title: Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers.
abstract: OBJECTIVE
  Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity.
  
  
  METHODS
  Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures.
  
  
  RESULTS
  Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons).
  
  
  CONCLUSIONS
  There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: I
authors.initials: I
authors.lastname: Mindlis
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: E
authors.initials: E
authors.lastname: Morales-Raveendran
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: E
authors.initials: E
authors.lastname: Goodman
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: K
authors.initials: K
authors.lastname: Xu
authors.affiliation: b The Graduate Center, City University of New York , New York , NY , USA.|c Queens College, City University of New York , Flushing , NY , USA.
authors.forename: C
authors.initials: C
authors.lastname: Vila-Castelar
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: K
authors.initials: K
authors.lastname: Keller
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: G
authors.initials: G
authors.lastname: Crawford
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: S
authors.initials: S
authors.lastname: James
authors.affiliation: d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Katz
authors.affiliation: e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Crowley
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.|f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: R E
authors.initials: RE
authors.lastname: de la Hoz
authors.affiliation: c Queens College, City University of New York , Flushing , NY , USA.
authors.forename: S
authors.initials: S
authors.lastname: Markowitz
authors.affiliation: a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.|f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D001249:Asthma / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D018635:Rescue Work / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D047851:September 11 Terrorist Attacks; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
keywords: 9/11; Asthma; PTSD; WTC; asthma management; asthma morbidity; asthma outcomes; stress; sub-threshold PTSD; trauma