The Burden of Subthreshold Posttraumatic Stress Disorder in World Trade Center Responders in the Second Decade After 9/11

Chen, Connie; Salim, Ryan; Rodriguez, Janice; Singh, Ritika; Schechter, Clyde B.; Dasaro, Christopher R.; Todd, Andrew C.; Crane, Michael; Moline, Jacqueline; Udasin, Iris; Harrison, Denise; Luft, Benjamin J.; Southwick, Steven M.; Pietrzak, Robert H.; Feder, Adriana

doi:10.4088/jcp.19m12881

Cited by 20 publications

(23 citation statements)

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“…Participants fell into two broad categories: individuals who currently met diagnostic criteria for full or subthreshold PTSD, and individuals who were assessed as never having met criteria for PTSD or any other DSM-5 Axis-1 disorder. As per previous studies from our research group (e.g., Chen et al, 2020), subthreshold PTSD was defined according to two commonly-used sets of criteria, adapted for DSM-5 (see McLaughlin et al, 2015). Specifically, this required the presence of one Criterion B (intrusion) symptom, plus 1) either three symptoms from across Criteria C (avoidance) and D (negative alterations in mood or cognition), or two symptoms from Criterion E (alterations in arousal and physiological reactivity); or 2) one criterion C or D symptom plus one Criterion E symptom.…”

Section: Participantsmentioning

confidence: 54%

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

et al. 2021

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Background Problems in learning that sights, sounds, or situations that were once associated with danger have become safe (extinction learning) may explain why some individuals suffer prolonged psychological distress following traumatic experiences. Although simple learning models have been unable to provide a convincing account of why this learning fails, it has recently been proposed that this may be explained by individual differences in beliefs about the causal structure of the environment. Methods Here, we tested two competing hypotheses as to how differences in causal inference might be related to trauma-related psychopathology, using extinction learning data collected from clinically well-characterised individuals with varying degrees of post-traumatic stress (N = 56). Model parameters describing individual differences in causal inference were related to multiple post-traumatic stress disorder (PTSD) and depression symptom dimensions via network analysis. Results Individuals with more severe PTSD were more likely to assign observations from conditioning and extinction stages to a single underlying cause. Specifically, greater re-experiencing symptom severity was associated with a lower likelihood of inferring that multiple causes were active in the environment. Conclusions We interpret these results as providing evidence of a primary deficit in discriminative learning in participants with more severe PTSD. Specifically, a tendency to attribute a greater diversity of stimulus configurations to the same underlying cause resulted in greater uncertainty about stimulus-outcome associations, impeding learning both that certain stimuli were safe, and that certain stimuli were no longer dangerous. In the future, better understanding of the role of causal inference in trauma-related psychopathology may help refine cognitive therapies for these disorders.

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Section: Participantsmentioning

confidence: 54%

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

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“…The WTC Health Program (WTC-HP) is a regional consortium of five clinical centers established in the greater New York City area by the Centers of Disease Control and Prevention in 2002, with the goal of providing health monitoring and treatment to WTC responders, comprising the WTC-HP General Responder Cohort 12 . In earlier studies in this cohort, we characterized the severity, chronicity, and psychosocial predictors and correlates of PTSD symptoms using data from self-report questionnaires 9,13,14 . For the present study, we recruited participants from the WTC-HP Responder Cohort who had completed at least three periodic health monitoring visits at one of the four WTC-HP clinical centers participating in this study – Mount Sinai Medical Center, New York University, Northwell Health, and Rutgers/The State University of New Jersey – and who had provided signed consent to be contacted for research studies.…”

Section: Methodsmentioning

confidence: 99%

“…The worker response to the WTC disaster was unprecedented in scope, involving tens of thousands of traditional and nontraditional responders in rescue, recovery, and clean-up efforts. PTSD arising in response to equally unprecedented traumatic exposures remains highly prevalent (10-22%) and persistent in WTC responders in the second decade following 9/11 [15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Polygenic regulation of PTSD severity and outcomes among World Trade Center responders

Huckins

Johnson

Cancelmo

et al. 2020

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Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition occurring in individuals exposed to trauma. The study of PTSD is complicated by highly heterogeneous presentations and experiences of trauma.Here, we studied genetic correlates of PTSD and resilience among a group of responders to the World Trade Center (WTC) 9/11/2001 attacks. This cohort represents a unique opportunity to study genetic risk factors for PTSD, and resilience, following a single, shared, well-documented trauma. We calculated polygenic risk scores associated with PTSD among these 375 individuals, and demonstrated a significant genetic association with social cognition traits, brain volumetric phenotypes, and PTSD-GWAS-derived PRS.Our results demonstrate significant genetic regulation of PTSD severity (CAPS scores) and chronicity (past-month CAPS). PRS derived from GWAS of ADHD, ASD, and brain imaging phenotypes (Amygdala and Putamen volume) were associated with multiple PTSD traits in this study. Interestingly, we find greater genetic contribution to PTSD among cases compared to our full cohort. In addition, we tested for associations between exposures to traumatic stressors, including WTC-related exposures, childhood trauma, and traumatic life events since 9/11. Together, polygenic risk and exposures to traumatic stress explain ∼45% of variance in lifetime CAPS among the full cohort (R2=0.454), and ∼48% of variance in past-month CAPS (R2=0.480). These participants represent a highly vulnerable population, with exposures to severe trauma during 9/11 and the following days. Identifying individuals at heightened risk for PTSD, or who may be suited to particular therapies, is of special importance and relevance in this group. In particular, the identification of MRI imaging phenotypes indicates that coupling of neuroimaging with genetic risk score calculations may predict PTSD outcomes.

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“…1,2 In a recent survey, the prevalence of probable full and subthreshold PTSD in police responders was 9.3% and 17.5%, respectively, and in non-traditional responders (e.g., construction workers) 21.9% and 24.1%, respectively. 3 Studies have also documented the persistent and pervasive impact of the 9/11 attacks on individuals who lived, worked, or were passersby in the areas surrounding the WTC, with rates of screening positive for PTSD ranging from 11.9-15.7% in the second decade post-9/11. 2 PTSD symptom chronicity is concerning, as symptomatic WTC responders and survivors have elevated rates of comorbid psychiatric and medical conditions, and impaired social and occupational functioning and quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…2 PTSD symptom chronicity is concerning, as symptomatic WTC responders and survivors have elevated rates of comorbid psychiatric and medical conditions, and impaired social and occupational functioning and quality of life. 3,4 Yet multi-wave surveys of WTC cohort members suggest mental healthcare utilization among WTC responders and survivors could be improved with 31.1% of respondents reporting previous unmet mental health care needs, and 43.1% of respondents screening positive for PTSD not seeking counseling. 5 Despite initiatives to expand access to mental health services to WTC cohort members via the WTC Health Program (WTC-HP), a government-initiated program established in response to the 9/11 attacks that provides free health monitoring and treatment to eligible WTC responders and survivors, considerable barriers to treatment remain.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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The Burden of Subthreshold Posttraumatic Stress Disorder in World Trade Center Responders in the Second Decade After 9/11

Cited by 20 publications

References 0 publications

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Polygenic regulation of PTSD severity and outcomes among World Trade Center responders

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

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