Frequently Asked Questions

Yes. In the multivariable model, greater severity of re-experiencing/intrusion symptoms was independently associated with CRP >3 mg/dL (OR=1.38; 95% CI [1.08, 1.75]; p=.009) in World Trade Center responders, even after accounting for other candidate demographic and clinical variables.

The authors reported that for each 1 SD increase in re-experiencing/intrusion symptom severity, approximately 10.9 points, the odds of elevated CRP increased by 38%.

The specific PTSD symptom independently associated with elevated CRP was emotional reactivity to trauma cues. In planned post-hoc analyses of individual re-experiencing/intrusion symptoms, emotional reactivity to trauma cues was associated with CRP >3 mg/dL (OR=1.50; 95% CI [1.15, 1.96]; p=.003), while no other individual intrusion symptoms were significant (all p values >.52).

Besides PTSD intrusion symptoms, the final multivariable model identified obesity and lower HDL cholesterol as independent correlates of CRP >3 mg/dL.

• Obesity: OR=2.96; 95% CI [1.68, 5.21]; p<.001
• Lower HDL cholesterol: OR=0.97; 95% CI [0.95, 0.99]; p=.016
• Greater re-experiencing/intrusion symptom severity: OR=1.38; 95% CI [1.08, 1.75]; p=.009

No other variables were retained in the final model.

The study defined elevated inflammation as CRP >3 mg/dL. The authors chose this cutoff based on prior work in populations with PTSD and on guidelines linking this level to increased cardiovascular disease risk.

This was a cross-sectional study of 371 World Trade Center responders who completed in-person psychiatric assessment and laboratory testing. PTSD symptoms were assessed with the clinician-administered CAPS, and CRP was measured from fasting morning blood samples collected on average 25 days after the clinical assessment visit.

Participants were evaluated a mean 13.6 years after September 11, 2001, and the main analysis used multivariable binary logistic regression to identify independent correlates of CRP >3 mg/dL.

This study suggests that elevated CRP in trauma-exposed patients may relate not only to obesity and dyslipidemia but also to more severe PTSD intrusion symptoms, especially emotional reactivity to trauma reminders. In this sample, intrusion symptoms remained associated with CRP >3 mg/dL even after accounting for physical health variables and metabolic factors.

The authors therefore suggest potential benefit in approaches that address both PTSD symptoms and metabolic risk factors such as obesity and dyslipidemia to help mitigate inflammation-related physical morbidity.

No. The study found an association between PTSD intrusion symptoms and elevated CRP, but its cross-sectional design does not allow causal conclusions.

The authors note that elevated CRP could be a pre-existing risk factor for PTSD, or persistent emotional reactivity to trauma cues could function as recurrent stress that maintains chronic inflammation.

The main limitations are that the study was cross-sectional, so it cannot determine causality or directionality, and the findings may not generalize beyond World Trade Center responders or to PTSD related to other traumas. The authors also note that, although all participants shared the same index traumatic event, World Trade Center-related exposures still varied considerably within the sample.