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Comorbid persistent lower respiratory symptoms and posttraumatic stress disorder 5–6 years post-9/11 in responders enrolled in the World Trade Center Health Registry

Authors

  • Dr. Stephen M. Friedman MD, MPH,

    Corresponding author
    • Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
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  • Mark R. Farfel ScD,

    1. Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
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  • Carey B. Maslow DrPH,

    1. Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
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  • James E. Cone MD, MPH,

    1. Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
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  • Robert M. Brackbill PhD, MPH,

    1. Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
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  • Steven D. Stellman PhD, MPH

    1. Division of Epidemiology, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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  • The authors wish to express their thanks to Dr. Sukhminder Osahan for his careful review of the manuscript, to Drs. Carolyn Greene and James Hadler for their thoughtful review and editing, and to Ms. Margaret Millstone and Ms. Rhoda Schlamm for their precise editing.
  • Disclosure Statement: The authors report no conflicts of interests.

Correspondence to: Dr. Stephen M. Friedman, MD, MPH, New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, 07-127 Long Island City, NY 11101. E-mail: sfriedm2@health.nyc.gov

Abstract

Background

Co-occurrence of lower respiratory symptoms (LRS) and posttraumatic stress disorder (PTSD) has been increasingly recognized among responders and survivors of the World Trade Center (WTC) disaster. Information is limited on the degree which comorbidity intensifies symptoms and compromises quality of life across exposed groups.

Methods

Among responders who completed the first and second Registry surveys, measures of respiratory illness, psychological distress, and diminished quality of life were compared between responders comorbid for LRS and PTSD and responders with only LRS or PTSD.

Results

Of 14,388 responders, 40% of those with LRS and 57% of those with PTSD were comorbid. When demographic and WTC exposure-related factors were controlled, comorbid responders compared to those with LRS alone were twice as likely to have frequent dyspnea and to have sought care for dyspnea. Compared to responders with PTSD alone, comorbid responders were 2.1 times more likely to report intense re-experiencing of the disaster, 2.5 times more likely to express feelings of significant non-specific psychological distress, and 1.4 times more likely to have received mental health care. Comorbid responders were approximately three times more likely to report only fair or poor general health and more than twice as likely to report being unable to perform usual activities for ≥14 of 30 days before interview.

Conclusions

Outcomes in comorbid responders were similar to or more severe than in comorbid survivors. Health care and disaster relief providers must suspect comorbid illness when evaluating responders' respiratory or mental illnesses and consider treatment for both. Am. J. Ind. Med. 56:1251–1261, 2013. © 2013 Wiley Periodicals, Inc.

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