scholarly journals The Intentional Self-Medication of 9/11-Related PTSD Symptoms with Alcohol: 15 Years after the Disaster

2020 ◽  
Vol 17 (15) ◽  
pp. 5327
Author(s):  
Sascha K. Garrey ◽  
Alice E. Welch ◽  
Melanie H. Jacobson ◽  
Robert M. Brackbill ◽  
Lisa M. Gargano
Keyword(s):  
Binge Drinking ◽  
Ptsd Symptom ◽  
World Trade Center ◽  
Symptom Clusters ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Public Health Importance ◽  
Self Medication ◽  
Specific Symptom ◽  
Co Morbidity

The self-medication hypothesis may explain the co-morbidity of affective and substance use disorders. Research shows increased prevalence, frequency, and intensity of binge drinking and post-traumatic stress disorder (PTSD) among those directly exposed to the 9/11 terrorist attacks on the World Trade Center (WTC), however, little is known about PTSD symptomology and intentional self-medication with alcohol (ISMA) among this group. We used WTC Health Registry data (N = 28,935) to describe the relationship between ISMA and specific symptom clusters of probable 9/11-related PTSD, the number of PTSD symptom clusters endorsed, and binge drinking intensity. Multivariable logistic regression models were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CI). ISMA was most strongly associated with the hyperarousal PTSD symptom cluster (AOR = 2.04 [1.88, 2.21]) and the endorsement of one (AOR = 1.80 CI [1.65, 1.95]), two (AOR = 2.51 CI [2.28, 2.77]), or three (AOR = 2.84 CI [2.55, 3.17]) PTSD symptom clusters, indicating a clear dose–response relationship. A significant number of 9/11-exposed persons continue to experience PTSD symptoms and engage in ISMA as a potential coping mechanism. Repeated screenings for self-medicative alcohol use among survivors of mass traumas with PTSD symptoms is of public health importance.

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

2019 ◽  
Vol 76 (12) ◽  
pp. 881-887 ◽  
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.

Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

2013 ◽  
Vol 44 (10) ◽  
pp. 2085-2098 ◽  
Author(s):  
R. H. Pietrzak ◽  
A. Feder ◽  
C. B. Schechter ◽  
R. Singh ◽  
L. Cancelmo ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Ptsd Symptom ◽  
World Trade Center ◽  
Symptom Clusters ◽  
Post Traumatic Stress ◽  
Anxious Arousal ◽  
Trade Center ◽  
Post Traumatic ◽  
Ptsd Symptomatology ◽  
Over Time

BackgroundPost-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations.MethodData were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11.ResultsCFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time.ConclusionsResults of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

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

2020 ◽  
Vol 17 (16) ◽  
pp. 5683 ◽  
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.

scholarly journals A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation

2017 ◽  
Vol 41 (4) ◽  
pp. 645-653 ◽  
Author(s):  
Maria Panagioti ◽  
Ioannis Angelakis ◽  
Nicholas Tarrier ◽  
Patricia Gooding
Keyword(s):  
Depressive Symptoms ◽  
Suicidal Ideation ◽  
Ptsd Symptom ◽  
Symptom Clusters ◽  
Self Report ◽  
Ptsd Symptoms ◽  
Cross Sectional ◽  
The Impact

AbstractInconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.

scholarly journals Associations Between PTSD Symptom Custers and Longitudinal Changes in Suicidal Ideation: Comparison Between 4-Factor and 7-Factor Models of DSM-5 PTSD Symptoms

2021 ◽  
Vol 12 ◽  
Author(s):  
Che-Sheng Chu ◽  
Po-Han Chou ◽  
Shao-Cheng Wang ◽  
Masaru Horikoshi ◽  
Masaya Ito
Keyword(s):  
Suicidal Ideation ◽  
Externalizing Behavior ◽  
Ptsd Symptom ◽  
Factor Model ◽  
Symptom Clusters ◽  
Ptsd Symptoms ◽  
Longitudinal Changes ◽  
Dsm 5 ◽  
Using Data

Objective: The association between posttraumatic stress disorder (PTSD) and suicidal ideation (SI) is well-known. However, a few studies have investigated the associations between PTSD symptom clusters based on the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and changes in suicide risk longitudinally.Methods: We adopted a longitudinal study design using data from the National Survey for Stress and Health of 3,090 of the Japanese population. The first and second surveys were conducted on November 2016 and March 2017, respectively. The suicidal ideation attributes scale was applied to assess the severity of suicidal ideation at baseline and the follow-up period. A multivariate linear regression model was conducted to examine the associations between the 4- or 7-factor model of PTSD symptom clusters at baseline and longitudinal changes in SI.Results: Overall, 3,090 subjects were analyzed (mean age, 44.9 ± 10.9 years; 48.8% female) at Baseline, and 2,163 completed the second survey. In the 4-factor model, we found that the severity of negative alternations in cognition and mood were significantly associated with increased SI after 4 months. In the 7-factor model, we found that the severity of anhedonia and externalizing behavior at baseline was significantly associated with increased SI during the follow-up period.Conclusions: We found that the seven-factor model of DSM-5 PTSD symptoms may provide greater specificity in predicting longitudinal SI change in the general population. Closely monitoring specific PTSD core symptoms may be more effective in mitigating key clinical and functional outcomes.

The Association Between Posttraumatic Stress Symptoms and Anxiety Sensitivity in a College Sample

2020 ◽  
pp. 003329412094822
Author(s):  
Nicole M. Caulfield ◽  
Rachel L. Martin ◽  
Aaron M. Norr ◽  
Daniel W. Capron
Keyword(s):  
Posttraumatic Stress ◽  
Anxiety Sensitivity ◽  
Ptsd Symptom ◽  
Traumatic Event ◽  
Physical Symptoms ◽  
Symptom Clusters ◽  
Posttraumatic Stress Symptoms ◽  
Sensitivity Index ◽  
Ptsd Symptoms ◽  
Stress Symptoms

Background/Objectives One-half of all U.S. adults will experience at least one traumatic event, and of those, approximately 11% develop posttraumatic stress disorder (PTSD) symptoms. Despite efficacious treatments for PTSD, one-third of people diagnosed still express symptoms after treatment.Thus, it is important to identify underlying factors that may be associated with PTSD symptom clusters to improve treatment efficacy. One potential factor is anxiety sensitivity (AS), or “the fear of fear,” and includes three different subfactors: physical, cognitive, and social concerns, yet few studies have examined this association using the Anxiety Sensitivity Index-3. Method Participants included 65 undergraduate students from a Southeastern University who were elevated on anxiety sensitivity cognitive concerns and experienced at least one traumatic event. Participants completed measures of trauma exposure, anxiety sensitivity, posttraumatic stress symptoms, and suicidal ideation. Results Results revealed that AS physical symptoms had the most robust association with potential PTSD symptoms and individual PTSD symptom clusters with the exception of the avoidance and numbing cluster Conclusions These findings may help clarify the nature of the relationship between PTSD symptoms and AS using the most updated measure of AS (ASI-3).

Polygenic prediction of PTSD trajectories in 9/11 responders

2020 ◽  
pp. 1-9
Author(s):  
Monika A. Waszczuk ◽  
Anna R. Docherty ◽  
Andrey A. Shabalin ◽  
Jiaju Miao ◽  
Xiaohua Yang ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Multiple Testing ◽  
World Trade Center ◽  
Risk Scores ◽  
Generalized Anxiety ◽  
Targeted Prevention ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Growth Mixture Model ◽  
Prospective Longitudinal

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.

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

2019 ◽  
Vol 16 (7) ◽  
pp. 1215 ◽  
Author(s):  
Rebecca Rosen ◽  
Zhaoyin Zhu ◽  
Yongzhao Shao ◽  
Mengling Liu ◽  
Jia Bao ◽  
...  
Keyword(s):  
World Trade ◽  
World Trade Center ◽  
Physical Symptoms ◽  
Symptom Clusters ◽  
Longitudinal Change ◽  
Ptsd Symptoms ◽  
Community Members ◽  
Wide Range ◽  
The World ◽  
Trade Center

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

Pharmacotherapy for PTSD

2021 ◽  
Author(s):  
James C. West ◽  
Gary H. Wynn ◽  
David M. Benedek
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Psychosocial Intervention ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Psychotropic Medications ◽  
Symptom Clusters ◽  
Ptsd Symptoms ◽  
Specific Symptom ◽  
Sleep Studies ◽  
Specific Symptoms

Psychotropic medications offer some benefit in treatment of posttraumatic stress disorder (PTSD) symptoms. This chapter reviews classes of medications used as monotherapy and augmentation agents and evidence for their use. Antidepressant medications, particularly selective serotonin reuptake inhibitors, have the greatest body of evidence to support their use in treatment of PTSD, but the benefit they offer is modest, and they are ineffective in some populations. This chapter also reviews novel pharmacologic approaches to treatment of PTSD still under investigation. Beyond sleep, studies to date have not identified strategies to target specific symptom clusters in PTSD. Such studies may help tailor future treatment to symptoms that are either particularly disabling or refractory to other medications of psychosocial intervention. “Repurposing” studies of older agents originally approved for other illnesses may prove effective for specific symptoms or symptom clusters of PTSD.

Examination of the Relation Between PTSD Symptoms, Smartphone Feature Uses, and Problematic Smartphone Use

2018 ◽  
Vol 37 (3) ◽  
pp. 385-403 ◽  
Author(s):  
Ateka A. Contractor ◽  
Nicole H. Weiss ◽  
Jon D. Elhai
Keyword(s):  
Ptsd Symptom ◽  
Social Process ◽  
Empirical Work ◽  
Symptom Clusters ◽  
Addictive Behaviors ◽  
Ptsd Symptoms ◽  
Problematic Smartphone Use ◽  
Smartphone Use ◽  
Process Oriented

Post-traumatic stress disorder (PTSD) symptoms are associated with addictive behaviors including problematic smartphone use (PSU). Drawing from existing theoretical models and empirical work, we examined the relation between PTSD symptoms, social/process-oriented smartphone feature uses, and PSU. Specifically, we examined the correlations between social/process-oriented smartphone feature uses with both PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity) and PSU and the mediating role of social/process-oriented smartphone feature uses in the relation between PTSD symptom clusters and PSU. The current study used data from a sample of 347 community participants recruited through Amazon’s Mechanical Turk platform. Correlation results indicated that process-oriented smartphone feature uses correlated significantly (positively) with all the PTSD symptom clusters and PSU. Further, mediation results indicated that process-oriented smartphone feature use significantly mediated the relationship between each PTSD symptom cluster and PSU. Beyond highlighting the role of process-oriented smartphone feature uses (e.g., watching videos/TV/movies, reading books/magazines, games) in the relation between PTSD symptoms and PSU, our findings suggest that efforts to reduce PSU among individuals with PTSD symptoms should integrate strategies for reducing process-oriented uses of smartphones.

Sign in / Sign up

Export Citation Format

Share Document