The Association Between Body Mass Index and Anxious Arousal, Depressive, and Insomnia Symptoms Among World Trade Center Responders

Health Behavior Research Volume 5 Number 1 Article 3 February 2022 The Association Between Body Mass Index and Anxious Arousal, Depressive, and Insomnia Symptoms Among World Trade Center Responders Brooke Y. Kauffman University of Houston, Roman Kotov Stony Brook University Lorra Garey University of Houston See next page for additional authors Follow this and additional works at: https://newprairiepress.org/hbr Part of the Clinical Psychology Commons This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License Recommended Citation Kauffman, Brooke Y.; Kotov, Roman; Garey, Lorra; Ruggero, Camilo J.; Luft, Benjamin J.; and Zvolensky, Michael J. (2022) "The Association Between Body Mass Index and Anxious Arousal, Depressive, and Insomnia Symptoms Among World Trade Center Responders," Health Behavior Research: Vol. 5: No. 1. https://doi.org/10.4148/2572-1836.1107 This Research Article is brought to you for free and open access by New Prairie Press. It has been accepted for inclusion in Health Behavior Research by an authorized administrator of New Prairie Press. For more information, please contact . The Association Between Body Mass Index and Anxious Arousal, Depressive, and Insomnia Symptoms Among World Trade Center Responders Abstract Elevations in body mass index (BMI) among World Trade Center (WTC) responders may be associated with poor mental health outcomes. The current study examined the association of BMI with anxious arousal, depressive, and insomnia symptoms among this group. Participants were 412 WTC responders (89.4% male, Mage = 55.3 years, SD = 8.66) who completed health monitoring assessments (self-report and objective) as part of the Long Island site of the WTC Health Program (LI-WTC-HP). Results suggested BMI was statistically significant only in relation to anxious arousal (sr2 = .02, p = .008), after accounting for age and sex. The current study suggests that weight management programs may aid in promoting additional benefits for WTC responders by reducing anxious arousal symptoms as a function of reduced BMI. Keywords World Trade Center, Body Mass Index, Mental Health Acknowledgements/Disclaimers/Disclosures This work was supported by a pre-doctoral National Research Service Award awarded from the National Institute on Drug Abuse to Ms. Brooke Kauffman (F31-DA046127). The authors have no conflict of interest to declare, financial or otherwise. Authors Brooke Y. Kauffman, Roman Kotov, Lorra Garey, Camilo J. Ruggero, Benjamin J. Luft, and Michael J. Zvolensky This research article is available in Health Behavior Research: https://newprairiepress.org/hbr/vol5/iss1/3 Kauffman et al.: BMI AND MENTAL HEALTH AMONG WTC RESPONDERS The Association Between Body Mass Index and Anxious Arousal, Depressive, and Insomnia Symptoms Among World Trade Center Responders Brooke Y. Kauffman, PhD Roman Kotov, PhD Lorra Garey, PhD Camilo J. Ruggero, PhD Benjamin J. Luft, MD Michael J. Zvolensky, PhD* Abstract Elevations in body mass index (BMI) among World Trade Center (WTC) responders may be associated with poor mental health outcomes. The current study examined the association of BMI with anxious arousal, depressive, and insomnia symptoms among this group. Participants were 412 WTC responders (89.4% male, Mage = 55.3 years, SD = 8.66) who completed health monitoring assessments (self-report and objective) as part of the Long Island site of the WTC Health Program (LI-WTC-HP). Results suggested BMI was statistically significant only in relation to anxious arousal (sr2 = .02, p = .008), after accounting for age and sex. The current study suggests that weight management programs may aid in promoting additional benefits for WTC responders by reducing anxious arousal symptoms as a function of reduced BMI. *Corresponding author can be reached at: Obesity rates continue to rise in the United States, with an estimated 42.4% of the adult population considered obese (Hales et al., 2020). Obesity rates among World Trade Center (WTC) responders (i.e., individuals who assisted with rescue, recovery, and/or clean-up efforts in response to the 09/11/2001 terrorists attacks on the WTC) are equally as high with cohort sample estimates as high as 42% (Aldrich et al., 2010; Icitovic et al., 2016; Skloot et al., 2009; Webber et al., 2011). Higher body mass index (a measure of overweight and obesity; [BMI]; USDHHS, 2020) among WTC responders may be due to a number of factors, including posttraumatic stress disorder (PTSD; Luft et al., 2012), low exercise frequency (Napier et al., 2017), and comorbid chronic diseases (Napier et al., 2017). Elevations in BMI have been found to be associated with a number of psychiatric Published by New Prairie Press, 2022 symptoms and disorders in past work (Avila et al., 2015). For example, research has found increasing gradations of BMI to be related to poor mental health outcomes (e.g., sleep quality, depression; Bjerkeset et al., 2008; Tepe et al., 2017). Among WTC responders, extant work, albeit limited, has examined the influence of BMI on adverse health outcomes (e.g., gastroesophageal reflux disease; Icitovic et al., 2016); however, relatively little is known about the impact it may have on anxious arousal, depressive, and insomnia symptoms among this population. This gap is unfortunate as mental health concerns are prevalent among WTC responders (Lucchini et al., 2012; CDC, 2021; Stellman et al., 2008), with factors such as long work shifts, fears related to safety, and exposure to human remains thought to contribute to such psychological distress (Bills et al., 2008). However, understanding additional factors 1 Health Behavior Research, Vol. 5, No. 1 [2022], Art. 3 that may maintain or contribute to psychiatric distress is warranted. Among WTC responders, higher levels of BMI may be associated with greater mental health and sleep disturbance symptoms, such as anxious arousal, depressive, and insomnia symptoms. For example, higher levels of BMI may be associated with pathophysiological alterations (e.g., adipokines, inflammation) which, in turn, may contribute to poor mental health and insomnia (Taylor & MacQueen, 2010). Moreover, individuals with higher levels of BMI may experience weight-related stigma resulting in maladaptive coping strategies (e.g., avoidance, behavioral withdrawal, self-criticism; Myers & Rosen, 1999) and subsequent mental health symptoms and sleep disturbance (Emmer et al., 2019). Yet, to our knowledge, no study has examined the relations between BMI and anxious arousal, depressive, and insomnia symptoms among WTC responders to determine if these relations are present within this population. The current study sought to examine the association between BMI and anxious arousal, depressive, and insomnia symptoms among WTC responders. It was hypothesized that higher levels of BMI would be associated with greater anxious arousal, depressive, and insomnia symptoms among a sample of WTC re (...truncated)