Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks-A Longitudinal Mediation Analysis.
Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks-A Longitudinal Mediation Analysis.
复制标题
9/11 世界贸易中心袭击后救援/恢复工作者和社区成员可能出现创伤后应激障碍和下呼吸道症状——纵向中介分析。
DOI：
10.1097/psy.0000000000000731
复制
发表时间：
2020
影响因子：
3.3
通讯作者：
Jordan,HannahT
中科院分区：
文献类型：
--
作者：
Wyka,Katarzyna;Friedman,StephenM;Jordan,HannahT
目的：在2001年9月11日（9/11）世界贸易中心（WTC）恐怖袭击的幸存者中，创伤后应激障碍（PTSD）和下呼吸道症状（LRS）经常并存。对警察和非传统反应者的研究表明，PTSD介导了9/11物理暴露和LRS之间的关系，而不是相反。我们在世贸中心救援/恢复工作者（R/R工作者）中复制了这些发现，并将其扩展到暴露的社区成员，并在10年的随访中探讨了9/11生理和心理暴露、可能的PTSD和LRS之间的相互作用。方法通过2003-2004年、2006-2007年和2011-2012年三次WTC健康登记调查，对12398名R/R工作人员和12745名社区成员进行评估。LRS和9/11暴露是自我报告的。PTSD检查表得分≥44分为可能的PTSD。结果PTSD可能预测LRS (R/R工作者：β= 0.88-0.98, p<。001年;社区成员：β= 0.67-0.86, p<。0.001)和LRS预测PTSD (R/R工作者：β= 0.83-0.91, p<。001年;社区成员：β= 0.68-0.75, p<。001)在随访中，调整既往症状和协变量。在R/R工人和社区成员中，可能的PTSD介导了9/11物理暴露（粉尘云，长时间工作）与LRS之间的关系(间接影响，p=。001 -。LRS介导了身体暴露与创伤后应激障碍的关系(间接效应，p=。001 -。006)。在R/R工作者中，创伤后应激障碍可能介导了心理暴露（失去朋友或亲人，目睹可怕的事件）-LRS关系(间接影响，p<。001)，但LRS没有调节心理暴露与ptsd的关系(间接效应，p=。332)。在社区成员中，高9/11心理暴露可预测随访时可能出现的PTSD和LRS；可能PTSD介导了心理暴露- lrs关系(间接效应，p<。001)， LRS介导了心理暴露与ptsd的关系(间接效应，p=。001)。结论可能的PTSD和LRS相互介导，在R/R工作者和社区成员之间存在细微差异。对其中一种疾病的诊断应引发对另一种疾病的评估；治疗应仔细协调。
ObjectivePosttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up.MethodsParticipants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003–2004, 2006–2007, and 2011–2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score≥ 44.ResultsProbable PTSD predicted LRS (R/R workers: β= 0.88–0.98, p<. 001; community members: β= 0.67–0.86, p<. 001) and LRS predicted PTSD (R/R workers: β= 0.83–0.91, p<. 001; community members: β= 0.68–0.75, p<. 001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p=. 001–. 006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p=. 001–. 006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)–LRS relationship (indirect effect, p<. 001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p=. 332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p<. 001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p=. 001).ConclusionsProbable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.