Grief and health-related quality of life in WTCHR Survivors: Associations with bereavement, trauma exposures, and mental and physical health conditions

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Project Summary Survivors of sudden and violent deaths, such as those that occurred on 9/11, are at higher risk for prolonged grief disorder (PGD), in response to both that death and subsequent deaths. Despite World Trade Center Health Registry (WTCHR) Survivors’ high rates of knowing someone who died on 9/11, there has been minimal study of bereavement, trauma, and grief and their effects on health-related quality of life (HRQoL), including cognitive functioning, in this population while accounting for the effects of gender, race, and ethnicity. This proposal will first determine grief severity and the presence of self-reported threshold PGD in a representative sample of English- and Spanish-speaking WTCHR Survivors. Study findings will provide a greater understanding of grief severity/PGD among gender, ethnic, and racial groups and help to ensure that public health efforts reflect the needs of the diverse WTCHR Survivor community. This proposal will also examine the associations between bereavement and trauma with current grief severity, including PGD. Using existing WTCHR data regarding 9/11-related bereavement and trauma and newly- collected information pertaining to subsequent bereavement and trauma, as well as current grief, we will examine the complex inter-relationships among these variables to outline pathways of risk. We will also examine the impact of grief and these factors on HRQoL by determining how risk pathways and associations described above (bereavement burden, trauma burden, grief severity/PGD) extend to HRQoL, while also taking into account the effects of physical and mental health burden. As bereavement has been associated with impairment in various cognitive functions that affect daily functioning which have also been associated with quality of life, and cognitive impairments have been associated with WTC-exposure, we plan to assess cognitive difficulties as an additional aspect of HRQoL. The last aim of this project addresses reports that treatments for PTSD, depression, and anxiety disorder have not been readily available or accessed by WTCHR participants. Therefore, we will determine the extent to which individuals who are at risk for PGD are ready and able to access grief support within the community, and are satisfied with the support they receive. This proposal brings together an experienced multidisciplinary team of collaborators from the Center for the Study of Traumatic Stress at Uniformed Services University, the Center for Prolonged Grief at Columbia University, the WTCHR, and Voices of September 11, Inc., which has an established history, familiarity, and rapport with the 9/11 survivor community, as well as established working relationships with one another.