Burden of Depression Among World Trade Center Health Registry Participants

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.

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.”

Reference

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.