PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers.

Ankura Singh,David J Prezant,Laura Rabin,David Appel,Mayris P Webber,Charles B Hall,Theresa Schwartz,Rachel Zeig-Owens

doi:10.3390/ijerph17165683

Abstract

We observed that World Trade Center (WTC) exposure, post-traumatic stress disorder (PTSD) symptoms and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers. This follow-up study examined whether PTSD symptoms and/or depressive symptoms mediate the observed association between WTC exposure and subjective cognitive concerns. We included WTC-exposed FDNY workers who completed the Cognitive Function Instrument (CFI), measuring self-perceived cognitive decline (N = 9516). PTSD symptoms and depressive symptoms were assessed using the PCL-S and CES-D, respectively. Multivariable linear regression estimated the association between WTC exposure and CFI score, adjusting for confounders. Mediation analyses followed the methods of Vanderweele (2014). Participants’ average age at CFI assessment was 56.6 ± 7.6 years. Higher-intensity WTC exposure was associated with worse CFI score, an effect that was entirely mediated by PTSD symptoms (%mediated: 110.9%; 95%CI: 83.1–138.9). When substituting depressive symptoms for PTSD symptoms, the WTC exposure–CFI association was largely mediated (%mediated: 82.1%; 95%CI: 60.6–103.7). Our findings that PTSD symptoms and depressive symptoms mediate the association between WTC exposure and subjective cognitive concerns indicate that in the absence of these symptoms, WTC exposure in rescue/recovery workers would not be associated with subjective cognition. Interventions targeting PTSD and depression may have additional value in mitigating cognitive decline in WTC-exposed populations.

Highlights

Self-perceived decline in cognitive functioning is a common experience for older adults and has, in older populations, been linked to future pathologic cognitive decline and dementia [1,2,3,4]
We reported that exposure to the World Trade Center (WTC) disaster site, post-traumatic stress disorder (PTSD) symptoms, and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers [6]
We further explore the relationship between WTC exposure and subjective cognitive function by assessing whether PTSD symptoms and depressive symptoms act as mediators of the association between WTC exposure intensity and subjective cognitive concerns

Summary

Introduction

Self-perceived decline in cognitive functioning is a common experience for older adults and has, in older populations, been linked to future pathologic cognitive decline and dementia [1,2,3,4]. Our findings were consistent with those from a study of non-FDNY WTC responders, which reported that WTC exposure and PTSD symptoms were associated with worse performance on an objective cognitive measure [7]. They accord with a large body of research showing PTSD symptoms and depressive symptoms to be risk factors for cognitive dysfunction, both in studies of veterans [8,9,10] and in general populations [11,12,13]. While the above analyses involved objective cognitive assessments, the literature contains evidence that PTSD symptoms and depressive symptoms are associated with greater subjective cognitive concerns as well [16,17,18]

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Discussion

Conclusion