Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder
Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder
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DOI：
10.1002/jts.22219
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发表时间：
2017-10-01
影响因子：
3.3
通讯作者：
Luft, Benjamin J.
中科院分区：
文献类型：
--
作者：
Clouston, Sean A. P.;Guralnik, Jack M.;Luft, Benjamin J.
创伤后应激障碍（PTSD）与自我报告的在社会和物质世界中导航困难有关，也可能与功能限制的风险有关。短期物理性能测试（SPPB）是一种客观的功能评估，在2015年1月至12月的监测测试期间，对1,268名救援人员、志愿者和其他在2011年9月11日袭击后在纽约世界贸易中心（WTC）协助响应、恢复和清理工作的救援人员进行了连续抽样调查。数据与WTC监测研究的诊断和纵向数据相关联。多变量分析用于检查功能限制的预测因子。对一般应答人群进行加权的患病率估计显示，功能限制的患病率相对较高，sppb9；16.0%, 95% ci[13.7, 18.4]。在控制诱发因素、创伤严重程度、行为因素和wtc相关医疗条件后，当前PTSD与功能限制风险增加两倍相关，调整风险比(aRR) = 2.11, 95% CI[1.48, 3.01]。在世贸中心暴露于人体工程学危险因素也增加了功能损伤的风险，aRR = 1.34 95% CI[1.05, 1.70]。纵向结果显示，自2001年9月11日以来，当前功能受限的个体经历了高基线PTSD严重程度（B = 2.94, SE = 1.33）和增加的PTSD症状严重程度（B = 0.29, SE = 0.10）。本研究确定了功能限制与PTSD之间的横断面关系，以及最终表现出功能限制的人PTSD症状的恶化。结果强调慢性创伤后应激障碍在功能限制中的潜在作用。
Posttraumatic stress disorder (PTSD) is associated with self-reported difficulties navigating the social and physical world and may also be associated with risk of functional limitations. The Short Physical Performance Battery (SPPB), an objective functional assessment, was administered during monitoring exams between January and December 2015 to a consecutive sample of 1,268 rescue workers, volunteers, and other responders who had aided in response, recovery, and cleanup efforts at the World Trade Center (WTC) in New York after the September 11, 2011 attacks. Data were linked with diagnostic and longitudinal data from the WTC monitoring study. Multivariable analyses were used to examine predictors of functional limitations. Prevalence estimates weighted to the general responder population revealed a relatively high prevalence of functional limitations, SPPB 9; 16.0%, 95% CI [13.7, 18.4]. Current PTSD was associated with a twofold increased risk of functional limitations after controlling for predisposing factors, trauma severity, behavioral factors, and WTC-related medical conditions, adjusted risk ratio (aRR) = 2.11, 95% CI [1.48, 3.01]. Exposure to ergonomic risk factors at the WTC also increased the risk of functional impairments, aRR = 1.34 95% CI [1.05, 1.70]. Longitudinal results suggest that individuals with current functional limitations experienced high baseline PTSD severity, B = 2.94, SE = 1.33, and increasing PTSD symptom severity, B = 0.29, SE = 0.10, since September 11, 2001. This study identified a cross-sectional relationship between functional limitations and PTSD and a worsening of PTSD symptoms in persons who eventually demonstrated functional limitations. Results highlight the potential role of chronic PTSD in functional limitations.