Handgrip Strength of World Trade Center (WTC) Responders: The Role of Re-Experiencing Posttraumatic Stress Disorder (PTSD) Symptoms

Background: This study sought to examine whether handgrip strength (HGS), a measure of muscle strength and a biomarker of aging, was associated with post-traumatic stress disorder (PTSD) in a cohort of World Trade Center (WTC) responders at midlife. Methods: HGS was assessed utilizing a computer-assisted hand dynamometer administered to a consecutive sample of men and women (n = 2016) who participated in rescue and recovery efforts following the World Trade Center (WTC) attacks and subsequently attended monitoring appointments in Long Island, NY. PTSD symptom severity and depressive symptoms were assessed using the PTSD specific-trauma checklist (PCL-S) and the Patient Health Questionnaire (PHQ-9). General linear models were used to examine the association of WTC-related PTSD with HGS after adjusting for confounders. Results: The sample was at midlife (mean age = 53.3) when assessed, and 91.3% were men. Nearly 10% of the sample had probable PTSD (PCL ≥ 44) with concomitant depression (PHQ ≥ 10), while 5.1% had probable PTSD without depression. Average HGS was 57.4 lbs. (95% confidence interval (95% CI): 56.6–58.1) among men and 36.1 lbs. (95% CI = 33.8–38.5) among women. Mean HGS of those with probable PTSD with concomitant depression was lower (45.9 lbs., 95% CI = 43.6–48.2) than responders with only PTSD (49.1 lbs., 95% CI = 46.0–52.4) and those without PTSD or depression (57.5 lbs., 95% CI = 56.2–57.8). Subdomain analyses of PTSD symptoms revealed that re-experiencing symptoms at enrollment (p = 0.003) was associated with lower HGS after adjusting for depressive symptoms and other confounders. Discussion: Results suggested that higher WTC-related PTSD symptom severity was associated with lower HGS. Results support ongoing work suggesting that PTSD may be associated with more rapid physical aging. The potential for developing interventions that might simultaneously improve physical and mental health in the aftermath of trauma may be considered.

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World Trade Center responders in their own words: predicting PTSD symptom trajectories with AI-based language analyses of interviews

Psychological Medicine ◽

10.1017/s0033291721002294 ◽

2021 ◽

pp. 1-9

Author(s):

Youngseo Son ◽

Sean A. P. Clouston ◽

Roman Kotov ◽

Johannes C. Eichstaedt ◽

Evelyn J. Bromet ◽

...

Keyword(s):

Symptom Severity ◽

World Trade ◽

Multilevel Models ◽

Ptsd Symptom ◽

World Trade Center ◽

First Person ◽

Symptom Trajectories ◽

Trade Center ◽

Ptsd Symptom Severity ◽

First Person Plural

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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PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165683 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5683 ◽

Cited By ~ 1

Author(s):

Ankura Singh ◽

Rachel Zeig-Owens ◽

Laura Rabin ◽

Theresa Schwartz ◽

Mayris P. Webber ◽

...

Keyword(s):

New York ◽

Depressive Symptoms ◽

Cognitive Decline ◽

World Trade ◽

World Trade Center ◽

Fire Department ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Mediation Analyses ◽

Trade Center

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

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Differential effect of Hurricane Sandy exposure on PTSD symptom severity: comparison of community members and responders

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105957 ◽

2019 ◽

Vol 76 (12) ◽

pp. 881-887 ◽

Cited By ~ 2

Author(s):

Adam Gonzalez ◽

Rehana Rasul ◽

Lucero Molina ◽

Samantha Schneider ◽

Kristin Bevilacqua ◽

...

Keyword(s):

Symptom Severity ◽

Differential Effect ◽

Ptsd Symptom ◽

Traumatic Event ◽

World Trade Center ◽

Hurricane Sandy ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Community Members ◽

Ptsd Symptom Severity

ObjectivesTo evaluate whether the association between Hurricane Sandy exposures and post-traumatic stress disorder (PTSD) symptom severity was greater for exposed community members compared with responders.MethodsData were analysed from three existing studies with similar methodologies (N=1648): two community studies, Leaders in Gathering Hope Together (n=531) and Project Restoration (n=763); and the Sandy/World Trade Center Responders Study (n=354). Sandy-related PTSD symptoms were measured using the PTSD checklist-specific traumatic event and dichotomised as elevated (>30) versus low/no (<30) PTSD symptoms. Sandy exposures were measured with a summed checklist. Multivariable logistic regression was performed to evaluate the differential effect of exposures on PTSD by responder status, adjusting for demographics and time elapsed since Sandy.ResultsResponders were somewhat older (50.5 years (SD=8.3) vs 45.8 years (SD=20.0)), more likely to identify as white (92.4% vs 48.1%) and were male (90.7% vs 38.4%). Responders were less likely to have elevated PTSD symptoms than community members (8.6% vs 31.1%; adjusted OR=0.28, 95% CI 0.17 to 0.46). While exposure was significantly related to elevated PTSD status, the effects were similar for responders and community members.ConclusionsResponders appear to be more resilient to PTSD symptoms post-Sandy than community members. Understanding the mechanisms that foster such resilience can inform interventions aimed at populations that are more vulnerable to experiencing PTSD after natural disasters.

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Associations between posttraumatic stress disorder and substance use: a longitudinal investigation of individuals recently exposed to trauma

10.32920/ryerson.14644506.v1 ◽

2021 ◽

Author(s):

Sonya G. Wanklyn

Keyword(s):

Posttraumatic Stress Disorder ◽

Substance Use ◽

Alcohol Use ◽

Posttraumatic Stress ◽

Symptom Severity ◽

Stress Disorder ◽

Ptsd Symptom ◽

Traumatic Event ◽

Ptsd Symptoms ◽

Ptsd Symptom Severity

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly cooccur following trauma, and their co-occurrence is associated with substantial costs; however, our understanding of the timing and sequencing of these posttrauma mental health conditions is limited. This study examined the trajectories of PTSD symptom severity and substance use among individuals recently exposed to a traumatic event, with a focus on the potential moderating roles of PTSD and SUD diagnoses at the final assessment. Additionally, in attempt to better understand the functional relationship between PTSD symptoms and substance use posttrauma, this study compared models reflecting the theories of self-medication, susceptibility, and mutual maintenance. Participants included 137 individuals who had experienced a traumatic event within 6 months prior to study enrollment. Participants completed four assessments over an approximate 1-year period that included clinician-administered measures for DSM-5 PTSD symptoms and SUD diagnosis and self-report measures of alcohol and drug use. Change over time in PTSD symptoms and substance use by diagnostic status were investigated using growth curve models. Temporal sequencing between PTSD symptom severity and substance use was investigated with bivariate latent difference score structural equation modeling. In line with the conceptualization of PTSD as a disorder of impeded recovery, having a diagnosis of PTSD at the final assessment moderated the trajectory of PTSD symptom severity such that symptom severity declined only among those without PTSD. In contrast, the influence of SUD appeared to be negligible. Both PTSD and SUD diagnoses were associated with initial drug use frequency. However, the relationship between alcohol use and diagnostic status did not reach statistical significance. Regarding temporal relationships between PTSD symptoms and substance use, significant and negative PTSD to change in substance use cross-lagged paths were found across most of the models, while only one significant substance use to change in PTSD severity crosslagged path emerged in the PTSD intrusion with alcohol use model. These results add to a growing body of research suggesting trauma-focused intervention is viable for individuals with PTSD/SUD. Further, examination of potential mediators and moderators of the relation between PTSD and SUD is recommended as a critical focus for future research.

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Internet-based cognitive behavioral therapy versus internet-based modified present-centered therapy for world trade center responders and survivors with posttraumatic stress disorder: rationale and design of a randomized controlled trial

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20212843 ◽

2021 ◽

Vol 8 (3) ◽

pp. 202

Author(s):

Hannah R. Brinkman ◽

Mary L. Kowalchyk ◽

Leah Cahn ◽

Cindy J. Aaronson ◽

Maria Böttche ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Randomized Controlled Trial ◽

World Trade ◽

Stress Disorder ◽

Controlled Trial ◽

World Trade Center ◽

Evidence Based ◽

Ptsd Symptoms ◽

Randomized Controlled ◽

Trade Center

Background: Nearly two decades following the 9/11/2001 world trade center (WTC) attacks, a substantial proportion of WTC rescue and recovery workers (“responders”) and WTC survivors continue to experience WTC-related posttraumatic stress disorder (PTSD) symptoms. Internet-based cognitive behavioral therapies (I-CBT) are short-term, evidence-based, scalable treatments with the potential to reach large numbers of symptomatic WTC workers and survivors. However, no I-CBT studies have been conducted in the WTC cohort.Methods: This report describes the rationale and design of an ongoing randomized controlled trial comparing integrative testimonial therapy (ITT), an I-CBT, to an active comparison treatment, internet-based modified present-centered therapy. The primary aim is to evaluate the efficacy of ITT in mitigating WTC-related PTSD symptoms in WTC responders and survivors with full or subthreshold WTC-related PTSD. The efficacy of ITT in reducing comorbid depressive and anxiety symptoms, and improving functioning, quality of life, and post-traumatic growth will additionally be evaluated. Saliva samples are also collected to explore genetic and epigenetic biomarkers of treatment response.Conclusions: This is the first I-CBT trial to compare ITT to a credible and active treatment, controlling for critical third-variable explanations of superiority (e.g., non-specific therapy effects). This RCT bridges an important research gap in the rising field of I-CBT interventions and adds to the literature on the design of trials investigating evidence-based treatments for PTSD in WTC- and other trauma-affected populations. Trial registration: This trial was registered on clinicalTrials.gov on May 16, 2017 (NCT03154151).

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Associations between posttraumatic stress disorder and substance use: a longitudinal investigation of individuals recently exposed to trauma

10.32920/ryerson.14644506 ◽

2021 ◽

Author(s):

Sonya G. Wanklyn

Keyword(s):

Posttraumatic Stress Disorder ◽

Substance Use ◽

Alcohol Use ◽

Posttraumatic Stress ◽

Symptom Severity ◽

Stress Disorder ◽

Ptsd Symptom ◽

Traumatic Event ◽

Ptsd Symptoms ◽

Ptsd Symptom Severity

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Posttraumatic Stress Disorder in Daily Life Among World Trade Center Responders: Temporal Symptom Cascades

10.31234/osf.io/xcs47 ◽

2020 ◽

Author(s):

Camilo Ruggero ◽

Keke Schuler ◽

Monika A. Waszczuk ◽

Jennifer Callahan ◽

Ateka A. Contractor ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

World Trade ◽

Stress Disorder ◽

Daily Life ◽

Critical Role ◽

World Trade Center ◽

Ptsd Symptoms ◽

Symptom Dimensions ◽

Trade Center

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 how other maintenance factors, such as stress, contribute to such events in daily life. 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. 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. Findings are from a unique population and based on naturalistic observation. 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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Differential Impact of PTSD Symptoms on Psychosocial Functioning in World Trade Center Responders

PsycEXTRA Dataset ◽

10.1037/e664932012-001 ◽

2012 ◽

Author(s):

Jared N. Kilmer ◽

Camilo Ruggero ◽

Jennifer Callahan ◽

Crystal Rodriguez ◽

Roman Kotov ◽

...

Keyword(s):

Psychosocial Functioning ◽

World Trade ◽

World Trade Center ◽

Ptsd Symptoms ◽

Differential Impact ◽

Trade Center

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Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster

Preventive Medicine ◽

10.1016/j.ypmed.2014.05.016 ◽

2014 ◽

Vol 66 ◽

pp. 34-38 ◽

Cited By ~ 38

Author(s):

Sara A. Miller-Archie ◽

Hannah T. Jordan ◽

Ryan R. Ruff ◽

Shadi Chamany ◽

James E. Cone ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

World Trade ◽

Stress Disorder ◽

World Trade Center ◽

Adult Survivors ◽

World Trade Center Disaster ◽

The World ◽

Trade Center ◽

New Onset

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Physical Exercise as Treatment for PTSD: A Systematic Review and Meta-Analysis

Military Medicine ◽

10.1093/milmed/usab497 ◽

2021 ◽

Author(s):

Frida Björkman ◽

Örjan Ekblom

Keyword(s):

Subgroup Analysis ◽

Symptom Severity ◽

Ptsd Symptom ◽

Meta Analysis ◽

Secondary Outcome ◽

Study Quality ◽

Ptsd Symptoms ◽

Military Trauma ◽

Exercise Type ◽

Ptsd Symptom Severity

ABSTRACT Introduction Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults. Materials and Methods Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI. Results Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: −0.15 to 0.51), and no sign of publication bias was found. Conclusions Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.

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