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

项目摘要 突然和暴力死亡的幸存者，如9/11事件中的幸存者， 悲伤障碍（PGD），对死亡和随后的死亡都有反应。尽管世界贸易中心 健康登记处（WTCHR）幸存者认识9/11死亡的人的比例很高， 对丧亲之痛、创伤和悲伤及其对健康相关生活质量（HRQoL）的影响进行最小限度的研究， 包括认知功能，同时考虑性别、种族和民族的影响。 这项建议将首先确定悲伤的严重程度和自我报告的阈值PGD的存在， 讲英语和西班牙语的WTTERA幸存者的代表性样本。研究结果将提供一个 更好地了解性别、民族和种族群体之间的悲伤严重程度/PGD，并有助于确保 公共卫生工作反映了不同的WTTERA幸存者社区的需求。 这项提案还将研究丧亲之痛和创伤与当前悲伤严重程度之间的联系， 包括PGD。利用现有的WTMENTOS数据，关于9/11相关的丧亲和创伤，以及新的- 收集有关随后的丧亲之痛和创伤的信息，以及当前的悲伤，我们将 研究这些变量之间复杂的相互关系，以概述风险的途径。我们还将 通过确定风险途径和关联，检查悲伤和这些因素对HRQoL的影响 上述（丧亲负担，创伤负担，悲伤严重程度/PGD）扩展到HRQoL，同时还 考虑到身心健康负担的影响。因为丧亲之痛 影响日常功能的各种认知功能障碍， 生活质量和认知障碍与WTC暴露有关，我们计划评估 认知困难作为HRQoL的附加方面。本项目的最后一个目标是处理报告， 创伤后应激障碍、抑郁症和焦虑症的治疗方法还没有现成的， WTTT参与者。因此，我们将确定处于PGD风险中的个体在多大程度上 准备好并能够在社区内获得悲伤支持，并对他们获得的支持感到满意。 该提案汇集了来自该中心的经验丰富的多学科合作者团队， 创伤压力研究在制服服务大学，中心延长悲伤在哥伦比亚 大学、世贸组织和9月11日之声，它有一个既定的历史，熟悉， 与9/11幸存者社区保持融洽关系，并相互建立工作关系。

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.