Evaluating Risk Factors and Possible Mediation Effects in Posttraumatic Depression and Posttraumatic Stress Disorder Comorbidity

Abstract

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.

World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers

“…Consistent with our EMS findings, previous 9/11 health studies found increased risks among WTC-exposed cohorts for aerodigestive conditions such as GERD6 and asthma,5 as well as for symptoms indicative of PTSD,7 depression,8 and harmful alcohol use 9. Unlike prior studies, ours is the first to concentrate on EMS workers, especially important as we used confirmed physician diagnoses from FDNY medical records rather than self-reports to describe the post-9/11 cumulative incidence of physical health conditions.…”

“…Rescue and recovery workers included first responders—firefighters, police officers and emergency medical service (EMS) workers—as well as operating engineers, iron workers, railway tunnel workers, sanitation workers, utility workers, and volunteers 1. Previous research has documented an array of WTC-related physical and mental health issues among these workers including: excess cancer risks;2–4 elevated rates of aerodigestive illnesses such as asthma5 or gastroesophageal reflux disease (GERD);6 and, increased risks of post-traumatic stress disorder (PTSD),7 depression,8 and frequent binge drinking 9. Substantial comorbidities between these health conditions were also found 10 11.…”

“…Substantial comorbidities between these health conditions were also found 10 11. While a number of studies have investigated the effects of the WTC disaster on rescue and recovery workers in general3–6 11–13 and Fire Department of New York (FDNY) firefighters2 8 14–16 and New York City (NYC) police officers17–20 in particular, no studies have focused on the effects in EMS workers.…”

Deployment-related difficulties of Japanese disaster relief workers by mission duration: a cross-sectional study

“…The hypothesis that relief workers' experience of difficulties is associated with mission duration was supported. Several studies have focused on the association between disaster phase (i.e., arrival time after disaster) and mental health problems (Chiu et al, 2011;Pietrzak et al, 2012). Conversely, another study has suggested that spending a longer duration on a disaster site generally appeared to be a risk factor for poor mental health (Brooks, Dunn, Amlot, Greenberg, & Rubin, 2016).…”

Mental Health Consequences of Disasters

“…For example, more than half of all survivors of both the Oklahoma City bombing and the WTC attacks who met criteria for PTSD were also identified as having major depression (20,55). Chiu and colleagues (15) describe three potential explanations for the high prevalence of PTSD and depression comorbidity following a traumatic event such as a disaster: Both disorders are psychological consequences of traumatic exposure, suffering with PTSD brings on secondary depression, and symptoms that characterize the two conditions overlap (15). Those with comorbid psychological disorders are generally more impaired than those with only one condition and are at greater risk for chronic disorder (42,69).…”