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PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers

1
The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York, NY 11201, USA
2
Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, NY 10467, USA
3
Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
4
Department of Psychology, Brooklyn College and The Graduate Center of CUNY, Brooklyn, New York, NY 11210, USA
5
Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
6
Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Block 312, 1300 Morris Park Avenue, Bronx, New York, NY 10461, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(16), 5683; https://doi.org/10.3390/ijerph17165683
Received: 20 June 2020 / Revised: 25 July 2020 / Accepted: 4 August 2020 / Published: 6 August 2020
(This article belongs to the Special Issue 9/11 Health Update)
We observed that World Trade Center (WTC) exposure, post-traumatic stress disorder (PTSD) symptoms and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers. This follow-up study examined whether PTSD symptoms and/or depressive symptoms mediate the observed association between WTC exposure and subjective cognitive concerns. We included WTC-exposed FDNY workers who completed the Cognitive Function Instrument (CFI), measuring self-perceived cognitive decline (N = 9516). PTSD symptoms and depressive symptoms were assessed using the PCL-S and CES-D, respectively. Multivariable linear regression estimated the association between WTC exposure and CFI score, adjusting for confounders. Mediation analyses followed the methods of Vanderweele (2014). Participants’ average age at CFI assessment was 56.6 ± 7.6 years. Higher-intensity WTC exposure was associated with worse CFI score, an effect that was entirely mediated by PTSD symptoms (%mediated: 110.9%; 95%CI: 83.1–138.9). When substituting depressive symptoms for PTSD symptoms, the WTC exposure–CFI association was largely mediated (%mediated: 82.1%; 95%CI: 60.6–103.7). Our findings that PTSD symptoms and depressive symptoms mediate the association between WTC exposure and subjective cognitive concerns indicate that in the absence of these symptoms, WTC exposure in rescue/recovery workers would not be associated with subjective cognition. Interventions targeting PTSD and depression may have additional value in mitigating cognitive decline in WTC-exposed populations. View Full-Text
Keywords: occupational exposure; mental health; stress disorders; post-traumatic; epidemiological studies; cognitive dysfunction occupational exposure; mental health; stress disorders; post-traumatic; epidemiological studies; cognitive dysfunction
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Singh, A.; Zeig-Owens, R.; Rabin, L.; Schwartz, T.; Webber, M.P.; Appel, D.; Prezant, D.J.; Hall, C.B. PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers. Int. J. Environ. Res. Public Health 2020, 17, 5683.

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