New Research Explores Association Between PTSD and Lower Respiratory Symptoms in WTC Responders
A recent study published in March 2017 in the journal Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association entitled “Pathway From PTSD to Respiratory Health: Longitudinal Evidence From a Psychosocial Intervention” reviewed the connection between post-traumatic stress disorder (PTSD) and respiratory illness
The researchers note that respiratory illness and PTSD are common and incapacitating conditions that frequently occur together. The researchers pointed out that observational studies indicate that PTSD—independently of smoking—is considered a significant risk and maintenance factor for lower respiratory symptoms (LRS).
This new study experimentally tested this etiologic (study of causation) pathway by reviewing if treating the symptom of PTSD would reduce LRS. The participants were 90 daily smokers who were exposed to the World Trade Center (WTC) disaster and who were a mean age of 50 years old. Of this group, 28 percent were female and 68 percent were Caucasian. They all completed an eight-session group-based weekly comprehensive trauma management and smoking cessation treatment that focused on those skills needed to alleviate PTSD symptoms. LRS, PTSD symptoms, and smoking were assessed on a weekly basis. Data was then analyzed using multilevel models of within-person associations between LRS, PTSD symptoms, smoking, and treatment dose across the eight weekly sessions with outcomes that were delayed, or occurred at the same time.
The researchers discovered that the patient’s LRS improved significantly with treatment (a reduction of .50 standard deviations). Also, a reduction in PTSD symptoms exclusively predicted improvement in LRS at consecutive sessions one week apart, completely accounting for the treatment effect on LRS. The effect of PTSD symptoms was stronger than that of smoking and was the only effect to remain significant when both entered the research model. A reduction in LRS did not predict future improvement in the symptoms associated with PTSD symptoms, according to the study team.
The researchers concluded that, “The results are in line with the etiologic pathway suggesting that PTSD symptoms are a risk and maintenance factor for chronic LRS and that treatment of PTSD can help to alleviate LRS in trauma-exposed populations. PTSD is emerging as a novel and important treatment target for chronic respiratory problems.
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Prior Research Also Sees Ties Between PTSD and LRS in Trauma-Exposed People
Prior research published in the May of 2015 issue of Psychosomatic Medicine, which describes itself as “Dedicated to the Integration of Biological, Psychological, and Social Factors of Medicine,” was undertaken to determine if PTSD is tied with high medical morbidity. The study is entitled “Posttraumatic Stress Disorder and the Risk of Respiratory Problems in World Trade Center Responders: Longitudinal Test of a Pathway.”
The researchers discovered that, among responders to the WTC disaster, PTSD is highly comorbid with LRS, which could not be explained by exposure alone. The researchers indicated that they sought to review the link longitudinally to establish the direction of the effects and to evaluate potential pathways to comorbidity. Comorbidity is the simultaneous presence of two chronic diseases or conditions in a patient; longitudinal studies involve repeated observations of the same variables over long periods of time.
The research was comprised of 18,896 responders that included 8466 police and 10,430 non-traditional responders who participated in the WTC-Health Program and who were first evaluated between 2002 and 2010 and assessed again 2.5 years later. Medical staff, abnormal pulmonary function by spirometry, and probable WTC-related PTSD with a symptom inventory determined the LRS diagnosis.
Study results fount that, in both groups of responders, initial PTSD and abnormal pulmonary function (predicted LRS 2.5 years later after controlling for initial LRS and covariates. At follow-up, LRS onset was 2.0 times likelier and remission was 1.8 times less likely in responders with initial PTSD than in responders without. PTSD mediated, in part, the link between WTC exposures and development of LRS and initial LRS and abnormal pulmonary function did not consistently predict PTSD onset.
The study authors concluded that the analyses provided further evidence that PTSD is a risk factor for respiratory symptoms and are consistent with evidence implicating physiological dysregulation tied with PTSD in the development of medical conditions. If these effects are verified experimentally, treatment of PTSD may prove helpful in managing physical and mental health of disaster responders.
“The Daily Burden of PTSD and Respiratory Problems in World Trade Center Responders.” The study information indicates that comorbid PTSD and LRS are among the most common and persistent health issue faced by WTC responders following the 9/11 terrorist attacks. For the first time, this proposed study will use an ecological momentary assessment approach to survey WTC responders in real time concerning the prevalence, burden, and sequence of PTSD and LRS, as well as to test biological processes involved.
According to the study information, WTC disaster responders exhibit persistent symptoms of PTSD and respiratory illness that is associated with the severity of exposure. Approximately 25 percent of the responders impacted by these conditions are diagnosed with both disorders, which results in increased disability and utilization of medical services. This research will examine possible mechanisms underlying PTSD/respiratory co-morbidity that may help in the development of more effective, theory-driven interventions for challenging-to-treat patients.
Study information indicates that, due to their toxic exposure at the World Trade Center, responders exhibit ongoing symptoms consistent with PTSD and respiratory illness. The overall study goal is to clarify the mechanisms that tie PTSD and LRS in WTC responders and expect to recruit 400 responders for genetic analysis and that this information will lead to new diagnostic and therapeutic approaches to diseases associated with the WTC disaster.
The study impact statement indicates that, “Our research program has shown that mental and physical health have walked arm-in-arm throughout the 12 years since 9/11. For WTC responders, PTSD and lower respiratory distress are particularly impacted. One reason is that both conditions arose from the horrific environmental and psychological exposures at the WTC site. Another reason, as our work suggests, is that these exposures led to basic biological changes that impact both mental and physical health…. The lesson learned is that adequate medical care requires an integrated approach that treats both the mind and the body simultaneously.”
Meanwhile, as far back as 2004, The American Journal of Psychiatry published a study entitled “Post-traumatic Stress Disorder and Health-Related Quality of Life in Long-Term Survivors of Acute Respiratory Distress Syndrome” that concluded that “Long-term survivors of acute respiratory distress syndrome seem to face a major risk of PTSD and major impairments in health-related quality of life in the long term.”
Legal Help for 9/11 Responders and Survivors
Parker Waichman is proud to have fought alongside Ground Zero residents, workers, first responders, and other survivors and advocates, to help ensure passage of Zadroga Act amendments. The firm vows to continue its efforts to safeguard all those who were exposed to Ground Zero’s toxic cloud and the trauma of the attacks, and ensure that all the deserved Zadroga Act compensation is received. To determine eligibility for compensation under the Act, fill out our online form or call 1-800-YOURLAWYER (1-800-968-7529).