Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers

I. Mindlis, E. Morales-Raveendran, E. Goodman, K. Xu, C. Vila-Castelar, K. Keller, G. Crawford, S. James, C. L. Katz, L. E. Crowley, R. E. de la Hoz, S. Markowitz, J. P. Wisnivesky

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12 Scopus citations


Objective: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. Methods: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. Results: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). Conclusions: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.

Original languageEnglish
Pages (from-to)723-731
Number of pages9
JournalJournal of Asthma
Issue number7
StatePublished - 9 Aug 2017


  • 9/11
  • Asthma
  • PTSD
  • WTC
  • asthma management
  • asthma morbidity
  • asthma outcomes
  • stress
  • sub-threshold PTSD
  • trauma


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