Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity
Open accessAbstract
OBJECTIVES: On September 11, 2001 (9/11), attacks on the World Trade Center (WTC) killed 341 Fire Department of the City of New York (FDNY) firefighters and injured hundreds more. Previous WTC-related studies reported high rates of comorbid depression and posttraumatic stress disorder (PTSD), identifying disability retirement, alcohol use, and early arrival at the WTC site as correlates. However, those studies did not evaluate risk factors that could have mediated the observed comorbidity. We identified unique risk factors for each condition in an effort to better understand comorbidity. METHODS: We screened retired WTC-exposed firefighters using self-administered questionnaires including the Center for Epidemiologic Studies Depression Scale, the Post Traumatic Stress Disorder Checklist, and the Alcohol Use Disorders Identification Test. We performed regression analyses to compare independent predictors of elevated depression and PTSD risk, and also tested a mediation hypothesis. RESULTS: From December 2005 to July 2007, 23% and 22% of 1,915 retirees screened positive for elevated depression and PTSD risk, respectively, with comorbidity > 70%. Controlling for comorbidity, we identified unique risk factors for (1) depression: problem alcohol use and (2) PTSD: early arrival at the WTC site. CONCLUSIONS: Our data support the premise that PTSD and depression are different responses to trauma with unique risk factors. The data also suggest a hypothesis that PTSD mediates the relationship between early WTC arrival and depression, while depression mediates the relationship between alcohol use and PTSD, a more complex relationship than shown in previous studies. Clinicians should consider these factors when evaluating patients for depression and PTSD.
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Approximately 22% of firefighters are at risk for depression.
“Approximately 22% of firefighters are also at risk for depression [4,5]”
From Mindful attention training workshop for firefighters: Design and methodology of a pilot randomized clinical trial (2022) · cites this paper as [4]
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“Approximately 22% of firefighters are also at risk for depression [4,5], 46.”
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- Authors
- Chiu, S., Niles, J. K., Webber, M. P., Zeig-Owens, R., Gustave, J., Lee, R., Rizzotto, L., Kelly, K. J., Cohen, H. W., & Prezant, D. J.
- Affiliations
- New York City Fire Department (US)
- Albert Einstein College of Medicine (US)
- Montefiore Medical Center, Bronx, NY
- Corresponding author
- Webber, Mayris P.
- Venue
- Public Health Reports
- Publisher
- SAGE Publications
- Published
- 2011-03
- Volume
- 126
- Issue
- 2
- Pages
- 201-209
- ISSN
- 0033-3549 (ISSN-L)
- 1468-2877
- PMC
- PMC3056033
- OpenAlex
- W2125836173
- Cited by
- 81
- References
- 47
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 7 · 2016: 7 · 2015: 8 · 2014: 9 · 2013: 6 · 2012: 2
- FWCI
- 6.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Public Health Reports (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Occupational Safety and Health (R01-OH07350)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- post-traumatic depression, post-traumatic stress disorder, comorbidities, September 11 attacks, risk factors, mediation, alcohol consumption
- MeSH terms
- Adult, Aged, Alcoholism, Depressive Disorder, Health Surveys, Humans, Male, Middle Aged, New York City, Risk Factors, Stress Disorders, Post-Traumatic, Rescue Work, September 11 Terrorist Attacks
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