Showing papers in "Journal of Traumatic Stress in 2007"

Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience.

Abstract: Resilience refers to an individual’s ability to thrive despite adversity. The current study examined the psychometric properties of the Connor–Davidson Resilience Scale (CD-RISC). Three undergraduate samples (ns > 500) were used to determine the factor structure of the CD-RISC. The first two samples were used to conduct exploratory factor analysis (EFA), and the third was used for confirmatory factor analysis. The EFA showed that the CD-RISC had an unstable factor structure across two demographically equivalent samples. A series of empirically driven modifications was made, resulting in a 10-item unidimensional scale that demonstrated good internal consistency and construct validity. Overall, the 10-item CD-RISC displays excellent psychometric properties and allows for efficient measurement of resilience.

Anger, hostility, and aggression among Iraq and Afghanistan War veterans reporting PTSD and subthreshold PTSD.

Abstract: Iraq and Afghanistan War veterans were grouped by level of posttraumatic stress disorder (PTSD) symptomatology and compared on self-report measures of trait anger, hostility, and aggression. Veterans who screened positive for PTSD reported significantly greater anger and hostility than those in the subthreshold-PTSD and non-PTSD groups. Veterans in the subthreshold-PTSD group reported significantly greater anger and hostility than those in the non-PTSD group. The PTSD and subthreshold-PTSD groups did not differ with respect to aggression, though both groups were significantly more likely to have endorsed aggression than the non-PTSD group. These findings suggest that providers should screen for anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of PTSD and incorporate relevant anger treatments into early intervention strategies.

The criterion a problem revisited: Controversies and challenges in defining and measuring psychological trauma

Abstract: The Criterion A problem in the field of traumatic stress refers to the stressor criterion for posttraumatic stress disorder (PTSD) and involves a number of fundamental issues regarding the definition and measurement of psychological trauma. These issues first emerged with the introduction of PTSD as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980) and continue to generate considerable controversy. In this article, the authors provide an update on the Criterion A problem, with particular emphasis on the evolution of the DSM definition of the stressor criterion and the ongoing debate regarding broad versus narrow conceptualizations of traumatic events.

Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery.

Abstract: Research suggests that responses to script-driven trauma imagery in posttraumatic stress disorder (PTSD) include reexperiencing and dissociative symptom subtypes. This functional magnetic resonance imaging (fMRI) study employed a dimensional approach to characterizing script-driven imagery responses, using the Responses to Script-Driven Imagery Scale and correlational analyses of relationships between severity of state posttraumatic symptoms and neural activation. As predicted, state reexperiencing severity was associated positively with right anterior insula activity and negatively with right rostral anterior cingulate cortex (rACC). Avoidance correlated negatively with rACC and subcallosal anterior cingulate activity. In addition, as predicted, dissociation correlated positively with activity in the left medial prefrontal and right superior temporal cortices, and negatively with the left superior temporal cortex. Theoretical and clinical implications are discussed, particularly with respect to an emotion-dysregulation account of PTSD.

Trauma coping strategies and psychological distress: A meta-analysis.

Abstract: The identification of adaptive and maladaptive coping strategies following traumatic events has been the subject of much scientific inquiry. The current study sought through meta-analysis to evaluate the relationship between the use of approach and avoidance strategies (both problem-focused and emotion/cognitive focused) following trauma and psychological distress. Thirty-nine studies of coping following two types of traumatic events (interpersonal violence and severe injury) were retained in the meta-analysis. There was a consistent association between avoidance coping and distress, overall r = .37, but no association between approach coping and distress, overall r = -.03, but some important moderators existed. Implications of the results for future research regarding coping and trauma recovery are discussed.

Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan.

Abstract: The purpose of the present research was to identify rates of posttraumatic stress and depressive symptoms in soldiers returning from war. During reintegration training, U.S. Army soldiers, who recently returned from a 12-month deployment to either Iraq (Operation Iraqi Freedom, n = 2,275) or Afghanistan (Operation Enduring Freedom, n = 1,814), completed study materials. Surveys assessed self-reported levels of depression, posttraumatic stress, and life satisfaction. Results indicated that approximately 44% of soldiers who volunteered to participate self-reported clinically significant levels of depressive symptoms, posttraumatic stress symptoms, or both. Although assessing symptoms and not disorders, these results suggest a potentially high rate of mental health concerns in soldiers immediately after returning from a combat zone. Further research should examine the utility of broad scale interventions.

Psychosocial correlates of PTSD symptom severity in sexual assault survivors

Abstract: This study's goal was to assess the effects of preassault, assault, and postassault psychosocial factors on current posttraumatic stress disorder (PTSD) symptoms of sexual assault survivors. An ethnically diverse sample of over 600 female sexual assault survivors was recruited from college, community, and mental health agency sources (response rate = 90%). Regression analyses tested the hypothesis that postassault psychosocial variables, including survivors' responses to rape and social reactions from support providers, would be stronger correlates of PTSD symptom severity than preassault or assault characteristics. As expected, few demographic or assault characteristics predicted symptoms, whereas trauma histories, perceived life threat during the assault, postassault characterological self-blame, avoidance coping, and negative social reactions from others were all related to greater PTSD symptom severity. The only protective factor was survivors' perception that they had greater control over their recovery process in the present, which predicted fewer symptoms. Recommendations for intervention and treatment with sexual assault survivors are discussed.

Pharmacotherapy to prevent PTSD: Results from a randomized controlled proof-of-concept trial in physically injured patients.

Abstract: Acute physical injury is frequently associated with mental health sequelae, which then accentuate disability and worsen functional outcomes. A pharmacological prevention approach to this problem has been proposed. This proof-of-concept study was a double-blind, randomized controlled trial of 14 days of the beta-blocker propranolol (n = 17), the anxiolytic anticonvulsant gabapentin (n = 14), or placebo (n = 17), administered within 48 hours of injury to patients admitted to a surgical trauma center. Of 569 accessible, potentially eligible subjects, 48 (8%) participated. Outcomes assessments were conducted at 1, 4, and 8 months postinjury. Although well tolerated, neither study drug showed a significant benefit over placebo on depressive or posttraumatic stress symptoms. Implications are discussed for future pharmacological prevention studies in survivors of acute traumatic injury.

School-based intervention for prevention and treatment of elementary-students' terror-related distress in Israel: a quasi-randomized controlled trial.

Abstract: A school-based intervention for preventing and reducing children's posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

Multiple Traumatic Events and Psychological Distress : The South Africa Stress and Health Study

Abstract: Using nationally representative data from South Africa, we examine lifetime prevalence of traumas and multiple traumas (number of events). Employing multiple regression analysis, the authors study the sociodemographic risk of trauma, and the association between trauma and distress. Results indicate most South Africans experience at least one traumatic event during their lives, with the majority reporting multiple. Consistent variation in risk is evident for gender and marital status, but not other sociodemographics. Trauma is positively related to high distress, and findings also support a cumulative effect of trauma exposure. Individuals with the most traumas (6+) appear at 5 times greater risk of high distress. This study highlights the importance of considering traumatic events in the context of other traumas in South Africa.

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks.

Abstract: A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed. Language: en

Posttraumatic stress disorder and posttraumatic growth among Israeli ex-POWs.

Abstract: In this article, the authors present a prospective study that dealt with pathological (posttraumatic stress disorder; PTSD) and salutary (posttraumatic growth; PTG) outcomes of captivity and the correlates of those outcomes among a sample of ex-prisoners of war (POWs) and a control group of combat veterans. Posttraumatic stress disorder and its correlates were assessed in 1991 and 2003, and PTG was assessed in 2003. The results indicate that ex-POWs exhibited higher levels of PTSD and PTG than did the controls. In addition, both linear and quadratic associations between PTSD and PTG were found. The authors discuss some unresolved issues related to assessment of PTG and salutary outcomes, and outline directions for future research.

PTSD symptoms, life events, and unit cohesion in U.S. soldiers: baseline findings from the neurocognition deployment health study.

Abstract: Relationships among a modifiable situational factor (unit cohesion), prior stressful life events, and posttraumatic stress disorder (PTSD) symptoms were assessed in 1,579 U.S. Army soldiers with no history of contemporary war zone deployment. It was predicted that unit cohesion would attenuate the dose-response relationship between past stressor exposures and PTSD symptoms at relatively moderate levels of exposure. Consistent with this hypothesis, regression analysis revealed that life experiences and unit cohesion strongly and independently predicted PTSD symptoms, and that unit cohesion attenuated the impact of life experiences on PTSD. Some military personnel reported significant predeployment, stress-related symptoms. These symptoms may serve as vulnerabilities that could potentially be activated by subsequent war-zone deployment. Higher predeployment unit cohesion levels appear to ameliorate such symptoms, potentially lessening future vulnerability.

Relationships between REM sleep findings and PTSD symptoms during the early aftermath of trauma.

Abstract: Laboratory sleep findings in posttraumatic stress disorder (PTSD) have been characterized as incongruent with subjective complaints. Most findings relate to rapid eye movement (REM) sleep. Chronicity confounds relationships between objective sleep and PTSD. The authors report relationships between PTSD symptoms and objective sleep measures from the early aftermath of trauma. Thirty-five patients received polsomnography and PTSD assessment within a month of traumatic injury. Posttraumatic stress disorder status was established at 2 months. The REM segment duration correlated negatively with initial PTSD and insomnia severity, which also correlated with total sleep time. Relative beta frequency during REM sleep from a subset of cases correlated negatively with PTSD and nightmare severity. These findings suggest a link between subjective symptoms and REM sleep phenomena acutely following trauma.

Risk factors for suicidal behavior among a national sample of adolescents: implications for prevention.

Abstract: Factors associated with suicidal ideation and attempts were examined among a national probability sample of adolescents. Sample prevalences of suicidal ideation and attempts were 24.3% and 3.3%, respectively, yielding weighted population prevalence estimates of 23.3% and 3.1%. Suicidal ideation was positively associated with female gender, age, family alcohol and drug problems, violence exposure, lifetime depression, and posttraumatic stress disorder (PTSD). Suicide attempts were associated with female gender, age, sexual and physical assault, lifetime substance abuse or dependence, PTSD, and depression. Implications for intervention and prevention are discussed.

Stress inoculation-induced indications of resilience in monkeys.

Abstract: The negative consequences of stress are well-recognized in mental health research. Exposure to early life stressors, for example, increases the risk for the development of mood, anger, anxiety, and substance abuse disorders. Interestingly, however, early life stressors have also been linked to the subsequent development of resilience. Variously described as inoculating, immunizing, steeling, toughening, or thriving, the hypothesis that early life stressors provide a challenge that, when overcome, induces adaptations that enhance emotional processing, cognitive control, curiosity, and neuroendocrine regulation is examined in this review of squirrel monkey research.

Stigma and the Military: Evaluation of a PTSD Psychoeducational Program

Abstract: Trauma risk management (TRiM) is an intensive posttraumatic stress disorder (PTSD) psychoeducational management strategy based on peer-group risk assessment developed by the UK Royal Navy (RN). TRiM seeks to modify attitudes about PTSD, stress, and help-seeking and trains military personnel to identify at-risk individuals and refer them for early intervention. This quasiexperimental study found that TRiM training significantly improved attitudes about PTSD, stress, and help-seeking from TRiM-trained personnel. There was a nonsignificant effect on attitudes to seeking help from normal military support networks and on general health. Within both the military and civilian populations, stigma is a serious issue preventing help-seeking and reducing quality of life. The results suggest that TRiM is a promising antistigma program within organizational settings.

Aggression among combat veterans: Relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety.

Abstract: Prior research has revealed heightened aggressive behavior among veterans with PTSD. This study tested a model examining the interrelationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, dysphoric symptoms, and anxiety symptoms in predicting aggressive behavior in a sample of 265 male combat veterans seeking diagnostic assessment of PTSD. Combat exposure was indirectly associated with aggression primarily through its relationship with PTSD symptoms. Symptoms of PTSD were directly related to aggression, and indirectly related to aggression through dysphoric symptoms. Results highlight the role of PTSD symptoms and dysphoric symptoms with respect to aggressive behavior among this population, and suggest the relevance of aggression theory to the study of combat veterans.

PTSD symptoms in children and adolescents 28 months after a flood: Age and gender differences

Abstract: The present study examined the prevalence and predictors of posttraumatic stress disorder symptoms (PTSD) in a sample of 533 students (aged 11 to 21), 28 months after the 1997 Flood in southwestern Poland. The results show that 18% of the participants met all diagnostic criteria for PTSD. Based on hierarchical multiple regression analyses, PTSD criteria symptoms were positively correlated with the degree of exposure to trauma experienced during the disaster. A three-way interaction of trauma, age, and gender showed that more PTSD symptoms were observed among the younger participants and girls than among the older boys. The results confirm the need of research testing culturally sensitive implementation of mental health programs for young victims of disasters, taking into account their age and gender.

Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults.

Abstract: Nightmares and sleep disturbance are fundamental concerns for victims of trauma. This study examined the efficacy of a manualized cognitive-behavioral treatment (CBT) for chronic nightmares in trauma-exposed individuals via a randomized clinical trial. Participants were randomly assigned to a treatment group or wait-list control group, with 27 participants completing the treatment. At the 6-month follow-up assessment, 84% of treated participants reported an absence of nightmares in the previous week. Significant decreases were also reported in symptoms of depression and posttraumatic stress, fear of sleep, and number of sleep problems, while sleep quality and quantity improved. The present study adds to the growing literature indicating this brief CBT as a first-line treatment for trauma-exposed individuals with chronic nightmares.

Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users.

Abstract: The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

Intergenerational transmission of trauma: exploring mother-infant prenatal attachment.

Abstract: Early childhood attachment and bonding and the intergenerational transmission of trauma are two key areas to address to understand the connection between parental trauma and the parent-child relationship. The purpose of the current study was to explore the relationship between trauma and past parental attachment behaviors of 41 expectant mothers and the subsequent development of attachment and bonding with their unborn child. Results of the current study suggest that trauma history, in general, does not negatively impact expectant mothers' current prenatal attachment with their unborn child. However, interpersonal trauma history does appear to have negative effects on prenatal attachment. These results point to the importance of understanding the role of interpersonal trauma exposure on prenatal attachment.

Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood

Abstract: Structural equation modeling was used to examine the relationship of childhood trauma, educational level, and the use of avoidant coping on substance abuse and psychological distress in a community sample of 285 women. Results indicated that self-reported childhood trauma was significantly related to greater substance abuse and psychological distress, through educational attainment and avoidant coping strategies. Lower level of education affected substance abuse through greater use of avoidant coping, but had no significant relationship with psychological distress. Greater use of avoidant coping was related to increased substance abuse and greater psychological distress. Findings indicate the need for supportive educational strategies and interventions to teach coping skills in preventing substance abuse and longer-term psychological distress in children exposed to trauma.

Partial and full PTSD in Brazilian ambulance workers: Prevalence and impact on health and on quality of life

Abstract: A cross-sectional survey for posttraumatic stress disorder (PTSD) was conducted with 234 Brazilian ambulance workers (180 men and 54 women) using a sociodemographic questionnaire, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Short Form Health Survey-36. Current prevalence rates for full and partial PTSD were 5.6% (men = 6.7%, women = 1.9%) and 15% (men = 13.3%, women = 20.4%), respectively. Male workers with full PTSD were more likely to be nonmarried (75% vs. 43%) and those with partial PTSD reported more emotional problems (65.2% vs. 30%) and medical visits (67% vs. 44%) than the controls. Workers with PTSD showed impairment in the physical and mental domains of the SF-36, whereas workers with partial PTSD had only the later compromised. The characteristics and the level of exposure to trauma of the study population may account for the low prevalence of PTSD.

Individual differences in fear: isolating fear reactivity and fear recovery phenotypes.

Abstract: Although different people respond differently to threatening events, animal research on the neural basis of fear tends to focus on typical responses. Yet there are substantial individual differences between animals exposed to identical behavioral procedures. In an effort to begin to understand the nature and causes of fear variability and resilience, we separated outbred Sprague-Dawley rats into high and low reactivity, and fast and slow recovery phenotypes, based on freezing levels during fear conditioning and extinction, respectively. Subsequent tests revealed stable differences in both measures, indicating that fear responses reflect trait-like phenotypes in outbred animals. Because clinical disorders may reflect extreme phenotypes, identification of the biological basis for these differences could provide insights into human individual differences in fear.

Differentiating biological correlates of risk, PTSD, and resilience following trauma exposure

Abstract: Risk and resilience factors presumably explain the individual differences in the response to adversity. However, little is known about how such factors are related. Risk and protective factors may reflect a quantitative difference along a single dimension (e.g., low IQ might be associated with risk and high IQ with resilience); however, they may also refer to orthogonal constructs that interact and/or moderate stress effects to increase or diminish the probability of developing trauma-related psychopathology (e.g., good coping could offset low IQ). The authors illustrate experimental strategies for distinguishing between these possibilities for any putative measure relating to symptom development, using a database that includes published and unpublished psychological and biological variables from a relatively homogenous cohort of exposed and nonexposed veterans.

Personality characteristics of adult survivors of childhood trauma.

Abstract: Lenore Terr (1991) proposed a framework for childhood trauma that distinguishes between single-incident trauma (Type I) and repeated or prolonged trauma (Type II). Terr's framework and data collected from the National Comorbidity Survey (NCS) are used to examine differences in personality between adult survivors of childhood Type I trauma, childhood Type II trauma, and a control group of adults not traumatized as children. Groups were compared on five personality scales. Results indicate that individuals in the trauma categories scored higher in neuroticism and openness to new experiences than individuals in the control group. The Type I group was lower than the control group on interpersonal dependency, whereas the Type II group scored higher than the control group on this measure.

Factors affecting burnout and compassion fatigue in psychotherapists treating torture survivors: Is the therapist's attitude to working through trauma relevant?

Abstract: In this study, a group of trauma therapists (N = 100) working with torture survivors was investigated with respect to the extent to which they advocated and practiced working through traumatic events as well as levels of symptomatology including compassion fatigue, burnout, and distress. Results showed that a combination of high advocacy and low degree of working through traumatic events was related to high symptomatology. Therapists with this combination showed more compassion fatigue, burnout, and distress than therapists who advocated and practiced working through traumatic events, as well as therapists who neither advocated nor practiced it. Results are discussed with respect to the pathogenic role of fear avoidance in therapists.

Factor structure of PTSD symptoms among west and central African refugees

Abstract: Although trauma is widespread in Africa, Africans are unrepresented in the literature on posttraumatic stress disorder (PTSD). The authors used confirmatory factor analysis of responses to the Harvard Trauma Questionnaire to model PTSD symptom structure in a sample of African refugees presenting at a U.S. torture treatment clinic. They tested four models that are proposed in the literature and one based on their clinical experience in which some symptoms of hyperarousal were integrated into intrusion. Their findings support a preference for a 4-factor aroused intrusion model. Discussion focuses on interpretation of models, the role of numbing and avoidance, and the limitations of Euro American symptoms in non-Euro American populations.

Genetics of posttraumatic stress disorder: Review and recommendations for future studies.

Abstract: Posttraumatic stress disorder (PTSD) is common and debilitating. Posttraumatic stress disorder is moderately heritable; however, the role of genetic factors in PTSD etiology has been largely neglected by trauma researchers. The goal of this study is to motivate trauma researchers to reflect on the role genetic variation may play in vulnerability and resilience following trauma exposure. Evidence from family, twin, and molecular genetic studies for genetic influences on PTSD is reviewed. Recommendations for future studies are presented with emphasis on study design and assessment issues particular to the field of trauma and PTSD. Clinical implications of PTSD genetic studies are discussed.