Predictors of PTSD and DPTSD after disaster: The impact of exposure and psychosocial resources

School of Social Welfare, Stony Brook University, Stony Brook, New York, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 08/2006; 194(7):485-93. DOI: 10.1097/01.nmd.0000228503.95503.e9
Source: PubMed


In the present study we sought to identify factors associated with posttraumatic stress disorder (PTSD) following the World Trade Center Disaster (WTCD) and examine changes in PTSD status over time. Our data come from a two-wave, prospective cohort study of New York City adults who were living in the city on September 11, 2001. We conducted a baseline survey 1 year after the attacks (year 1), followed by a survey 1 year later (year 2). Overall, 2368 individuals completed the year 1 survey, and 1681 were interviewed at year 2. Analyses for year 1 indicated that being younger, being female, experiencing more WTCD events, reporting more traumatic events other than the WTCD, experiencing more negative life events, having low social support, and having low self-esteem increased the likelihood of PTSD. For year 2, being middle-aged, being Latino, experiencing more negative life events and traumas since the WTCD, and having low self-esteem increased the likelihood of PTSD. Exposure to WTCD events was not related to year 2 PTSD once other factors were controlled. Following previous research, we divided study respondents into four categories: resilient cases (no PTSD years 1 or 2), remitted cases (PTSD year 1 but not year 2), delayed cases (no PTSD year 1 but PTSD year 2), and acute cases (PTSD both years 1 and 2). Factors predicting changes in PTSD between year 1 and year 2 suggested that delayed PTSD cases were more likely to have been Latino, to have experienced more negative life events, and to have had a decline in self-esteem. In contrast, remitted cases experienced fewer negative life events and had an increase in self-esteem. We discuss these findings in light of the psychosocial context associated with community disasters and traumatic stress exposures.

    • "These contribute to increased likelihood of PTSD (Adams and Boscarino, 2006), PTSD severity (Maes et al., 2001), and depression (Person et al., 2006). Negative life events have also been linked to an increase in workdays lost (Boscarino et al., 2006) and poorer mental health outcome (Adams et al., 2006). Long-standing psychosocial and personality issues that predate the disaster may confound the risk for experiencing negative life events after a disaster (North, 2003). "

    Psychiatry, 4th edited by A. Tasman, J. Leiberman, M. First, M. Riba eds, 07/2015: chapter 127: pages 2521-2532; Wiley.
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    • "The associations between PTSD and these stressful life events have been examined in several studies. For example, two prospective cohort studies involving the World Trade Center disaster showed that higher numbers of negative life events experienced before and after 9/11 were associated with PTSD among New York City adults and rescue, recovery, and clean-up employees on September 11, 2001 [6,7]. In several other prospective studies involving combat-related PTSD, pre-traumatic life events, such as multiple deployments, preparedness, unit cohesion, and post-traumatic life events (e.g., job loss, serious illness, and relationship and social difficulties) were predictors of PTSD onset [8-11]. "
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    ABSTRACT: Background It is debatable whether or not glucocorticoid receptor (GR) polymorphisms moderate susceptibility to PTSD. Our objective was to examine the effects of stressful life events, social support, GR genotypes, and gene-environment interactions on the etiology of PTSD.Methods Three tag single nucleotide polymorphisms, trauma events, stressful life events, and social support were assessed in 460 patients with PTSD and 1158 control subjects from a Chinese Han population. Gene¿environment interactions were analyzed by generalized multifactor dimensionality reduction (GMDR).ResultsVariation in GR at rs41423247 and rs258747, stressful life events, social support, and the number of traumatic events were each separately associated with the risk for PTSD. A gene¿environment interaction among the polymorphisms, rs41423247 and rs258747, the number of traumatic events, stressful life events, and social support resulted in an increased risk for PTSD. High-risk individuals (a large number of traumatic events, G allele of rs258747 and rs41423247, high level stressful life events, and low social support) had a 3.26-fold increased risk of developing PTSD compared to low-risk individuals. The association was statistically significant in the sub-groups with and without childhood trauma.Conclusions Our data support the notion that stressful life events, the number of trauma events, and social support may play a contributing role in the risk for PTSD by interacting with GR gene polymorphisms.
    BMC Psychiatry 08/2014; 14(1):232. DOI:10.1186/s12888-014-0232-9 · 2.21 Impact Factor
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    • "In this study, a dominant proportion of traditional responders and a majority of the non-traditional responders were males and whites, while the sociodemographic profiles of the civilian groups were more diverse. Studies have shown a general elevated prevalence in PTSD and other anxiety and mood symptoms among females compared to males and/or among Hispanic ethnicity [2][4][17][31][33][34]. Other studies have argued that concerns of repercussions could also lead to underreporting of mental health symptoms among police [35]. "
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    ABSTRACT: The World Trade Center (WTC) disaster on September 11, 2001 was an unprecedented traumatic event with long-lasting health consequences among the affected populations in the New York metropolitan area. This meta-analysis aimed to estimate the risk of probable posttraumatic stress disorder (PTSD) associated with specific types of WTC exposures. Meta-analytical findings from 10 studies of 3,271 to 20,294 participants yielded 37 relevant associations. The pooled summary odds ratio (OR) was 2.05 (95% confidence interval (CI): 1.82, 2.32), with substantial heterogeneity linked to exposure classification, cohort type, data source, PTSD assessment instrument/criteria, and lapse time since 9/11. In general, responders (e.g. police, firefighters, rescue/recovery workers and volunteers) had a lower probable PTSD risk (OR = 1.61; 95% CI: 1.39, 1.87) compared to civilians (e.g. residents, office workers, and passersby; OR = 2.71, 95% CI: 2.35, 3.12). The differences in ORs between responders and civilians were larger for physical compared to psychosocial exposure types. We also found that injury, lost someone, and witnessed horror were the three (out of six) most pernicious exposures. These findings suggest that these three exposures should be a particular focus in psychological evaluation and treatment programs in WTC intervention and future emergency preparedness efforts.
    PLoS ONE 07/2014; 9(7):e101491. DOI:10.1371/journal.pone.0101491 · 3.23 Impact Factor
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