The study objective is to test mechanisms thought to be responsible for the comorbidity between psychiatric and medical sequelae of World Trade Center (WTC) exposures. We propose to study responders participating in the WTC-Health Programs. Of the entire cohort, approximately 16,000 completed the first two monitoring visits, about two years apart. In addition to routine questionnaires completed by responders at their monitoring visits, we conduct standard interviews designed to diagnose WTC-related post-traumatic stress disorder (PTSD). The longitudinal data will allow us to evaluate potential mechanisms underlying the links between mental and physical disorders.
OBJECTIVE: Prior studies of general population and primary care samples find strong associations between mental and physical health. Each domain is related to psychosocial functioning. However, epidemiologic analyses find that the physical health associations disappear after adjusting for mental health. The aim of this talk is to assess the patterns for PTSD, lower respiratory symptoms (LRS), and psychosocial impairments in WTC responders seen at the SB/LI WTC-HP.
METHOD: A sample of 2,646 responders participated in the Health & Wellness Project during their monitoring visit (response rate 93%). The Project included the SCID PTSD and depression modules, a measure of functional impairment (RIFT), health risk perceptions, and subjective health ratings. DCC data on demographics, current LRS, health risk factors, and exposure were obtained. Hierarchical logistic regression analyses examined the relative contribution of current DSM-IV WTC- PTSD and LRS to impairments, adjusting for demographic, exposure, and health risk factors.
RESULTS: percent had current PTSD, and 43% had LRS. The odds ratio was 4.4, and the two conditions shared 8 risk factors. PTSD and LRS were independently associated with impairment (loneliness, poor subjective health, low life satisfaction, poor marital relationship, negative health risk perception). Except for subjective health, the associations for PTSD were stronger. Interaction effects were non-significant.
CONCLUSIONS: In contrast to general population studies, associations of LRS with impairment were not explained away by PTSD. The findings support the importance of integrated care models and mind-body approaches to treating physical and mental health problems simultaneously.
Our research program has shown that mental and physical health have walked arm-in-arm throughout the 12 years since 9/11. For WTC responders, PTSD and lower respiratory distress are particularly impacted. One reason is that both conditions arose from the horrific environmental and psychological exposures at the WTC site. Another reason, as our work suggests, is that these exposures led to basic biological changes that impact both mental and physical health. Consistent with this picture, we documented that both aspects of health place a significant burden on occupational, social, and family functioning. The lesson learned is that adequate medical care requires an integrated approach that treats both the mind and the body simultaneously.
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