health Monitoring Cohort. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:427-434. [PMID: 31776767 DOI: 10.1007/s10488-019-00998-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nearly two decades after the 9/11 attacks on the World Trade Center (WTC), the prevalence of mental disorders remains elevated among traditional (e.g., police) and non-traditional (e.g., construction workers) responders who were involved in the WTC rescue, recovery, and clean-up efforts. To date, however, scarce research has examined factors associated with perceived need for mental health care, which is critical to promoting engagement in mental health treatment in this population. Data were analyzed from 16,170 WTC responders, including 8881 police responders and 7289 non-traditional responders, who completed their first annual health monitoring visit with the WTC Health Program an average of 6.5 years after September 11, 2001. Predisposing, enabling, and need-based factors associated with perceived need for mental health care were examined using multivariable logistic regression analyses. Nearly half (48.7%) of non-traditional responders and a fifth (20.6%) of police responders reported a need for mental health care. The most common perceived needs were for psychotropic medication, individual psychotherapy, and stress management counseling. Predisposing (e.g., female gender) and need-based factors (e.g., WTC-related posttraumatic stress disorder) predicted perceived need for mental health care in both groups. Among non-traditional responders, Hispanic ethnicity and current suicidal ideation were additionally associated with this outcome. Non-traditional WTC responders are substantially more likely than police WTC responders to perceive a need for mental health treatment. Characterization of factors associated with perceived need for treatment can help inform population-based outreach and monitoring efforts designed to promote engagement in mental health treatment in WTC responders.
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43
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Zheng Y, Xiao L, Huang Y, Wang Q, Xie Y, Wang H, Wang G. Possible Vicarious Traumatization Among Psychiatric Inpatients During the Remission Phase of the COVID-19: A Single-Center Cross-Sectional Study. Front Psychiatry 2021; 12:677082. [PMID: 34504442 PMCID: PMC8421644 DOI: 10.3389/fpsyt.2021.677082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Far from being a clinical disease, the COVID-19 pandemic has become a threatening social event worldwide exerting long-term impacts on human beings. Objective: This study was designed to determine if and to what extent psychiatric inpatients during the remission phase of the pandemic suffered from vicarious traumatization. Method: Totally 266 eligible participants from psychiatric and psychological wards in a hospital were recruited during October 26th, 2020 to February 4th, 2021 to finish a self-made online questionnaire consisting of Impact of Event Scale-Revised (IES-R), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Obsessive-Compulsive Inventory-Revised (OCI-R), Pittsburgh Sleep Quality Index-Revised (PSQI-R), Social Support Rating Scale (SSRS), Beck Suicide Ideation Scale (SSI), 12-Item Short-Form Health Survey (SF-12). Meanwhile, some socio-demographics and information related to the pandemic were also recorded. Results: The detection rate of vicarious traumatic symptoms (VTS) was 80.83%, including 40.98% for mild ones, 25.56% for moderate ones, and 14.29% for severe ones, among whom 98.14% possessed all three phenotypes. 27.07% of the sample were considered possible vicarious traumatization (pVT). Having acquaintances infected with or died from COVID-19, worries on re-outbreak of COVID-19, a higher score of OCI-R or lower score of SF-12, and long latency of VTS were independent risk factors of pVT. Conclusion: Our study showed that COVID-19 could have profound mental influences on psychiatric inpatients. It is high time we did some screening in the wards to seek for patients at risk.
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Affiliation(s)
- Yage Zheng
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yonglan Huang
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Wang
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yinping Xie
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Mental Health Center, Renmin Hospital of Wuhan University, Wuhan, China
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Clouston SA, Kritikos M, Deri Y, Horton M, Pellecchia AC, Santiago-Michels S, Carr MA, Gandy S, Sano M, Bromet EJ, Lucchini RG, Luft BJ. A cortical thinning signature to identify World Trade Center responders with possible dementia. INTELLIGENCE-BASED MEDICINE 2021; 5. [PMID: 35991958 PMCID: PMC9387912 DOI: 10.1016/j.ibmed.2021.100032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: World Trade Center (WTC) responders have a high risk of early-onset cognitive impairment (CI), but little is known about the etiology including the extent to which CI in WTC responders is accompanied by cortical atrophy as is common in progressive diseases causing age-related CI such as Alzheimer’s disease and related dementias. In the current study, we entrained an artificial neural network (ANN) to determine the accuracy of cortical thickness (CTX) on magnetic resonance imaging to identify World Trade Center responders at midlife (aged 44–65 years) with possible dementia. Methods: A total of 119 WTC responders (57 with CI and 62 with intact cognition) underwent a structural MRI scanning protocol including T1-weighted MPRAGE as part of two imaging studies. The discovery study was divided into training and validation samples, while a second replication sample was used. An ANN was trained using regional CTX measured across 34 unilateral regions of interest (ROIs) using Freesurfer software and ‘Desikan-Killiany’ brain atlas. The discovery sample was used for model development, and the replication sample was used to evaluate predictive accuracy. Results: In the WTC responder cohort, the ANN algorithm showed high discrimination performance for CI. The ANN model using regional CTX data from both hemispheres achieved an area under the receiver operating characteristic curve (AUC) of 0.96 95% C.I. = [0.91–1.00] (Accuracy = 96.0%, Precision = 97.8%, Recall = 95.8%, Sensitivity = 95.8%, Specificity = 98.0%, F1 = 96.8%) for the discovery sample and AUC = 0.90 [0.70–1.00] (Accuracy = 90.0%, Precision = 90.0%, Sensitivity = 90.0%, Specificity = 90.0%, F1 = 90.0%) in the replication sample. Conclusion: Analysis of bilateral regional CTX data derived from T1-weighted MPRAGE images by ANN analysis demonstrated excellent accuracy in distinguishing WTC responders with early-onset CI.
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Affiliation(s)
- Sean A.P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
- Corresponding author. Program in Public Health, 101 Nichols Rd., Health Sciences Center, #3-071, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA. (S.A.P. Clouston)
| | - Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Yael Deri
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Stephanie Santiago-Michels
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Sam Gandy
- Center for Cognitive Health and NFL Neurological Care, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Benjamin J. Luft
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794, USA
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45
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Mental and Physical Factors Influencing Wellbeing among South Korean Emergency Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010070. [PMID: 33374138 PMCID: PMC7795396 DOI: 10.3390/ijerph18010070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/28/2022]
Abstract
Emergency workers are frequently exposed to hazardous situations and such life patterns can influence their wellbeing. This study examined the relationships among South Korean emergency workers’ precedents and consequences of positive emotion, engagement, relationship, meaning, and achievement (PERMA), a wellbeing concept, and offered solutions. A total of 597 emergency workers in Daegu, South Korea, participated in a survey. This study measured post-traumatic stress disorder syndrome, burnout, depression, PERMA, quality of life, life satisfaction, and sleep quality to test the relationships. Results demonstrated that post-traumatic stress disorder syndrome and burnout predicted distracting sleep behavior and sleep health. Depression was significantly related to PERMA. The better the emergency workers’ PERMA was, the better their quality of life and life satisfaction were. PERMA significantly predicted sleep behavior, a portion of sleep quality. Depression had an indirect influence on quality of life mediated by PERMA. Post-traumatic stress disorder syndrome, burnout, and PERMA were significant predictors of low sleep health and sleep behavior. The results indicate that South Korean emergency workers struggle with depression and sleep quality. As the data were collected during the coronavirus disease 19 pandemic, individual efforts and relevant programs to improve South Korean emergency workers’ PERMA and sleep quality in a crisis are recommended. Possible solutions to improve the wellbeing of South Korean emergency workers are suggested.
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46
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Werner EA, Aloisio CE, Butler AD, D'Antonio KM, Kenny JM, Mitchell A, Ona S, Monk C. Addressing mental health in patients and providers during the COVID-19 pandemic. Semin Perinatol 2020; 44:151279. [PMID: 32972778 PMCID: PMC7373005 DOI: 10.1016/j.semperi.2020.151279] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The pandemic, and the associated changes to pregnancy and postpartum experiences, can lead to profound psychological reactions including panic, hyperarousal, sleep disturbance, anxiety, depression, and traumatic stress disorders. Providers face compassion fatigue and shared trauma. In this article, we describe the mental health outcomes known to date in regard to the novel coronavirus disease 2019 pandemic for obstetric patients and their providers as well as therapeutic approaches, including our novel embedded mental health service, to address these mental health needs.
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Affiliation(s)
- Elizabeth A. Werner
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cara E. Aloisio
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ashlie D. Butler
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kristina M. D'Antonio
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jennifer M. Kenny
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Samsiya Ona
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, From Columbia University Irving Medical Center, New York, NY 10032.
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47
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Waszczuk MA, Docherty AR, Shabalin AA, Miao J, Yang X, Kuan PF, Bromet E, Kotov R, Luft BJ. Polygenic prediction of PTSD trajectories in 9/11 responders. Psychol Med 2020; 52:1-9. [PMID: 33092657 PMCID: PMC8186149 DOI: 10.1017/s0033291720003839] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Genetics hold promise of predicting long-term post-traumatic stress disorder (PTSD) outcomes following trauma. The aim of the current study was to test whether six hypothesized polygenic risk scores (PRSs) developed to capture genetic vulnerability to psychiatric conditions prospectively predict PTSD onset, severity, and 18-year course after trauma exposure. METHODS Participants were 1490 responders to the World Trade Center (WTC) disaster (mean age at 9/11 = 38.81 years, s.d. = 8.20; 93.5% male; 23.8% lifetime WTC-related PTSD diagnosis). Prospective longitudinal data on WTC-related PTSD symptoms were obtained from electronic medical records and modelled as PTSD trajectories using growth mixture model analysis. Independent regression models tested whether six hypothesized psychiatric PRSs (PTSD-PRS, Re-experiencing-PRS, Generalized Anxiety-PRS, Schizophrenia-PRS, Depression-PRS, and Neuroticism-PRS) are predictive of WTC-PTSD outcomes: lifetime diagnoses, average symptom severity, and 18-year symptom trajectory. All analyses were adjusted for population stratification, 9/11 exposure severity, and multiple testing. RESULTS Depression-PRS predicted PTSD diagnostic status (OR 1.37, CI 1.17-1.61, adjusted p = 0.001). All PRSs, except PTSD-PRS, significantly predicted average PTSD symptoms (β = 0.06-0.10, adjusted p < 0.05). Re-experiencing-PRS, Generalized Anxiety-PRS and Schizophrenia-PRS predicted the high severity PTSD trajectory class (ORs 1.21-1.28, adjusted p < 0.05). Finally, PRSs prediction was independent of 9/11 exposure severity and jointly accounted for 3.7 times more variance in PTSD symptoms than the exposure severity. CONCLUSIONS Psychiatric PRSs prospectively predicted WTC-related PTSD lifetime diagnosis, average symptom severity, and 18-year trajectory in responders to 9/11 disaster. Jointly, PRSs were more predictive of subsequent PTSD than the exposure severity. In the future, PRSs may help identify at-risk responders who might benefit from targeted prevention approaches.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrey A Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jiaju Miao
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Xiaohua Yang
- World Trade Center Health and Wellness Program, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Evelyn Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
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Charney AW, Katz C, Southwick SM, Charney DS. A Call to Protect the Health Care Workers Fighting COVID-19 in the United States. Am J Psychiatry 2020; 177:900-901. [PMID: 32731814 DOI: 10.1176/appi.ajp.2020.20040535] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander W Charney
- Department of Psychiatry (A.W. Charney, Katz, Southwick, D.S. Charney), Department of Genetics and Genomic Sciences, Department of Neurosurgery, Mount Sinai COVID Informatics Center (A.W. Charney), Department of Neuroscience (A.W. Charney, D.S. Charney), and Department of Medical Education and Department of Health System Design and Global Health (Katz), Icahn School of Medicine at Mount Sinai, New York; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (A.W. Charney); and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Southwick)
| | - Craig Katz
- Department of Psychiatry (A.W. Charney, Katz, Southwick, D.S. Charney), Department of Genetics and Genomic Sciences, Department of Neurosurgery, Mount Sinai COVID Informatics Center (A.W. Charney), Department of Neuroscience (A.W. Charney, D.S. Charney), and Department of Medical Education and Department of Health System Design and Global Health (Katz), Icahn School of Medicine at Mount Sinai, New York; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (A.W. Charney); and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Southwick)
| | - Steven M Southwick
- Department of Psychiatry (A.W. Charney, Katz, Southwick, D.S. Charney), Department of Genetics and Genomic Sciences, Department of Neurosurgery, Mount Sinai COVID Informatics Center (A.W. Charney), Department of Neuroscience (A.W. Charney, D.S. Charney), and Department of Medical Education and Department of Health System Design and Global Health (Katz), Icahn School of Medicine at Mount Sinai, New York; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (A.W. Charney); and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Southwick)
| | - Dennis S Charney
- Department of Psychiatry (A.W. Charney, Katz, Southwick, D.S. Charney), Department of Genetics and Genomic Sciences, Department of Neurosurgery, Mount Sinai COVID Informatics Center (A.W. Charney), Department of Neuroscience (A.W. Charney, D.S. Charney), and Department of Medical Education and Department of Health System Design and Global Health (Katz), Icahn School of Medicine at Mount Sinai, New York; Mental Illness Research, Education, and Clinical Center (VISN 2 South), James J. Peters Veterans Affairs Medical Center, Bronx, N.Y. (A.W. Charney); and Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Southwick)
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Kuan PF, Clouston S, Yang X, Kotov R, Bromet E, Luft BJ. Molecular linkage between post-traumatic stress disorder and cognitive impairment: a targeted proteomics study of World Trade Center responders. Transl Psychiatry 2020; 10:269. [PMID: 32753605 PMCID: PMC7403297 DOI: 10.1038/s41398-020-00958-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Existing work on proteomics has found common biomarkers that are altered in individuals with post-traumatic stress disorder (PTSD) and mild cognitive impairment (MCI). The current study expands our understanding of these biomarkers by profiling 276 plasma proteins with known involvement in neurobiological processes using the Olink Proseek Multiplex Platform in individuals with both PTSD and MCI compared to either disorder alone and with unaffected controls. Participants were World Trade Center (WTC) responders recruited through the Stony Brook WTC Health Program. PTSD and MCI were measured with the PTSD Checklist (PCL) and the Montreal Cognitive Assessment, respectively. Compared with unaffected controls, we identified 16 proteins associated with comorbid PTSD-MCI at P < 0.05 (six at FDR < 0.1), 20 proteins associated with PTSD only (two at FDR < 0.1), and 24 proteins associated with MCI only (one at FDR < 0.1), for a total of 50 proteins. The multiprotein composite score achieved AUCs of 0.84, 0.77, and 0.83 for PTSD-MCI, PTSD only, and MCI only versus unaffected controls, respectively. To our knowledge, the current study is the largest to profile a large set of proteins involved in neurobiological processes. The significant associations across the three case-group analyses suggest that shared biological mechanisms may be involved in the two disorders. If findings from the multiprotein composite score are replicated in independent samples, it has the potential to add a new tool to help classify both PTSD and MCI.
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Affiliation(s)
- Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Sean Clouston
- Department of Family and Preventive Medicine, Stony Book University, Stony Brook, NY, USA
| | - Xiaohua Yang
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Book University, Stony Brook, NY, USA
| | - Evelyn Bromet
- Department of Psychiatry, Stony Book University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
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Clouston SAP, Deri Y, Horton M, Tang C, Diminich E, DeLorenzo C, Kritikos M, Pellecchia AC, Santiago‐Michels S, Carr MA, Gandy S, Sano M, Bromet EJ, Lucchini RG, Luft BJ. Reduced cortical thickness in World Trade Center responders with cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12059. [PMID: 32695871 PMCID: PMC7364857 DOI: 10.1002/dad2.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study examined cortical thickness (CTX) in World Trade Center (WTC) responders with cognitive impairment (CI). METHODS WTC responders (N = 99) with/without CI, recruited from an epidemiologic study, completed a T1-MPRAGE protocol. CTX was automatically computed in 34 regions of interest. Region-based and surface-based morphometry examined CTX in CI versus unimpaired responders. CTX was automatically computed in 34 regions of interest. Region-based measures were also compared to published norms. RESULTS Participants were 55.8 (SD = 0.52) years old; 48 had CI. Compared to unimpaired responders, global mean CTX was reduced in CI and across 21/34 cortical subregions. Surface-based analyses revealed reduced CTX across frontal, temporal, and parietal lobes when adjusting for multiple comparisons. Both CI and unimpaired WTC groups had reduced CTX in the entorhinal and temporal cortices compared to published normative data. DISCUSSION Results from the first structural magnetic resonance imaging study in WTC responders identified reduced CTX consistent with a neurodegenerative disease of unknown etiology.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Yael Deri
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Megan Horton
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Cheuk Tang
- Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erica Diminich
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Christine DeLorenzo
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Minos Kritikos
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Stephanie Santiago‐Michels
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Samuel Gandy
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Evelyn J. Bromet
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Benjamin J. Luft
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
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