Burden of Depression Among World Trade Center Health Registry Participants

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Determinants of depression were assessed in September 11, 2001 attacks from 2003 to 2016.

Among New York City survivors of the September 11, 2001, terrorist attacks, one-fifth have experienced depression since 2011, and depression was more common among participants who had symptoms of posttraumatic stress disorder (PTSD), according to the results of a recent study published in the Journal of Affective Disorders.

Researchers evaluated the longitudinal determinants of depression among 21,258 World Trade Center Health Registry enrollees over 14 years of follow-up. PTSD status was defined as a score of ≥44 on the PTSD checklist, and depression was measured with the 8-item Patient Health Questionnaire and considered positive with a score of ≥10. PTSD was measured at 4 time points (2003-2004, 2005-2006, 2011-2012, and 2015-2016), whereas depression was measured in 2011 through 2012 and 2015 through 2016.

Symptoms suggestive of PTSD were reported in 25.7% of participants over the course of 4 waves. A total of 18.6% of participants reported depression in at least one time point, with 13.8% reporting depression in 2011 through 2012 and 13.1% reporting depression in 2015 through 2016.

Depression was reported at a higher rate among participants who had ever had PTSD compared with those who had never had PTSD (56.1% vs 5.6%). Moreover, median depression symptoms scores were higher in patients with comorbid PTSD compared with those with only depression.

Other factors associated with depression diagnoses included age <65 years, annual income <$50,000, lower level of education, unemployment, and a low level of social support or integration.

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In an interview with Psychiatry Advisor, Melanie Jacobson, PhD, MPH, of the New York City Department of Health and Mental Hygiene, concluded that, “in a cohort of individuals exposed to the 9/11 attacks up to 15 years post-disaster, there was a substantial burden of depression overall and especially among those who had a history of PTSD. Clinical providers may consider screening for depression among high-risk individuals, such as those who have experienced a trauma or who have PTSD symptoms.”


Jacobson MH, Norman C, Nguyen A, Brackbill RM. Longitudinal determinants of depression among World Trade Center Health Registry enrollees, 14-15 years after the 9/11 attacks. J Affect Disord. 2018;229:483-490.