The Daily Burden of PTSD and Respiratory Problems in World Trade Center Responder

描述(申请人提供)：在世界贸易中心(WTC)遭受9/11袭击后，超过60,000人参与了救援、恢复和清理工作。其中许多人现在面临身体和精神健康问题，高达60%的人报告有创伤后应激障碍(PTSD)或下呼吸道症状(LRS)的症状。此外，PTSD和LRS之间的共同出现率高于共同的风险因素，如与WTC相关的暴露。在两年半的时间里，创伤后应激障碍被证明增加了新的LRS的开始。尽管有这些证据，但我们对合并症的理解仍然存在重大差距。特别是，关于WTC应答者中PTSD/LRS的所有现有数据都来自传统的、基于临床的评估。这些要求患者在症状发生几周或几个月后回忆，这引入了可能的回忆偏差，并掩盖了症状的日常流行率和负担。此外，传统的评估只考虑平均症状水平，因此很难检查创伤后应激障碍和LRS之间的实时动态，也很难测试它们之间可能的生物学途径。创伤后应激障碍与对压力的过度反应和免疫系统的失调有关，这可能会增加对包括肺部炎症和呼吸问题在内的内科合并症的易感性。然而，这些假设的途径还没有得到测试。拟议的研究将通过生态瞬时评估(EMA)解决我们对创伤后应激障碍/LRS理解上的这些差距。与传统措施不同，EMA专门设计为通过每天多次在诊所外采样来提供内科患者症状和生物标记物的日常波动数据。我们将使用EMA和WTC响应者1)以生态有效的方式建立PTSD/LRS的每日患病率和负担，2)实时评估PTSD和LRS之间的时间动态，测试PTSD症状的发生是否会增加未来LRS的可能性，3)重复采样生物标记物以测试生理应激反应、免疫调节失调和肺部炎症与PTSD和LRS之间的联系，以及4)评估PTSD和LRS的回顾测量与基于EMA的估计的一致性，并根据需要重新校准传统的临床测量方法。这项研究的结果将首次对WTC应答者的日常创伤后应激障碍症状和LRS患病率进行生态有效的估计，以及对他们日常生活负担的估计。这项研究还将实时调查创伤后应激障碍-LRS联系的方向，并测试可能解释这种关系的生物学机制，这是以前从未尝试过的。此外，每天对肺部生物标志物的动态采样将为响应者的呼吸健康提供一个新的视角。在这项研究中获得的对症状负担的更有效的估计将为管理WTC相关条件的政策和向应答者提供服务提供参考。有关时间序列和生物介体的信息将有助于指导制定干预措施，以减轻接触WTC和其他创伤人群的创伤后应激障碍和LRS负担。

DESCRIPTION (provided by applicant): In the wake of the 9/11 attacks on the World Trade Center (WTC), over 60,000 individuals took part in the rescue, recovery and clean-up efforts. Many of these individuals now face physical and mental health problems, with up to 60% reporting symptoms of post-traumatic stress disorder (PTSD) or lower respiratory symptoms (LRS). Moreover, the rate of co-occurrence between PTSD and LRS is higher than what can be explained by shared risk factors, such as WTC-related exposure. Across 2.5 years, PTSD was shown to increase new onsets of LRS. Despite this evidence, significant gaps in our understanding of the comorbidity remain. In particular, all existing data about PTSD/LRS in WTC responders comes from traditional, clinic-based assessments. These require patients to recall symptoms weeks or months after they occurred, which introduces possible recall biases and conceals the daily prevalence and burden of the symptoms. Moreover, traditional assessments consider only average symptom levels, making it difficult to examine the real time dynamic between PTSD and LRS or to test possible biological pathways between them. PTSD has been linked with exaggerated response to stress and dysregulation of immune system, which may increase vulnerability to medical comorbidities, including pulmonary inflammation and respiratory problems. However, these hypothesized pathways have not been tested. The proposed study will address these gaps in our understanding of PTSD/LRS via ecological momentary assessments (EMA). Unlike traditional measures, EMA was designed specifically to provide data on daily fluctuations of symptoms and biomarkers in medical patients by sampling health status outside the clinic multiple times per day. We will use EMA with WTC responders to 1) establish the daily prevalence and burden of PTSD/LRS in an ecologically valid manner, 2) evaluate the temporal dynamics between PTSD and LRS in real time, testing whether occurrences of PTSD symptoms increase the probability of future LRS, 3) repeatedly sample biomarkers to test pathways linking physiologic stress response, immune dysregulation, and pulmonary inflammation to PTSD and LRS, and 4) evaluate the congruence of retrospective measures of PTSD and LRS with EMA-based estimates and recalibrate traditional clinical measures as needed. Results from the study will provide the first ecologically valid estimates of daily PTSD symptom and LRS prevalence in WTC responders, along with estimates of their burden in daily life. The study also will investigate the direction of PTSD-LRS link in real time and test biological mechanisms that may explain this relationship, which has not been attempted previously. Moreover, daily ambulatory sampling of pulmonary biomarkers will provide a novel perspective on respiratory health of responders. More valid estimates of symptom burden obtained in this study will inform both the policy for managing WTC-related conditions and provision of services to responders. The information on the temporal sequence and biological mediators will help to guide development of interventions to reduce PTSD and LRS burden in WTC-exposed and other traumatized populations.