Lupo Geronazzo-Alman1, Ruth Eisenberg2, Sa Shen3, Cristiane S Duarte4, George J Musa5, Judith Wicks6, Bin Fan7, Thao Doan8, Guia Guffanti9, Michaeline Bresnahan10, Christina W Hoven11. 1. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: geronazl@nyspi.columbia.edu. 2. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: eisenbe@nyspi.columbia.edu. 3. The Center on Health, Aging, and Disability, University of Illinois at Urbana-Champaign, 1206 South 4th Street, Champaign, IL. Electronic address: sashen2@illinois.edu. 4. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: DuarteC@nyspi.columbia.edu. 5. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: MUSAG@nyspi.columbia.edu. 6. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: WicksJ@nyspi.columbia.edu. 7. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: fanb@nyspi.columbia.edu. 8. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: DoanT@nyspi.columbia.edu. 9. Department of Psychiatry, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478.. Electronic address: gguffantimasetti@mclean.harvard.edu. 10. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: bresnah@nyspi.columbia.edu. 11. Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032. Electronic address: HOVEN@nyspi.columbia.edu.
Abstract
BACKGROUND AND OBJECTIVES: Cumulative exposure to work-related traumatic events (CE) is a foreseeable risk for psychiatric disorders in first responders (FRs). Our objective was to examine the impact of work-related CE that could serve as predictor of posttraumatic stress disorder (PTSD) and/or depression in FRs. DESIGN: Cross-sectional examination of previous CE and past-month PTSD outcomes and depression in 209 FRs. METHODS: Logistic (probable PTSD; probable depression) and Poisson regressions (PTSD score) of the outcomes on work-related CE indexes, adjusting for demographic variables. Differences across occupational groups were also examined. Receiver operating characteristic analysis determined the sensitivity and specificity of CE indexes. RESULTS: All indexes were significantly and differently associated with PTSD; associations with depression were non-significant. The index capturing the sheer number of different incidents experienced regardless of frequency ('Variety') showed conceptual, practical and statistical advantages compared to other indexes. In general, the indexes showed poor to fair discrimination accuracy. CONCLUSIONS: Work-related CE is specifically associated with PTSD. Focusing on the variety of exposures may be a simple and effective strategy to predict PTSD in FRs. Further research on sensitivity and specificity of exposure indexes, preferably examined prospectively, is needed and could lead to early identification of individuals at risk.
BACKGROUND AND OBJECTIVES: Cumulative exposure to work-related traumatic events (CE) is a foreseeable risk for psychiatric disorders in first responders (FRs). Our objective was to examine the impact of work-related CE that could serve as predictor of posttraumatic stress disorder (PTSD) and/or depression in FRs. DESIGN: Cross-sectional examination of previous CE and past-month PTSD outcomes and depression in 209 FRs. METHODS: Logistic (probable PTSD; probable depression) and Poisson regressions (PTSD score) of the outcomes on work-related CE indexes, adjusting for demographic variables. Differences across occupational groups were also examined. Receiver operating characteristic analysis determined the sensitivity and specificity of CE indexes. RESULTS: All indexes were significantly and differently associated with PTSD; associations with depression were non-significant. The index capturing the sheer number of different incidents experienced regardless of frequency ('Variety') showed conceptual, practical and statistical advantages compared to other indexes. In general, the indexes showed poor to fair discrimination accuracy. CONCLUSIONS: Work-related CE is specifically associated with PTSD. Focusing on the variety of exposures may be a simple and effective strategy to predict PTSD in FRs. Further research on sensitivity and specificity of exposure indexes, preferably examined prospectively, is needed and could lead to early identification of individuals at risk.
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