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Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity.

Authors
Chiu-S; Niles-JK; Webber-MP; Zeig-Owens-R; Gustave-J; Lee-R; Rizzotto-L; Kelly-KJ; Cohen-HW; Prezant-DJ
Source
Public Health Rep 2011 Mar; 126(2):201-209
NIOSHTIC No.
20038457
Abstract
OBJECTIVES: On September 11, 2001 (9/11), attacks on the World Trade Center (WTC) killed 341 Fire Department of the City of New York (FDNY) firefighters and injured hundreds more. Previous WTC-related studies reported high rates of comorbid depression and posttraumatic stress disorder (PTSD), identifying disability retirement, alcohol use, and early arrival at the WTC site as correlates. However, those studies did not evaluate risk factors that could have mediated the observed comorbidity. We identified unique risk factors for each condition in an effort to better understand comorbidity. METHODS: We screened retired WTC-exposed firefighters using self-administered questionnaires including the Center for Epidemiologic Studies Depression Scale, the Post Traumatic Stress Disorder Checklist, and the Alcohol Use Disorders Identification Test. We performed regression analyses to compare independent predictors of elevated depression and PTSD risk, and also tested a mediation hypothesis. RESULTS: From December 2005 to July 2007, 23% and 22% of 1,915 retirees screened positive for elevated depression and PTSD risk, respectively, with comorbidity > 70%. Controlling for comorbidity, we identified unique risk factors for (1) depression: problem alcohol use and (2) PTSD: early arrival at the WTC site. CONCLUSIONS: Our data support the premise that PTSD and depression are different responses to trauma with unique risk factors. The data also suggest a hypothesis that PTSD mediates the relationship between early WTC arrival and depression, while depression mediates the relationship between alcohol use and PTSD, a more complex relationship than shown in previous studies. Clinicians should consider these factors when evaluating patients for depression and PTSD.
Keywords
Traumatic-injuries; Mortality-data; Psychological-effects; Psychological-factors; Psychological-reactions; Psychological-responses; Psychological-stress; Fire-fighters; Exposure-levels; Exposure-limits; Age-groups
Contact
Mayris P. Webber, DrPH, Fire Department of the City of New York, Bureau of Health Services, 9 Metrotech Center, 4N-1, Brooklyn, NY 11201
CODEN
PHRPA6
Publication Date
20110301
Document Type
Journal Article
Email Address
webberm@fdny.nyc.gov
Funding Type
Grant; Cooperative Agreement
Fiscal Year
2011
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-007350; Cooperative-Agreement-Number-U10-OH-008243; Cooperative-Agreement-Number-U10-OH-008242
Issue of Publication
2
ISSN
0033-3549
Source Name
Public Health Reports
State
NY
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