I Mindlis1, E Morales-Raveendran1, E Goodman1, K Xu1, C Vila-Castelar2,3, K Keller1, G Crawford1, S James1, C L Katz4, L E Crowley5, R E de la Hoz1,6, S Markowitz3, J P Wisnivesky1,6. 1. a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA. 2. b The Graduate Center, City University of New York , New York , NY , USA. 3. c Queens College, City University of New York , Flushing , NY , USA. 4. d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA. 5. e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA. 6. f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.
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.
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: M C Zanarini; A E Skodol; D Bender; R Dolan; C Sanislow; E Schaefer; L C Morey; C M Grilo; M T Shea; T H McGlashan; J G Gunderson Journal: J Pers Disord Date: 2000
Authors: Robert M Brackbill; James L Hadler; Laura DiGrande; Christine C Ekenga; Mark R Farfel; Stephen Friedman; Sharon E Perlman; Steven D Stellman; Deborah J Walker; David Wu; Shengchao Yu; Lorna E Thorpe Journal: JAMA Date: 2009-08-05 Impact factor: 56.272
Authors: Rafael E de la Hoz; Yunho Jeon; Gregory E Miller; Juan P Wisnivesky; Juan C Celedón Journal: Am J Respir Crit Care Med Date: 2016-12-01 Impact factor: 21.405
Authors: Camilo J Ruggero; Roman Kotov; Jennifer L Callahan; Jared N Kilmer; Benjamin J Luft; Evelyn J Bromet Journal: Psychiatry Res Date: 2013-09-21 Impact factor: 3.222
Authors: L Keoki Williams; Christine L Joseph; Edward L Peterson; Karen Wells; Mingqun Wang; Vimal K Chowdhry; Matthew Walsh; Janis Campbell; Cynthia S Rand; Andrea J Apter; David E Lanfear; Kaan Tunceli; Manel Pladevall Journal: J Allergy Clin Immunol Date: 2007-10-22 Impact factor: 10.793
Authors: Belen Rojano; Erin West; Emily Goodman; Jeffrey J Weiss; Rafael E de la Hoz; Michael Crane; Laura Crowley; Denise Harrison; Steven Markowitz; Juan P Wisnivesky Journal: J Asthma Date: 2018-07-09 Impact factor: 2.515
Authors: Juan P Wisnivesky; Jacqueline H Becker; Jyoti Ankam; Steven B Markowitz; Molly Doernberg; Brittany Dickens; Paula Busse; Laura Crowley; Alex Federman; Craig Katz; Jeffrey J Weiss; Adam Gonzalez Journal: J Allergy Clin Immunol Pract Date: 2021-09-14
Authors: Jordana L Sommer; Renée El-Gabalawy; Tamara Taillieu; Tracie O Afifi; R Nicholas Carleton Journal: Can J Psychiatry Date: 2020-04-10 Impact factor: 4.356
Authors: Belen Rojano; Erin West; Emily Ferdermann; Steven Markowitz; Denise Harrison; Laura Crowley; Paula Busse; Alex D Federman; Juan P Wisnivesky Journal: Int J Environ Res Public Health Date: 2019-03-01 Impact factor: 3.390