Comorbid posttraumatic stress disorder and lower respiratory symptoms in disaster survivors: Qualitative results of a 17-year follow-up of World Trade Center disaster survivors

Abstract

A better understanding of the experiences of disaster survivors with post-traumatic stress disorder (PTSD) and serious comorbid medical conditions may lead to improvements in treatment, and help reduce the public health and healthcare burden of affected individuals. The purpose of this qualitative study was threefold; first, to explore the relationship between PTSD and lower respiratory symptoms (LRS); second, to identify factors influencing self-management and treatment of both disorders; and third, to determine the impact of these comorbidities on quality of life. The goal was to identify strategies to improve coordination of medical and mental health management in order to reduce the symptomatic burden of these two health conditions. In-depth, semi-structured qualitative interviews were conducted among 34 World Trade Center Health Registry (WTCHR) rescue/recovery workers and community members with both active LRS (self-reported history of cough, wheeze or shortness of breath) and report of PTSD diagnosis on their 2015–2016 survey. Thematic analysis identified 14 themes grouped into six main categories: relationship between LRS and PTSD, impact of symptoms on quality of life, medical management, symptom management strategies, current health status, and exposure history and symptoms. Participants spoke of a wide range of both symptom triggers and management strategies, including self-management and some maladaptive management behaviors such as smoking and alcohol consumption. Participants also spoke of feeling like there were gaps in their healthcare, particularly for mental health. In addition, many spoke to a lack of coordinated care between physical and mental health. The majority of participants did not feel that there was a link between their PTSD and LRS, and among them a large portion also reported a lack of control over their symptoms. Proactive and collaborative planning steps at multiple levels (healthcare, public health, disaster management) are needed to prevent adverse impacts of disasters. Because of the increasing trend in disasters (both natural and man-made), with potentially wide-ranging exposures, it is important to plan for the complex treatment of PTSD and other co-morbidities. Keywords: September 11, 2001, World Trade Center, Post-traumatic stress disorder, Lower respiratory symptoms, Qualitative research