title: Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster.
abstract: Many studies report elevated prevalence of posttraumatic stress disorder (PTSD) and depression among persons exposed to the September 11, 2001 (9/11) disaster compared to those unexposed; few have evaluated long-term PTSD with comorbid depression. We examined prevalence and risk factors for probable PTSD, probable depression, and both conditions 10-11 years post-9/11 among 29,486 World Trade Center Health Registry enrollees who completed surveys at Wave 1 (2003-2004), Wave 2 (2006-2007), and Wave 3 (2011-2012). Enrollees reporting physician diagnosed pre-9/11 PTSD or depression were excluded. PTSD was defined as scoring ≥ 44 on the PTSD Checklist and depression as scoring ≥ 10 on the 8-item Patient Health Questionnaire. We examined 4 groups: comorbid PTSD and depression, PTSD only, depression only, and neither. Among enrollees, 15.2% reported symptoms indicative of PTSD at Wave 3, 14.9% of depression, and 10.1% of both. Comorbid PTSD and depression was associated with high 9/11 exposures, low social integration, health-related unemployment, and experiencing ≥ 1 traumatic life event post-9/11. Comorbid persons experienced poorer outcomes on all PTSD-related impairment measures, life satisfaction, overall health, and unmet mental health care need compared to those with only a single condition. These findings highlight the importance of ongoing screening and treatment for both conditions, particularly among those at risk for mental health comorbidity.
authors.affiliation: New York City Department of Health and Mental Hygiene, Long Island City, New York, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Caramanica
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.forename: Tim
authors.initials: T
authors.lastname: Liao
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D060731:Emergency Responders / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000600:supply & distribution; D008875:Middle Aged; D020380:Needs Assessment; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D013995:Time; D055815:Young Adult