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

Long-Term Lower Respiratory Symptoms among World Trade Center Health Registry Enrollees Following Hurricane Sandy

Several studies showed an association between lower respiratory tract symptoms (LRS) and exposure to the 9/11 terrorist attack. However, few studies have examined the long-term impact of natural disasters on those with prior respiratory distress. The present study aims to assess the impact of Hurricane Sandy on persistent LRS among people exposed to the World Trade Center (WTC) terrorist attack. The analytic sample consisted of WTC Health Registry enrollees who completed survey waves 1, 3, and 4 and the Hurricane Sandy Survey and did not report LRS before the WTC terrorist attack. The log binomial was used to assess the association between the impact of Hurricane Sandy and persistent LRS. Of 3277 enrollees, 1111 (33.9%) reported persistent LRS post-Sandy. Participants of older age, males, lower household income, current smokers, and those with previous asthma were more likely to report persistent LRS. In separate adjusted models, multiple Sandy-related inhalation exposures (relative risk (RR): 1.2, 95% CI: 1.06-1.37), Sandy-related PTSD (RR: 1.27, 95% CI: 1.15-1.4), and Sandy LRS (RR: 1.64, 95% CI: 1.48-1.81) were associated with persistent LRS post-Sandy. Our findings suggest that respiratory protection is important for everyone performing reconstruction and clean-up work after a natural disaster, particularly among those with previous respiratory exposures.

Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11

A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.

A Cross-Sectional Time Course of COVID-19 Related Worry, Perceived Stress, and General Anxiety in the Context of Post-Traumatic Stress Disorder-like Symptomatology

The COVID-19 pandemic within the United States of America resulted in over 800,000 deaths as of February 2022 and has been addressed by social distancing or stay-at-home measures. Collective prolonged multimodal trauma on this scale is likely to elicit symptomatology in the general population consistent with post-traumatic stress disorder (PTSD), somatization, anxiety, and stress. The psychological component of this response contributes substantially to the burden of this disease worldwide. This cross-sectional study examines the relationship between COVID-19-related concern, anxiety, and perceived stress on PTSD-like symptomatology over the course of the COVID-19 pandemic. Participants were recruited via social media within the United States of America between 8th May 2020 and 11th August 2021 to complete an internet questionnaire including mood, personality, and COVID-19-specific scales. General anxiety and PTSD-like symptomatology were above the screening cutoffs for most respondents. These measures increased in severity over the pandemic, with the change point of our Concern scale preceding that of the other significant measures. Measures of COVID-19-related concern, generalized anxiety, and PTSD-like symptomatology were strongly correlated with each other. Anxiety, perceived stress, and PTSD-like symptomatology are strongly interrelated, increase with pandemic length, and are linked to reported levels of concern over COVID-19. These observations may aid future research and policy as the pandemic continues.

Change in 9/11-related post-traumatic stress symptoms following cancer diagnosis

OBJECTIVE

Cancer can be a life-threatening stressor that may evoke pre-existing post-traumatic stress disorder (PTSD). We assessed change in 9/11-related PTSD symptoms following cancer diagnosis in a 9/11-exposed cohort, the World Trade Center Health Registry.

METHODS

We examined enrollees who had a first-time post-9/11 invasive cancer diagnosis and at least one pre- and two post-diagnosis 9/11-related PTSD assessments from enrolment through 2015. PTSD symptoms were measured using 17-item PTSD Checklist (PCL, range 17-85). Cancer was identified from New York State Cancer Registry and categorized as localized or advanced stage. We used piecewise spline linear mixed-effects models to examine rate of change in PCL scores from pre- to post-diagnosis periods, and whether the change differed by gender or stage, with time as fixed and random effects, adjusting for baseline age, race, and education.

RESULTS

9/11-related PTSD symptoms were slightly increasing in the pre-diagnosis period, while this trend reversed in the post-diagnosis period (β: -0.38; 95% CI: -0.60, -0.15). This trend was driven by male rescue/recovery workers (RRW), among whom significant decrease in rate of change in PCL scores was observed for those with advanced stage (slope change difference [95% CI]: -1.81 [-2.73, -0.90]). No significant difference in rate of change was observed among non-RRW. Among females, PCL scores tended to decrease slightly, with no significant difference in rate of change between pre- and post-diagnosis periods.

CONCLUSIONS

We observed significant reduction in the rate of change in 9/11-related PTSD symptoms among male RRW. The underlying mechanism is unknown, necessitating future research.

Psychological outcomes for young adults after disastrous events: A mixed-methods scoping review

RATIONALE

Young adulthood (18 to 34) is a time of transitional change where individuals can be highly susceptible to mental health concerns. Despite similar vulnerabilities to their adolescent counterparts, the psychological outcomes for young adults following disasters are not well understood.

OBJECTIVE

This scoping review aimed to explore the literature on the psychological outcomes for young adults after disaster events.

METHODS

A systematic search of the literature was conducted in seven electronic databases, including PsycINFO, Medline, CINAHL, PILOTS, EMBASE, Scopus, and ProQuest dissertations and theses global. In total, 91 reports from 15 countries were included.

RESULTS

Findings suggested that young adults experience a range of psychological consequences after disasters, including posttraumatic stress symptoms, depression, anxiety, and other psychological outcomes, such as general/non-specific psychological distress. Pre-disaster, peri-disaster, and post-disaster factors were also found to influence the degree of psychological outcomes experienced by young adults, including prior psychological functioning and disaster exposure, among a host of other factors.

CONCLUSION

Future research is recommended to better understand young adults' psychological outcomes, experiences, and service needs following disasters.

A Mixed-Methods Study After Multiple Disasters: September 11, 2001, World Trade Center Terrorist Attacks and Hurricane Sandy

OBJECTIVE

The aim of this study was to use a mixed-method analysis to investigate the associations between qualitative themes found in written responses and quantitative reported level of stress after Hurricane Sandy.

METHODS

A survey was conducted among World Trade Center Health Registry enrollees 5-12 mo after Hurricane Sandy. This study included 1202 participants who completed the free-response section and answered the question on how stressful their experiences were with Hurricane Sandy and its aftermath. Content analysis was used to generate qualitative data. Mixed-methods analysis was performed using a 1-way analysis of variance test for bivariate comparisons of qualitative thematic codes and the quantitative outcome of mean Sandy stress scores.

RESULTS

Seven themes emerged from the qualitative analysis. The themes of lack of information, negative emotional response, and financial stress had higher quantitative mean Sandy stress scores compared with other themes. The theme of patriotism/gratitude had an overall lower quantitative Sandy stress scores than other themes.

CONCLUSIONS

Qualitative and mixed-methods research on mental health outcomes after a disaster add new depth and findings to the existing literature. Using such methodologies to identify modifiable factors, such as improving communication during a disaster, may confer better mental health outcomes after a disaster.

Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis

Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees

Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.

Change in binge drinking behavior after Hurricane Sandy among persons exposed to the 9/11 World Trade Center disaster

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4.7% participants were new binge drinkers after Hurricane Sandy.

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Persons with high Sandy exposure were more likely to be new/consistent binge drinkers.

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Among persons without 9/11 PTSD, Sandy PTSD was associated with new binge drinking.

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High Sandy exposure, and Sandy PTSD were associated with higher binge intensity after Sandy.

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Response to future disasters should address alcohol use and PTSD simultaneously.

The objective of this study was to examine changes in drinking behavior after Hurricane Sandy among 3199 World Trade Center Health Registry (Registry) enrollees before (2011–12) and after Hurricane Sandy (2015–16). A composite Sandy exposure scale (none, low, medium and high) included Sandy traumatic experiences, financial and other factors. Probable Sandy-related posttraumatic stress disorder (PTSD) was defined as scoring ≥44 on PTSD Checklist, and binge drinking as consuming ≥5 alcoholic drinks for men or ≥4 for women on one occasion in the past 30 days. Some of the enrollees reported binge drinking post Sandy as new binge drinkers (4.7%) or consistent binge drinkers pre- and post-Sandy (19%). Compared with non-binge drinkers pre- and post-Sandy (66.9%), the adjusted odds ratios (aOR) for being new binge drinkers and consistent binge drinkers among high Sandy exposure enrollees were 2.1 (95%CI 1.1–4.1) and 2.5 (95%CI: 1.7–3.6), respectively. High Sandy traumatic experience alone was associated with consistent binge drinking (aOR: 1.9, 95%CI: 1.4–2.6). Among enrollees without 9/11 PTSD, those with Sandy PTSD were more likely to become new binge drinkers (aOR: 4.4, 95%CI: 1.4–13.9), while Sandy PTSD was not associated with any binge drinking behavior changes among those with 9/11 PTSD. Sandy exposure, Sandy traumatic experience, and Sandy PTSD were all associated with higher binge drinking intensity. Future natural disaster response should plan for treatment to address alcohol use and PTSD simultaneously.

Post-Traumatic Stress Disorder among Survivors of the September 11, 2001 World Trade Center Attacks: A Review of the Literature

Prior reviews of 9/11-related post-traumatic stress disorder (PTSD) have not focused on the civilian survivors most directly exposed to the attacks. Survivors include those individuals who were occupants of buildings in or near the World Trade Center (WTC) towers, those whose primary residence or workplace was in the vicinity, and persons who were on the street passing through the area. This review reports published information on the prevalence of and risk factors for PTSD, as well as comorbidities associated with PTSD among 9/11 survivors. Articles selected for inclusion met the following criteria: (1) full-length, original peer-reviewed empirical articles; (2) published in English from 2002-2019; (3) collected data from persons directly exposed; (4) adult populations; and (5) focused on non-rescue or recovery workers (i.e., survivors). Data were extracted with focus on study design, sample size, time frame of data collection post-9/11, PTSD assessment instrument, and PTSD prevalence, risk factors, and comorbidities. Our review identified the use of cross-sectional and longitudinal designs, finding multiple direct comorbidities with PTSD, as well as the prevalence and persistence of PTSD. Future research would benefit from incorporating more mixed methods designs, and exploring the mediating mechanisms and protective factors of the known associations of PTSD among the 9/11 survivor population.

Injury Severity and Psychological Distress Sustained in the Aftermath of the Attacks of 11 September 2001 Predict Somatic Symptoms in World Trade Center Health Registry Enrollees Sixteen Years Later

The World Trade Center attacks of 11 September 2001 (9/11) have been associated with the subsequent development of chronic diseases. Few studies have investigated the burden of somatic symptoms on attack victims, or the association of such symptoms with exposure to the 9/11 attacks. World Trade Center Health Registry (Registry) enrollees who were present south of Chambers Street during or immediately after the 9/11 attacks and who provided consistent answers regarding injury sustained on 9/11 were followed prospectively for up to 16 years post-9/11/01. We employed linear regression to evaluate the associations between injury severity, psychological distress and somatic symptoms in 2322 persons who completed all four Registry surveys and a subsequent Health and Quality of Life survey. Twenty-one percent of subjects had a “very high” burden of somatic symptoms, greater than in populations not exposed to a disaster. Somatic symptoms exhibited a dose-response association separately with injury severity and psychological distress trajectories. Victims of the 9/11 attacks suffer from a substantial burden of somatic symptoms which are associated with physical and psychological consequences of exposure to the attacks. Physical and mental health professionals need to work together when treating those exposed to complex disasters such as 9/11.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018

PURPOSE OF REVIEW

As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events.

RECENT FINDINGS

Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

Exposure to multiple disasters: The long-term effect of Hurricane Sandy (October 29, 2012) on NYC survivors of the September 11, 2001 World Trade Center attack

This study evaluated the impact of pre-Hurricane Sandy (Sandy) post-traumatic stress disorder (PTSD) trajectories on the relationship between Sandy exposures and post-Sandy 9/11-related PTSD among World Trade Center Health Registry (Registry) enrollees. The study population included 3,199 adult Registry enrollees who completed three surveys prior to Sandy in 2003-4, 2006-7, and 2011-12; a post-Hurricane Sandy survey (2013); and a follow-up survey in 2015-16. PTSD was assessed using the PTSD Checklist (PCL). Latent class growth analysis was used to identify groups of enrollees who shared a similar trajectory of change in PCL score in the time period prior to Sandy. We compared enrollees in each trajectory group to assess the impact of Sandy-related PTSD, Sandy exposures, and optimism on 9/11-related PTSD status post-Sandy (2015-16) using bivariate analyses and multivariable log-binomial regression. Sandy-related PTSD was the strongest predictor of subsequent 9/11-related PTSD. Lower optimism and higher Sandy exposure significantly predicted 9/11-related PTSD only in some trajectory groups. Hurricane Sandy may have exacerbated previously resolved symptoms of 9/11-related PTSD. This indicates a need after a disaster to assess and address mental health sequelae from previous traumatic exposures.