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From page 100... ...
; serious mental illness (SMI) , which includes bipolar disorder and psychosis and schizophrenia-spectrum disorders; sleep disorders; substance use disorders (SUD)
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From page 101... ...
cases of adjustment disorders. Figure 6-1 shows that exposure to dust and PM, exhaust, and incinerator emissions is associated with a risk-conferring relationship with adjustment disorder, with adjusted ORs of 1.11 (95% CI: 1.10-1.13)
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MENTAL AND BEHAVIORAL HEALTH RESULTS 6-3 (compared to zero) was generally associated with elevated risk, despite no synergy among exposure groupings.
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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Metals and Adjustment Disorders One cohort study that pooled data from six European countries found no association between long-term exposure to seven metal and metalloid components of PM2.5 (copper, iron, nickel, potassium, silicon, vanadium, and zinc) and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including adjustment disorders (Andersen et al., 2022)
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of attention disorders. In Figure 6-2, none of the adjusted ORs and associated CIs for the exposures and attention disorders met the prioritization criteria for additional discussion.
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio ; PM = particulate matter.
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From page 107... ...
, who found genetically predicted PM2.5 exposure significantly increased risk of ADHD among adults in a two-sample Mendelian randomization study using publicly available genome-wide association study 3 data, though this effect could have been confounded by other air pollutants. The Zhao and colleagues (2024a)
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From page 108... ...
found long-term exposure to nitrogen dioxide and black carbon were positively associated with psychiatric disorder mortality; ozone was negatively associated with mortality, but this association attenuated and was no longer significant after adjusting for other pollutants. Metals and Attention Disorders The literature search yielded a meta-analysis (Dimitrov et al., 2024)
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Synthesizing the committee's data analysis and literature review, the committee concludes there is inadequate or insufficient evidence of a possible risk-conferring relationship between exposure to burn pits, dust and PM, exhaust, fuels, incinerator emissions, metals, mold, radiation, or solvents and attention disorders. ANXIETY DISORDERS Anxiety disorders (for example, generalized anxiety disorder and panic disorder)
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In Figure 6-3, none of the adjusted ORs and associated CIs for the exposures and anxiety disorders met the prioritization criteria for additional discussion. All exposures had no differences in the magnitude of association when stratifying by TBI, and that suggests no interaction between these exposures and TBI on odds of anxiety disorders.
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 112... ...
. Additionally, a cohort study that pooled data from six European countries found a positive but not significant association between long-term exposure to PM2.5 and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including anxiety disorders (Andersen et al., 2022)
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. Radiation and Anxiety Disorders A systematic review and meta-analysis of low-to-moderate exposure to ionizing radiation on mortality from a heterogenous composite measure of mental and behavioral disorders, which included anxiety disorders, found a significantly lower mortality of such disorders among the PREPUBLICATION COPY: UNCORRECTED PROOFS
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Burn Pits, Fuels, Mold, or Solvents, and Anxiety Disorders The committee's search yielded zero results on possible relationships between exposure to burn pits, fuels, mold, or solvents and the risk of anxiety disorders. Conclusion Conclusion 6-3: Based on its analysis of the available data, the committee does not find a possible risk-conferring relationship between exposure to burn pits, dust and particulate matter (PM)
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cases of depression. In Figure 6-4, none of the adjusted ORs and associated CIs for the exposures and depression met the prioritization criteria for additional discussion.
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CI = confidence interval; ILER= Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 117... ...
. Additionally, a cohort study that pooled data from six European countries found a positive but not significant association between long-term exposure to PM2.5 and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9 and 10-coded mental and behavioral disorders, including depression (Andersen et al., 2022)
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found longterm exposure to black carbon was associated with increased risk of psychiatric disorder mortality. Metals and Depression Six studies examined metals and depression, including one systematic review (Cybulska et al., 2021)
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also did not find an association with selenium. The cohort study that pooled data from six European countries found no association between long-term exposure to seven metal and metalloid components of PM2.5 (copper, iron, nickel, potassium, silicon, vanadium, and zinc)
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From page 120... ...
The committee further concludes there is inadequate or insufficient evidence of a possible risk-conferring relationship between exposure to burn pits, dust, exhaust, fuels, incinerator emissions, metals, mold, radiation, or solvents and depression. PTSD PTSD affects someone who was exposed to actual or threatened death, serious injury, or sexual violence and causes disturbances lasting more than 1 month.
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From page 121... ...
Sensitivity analyses of the same analysis was conducted in a cohort of VHA users identified as serving post-9/11 using an alternate indicator (post-911 service and combat service indicators) to control for combat exposure; the corresponding adjusted ORs for dust, exhaust, incinerator emissions, and solvents exhibit risk-conferring associations.
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From page 122... ...
CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 123... ...
Metals and PTSD One cohort study that pooled data from six European countries found no association between long-term exposure to seven metal and metalloid components of PM2.5 (copper, iron, nickel, potassium, silicon, vanadium, and zinc) and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including PTSD (Andersen et al., 2022)
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. Psychosis has no single cause, and symptoms can occur without a co-occurring mental health condition, though psychosis can also be a symptom of physical illnesses or mental illnesses, like bipolar disorder or depression (NIMH, 2023c)
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6-26 POST-9/11 VETERAN EXPOSURES & HEALTH OR of 1.13 (95% CI 1.08-1.17)
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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6-28 POST-9/11 VETERAN EXPOSURES & HEALTH In Figure 6-7, none of the adjusted ORs and associated CIs for the exposures and bipolar disorder met the prioritization criteria for additional discussion. There were no differences in the magnitude of association when stratifying by TBI, suggesting no interaction between these exposures and TBI on odds of bipolar disorder.
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 129... ...
. However, a cohort study that pooled data from six European countries found a positive but not significant association between long-term exposure to PM2.5 and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including SMI (Andersen et al., 2022)
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From page 130... ...
again found a small but significant increased risk of psychosis-related emergency department visits associated with short-term PM10 exposure. These authors also found significant associations between short-term nitrogen dioxide and sulfur dioxide and psychosis-related emergency department visits, and null results for carbon monoxide and ozone (Lee et al., 2022)
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From page 131... ...
While the Italian longitudinal cohort study did not find an association between long-term exposure to nitrogen dioxide and bipolar disorder (Nobile et al., 2023) , another prospective cohort study did find an increased risk of the disorder, along with an association with nitrogen oxides (Li et al., 2023)
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From page 132... ...
, exhaust, fuels, incinerator emissions, metals, mold, radiation, or solvents and bipolar disorder. Based on the literature search there is mixed evidence of a possible risk-conferring relationship between exposure to PM and bipolar disorder.
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cases of sleep disorders. None of the adjusted ORs and associated CIs for any exposure of interest and sleep disorders met the prioritization criteria for additional discussion (see Figure 6-8)
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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The studies investigated air pollution overall, PM2.5, PM10, and specific air pollutants. A systematic review stated general support for an association between ambient air pollution and disrupted sleep and between PM, nitrogen dioxide, and poor sleep quality (Wallace et al., 2023)
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From page 136... ...
. A cohort study that pooled data from six European countries found a positive but not significant association between long-term exposure to PM2.5 and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including sleep disorders (Andersen et al., 2022)
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From page 137... ...
. Radiation and Sleep Disorders A systematic review and meta-analysis of low-to-moderate exposure to ionizing radiation on mortality from a composite measure of diseases of the nervous system, which included sleep disorders, found a significantly lower mortality of such disorders among the exposed populations compared to the general population (Lopes et al., 2022)
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The committee further concludes there is inadequate or insufficient evidence of a possible risk-conferring relationship between exposure to burn pits, dust, exhaust, fuels, incinerator emissions, metals, mold, radiation, or solvents and sleep disorders.
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was generally associated with elevated risk of SUD, though there was no synergy among exposure groupings.
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter; SUD = substance use disorder.
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From page 141... ...
. A cohort study that pooled data from six European countries found a positive but not significant association between long-term exposure to PM2.5 and mortality from psychiatric disorders, which the authors defined as a broad range of ICD-9- and ICD-10-coded mental and behavioral disorders, including SUD (Andersen et al., 2022)
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From page 142... ...
Burn Pits, Fuels, Mold, or Solvents and SUD The committee's search yielded zero results on the possible relationships between exposure to burn pits, fuels, mold, or solvents and the risk of SUD. However, it should be noted that solvents themselves can be abused or self-administered much like other drugs.
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From page 143... ...
cases of nonfatal suicide attempts and intentional self-harm. Figure 6-10 shows that exposure to dust and PM, exhaust, and incinerator emissions were associated with a risk-conferring relationship with nonfatal suicide attempts and intentional selfharm with adjusted ORs of 1.15 (95% CI: 1.08-1.23)
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CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 145... ...
did not find a significant association between black carbon and suicide, and neither study found a significant association with ozone or nitrogen dioxide. Metals and Suicide One cohort study that pooled data from six European countries found no association between long-term exposure to seven metal and metalloid components of PM2.5 (copper, iron, nickel, potassium, silicon, vanadium, and zinc)
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From page 146... ...
The health outcomes assessed included adjustment disorders, attention disorders, anxiety disorders, depression, PTSD, SMI including bipolar disorder and psychosis and schizophrenia-spectrum disorders, sleep disorders, SUD, and nonfatal suicide attempts and intentional self-harm. The exposures were burn pits, dust and PM, exhaust, fuels, incinerator emissions, metals, mold, PM alone, radiation, and solvents.
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From page 147... ...
2019. Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD)
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2023. Emergency department visits associated with wildfire smoke events in California, 2016–2019.
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2020. Particulate matter exposure and attention-deficit/hyperactivity disorder in children: A systematic review of epidemiological studies.
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2011. Long-term health consequences of exposure to burn pits in Iraq and Afghanistan.
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2023. Long-term exposure to ambient air pollutants and their interaction with physical activity on insomnia: A prospective cohort study.
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2022. PM2.5 and PM10 air pollution peaks are associated with emergency department visits for psychotic and mood disorders.
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2018. Ambient air pollution exposure and emergency department visits for substance abuse.
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2024b. Association between air pollutants and the risk of sleep disorders: A systematic review and meta-analysis.
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2022. Air pollution, depressive and anxiety disorders, and brain effects: A systematic review.
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