title: Elevated C-reactive protein and posttraumatic stress pathology among survivors of the 9/11 World Trade Center attacks.
abstract: Systemic inflammation has emerged as a promising marker and potential mechanism underlying post-traumatic stress disorder (PTSD). The relationship between posttraumatic stress pathology and systemic inflammation has not, however, been consistently replicated and is potentially confounded by comorbid illness or injury, common complications of trauma exposure.
  
  
  
  We analyzed a large naturalistic cohort sharing a discrete physical and mental health trauma from the destruction of the World Trade Center (WTC) towers on September 11, 2001 (n = 641). We evaluated the relationship between multiple physical and mental health related indices collected through routine evaluations at the WTC Environmental Health Center (WTC EHC), a treatment program for community members exposed to the disaster. C-Reactive Protein (CRP), a marker of systemic inflammation, was examined in relation to scores for PTSD, PTSD symptom clusters (re-experiencing, avoidance, negative cognitions/mood, arousal), depression and anxiety, while controlling for WTC exposures, lower respiratory symptoms, age, sex, BMI and smoking as potential risks or confounders.
  
  
  
  CRP was positively associated with PTSD severity (p < 0.001), trending toward association with depression (p = 0.06), but not with anxiety (p = 0.27). CRP was positively associated with re-experiencing (p < 0.001) and avoidance (p < 0.05) symptom clusters, and trended toward associations with negative cognitions/mood (p = 0.06) and arousal (p = 0.08).
  
  
  
  In this large study of the relationship between CRP and posttraumatic stress pathology, we demonstrated an association between systemic inflammation and stress pathology (PTSD; trending with depression), which remained after adjusting for potentially confounding variables. These results contribute to research findings suggesting a salient relationship between inflammation and posttraumatic stress pathology.
authors.affiliation: NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States. Electronic address: RebeccaLRosen@nyumc.org.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Rosen
authors.affiliation: NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States.
authors.forename: Nomi
authors.initials: N
authors.lastname: Levy-Carrick
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Environmental Medicine, 550 First Ave, New York, NY 10016, United States.
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
authors.affiliation: NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States.
authors.forename: Ning
authors.initials: N
authors.lastname: Xu
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States.
authors.forename: Yongzhao
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States.
authors.forename: Mengling
authors.initials: M
authors.lastname: Liu
authors.affiliation: NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ferri
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Kazeros
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States.
authors.forename: Caralee E
authors.initials: CE
authors.lastname: Caplan-Shaw
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Medicine, 550 First Ave, New York, NY 10016, United States.
authors.forename: Deepak R
authors.initials: DR
authors.lastname: Pradhan
authors.affiliation: Health and Hospitals World Trade Center Environmental Health Center, Bellevue Hospital Center, Ambcare 2E, 462 First Ave, New York, NY 10016, United States; NYU School of Medicine, Department of Population Health, 650 First Ave, Fifth Floor, New York, NY 10016, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Marmor
authors.affiliation: NYU School of Medicine, Department of Psychiatry, 550 First Ave, New York, NY 10016, United States; Steven and Alexandra Cohen Veteran's Center, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, United States.
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Galatzer-Levy
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000378:metabolism* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Depression; PTSD; Systemic inflammation; Trauma; World Trade Center