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

描述（由申请人提供）：在9/11袭击世界贸易中心（WTC）之后，超过60，000人参加了救援，恢复和清理工作。这些人中的许多人现在面临身心健康问题，高达60%的人报告有创伤后应激障碍（PTSD）或下呼吸道症状（LRS）。此外，PTSD和LRS之间的共同发生率高于共同风险因素（如WTC相关暴露）所能解释的。在2.5年的时间里，PTSD被证明会增加LRS的新发病例。尽管有这些证据，我们对科摩罗的理解仍然存在重大差距。特别是，所有关于WTC应答者PTSD/LRS的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数周或数月后回忆症状，这可能会引入回忆偏差，并掩盖症状的日常流行和负担。此外，传统的评估只考虑平均症状水平，这使得难以检查PTSD和LRS之间的真实的时间动态或测试它们之间可能的生物学途径。PTSD与对压力的过度反应和免疫系统的失调有关，这可能会增加对医学合并症的脆弱性，包括肺部炎症和呼吸系统问题。然而，这些假设的途径还没有被测试。拟议的研究将通过生态瞬时评估（EMA）来解决我们对PTSD/LRS理解的这些差距。与传统的测量方法不同，EMA是专门设计的，通过每天多次在诊所外对健康状况进行采样，来提供关于内科患者症状和生物标志物的每日波动数据。我们将使用EMA与WTC应答者1）以生态有效的方式建立PTSD/LRS的每日患病率和负担，2）在真实的时间内评估PTSD和LRS之间的时间动态，测试PTSD症状的发生是否增加未来LRS的概率，3）重复采样生物标志物以测试将生理应激反应、免疫失调和肺部炎症与PTSD和LRS联系起来的途径，4）评估PTSD和LRS的回顾性测量与基于EMA的估计的一致性，并根据需要重新校准传统的临床测量。这项研究的结果将提供第一个生态有效的估计日常创伤后应激障碍症状和LRS患病率在世贸中心反应，沿着与估计他们的负担在日常生活中。该研究还将调查PTSD-LRS联系在真实的时间的方向，并测试可能解释这种关系的生物学机制，这是以前没有尝试过的。此外，每日动态采样的肺部生物标志物将提供一个新的角度对呼吸健康的反应。本研究中获得的症状负担的更有效估计将为管理WTC相关条件和向响应者提供服务的政策提供信息。时间顺序和生物介质的信息将有助于指导干预措施的发展，以减少创伤后应激障碍和LRS的负担在WTC暴露和其他创伤人群。

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.