Journal of affective disorders · 2025
Adverse childhood experiences, exposure to the World Trade Center attacks, and chronic symptoms of depression, PTSD, and unhealthy drinking.
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Parcesepe Angela M, Sanborn Jenna, Sisti Julia S, Metzler Janna
Аннотация
BACKGROUND: Exposure to potentially traumatic events (PTE) is common and associated with poor mental health. Little is known about factors that influence the relationship between PTE and long-term mental health.
METHODS: This sample included 26,178 individuals who were 18 years or older on September 11, 2001, enrolled in the World Trade Center Health Registry, and completed the Wave 5 survey in 2020-21. We investigated the extent to which adverse childhood events (ACE) modified the relationship between WTC-related PTE exposure and the risk of prevalent or persistent symptoms of post-traumatic stress disorder (PTSD), depression, and unhealthy drinking on multiplicative and additive scales. For each outcome, we fit a log-binomial regression model including categorical variables for WTC-related PTE and ACE, their interaction, and covariates. Adjusted risk ratios were estimated for each joint level of PTE and ACE, using the doubly unexposed group (medium/low PTE and no ACEs) as reference.
RESULTS: ACE exposure and WTC-related PTE exposure were independently associated with greater risk of prevalent and persistent symptoms of PTSD, depression, and unhealthy drinking. There was evidence of positive additive and negative multiplicative modification by ACE exposure of the relationship between WTC-related PTE exposure and symptoms of persistent PTSD and depression.
CONCLUSION: Findings suggest that adverse experiences in childhood increase the risk and persistence of symptoms of PTSD and depression after mass trauma in adulthood. Screening of traumatic events throughout the life course may increase identification of individuals at increased risk of poor mental health outcomes following subsequent PTE exposure.
METHODS: This sample included 26,178 individuals who were 18 years or older on September 11, 2001, enrolled in the World Trade Center Health Registry, and completed the Wave 5 survey in 2020-21. We investigated the extent to which adverse childhood events (ACE) modified the relationship between WTC-related PTE exposure and the risk of prevalent or persistent symptoms of post-traumatic stress disorder (PTSD), depression, and unhealthy drinking on multiplicative and additive scales. For each outcome, we fit a log-binomial regression model including categorical variables for WTC-related PTE and ACE, their interaction, and covariates. Adjusted risk ratios were estimated for each joint level of PTE and ACE, using the doubly unexposed group (medium/low PTE and no ACEs) as reference.
RESULTS: ACE exposure and WTC-related PTE exposure were independently associated with greater risk of prevalent and persistent symptoms of PTSD, depression, and unhealthy drinking. There was evidence of positive additive and negative multiplicative modification by ACE exposure of the relationship between WTC-related PTE exposure and symptoms of persistent PTSD and depression.
CONCLUSION: Findings suggest that adverse experiences in childhood increase the risk and persistence of symptoms of PTSD and depression after mass trauma in adulthood. Screening of traumatic events throughout the life course may increase identification of individuals at increased risk of poor mental health outcomes following subsequent PTE exposure.