[Show abstract][Hide abstract] ABSTRACT: Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11.
Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self-report measures. PTSD symptoms were assessed by the CAPS and the PCL; co-morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses.
Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to one's life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both.
Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers.
Depression and Anxiety 03/2011; 28(3):210-7. DOI:10.1002/da.20776 · 4.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Empirical evidence suggests that social and occupational disability plays a significant role in posttraumatic stress disorder (PTSD). The purpose of this study was to assess the role of social/occupational disability and to identify predictors of the development of PTSD in a group of disaster relief workers (DRWs) who had been deployed to the World Trade Center (WTC) following September 11, 2001. Eight hundred forty-two utility workers completed a battery of comprehensive tests measuring PTSD and social occupational functioning. Results indicated a significant association between PTSD symptoms and impaired social/occupational functioning. Symptomatic workers were also more likely to have a history of trauma, panic disorder, and depression. Those with a history of trauma, depression, generalized anxiety disorder or panic reported significantly more disability than those without a psychiatric history. Careful screening of PTSD and social/occupational functioning in DRWs following a disaster is warranted so that early treatment can be undertaken to prevent a chronic and disabling course.
[Show abstract][Hide abstract] ABSTRACT: Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 () indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.
The Journal of nervous and mental disease 12/2008; 196(11):844-6. DOI:10.1097/NMD.0b013e31818b492c · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC)--and posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that, of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.
[Show abstract][Hide abstract] ABSTRACT: This preliminary study endeavored to evaluate the use of virtual reality (VR) enhanced exposure therapy for the treatment of posttraumatic stress disorder (PTSD) consequent to the World Trade Center attacks of September 11, 2001.
Participants were assigned to a VR treatment (N = 13) or a waitlist control (N = 8) group and were mostly middle-aged, male disaster workers. All participants were diagnosed with PTSD according to DSM-IV-TR criteria using the Clinician-Administered PTSD Scale (CAPS). The study was conducted between February 2002 and August 2005 in offices located in outpatient buildings of a hospital campus.
Analysis of variance showed a significant interaction of time by group (p < .01) on CAPS scores, with a between-groups posttreatment effect size of 1.54. The VR group showed a significant decline in CAPS scores compared with the waitlist group (p < .01).
Our preliminary data suggest that VR is an effective treatment tool for enhancing exposure therapy for both civilians and disaster workers with PTSD and may be especially useful for those patients who cannot engage in imaginal exposure therapy.
The Journal of Clinical Psychiatry 11/2007; 68(11):1639-47. DOI:10.4088/JCP.v68n1102 · 5.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined whether male disaster workers with Vietnam service histories were at risk for posttraumatic stress disorder when compared with colleagues following duties at Ground Zero. The study compared participants from ongoing psychiatric screening of disaster workers: those with Vietnam service (Vietnam veteran; N = 125), those without trauma history (no trauma; N = 116); and those with childhood physical abuse but no combat history (physical abuse; N = 57). ANOVA indicated the trauma groups differed significantly in clinician-rated posttraumatic stress disorder severity (p < 0.005). However, post hoc analyses revealed the Vietnam veteran group did not differ significantly from the no trauma group; both had significantly lower severity compared with the physical abuse group. It should be noted that veterans in this sample, unlike in many studies, were in the workforce. Research with different veteran groups is warranted to clarify further the relation of combat experience and symptoms in disaster workers.
[Show abstract][Hide abstract] ABSTRACT: This study examined male utility disaster workers' responses to referral for trauma-specific psychotherapy. Among 328 workers offered referral for symptoms related to the World Trade Center (WTC) attacks during psychological screening, approximately 48% chose to accept, 28% chose to consider only, and 24% chose to decline. Analyses examined predisposing factors, i.e., age, race/ethnicity, marital status, education, previous mental health treatment, and previous disorder; as well as illness level; i.e., posttraumatic stress disorder (PTSD), depression, and general psychiatric distress; current treatment; and time of referral as predictors of referral response. PTSD (specifically reexperiencing and hyperarousal symptoms), depressive symptoms, and previous mental health treatment were positively associated with workers' accepting referral. Implications and limitations of these findings are discussed.
[Show abstract][Hide abstract] ABSTRACT: Empirical evidence suggests that anger plays a significant role in posttraumatic stress disorder (PTSD) and may impede recovery from traumatic events. The purpose of this study was to assess the role of anger and its relationship to distress and social/occupational functioning in disaster relief workers (DRWs) who had PTSD symptoms who were deployed to the World Trade Center after September 11, 2001. Six hundred twenty-six utility workers (96% male) completed measures of anger, distress, PTSD severity, and social/occupational functioning. Results indicated that anger was significantly higher in DRWs who had PTSD symptoms than in those who did not, and statistically significant associations were found among anger, distress, PTSD severity, and social/occupational functioning in workers who had PTSD symptoms. Careful assessment of anger in DRWs exposed to traumatic events is warranted as well as longitudinal studies to further understand the relationship between anger and PTSD.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the association between coping strategies and reports of with pain and distress in patients with HIV-related peripheral neuropathy. Seventy-eight HIV seropositive subjects completed the Coping Strategies Questionnaire (CSQ), a self-report measure that assesses seven factors, the Brief Pain Inventory (BPI), the Brief Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Bivariate correlations revealed that younger patients used more Praying-Hoping (r=-.23, p<.04) and Catastrophizing (r=-.30, p<.007). t-tests demonstrated that women used more Praying-Hoping (t(76) = 3.42, p<.01), while Hispanic and African American patients used more Praying-Hoping more than Caucasians (F (1,77) = 22.11, p=.0005). Catastrophizing significantly predicted higher scores on the BDI (t=2.968, p=.004), the Global Severity Index (GSI) of the Brief Symptom Inventory BSI (t=2.400, p=.02); and pain interference on the Brief Pain Inventory BPI (t=2.996, p=.004) controlling for age, gender, and ethnic background. These results demonstrate that coping strategies may differ according to age, gender, and ethnic background in an HIV population, and that Catastrophizing predicts distress and interference with functioning in this sample.
AIDS Care 08/2005; 17(6):711-20. DOI:10.1080/09540120412331336715 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined treatment utilization in disaster workers deployed to the World Trade Center (WTC) during or after the terrorist attacks of September 11, 2001. Among 174 workers who accepted psychotherapy referrals following psychiatric screening for WTC-related symptoms, 74 (42.5%) attended at least one session, while 100 (57.5%) chose not to attend at all. The study assessed whether treatment utilization was associated with sociodemographic background, trauma history, psychiatric history, WTC attack exposure, diagnoses, or symptom severity. Analyses indicated that, of study variables, race/ethnicity and clinician-rated Post Traumatic Stress Disorder (PTSD) symptom severity distinguished workers who utilized treatment from those who did not. Implications for outreach and referral are discussed.
International journal of emergency mental health 02/2005; 7(2):91-9.
[Show abstract][Hide abstract] ABSTRACT: The objective of this paper was to identify predictors of attrition in a study designed to assess whether cognitive behavioural therapy (CBT) was more helpful than supportive therapy (SP) in reducing pain associated with peripheral neuropathy in HIV-positive patients. Sixty-one subjects were randomized into either CBT or SP for six weekly one-hour sessions. Twenty-eight subjects dropped out before week six. Demographic variables such as age, gender, ethnicity, socioeconomic status and level of education were not predictive of attrition. However, higher scores on the Hamilton Depression Inventory (HAM-D, 17-item) (t (59) = - 0.09, p<0.05) were predictive. These findings suggest that while dropouts were not more physically ill (e.g. CD4 counts, viral loads and opportunistic infections were not statistically higher), they reported greater psychological distress.
AIDS Care 04/2004; 16(3):395-402. DOI:10.1080/09540120410001665394 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A growing body of literature suggests that negative thoughts and interpretations in response to pain can significantly increase the suffering associated with the pain experience. As part of an outcome study on a cognitive-behavioral treatment for HIV-related peripheral neuropathic pain, 85 seropositive men and women were administered the inventory of negative thoughts in response to pain (INTRP), a self-report assessment that includes three subscales: negative self-statements, negative social cognitions and self-blame. Pearson product moment correlations coefficients were calculated between INTRP scores and pain and distress ratings. A series of regression analyses were performed to determine predictors of pain and distress. Results demonstrated highly significant associations between the negative self-statements and negative social cognitions and pain intensity. Highly significant associations were also found between negative self-statements, negative social cognitions, self-blame and measures of pain interference, affective symptoms and distress. Additionally, negative cognitions significantly predicted interference in daily functional activities, overall distress and affective symptoms. Future directions for developing and testing cognitive-behavioral treatments for restructuring dysfunctional cognitions are indicated. Finally, internal scale reliability of the INTRP was shown to be moderately high and this study offers construct validity of the INTRP as a useful tool for assessing thoughts in response to pain in people with HIV.
[Show abstract][Hide abstract] ABSTRACT: The feasibility and acceptability of cognitive behavior therapy for HIV-related peripheral neuropathic pain was examined and the potential efficacy of the intervention was compared with that of supportive psychotherapy in reducing pain, pain-related interference with functioning, and distress. Sixty-one patients were randomly assigned to receive six weekly sessions of cognitive behavior therapy or supportive psychotherapy. Thirty-three subjects completed the protocol. Both groups showed significant reductions in pain. The cognitive behavior group improved in most domains of pain-related functional interference and distress; the supportive psychotherapy group showed fewer gains. The high dropout rate suggests that psychotherapeutic treatments for HIV-related pain may have limited feasibility and acceptability.
[Show abstract][Hide abstract] ABSTRACT: The authors evaluated personality disorder symptoms as predictors of change in global functioning and quality of life among elderly depressed patients. Treated elderly patients (N=40) who no longer met RDC criteria for major depression were assessed for personality disorders, depression, global functioning, and quality of life after treatment of the acute episode and at 1-year follow-up. In interaction with persisting or recurrent depression, Cluster B personality disorder symptoms contributed to declines in global functioning and quality of life over a 1-year period. Personality disorder symptoms in elderly patients appear to operate as co-factors that amplify or exacerbate the impact of residual depression on long-term functioning and quality of life.
American Journal of Geriatric Psychiatry 02/2001; 9(1):67-71. DOI:10.1097/00019442-200102000-00010 · 3.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few data address the relationship between ethnic status and psychotherapy outcome. This study reports data from a four-cell, 16-week controlled clinical trial for HIV-positive patients with depressive symptoms. Patients (N = 101) were randomized to 16 weeks of treatment with interpersonal psychotherapy, cognitive-behavioral therapy (CBT), supportive psychotherapy, or imipramine plus supportive psychotherapy. Analyses found an ethnicity-by-treatment interaction wherein African-American subjects (n = 18) assigned to CBT (n = 4) had significantly poorer outcomes than other patients. This is the first study to uncover an ethnicity-by-specific psychotherapy interaction. Its meaning is unclear. This charged topic requires cautious treatment, particularly given the small sample size in this study, but warrants further research.
The Journal of psychotherapy practice and research 02/2000; 9(4):226-31.
[Show abstract][Hide abstract] ABSTRACT: This study seeks to determine how panic disorder patients with anxiety and depression comorbidity differ from panic disorder patients without comorbidity at the time of presentation for treatment. One-hundred seventy-one panic disorder patients presenting for their initial assessment and treatment at the Payne Whitney Anxiety Disorders Clinic agreed to participate and completed self-report and diagnostic assessments. Sixty-seven percent of panic disorder subjects were found to have at least one comorbid anxiety or depression diagnosis. Age and gender ratio were not affected by the presence of comorbid diagnoses. Comorbidity significantly contributed to psychological distress and symptom load, overall impairment, and interpersonal impairment.
Depression and Anxiety 01/2000; 12(2):78-84. DOI:10.1002/1520-6394(2000)12:2<78::AID-DA3>3.0.CO;2-5 · 4.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adherence monitoring, a technology to specify research psychotherapies, was used in the NIMH Treatment of Depression Collaborative Research Program (TDCRP). The authors present adherence data from a similar randomized treatment trial of 56 depressed HIV-positive patients, comparing 16-week interventions with cognitive-behavioral therapy, interpersonal psychotherapy, and supportive psychotherapy alone or with imipramine. Therapists were certified in manualized treatments. Blind independent raters rated randomly selected taped sessions on an adaptation of the NIMH scale, yielding adherence scores for interventions and for therapist "facilitative conditions" (FC). All therapists were rated adherent. Interrater reliability was 0.89-0.99. The scale discriminated among the four treatments (P<0.0001), with each scoring highest on its own scale. FC, which might measure therapist competence independent of treatment technique, varied by intervention but did not predict treatment outcome. This study demonstrates the ability to reliably train adherence monitors and therapists able to deliver specified treatments. Its adherence findings provide the first replication of those from the landmark NIMH TDCRP study.
The Journal of psychotherapy practice and research 01/2000; 9(2):75-80.
[Show abstract][Hide abstract] ABSTRACT: This study compares the efficacy of two time-limited group psychotherapies for depression and functional disability in late life. Goal-focused group psychotherapy (GFGP) utilized focused psychoeducation and skills training to assist each patient in the achievement of individualized goals. Reminiscence therapy (RT) emphasized individual life review to facilitate discussion. Subjects (N = 13), ages 55 and above, with major depression were randomly assigned to one of the two groups. Most were receiving antidepressant treatment. All had failed to achieve full remission. Whereas both treatment groups improved in depressed mood and disability, GFGP subjects had a far greater change in depressive symptomatology and also improved in the areas of hope, hopelessness, anxiety and social functioning.
International Journal of Geriatric Psychiatry 11/1998; 13(10):707-16. DOI:10.1002/(SICI)1099-1166(1998100)13:103.0.CO;2-Q · 3.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms.
Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored.
Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample.
Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.
Archives of General Psychiatry 06/1998; 55(5):452-7. DOI:10.1001/archpsyc.55.5.452 · 13.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors evaluated the relationship of personality disorder symptoms to disability and social and interpersonal functioning in geriatric depression. Measures of personality disorder and cognitive, affective, social, interpersonal, medical, socioeconomic factors, and instrumental activities of daily living (IADL) status were administered to 47 elderly patients at various levels of remission from major depression. Total personality disorder scores were inversely associated with IADL, sociability, and presence of a satisfying relationship, both alone and in interaction with depression. The associations between personality disorder and functioning were most prominent in subjects with low residual depression. Symptoms of personality disorder in elderly patients may be associated with disability and impaired social and interpersonal functioning after an acute depressive episode; personality disorder symptoms may also have treatment implications for geriatric depression.
American Journal of Geriatric Psychiatry 02/1998; 6(1):24-30. DOI:10.1097/00019442-199802000-00004 · 3.52 Impact Factor