Posttraumatic stress disorder and physical functional decline among aging World Trade Center Responders: A focus on vulnerabilities

PROJECT SUMMARY Responders to the September 11, 2001 World Trade Center (WTC) attacks have shown greater than expected cognitive and physical functional impairment as they age, which have been preliminarily linked to posttraumatic stress disorder (PTSD). Over a decade after the attacks, 10% of responders still met criteria for clinical PTSD, and about one-third of responders continued to report re-experiencing symptoms (flashbacks or nightmares), considered hallmark symptoms of PTSD. PTSD has been shown to be associated with worse cross-sectional physical functional performance in WTC responders (e.g., slower gait speed and chair rise speed, weaker handgrip strength), especially among those with re-experiencing symptoms. Physical functional impairment (PFI), an early marker of physical disability defined by these performance measures, predicts future cognitive decline in older adults. PFI is additionally associated with many other health outcomes including cardiovascular disease and mortality. However, the incidence of PFI in WTC responders as they age—and the decline in function over time that leads to this impairment—is unknown, because prior studies have used cross-sectional physical function data. It is also unclear how long-term PTSD over time contributes to physical function over time, and which demographic groups are most at risk for impairment. The overall objectives of this project are to measure the relationships between PTSD—including specific symptom types and standardized diagnoses—and PFI among over 10,000 WTC responders, using an existing longitudinal dataset with 20 years of data and validated measures of PTSD and PFI. The central hypothesis is that long-term PTSD—particularly re-experiencing symptoms—will be associated with physical functional decline over time. Additionally, it is hypothesized that older adults and gender- and race-based sub-groups will be particularly vulnerable to these effects. This innovative project will provide the applicant with mentored training in: trends in aging (i.e., cognitive and physical functional decline), complex longitudinal statistical modeling, and the influence of stress on accelerated aging outcomes, as well key professional development skills. The applicant is well positioned for this work, given a background in psychiatric epidemiology including PTSD, preliminary work among WTC responders, and a team of mentors who are experts in aging trends, stress-related accelerated aging, and longitudinal modeling of correlated change over time. The proposed research and training aims will allow the applicant to establish an impactful, independent career in the study of long-term effects of PTSD in aging, traumatized populations—while simultaneously helping identify potentially vulnerable sub-groups among WTC responders.