Longitudinal determinants of depression among World Trade Center Health Registry enrollees, 14–15 years after the 9/11 attacks

Abstract

BackgroundExposure to the September 11, 2001 (9/11) terrorist attacks has been found to be associated with posttraumatic stress disorder (PTSD) and comorbid PTSD and depression up to 10–11 years post-disaster. However, little is known about the longitudinal predictors of mental health conditions over time. MethodsWe examined longitudinal determinants of depression within strata of PTSD among 21,258 enrollees of the World Trade Center Health Registry who completed four questionnaires over 14 years of follow-up (Wave 1 in 2003–04; Wave 2 in 2005–06; Wave 3 in 2011–12; and Wave 4 in 2015–16). PTSD status was measured using the PTSD checklist on all four waves and defined as a score of ≥ 44; depression was assessed using the 8-item Patient Health Questionnaire at Waves 3 and 4 and defined as a score of ≥ 10. ResultsAcross Waves 3 and 4, 18.6% experienced depression, and it was more common among those who ever had PTSD (56.1%) compared with those who had not (5.6%). Across PTSD strata, predictors of depression included low income, unemployment, low social integration and support, post-9/11 traumatic life events, and chronic physical illness. These factors also decreased the likelihood of recovering from depression. LimitationsDepression symptoms were not measured at Waves 1 and 2; data was self-reported. ConclusionsThese findings highlight the substantial burden of depression in a trauma-exposed population 14–15 years post-disaster, especially among those with PTSD. Similar life stressors predicted the course of depression among those with and without PTSD which may inform public health and clinical interventions.