Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors
Abstract
:1. Introduction
Study Aims
2. Materials and Methods
2.1. Measures
2.2. Analytic Strategy
3. Results
3.1. Demographic Characteristics
3.2. Social Embeddedness
3.3. Emotional Embeddedness
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All four PTSD Groups | No PTSD Group | Delayed PTSD Group | Chronic PTSD Group | Recovered PTSD Group | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Yes | Total | No | Yes | Total | No | Yes | Total | No | Yes | Total | No | Yes | Total | |
n = 3100 | n = 2570 | 5670 | n = 1959 | n = 2138 | 4097 | n = 228 | n = 81 | 309 | n = 341 | n = 65 | 406 | n = 66 | n = 31 | 97 | |
Characteristic | 54.7% | 45.3% | 47.8% | 52.2% | 73.8% | 26.2% | 84.0% | 16.0% | 68.0% | 32.0% | |||||
Gender | |||||||||||||||
Male | 2036 | 1651 | 3687 | 1313 | 1402 | 2715 | 158 | 59 | 217 | 198 | 32 | 230 | 38 | 17 | 55 |
55.2 | 44.8 | 48.4 | 51.6 | 72.8 | 27.2 | 86.1 | 13.9 | 69.1 | 30.9 | ||||||
Female | 1064 | 919 | 1983 | 646 | 736 | 1382 | 70 | 22 | 92 | 143 | 33 | 176 | 28 | 14 | 42 |
53.7 | 46.3 | 46.7 | 53.3 | 76.1 | 23.9 | 81.3 | 18.8 | 66.7 | 33.3 | ||||||
Age on Injury Survey (years) | |||||||||||||||
<50 | 597 | 573 | 1170 | 388 | 480 | 868 | 48 | 24 | 72 | 53 | 8 | 61 | 12 | 5 | 17 |
51.0 | 49.0 | 44.7 | 55.3 | 66.7 | 33.3 | 86.9 | 13.1 | 70.6 | 29.4 | ||||||
50–59 | 1075 | 791 | 1866 | 640 | 644 | 1284 | 98 | 25 | 123 | 134 | 28 | 162 | 24 | 13 | 37 |
57.6 | 42.4 | 49.8 | 50.2 | 79.7 | 20.3 | 82.7 | 17.3 | 64.9 | 35.1 | ||||||
60–64 | 607 | 437 | 1044 | 372 | 356 | 728 | 42 | 15 | 57 | 68 | 10 | 78 | 19 | 6 | 25 |
58.1 | 41.9 | 51.1 | 48.9 | 73.7 | 26.3 | 87.2 | 12.8 | 76.0 | 24.0 | ||||||
65+ | 821 | 769 | 1590 | 559 | 658 | 1217 | 40 | 17 | 57 | 86 | 19 | 10 | 11 | 7 | 18 |
51.6 | 48.4 | 45.9 | 54.1 | 70.2 | 29.8 | 81.9 | 18.1 | 61.1 | 38.9 | ||||||
Marital Status W1–W4 | |||||||||||||||
Always | 1665 | 1658 | 3323 | 1101 | 1414 | 2515 | 121 | 50 | 171 | 150 | 38 | 188 | 30 | 17 | 47 |
50.1 | 49.9 | 43.8 | 56.2 | 70.8 | 29.2 | 79.8 | 20.2 | 63.8 | 36.2 | ||||||
Never/sometimes | 1435 | 912 | 2347 | 858 | 724 | 1582 | 107 | 31 | 138 | 191 | 27 | 218 | 36 | 14 | 50 |
61.1 | 38.9 | 54.2 | 45.8 | 77.5 | 22.5 | 87.6 | 12.4 | 72.0 | 28.0 | ||||||
Race/ethnicity | |||||||||||||||
Non-Hispanic White | 2323 | 2139 | 4462 | 1527 | 1799 | 3326 | 166 | 71 | 237 | 217 | 44 | 261 | 44 | 25 | 69 |
52.1 | 47.9 | 45.9 | 54.1 | 70.0 | 30.0 | 83.1 | 16.9 | 63.8 | 36.2 | ||||||
Non-Hispanic Black | 261 | 143 | 404 | 149 | 117 | 266 | 23 | 0 | 23 | 39 | 10 | 49 | 5 | 0 | 5 |
64.6 | 35.4 | 56.0 | 44.0 | 100.0 | 0.0 | 79.6 | 20.4 | 100.0 | 0.0 | ||||||
Hispanic | 300 | 170 | 470 | 154 | 121 | 275 | 25 | 7 | 32 | 50 | 9 | 59 | 12 | 6 | 18 |
63.8 | 36.2 | 56.0 | 44.0 | 78.1 | 21.9 | 84.8 | 15.3 | 66.7 | 33.3 | ||||||
Asian | 117 | 73 | 190 | 73 | 64 | 137 | 6 | 2 | 8 | 19 | 1 | 20 | 2 | 0 | 2 |
61.6 | 38.4 | 53.3 | 46.7 | 75.0 | 25.0 | 95.0 | 5.0 | 100.0 | 0.0 | ||||||
Multiracial/other | 99 | 45 | 144 | 56 | 37 | 93 | 8 | 1 | 9 | 16 | 1 | 17 | 3 | 0 | 3 |
68.8 | 31.3 | 60.2 | 39.8 | 88.9 | 11.1 | 94.1 | 5.9 | 100.0 | 0.0 | ||||||
Employment W4 | |||||||||||||||
No | 1365 | 1048 | 2413 | 777 | 823 | 1600 | 110 | 45 | 155 | 217 | 39 | 256 | 23 | 14 | 37 |
56.6 | 43.4 | 48.6 | 51.4 | 71.0 | 29.0 | 84.8 | 15.2 | 62.2 | 37.8 | ||||||
Yes | 1735 | 1522 | 3257 | 1182 | 1315 | 2497 | 118 | 36 | 154 | 124 | 26 | 150 | 43 | 17 | 60 |
53.3 | 46.7 | 47.3 | 52.7 | 76.6 | 23.4 | 82.7 | 17.3 | 71.7 | 28.3 | ||||||
Social Support W4 | |||||||||||||||
Low | 1027 | 219 | 1246 | 511 | 144 | 655 | 98 | 16 | 114 | 188 | 15 | 203 | 32 | 4 | 36 |
82.4 | 17.6 | 78.0 | 22.0 | 86.0 | 14.0 | 92.6 | 7.4 | 88.9 | 11.1 | ||||||
Medium | 1025 | 604 | 1629 | 657 | 495 | 1152 | 85 | 21 | 106 | 94 | 21 | 115 | 22 | 8 | 30 |
62.9 | 37.1 | 57.0 | 43.0 | 80.2 | 19.8 | 81.7 | 18.3 | 73.3 | 26.7 | ||||||
High | 998 | 1704 | 2702 | 759 | 1465 | 2224 | 42 | 43 | 85 | 51 | 28 | 79 | 12 | 19 | 31 |
36.9 | 63.1 | 34.1 | 65.9 | 49.4 | 50.6 | 64.6 | 35.4 | 38.7 | 61.3 | ||||||
Social Integration W4 | |||||||||||||||
low 0–1 | 200 | 35 | 235 | 81 | 17 | 98 | 23 | 3 | 26 | 54 | 2 | 56 | 3 | 2 | 5 |
85.1 | 14.9 | 82.7 | 17.4 | 88.5 | 11.5 | 96.4 | 3.6 | 60.0 | 40.0 | ||||||
Medium 2 | 1379 | 875 | 2254 | 858 | 723 | 1581 | 93 | 28 | 121 | 157 | 21 | 178 | 28 | 11 | 39 |
61.2 | 38.8 | 54.3 | 45.7 | 76.9 | 23.1 | 88.2 | 11.8 | 71.8 | 28.2 | ||||||
High 3–4 | 1477 | 1616 | 3093 | 988 | 1363 | 2351 | 109 | 48 | 157 | 127 | 41 | 168 | 35 | 18 | 53 |
47.8 | 52.3 | 42.0 | 58.0 | 69.4 | 30.6 | 75.6 | 24.4 | 66.0 | 34.0 | ||||||
Self-efficacy W4 | |||||||||||||||
low <17 | 1944 | 983 | 2927 | 1042 | 728 | 1770 | 180 | 49 | 229 | 291 | 49 | 340 | 48 | 15 | 63 |
66.4 | 33.6 | 58.9 | 41.1 | 78.6 | 21.4 | 85.6 | 14.4 | 76.2 | 23.8 | ||||||
High 17+ | 1134 | 1570 | 2704 | 905 | 1396 | 2301 | 44 | 31 | 75 | 46 | 16 | 62 | 18 | 16 | 34 |
41.9 | 58.1 | 39.3 | 60.7 | 58.7 | 41.3 | 74.2 | 25.8 | 52.9 | 47.1 |
All four PTSD Groups | No PTSD Group | Delayed PTSD Group | Chronic PTSD Group | Recovered PTSD Group | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | ||||||
Characteristic | Lower | Upper | Lower | Upper | Lower | Upper | Lower | Upper | Lower | Upper | |||||
Marital Status W1-W4 | |||||||||||||||
Always | 0.99 | 0.94 | 1.06 | 0.99 | 0.93 | 1.06 | 1.01 | 0.68 | 1.51 | 0.81 | 0.50 | 1.29 | 1.25 | 0.68 | 2.28 |
Never/sometimes | ref | ref | ref | ||||||||||||
Employment W4 | |||||||||||||||
No | ref | ||||||||||||||
Yes | 1.06 | 1.01 | 1.12 | 1.05 | 1.00 | 1.12 | 0.95 | 0.66 | 1.38 | 1.05 | 0.61 | 1.47 | 0.68 | 0.40 | 1.15 |
Social Support W4 | |||||||||||||||
Low | ref | ref | ref | ref | ref | ||||||||||
Medium | 1.95 | 1.70 | 2.24 | 1.86 | 1.59 | 2.19 | 1.30 | 0.69 | 2.45 | 2.27 | 1.18 | 4.36 | 2.87 | 0.91 | 9.08 |
High | 2.99 | 2.63 | 3.41 | 2.68 | 2.30 | 3.12 | 3.07 | 1.77 | 5.35 | 3.91 | 2.11 | 7.23 | 4.99 | 1.77 | 14.03 |
Social Integration W4 | |||||||||||||||
Low 0–1 | ref | ref | ref | ref | ref | ||||||||||
Medium 2 | 1.68 | 1.25 | 2.26 | 1.89 | 1.25 | 2.84 | 1.35 | 0.42 | 4.28 | 2.46 | 0.57 | 10.59 | 0.57 | 0.13 | 2.47 |
High 3–4 | 2.04 | 1.52 | 2.73 | 2.23 | 1.48 | 3.36 | 1.52 | 0.49 | 4.67 | 4.93 | 1.20 | 20.26 | 0.72 | 0.16 | 3.16 |
Self-efficacy W4 | |||||||||||||||
Low <17 | ref | ref | ref | ref | ref | ||||||||||
High 17+ | 1.39 | 1.31 | 1.48 | 1.30 | 1.22 | 1.39 | 1.33 | 0.94 | 1.90 | 1.45 | 0.86 | 2.45 | 1.52 | 0.85 | 2.73 |
All four PTSD Groups | No PTSD Group | Delayed PTSD Group | Chronic PTSD Group | Recovered PTSD Group | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Yes | Total | No | Yes | Total | No | Yes | Total | No | Yes | Total | No | Yes | Total | |
n = 1815 | n = 3851 | 5666 | n = 857 | n = 3239 | 4096 | n = 197 | n = 113 | 310 | n = 298 | n = 103 | 401 | n = 56 | n = 40 | 96 | |
Characteristic | 32.0% | 68.0% | 32.0% | 68.0% | 63.6% | 36.5% | 74.3% | 25.7% | 58.3% | 41.7% | |||||
Gender | |||||||||||||||
Male | 1118 | 2562 | 3680 | 521 | 2190 | 2711 | 138 | 79 | 217 | 172 | 56 | 228 | 31 | 22 | 53 |
30.4 | 69.6 | 19.2 | 80.8 | 63.6 | 36.4 | 75.4 | 24.6 | 58.5 | 41.5 | ||||||
Female | 697 | 1289 | 1986 | 336 | 1049 | 1385 | 59 | 34 | 93 | 126 | 47 | 173 | 25 | 18 | 43 |
35.1 | 64.9 | 24.3 | 75.7 | 63.4 | 36.6 | 72.8 | 27.2 | 58.1 | 41.9 | ||||||
Age on Injury Survey(years) | |||||||||||||||
<50 | 359 | 824 | 1183 | 177 | 699 | 876 | 46 | 27 | 73 | 51 | 11 | 62 | 8 | 9 | 17 |
30.4 | 69.7 | 20.2 | 79.8 | 63.0 | 37.0 | 82.3 | 17.7 | 47.1 | 52.9 | ||||||
50–59 | 649 | 1208 | 1857 | 291 | 987 | 1278 | 80 | 44 | 124 | 115 | 44 | 159 | 21 | 16 | 37 |
35.0 | 65.1 | 22.8 | 77.2 | 64.5 | 35.5 | 72.3 | 27.7 | 56.8 | 43.2 | ||||||
60–64 | 358 | 688 | 1046 | 160 | 571 | 731 | 33 | 24 | 57 | 58 | 19 | 77 | 14 | 11 | 25 |
34.2 | 65.8 | 21.9 | 78.1 | 57.9 | 42.1 | 75.3 | 24.7 | 56.0 | 44.0 | ||||||
65+ | 449 | 1131 | 1580 | 229 | 982 | 1211 | 38 | 18 | 56 | 74 | 29 | 103 | 13 | 4 | 17 |
28.4 | 71.6 | 18.9 | 81.1 | 67.9 | 32.1 | 71.8 | 28.2 | 76.5 | 23.5 | ||||||
Marital Status W1–W4 | |||||||||||||||
Always | 926 | 2401 | 3327 | 452 | 2069 | 2521 | 109 | 64 | 173 | 142 | 43 | 185 | 23 | 22 | 45 |
27.8 | 72.2 | 17.9 | 82.1 | 63.0 | 37.0 | 76.8 | 23.2 | 51.1 | 48.9 | ||||||
Never/sometimes | 889 | 1450 | 2339 | 405 | 1170 | 1575 | 88 | 49 | 137 | 156 | 60 | 216 | 33 | 18 | 51 |
38.0 | 62.0 | 25.7 | 74.3 | 64.2 | 35.8 | 72.2 | 27.8 | 64.7 | 35.3 | ||||||
Race/ethnicity | |||||||||||||||
Non-Hispanic White | 1344 | 3120 | 4464 | 668 | 2660 | 3328 | 148 | 89 | 237 | 188 | 73 | 261 | 37 | 31 | 68 |
30.1 | 69.9 | 20.1 | 79.9 | 62.5 | 37.6 | 72.0 | 28.0 | 54.4 | 45.6 | ||||||
Non-Hispanic Black | 138 | 262 | 400 | 48 | 216 | 264 | 17 | 6 | 23 | 37 | 11 | 48 | 4 | 1 | 5 |
34.5 | 65.5 | 18.2 | 81.8 | 73.9 | 26.1 | 77.1 | 22.9 | 80.0 | 20.0 | ||||||
Hispanic | 203 | 266 | 469 | 80 | 194 | 274 | 21 | 12 | 33 | 44 | 13 | 57 | 11 | 7 | 18 |
43.3 | 56.7 | 29.2 | 70.8 | 63.6 | 36.4 | 77.2 | 22.8 | 61.1 | 38.9 | ||||||
Asian | 70 | 120 | 190 | 34 | 103 | 137 | 4 | 4 | 8 | 17 | 3 | 20 | 1 | 1 | 2 |
36.8 | 63.2 | 24.8 | 75.2 | 50.0 | 50.0 | 85.0 | 15.0 | 50.0 | 50.0 | ||||||
Multiracial/other | 60 | 83 | 143 | 27 | 66 | 93 | 7 | 2 | 9 | 12 | 3 | 15 | 3 | 0 | 3 |
42.0 | 58.0 | 29.0 | 71.0 | 77.8 | 22.2 | 80.0 | 20.0 | 100.0 | 0.0 | ||||||
Employment W4 | |||||||||||||||
No | 864 | 1541 | 2405 | 349 | 1249 | 1598 | 99 | 56 | 155 | 195 | 58 | 253 | 24 | 12 | 36 |
35.9 | 64.1 | 21.8 | 78.2 | 63.9 | 36.1 | 77.1 | 22.9 | 66.7 | 33.3 | ||||||
Yes | 951 | 2310 | 3261 | 508 | 1990 | 2498 | 98 | 57 | 155 | 103 | 45 | 148 | 32 | 28 | 60 |
29.2 | 70.8 | 20.3 | 79.7 | 63.2 | 36.8 | 69.6 | 30.4 | 53.3 | 46.7 | ||||||
Social Support W4 | |||||||||||||||
Low | 749 | 499 | 1248 | 292 | 366 | 658 | 92 | 21 | 113 | 158 | 44 | 202 | 30 | 6 | 36 |
60.0 | 40.0 | 44.4 | 55.6 | 81.4 | 18.6 | 78.2 | 21.8 | 83.3 | 16.7 | ||||||
Medium | 556 | 1068 | 1624 | 277 | 873 | 1150 | 59 | 47 | 106 | 80 | 33 | 113 | 14 | 15 | 29 |
34.2 | 65.8 | 24.1 | 75.9 | 55.7 | 44.3 | 70.8 | 29.2 | 48.3 | 51.7 | ||||||
High | 469 | 2232 | 2701 | 266 | 1958 | 2224 | 43 | 44 | 87 | 51 | 25 | 76 | 11 | 19 | 30 |
17.4 | 82.6 | 12.0 | 88.0 | 49.4 | 50.6 | 67.1 | 32.9 | 36.7 | 63.3 | ||||||
Social Integration W4 | |||||||||||||||
Low 0–1 | 158 | 75 | 233 | 47 | 50 | 97 | 22 | 4 | 26 | 49 | 6 | 55 | 3 | 2 | 5 |
67.8 | 32.2 | 48.5 | 51.6 | 84.6 | 15.4 | 89.1 | 10.9 | 60.0 | 40.0 | ||||||
Medium 2 | 814 | 1434 | 2248 | 389 | 1189 | 1578 | 81 | 41 | 122 | 131 | 46 | 177 | 22 | 15 | 37 |
36.2 | 63.8 | 24.7 | 75.4 | 66.4 | 33.6 | 74.0 | 26.0 | 59.5 | 40.5 | ||||||
High 3–4 | 817 | 2280 | 3097 | 407 | 1947 | 2354 | 90 | 67 | 157 | 116 | 49 | 165 | 31 | 23 | 54 |
26.4 | 73.6 | 17.3 | 82.7 | 57.3 | 42.7 | 70.3 | 29.7 | 57.4 | 42.6 | ||||||
Self-efficacy W4 | |||||||||||||||
Low <17) | 1337 | 1585 | 2922 | 560 | 1206 | 1766 | 151 | 78 | 229 | 259 | 79 | 338 | 41 | 22 | 63 |
45.8 | 54.2 | 31.7 | 68.3 | 65.9 | 34.1 | 76.6 | 23.4 | 65.1 | 34.9 | ||||||
High 17+ | 460 | 2246 | 2706 | 288 | 2017 | 2305 | 42 | 34 | 76 | 35 | 24 | 59 | 15 | 18 | 33 |
17.0 | 83.0 | 12.5 | 87.5 | 55.3 | 44.7 | 59.3 | 40.7 | 45.5 | 55.5 |
All Four PTSD Groups | No PTSD Group | Delayed PTSD Group | Chronic PTSD Group | Recovered PTSD Group | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | aOR | 95% CI | ||||||
Characteristic | Lower | Upper | Lower | Upper | Lower | Upper | Lower | Upper | Lower | Upper | |||||
Marital Status W1–W4 | |||||||||||||||
Always | 1.00 | 0.96 | 1.04 | 0.99 | 0.96 | 1.03 | 1.25 | 0.93 | 1.68 | 1.33 | 0.93 | 1.92 | 1.05 | 0.68 | 1.63 |
Never/sometimes | ref | ref | ref | ref | ref | ||||||||||
Employment W4 | |||||||||||||||
No | ref | ref | ref | ref | ref | ||||||||||
Yes | 1.09 | 1.05 | 1.13 | 1.03 | 0.99 | 1.06 | 1.06 | 0.80 | 1.40 | 1.18 | 0.85 | 1.65 | 1.32 | 0.78 | 2.24 |
Social Support W4 | |||||||||||||||
Low | ref | ref | ref | ref | ref | ||||||||||
Medium | 1.55 | 1.44 | 1.67 | 1.33 | 1.23 | 1.43 | 2.63 | 1.67 | 4.15 | 1.32 | 0.88 | 1.97 | 3.34 | 1.49 | 7.49 |
High | 1.78 | 1.66 | 1.92 | 1.47 | 1.37 | 1.58 | 2.88 | 1.82 | 4.54 | 1.42 | 0.92 | 2.20 | 3.62 | 1.60 | 8.20 |
Social Integration W4 | |||||||||||||||
Low 0–1 | ref | ref | ref | ref | ref | ||||||||||
Medium 2 | 1.53 | 1.28 | 1.84 | 1.27 | 1.05 | 1.54 | 1.92 | 0.74 | 4.99 | 1.80 | 0.80 | 4.07 | 1.11 | 0.38 | 3.21 |
High 3–4 | 1.66 | 1.38 | 1.99 | 1.35 | 1.11 | 1.63 | 2.04 | 0.80 | 5.19 | 2.10 | 0.93 | 4.73 | 1.17 | 0.41 | 3.32 |
Self-efficacy W4 | |||||||||||||||
Low <17 | ref | ref | ref | ref | ref | ||||||||||
High 17+ | 1.35 | 1.30 | 1.40 | 1.21 | 1.17 | 1.25 | 1.16 | 0.86 | 1.56 | 1.62 | 1.12 | 2.35 | 1.20 | 0.72 | 2.01 |
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Hamwey, M.K.; Pollari, C.D.; Osahan, S.; Garrey, S.K.; Ortega, F.M.; Solomon, A.; Brackbill, R.M. Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. Epidemiologia 2021, 2, 608-620. https://doi.org/10.3390/epidemiologia2040041
Hamwey MK, Pollari CD, Osahan S, Garrey SK, Ortega FM, Solomon A, Brackbill RM. Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. Epidemiologia. 2021; 2(4):608-620. https://doi.org/10.3390/epidemiologia2040041
Chicago/Turabian StyleHamwey, Meghan K., Cristina D. Pollari, Sukhminder Osahan, Sascha K. Garrey, Felix M. Ortega, Adrienne Solomon, and Robert M. Brackbill. 2021. "Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors" Epidemiologia 2, no. 4: 608-620. https://doi.org/10.3390/epidemiologia2040041
APA StyleHamwey, M. K., Pollari, C. D., Osahan, S., Garrey, S. K., Ortega, F. M., Solomon, A., & Brackbill, R. M. (2021). Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. Epidemiologia, 2(4), 608-620. https://doi.org/10.3390/epidemiologia2040041