213209 Co-Morbid Trends in Physical and Mental Health Symptoms in World Trade Center-Exposed Firefighters

Wednesday, November 11, 2009: 12:54 PM

Justin Niles, MA , Bureau of Health Services, Fire Department, New York City, Brooklyn, NY
Mayris P. Webber, DrPH , Bureau of Health Services, Fire Department, City of New York, Brooklyn, NY
Jackson Gustave, MPH , Bureau of Health Services, Fire Department, City of New York, Brooklyn, NY
Hillel W. Cohen, MPH, DrPH , Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
Kerry J. Kelly, MD , Bureau of Health Services, Fire Department, City of New York, Brooklyn, NY
David Prezant, MD , Bureau of Health Services, Fire Department, City of New York, New york, NY
Objective: To evaluate co-morbidity of World Trade Center (WTC)-related physical health symptoms and Post-Traumatic Stress Disorder (PTSD) in Fire Department, City of New York (FDNY) firefighters.

Methods: Firefighters were enrolled in the FDNY-WTC-Monitoring Program, which includes pulmonary function tests (PFTs) and health questionnaires. FDNY-defined PTSD required endorsement of both >9 of 14 symptoms and all DSM-IV-TRŪ domains (arousal, avoidance and re-experiencing). We evaluated WTC-related physical health symptoms in firefighters with and without PTSD and the relationship between endorsement of each DSM-IV-TRŪ PTSD domain and presence in the top quartile of physical symptom counts (TQ-PSC).

Results: 8.6% of 5,280 firefighters met our definition of PTSD within 1 year of 9/11; 10.3% did so 2-4 years later. In multivariable analysis, > 2 lower respiratory and >2 gastrointestinal symptoms were independently associated with PTSD (ORs 1.9 and 3.1, respectively). Endorsement of individual domains including arousal, avoidance and re-experiencing was associated with TQ-PSC (ORs 2.8, 2.0 and 1.6, respectively). Better pulmonary function was protective against TQ-PSC (OR 0.87).

Conclusions: We found concordance between PTSD and post-WTC physical symptoms at both time points. Because PTSD and physical symptoms were measured simultaneously, we could not determine directionality. However, PFT results were only associated with physical symptoms.

Learning Objectives:
Describe the relationship between PTSD and total WTC-related physical symptom count at two time points in WTC-exposed FDNY firefighters. Identify correlates of PTSD and top-quartile of physical symptom count (TQ-PSC) at each time point. Describe the relationship between pulmonary function test results, PTSD, and TQ-PSC at each time point.

Keywords: Asthma, Psychological Indicators

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted research reported.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.