Evaluating Risk Factors and Possible Mediation Effects in Posttraumatic Depression and Posttraumatic Stress Disorder Comorbidity
Evaluating Risk Factors and Possible Mediation Effects in Posttraumatic Depression and Posttraumatic Stress Disorder Comorbidity
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DOI：
10.1177/003335491112600211
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发表时间：
2011-03-01
影响因子：
3.3
通讯作者：
Prezant, David J.
中科院分区：
文献类型：
--
作者：
Chiu, Sydney;Niles, Justin K.;Prezant, David J.
目标. 2001年9月11日（9/11），世界贸易中心（WTC）遭到袭击，纽约市消防局（FDNY）341名消防员丧生，数百人受伤。以前的WTC相关研究报告了高比例的共病抑郁症和创伤后应激障碍（PTSD），确定残疾退休，酒精使用和早期到达WTC网站的相关性。然而，这些研究没有评估可能介导观察到的合并症的风险因素。我们确定了每种疾病的独特危险因素，以更好地了解共病。我们使用自我管理的问卷调查，包括流行病学研究中心抑郁量表，创伤后应激障碍检查表和酒精使用障碍识别测试，筛选退休的WTC暴露的消防员。我们进行了回归分析，比较抑郁和PTSD风险升高的独立预测因素，并测试了中介假设。从2005年12月到2007年7月，在1,915名退休人员中，分别有23%和22%的人抑郁症和创伤后应激障碍风险升高，共病率> 70%。控制合并症后，我们确定了（1）抑郁症：酗酒问题和（2）创伤后应激障碍：提前到达世贸中心场地的独特风险因素。结论。我们的数据支持这样一个前提，即创伤后应激障碍和抑郁症是对创伤的不同反应，具有独特的风险因素。这些数据还提出了一个假设，即PTSD介导了早期WTC到达和抑郁症之间的关系，而抑郁症介导了酒精使用和PTSD之间的关系，这是一种比以往研究更复杂的关系。临床医生在评估抑郁症和PTSD患者时应考虑这些因素。
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.