Predictors of posttraumatic stress among victims of motor vehicle accidents

OBJECTIVE: This study identified factors that predict individual vulnerability to psychological trauma by examining the relationships among situation and person variables and symptoms of posttraumatic stress disorder (PTSD) 1, 6, and 12 months after a serious motor vehicle accident (MVA). METHODS: Background characteristics, exposure variables (ie, injury severity and accident characteristics), and psychosocial variables (ie, perceived loss of control, social support, and coping) were used to predict symptoms of PTSD and recovery in 115 injured MVA victims. All participants were injured during the MVA and provided data prospectively over the course of a year after their accidents. RESULTS: Along with background and exposure variables, use of wishful thinking coping distinguished between victims with and without symptoms of PTSD. CONCLUSIONS: Psychosocial variables such as wishful thinking coping can be used to identify MVA victims who are at risk of developing chronic posttraumatic stress and warrant further investigation.     

Central and peripheral psychophysiological responses to trauma-related cues in subclinical posttraumatic stress disorder: a pilot study

This study examined verbal-subjective, peripheral and central physiological responses of motor vehicle accident (MVA) survivors with subclinical posttraumatic stress disorder (PTSD), without PTSD symptoms as well as healthy controls. Seven persons of each group were exposed to positive, neutral, accident-related and negative, non-accident-related slides. The verbal-subjective ratings of the slides did not differ between the groups. In contrast to the verbal ratings of the trauma-related materials, the behavioral and physiological responses showed a remarkable dissociation from these reports. The startle responses were enhanced to accident-related slides only in the PTSD group and MVA survivors with PTSD had a significantly lower response to the neutral slides than MVA survivors without PTSD. P200 was lower to positive, neutral and negative slides in the PTSD group compared to both other groups. The late positive complex showed no group-related effects. The data suggest that traumatized persons with PTSD show exaggerated emotional responses to trauma-related stimuli and reduced cognitive responses to several types of stimuli that may interfere with the extinction of the emotional trauma memory.     

Memory performance and dysfunctional cognitions in recent trauma victims and patients with post‐traumatic stress disorder

In order to investigate whether cognitive dysregulation contributed to memory impairment in trauma patients, recent trauma victims, post‐traumatic stress disorder (PTSD) patients and healthy controls were compared with regard to verbal memory and dysfunctional cognitions. There were no significant group differences with regard to verbal memory. Concerning dysfunctional cognitions, recent trauma victims hardly differed from controls, unlike PTSD patients, who showed more negative appraisal, more dysfunctional thought control strategies and externality than controls. None of them were related to memory performance in the recent trauma group, and there was a negative correlation with distraction strategy in PTSD patients. In recent trauma victims, negative appraisal increased with time since the trauma. Copyright © 2007 John Wiley & Sons, Ltd.     

Attributional cognitions, coping behavior, and self-esteem in inpatients with severe spinal cord injuries

The purpose of this study was to examine the relation between attributional cognitions, coping behavior, and self-esteem of inpatients with severe spinal cord injuries. Thirty inpatients from rehabilitation centers were interviewed. Their coping behavior was assessed by a physician, a nurse, and a psychologist. The results showed sometimes different tendencies for the recently vs. long-disabled patients with respect to the direction of the relation between attributional cognitions and rehabilitation outcome (coping behavior and self-esteem). Especially noteworthy is the evident adaptiveness in the group of the long-disabled inpatients with regard to being concerned with the causes of the accident and being concerned with the avoidability of the accident that led to the injury, while in the recently disabled group these cognitions are related to nonadaptiveness. To be concerned with the question, "Why did this have to occur to me?" was strongly related for the long-disabled inpatients with poor coping behavior, while this was not the case for the recently disabled.     

Meaning of illness and psychological adjustment to HIV/AIDS

The authors explored the relationship between meaning of illness and psychological adjustment in persons with symptomatic HIV disease and AIDS. A group of 203 participants completed self-report questionnaires measuring meaning of illness, problem-focused coping, social support, psychological well-being, and depressed mood. Positive meaning was associated with a higher level of psychological well-being and a lower level of depressed mood. Further, meaning contributed significantly to predicting both psychological well-being and depressed mood over and above the contributions of problem-focused coping and social support. These findings have implications for HIV coping and adjustment models and for HIV-related psychotherapy.     

Driving cognitions,rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic‐related cognitions, accident‐related cognitions, and social‐related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social‐related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.     

Developing interventions for chronically ill patients: is coping a helpful concept?

In this review, the role of coping in the development of psychosocial interventions for chronically ill patients is discussed. After summarizing the theoretical issues involved in the translation of the coping concept into an intervention, a review is undertaken of 35 studies concerned with the impact of interventions aimed at improving coping on patients' quality of life. These studies concern seven different chronic disease types (AIDS, asthma, cancer, cardiovascular diseases, chronic pain, diabetes, and rheumatoid arthritis) and show explicit consideration of attempts to manage illness in terms of coping to be rare. Many studies nevertheless address the equivalent of coping, namely behaviors and/or cognitions intended to deal with an illness situation appraised as stressful. The results of these studies are encouraging, although largely limited to the improvement of one or two particular coping strategies and problem-focused strategies in particular. It is argued that in order to expand on these initially positive findings, greater and more explicit consideration should be given to the potential of the coping concept for intervention with the chronically ill. The appraisal of stressful situations, the use of coping resources, and the strategic application of particular coping strategies should, for example, be given more careful consideration.     

Who develops acute stress disorder after accidental injuries?

BACKGROUND: Acute stress disorder (ASD) is still a much discussed diagnosis, and research on predictors of ASD is sparse. The aim of this study was to assess the prevalence of ASD in a random sample of accident victims and to investigate the associations between different independent variables and ASD symptomatology with the objective to find a regression model best explaining the variance in ASD symptom level. METHODS: We collected a randomized sample of hospitalized accident victims (n = 323). ASD was assessed using the Peritraumatic Dissociative Experiences Questionnaire and the Clinician-Administered Posttraumatic Stress Disorder Scale. Correlations and multiple regression analyses were computed with four groups of variables. This yielded the variables entered into a final multiple regression analysis. RESULTS: Thirteen patients (4.0%) met all criteria for a diagnosis of ASD. Thirty-two patients (9.9%) met the criteria for a diagnosis of subsyndromal ASD. Thirty-eight percent of the variance in ASD symptom level was explained with a regression model including stay at the intensive care unit, preexisting psychiatric disorder, sense of coherence, sense of death threat, appraisal of accident severity, preventability of the accident by others, pain and appraisal of coping ability regarding physical recovery. CONCLUSIONS: This study furthers the discussion about the requirements for the ASD diagnosis. It also points to the importance of not only assessing objective accident-related variables in the aftermath of an accident but also of giving more consideration to the subjective experience and appraisal of the accident in the prevention of ASD.     

Coping with breast cancer: patient, spouse, and dyad models

OBJECTIVE: The objectives of this study were 1) to assess similarities and differences between patients with breast cancer and their spouses in terms of coping strategies and adjustment (psychosocial and psychological) to cancer and 2) to investigate the pattern of relationships between the patients' and spouses' coping strategies and between each of these strategies and the patient's adjustment to the illness using three types of models: patient, spousal, and dyadic coping. METHODS: Seventy-three patients with breast cancer and their spouses completed questionnaires that measured distress (Brief Symptom Inventory), psychosocial adjustment, and coping strategies. RESULTS: The patients' distress was greater than their spouses', but a similar level of psychosocial adjustment was reported. The patients used more strategies involving problem-focused coping than their spouses. The use of emotion-focused coping, which included ventilation and avoidance strategies, was highly related to distress and poor adjustment on the part of the patient. The spouses' emotion-focused coping and distress were related to that of the patients. Dyad emotion-focused coping measures were highly associated with the patients' distress and adjustment. CONCLUSIONS: Spousal and dyad coping are important factors in a patient's adjustment to breast cancer.     

Differences in posttraumatic stress disorder symptoms between elderly non-Hispanic Whites and African Americans

This study was a secondary analysis of two similar data sets to examine potential differences in PTSD symptoms between elderly whites and African Americans (n=90). Without regard to trauma type, there were no differences between the races in the distribution of PTSD diagnosis or specific symptom constellations (e.g., re-experiencing, avoidance, or arousal). No significant differences were yielded for individuals who experienced a physical trauma. However, in cases of nonphysical trauma, elderly whites were significantly more likely than elderly African Americans to report hyperarousal symptoms. These results suggest the need to better understand coping strategies used by whites and African Americans in the face of trauma.     

Resolution of trauma-related guilt following treatment of PTSD in female rape victims: a result of cognitive processing therapy targeting comorbid depression?

BACKGROUND AND METHODS: Although Resick et al. [Resick, P.A., Nishith, P., Weaver, T.L., Astin, M.C., Feuer, C.A., 2002. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J. Consult. Clin. Psychol. 70, 867-879.] reported comparable results for treating rape-related posttraumatic stress disorder (PTSD) using either cognitive-processing therapy (CPT) or prolonged exposure (PE), there was some suggestion that CPT resulted in better outcomes than PE for certain aspects of trauma-related guilt. The present study revisited these findings to examine whether this effect was a function of improvement in a subset of participants with both PTSD and major depressive disorder (MDD). RESULTS: Results indicated that CPT was just as effective in treating "pure" PTSD and PTSD with comorbid MDD in terms of guilt. Clinical significance testing underscored that CPT was more effective in reducing certain trauma-related guilt cognitions than PE. LIMITATIONS: Findings cannot be generalized to men, and only one measure of guilt was used. CONCLUSIONS: The observed superiority of CPT over PE for treating certain guilt cognitions was not due to participant comorbidity. Further research is recommended to untangle the relationship between guilt, depression and differential response to treatment in PTSD following sexual assault trauma.     

Cognitive distortions and irrational beliefs in post-traumatic stress,anxiety, and depressive disorders

This study examined the validity of PTSD by comparing the dysfunctional cognitions found in a PTSD group, a clinical group (anxiety or depression), and a nonclinical group. Subjects completed the Millon Clinical Multiaxial Inventory-11, the Impact of Event Scale, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Cognitive Error Questionnaire, and the Survey of Personal Beliefs. Results revealed that PTSD and. clinical groups were significantly more depressed and anxious than nonclinical subjects. Unlike the PTSD group, only the clinical group endorsed more dysfunctional cognitions than the nonclinical group, which supports the uniqueness of the PTSD group as differing cognitively from clinical groups.     

Incidence of posttraumatic stress disorder after prolonged surgical intensive care unit treatment

The purpose of the study was to investigate the prevalence of posttraumatic stress disorder (PTSD) after prolonged intensive care unit (ICU) treatment and to study the differences between trauma patients and patients who were admitted with other diagnoses. Survivors of surgical intensive care of at least 30 days' duration underwent follow-up examination at about 35 months after discharge from the ICU. Thirty-seven patients were investigated. Seven patients met full DSM-IV criteria for diagnosis of PTSD. All of them had sustained severe multiple injuries. Patients with trauma were at significantly higher risk for developing PTSD than were non-trauma patients. After prolonged ICU treatment, PTSD seems more likely to occur when the reason for admission to the ICU was severe physical injury. The prevalence of PTSD does not seem to be related to injury severity or duration of ICU treatment.     

Facilitating problem- and emotion-focused coping in victims of burglary: Evaluating a police crisis intervention program

The impact of a police crisis intervention program on problem- and emotion- focused coping with burglary victims was assessed. Major program components included: conducting a criminal investigation in the victim's home, providing oral and written crime prevention information, and performing a security check. All participating police officers were trained in utilizing interview techniques facilitating emotion- and problem-focused coping with the event. Results suggested that the program actually facilitated coping with the event: Victims' perceived police protection against crime was enhanced; concern about crime was reduced; while preventive cognitions, prevention awareness and responsibility, and preventive intentions were strengthened and more extreme preventive options were generally rejected. Criminal investigations per se, however, may backfire and hamper coping processes. Several implications for future studies on victim intervention programs are discussed.     

Adjustment to a dyadic stressor: a longitudinal study of coping and depressive symptoms in infertile couples over an insemination attempt

In a study designed to examine how intimate partners' coping processes with regard to infertility predicted depressive symptoms across the course of a treatment cycle, 43 couples completed assessments in the week prior to and the week after receiving a negative pregnancy result from an alternate insemination attempt by the partner. Depressive symptoms in both partners increased significantly after the pregnancy result receipt. As hypothesized, avoidant coping predicted increased distress over time. and approach-oriented coping (e.g., problem-focused coping, emotional processing, and expression) predicted decreased distress. Coping strategies engaged in by both individuals and partners predicted depressive symptoms, and for women, interactions also emerged between their own and their partners' coping.     

Repressive coping style,acute stress disorder,and posttraumatic stress disorder after myocardial infarction

OBJECTIVE: The study examined the associations between repressive coping style, acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) after myocardial infarction (MI) to ascertain the efficacy of repressive coping style in immediate and long-term adjustment to stress. METHODS: A total of 116 MI patients were examined twice: within a week of their MI (time 1) and 7 months later (time 2). At time 1, repressive coping style, perceived threat, and ASD were measured by self-report questionnaires. In addition, medical measures indicative of the severity of the MI were obtained from patients' hospital records. At time 2, PTSD was assessed. The distribution of the repressive coping style was compared with that of 72 matched control subjects. RESULTS: Findings revealed the adaptiveness of repressive coping style both in the immediate and longer-term aftermath of MI: repressors endorsed less ASD and PTSD than nonrepressors. In addition, the contribution of repressive coping style to PTSD was unique and beyond the implications of severity of MI, perceived threat, and immediate ASD. CONCLUSIONS: The findings support the role of repressive coping style as a stress-buffer; several mechanisms that explain this role are suggested.     

Sense of coherence - a mediator between disability and handicap?

BACKGROUND: The aim of this study was first to analyze the associations between disability and handicap and Antonovsky's concept of sense of coherence (SOC); secondly, to find out how the SOC concept could be integrated in the WHO model of impairments, disabilities, and handicaps (ICIDH). METHODS: Data from two studies were used: one on patients with rheumatoid arthritis, one on severely injured accident victims. Objective measures of the illness or the injury were conceptualized as indicator variables for disability, whereas variables related to the patients' subjective judgement were conceptualized as indicator variables for handicap. Correlations were calculated between both sets of variables and the SOC scale total score. RESULTS: SOC showed no significant correlation with 'disability variables' (rheumatoid arthritis: HAQ, SF36 physical functioning; accidental injuries: ISS, GCS). However, significant correlations were found between SOC and all 'handicap variables' (rheumatoid arthritis: HAD, SF36 social functioning; accidental injuries: CAPS-2, IES, SCL-90-R depression subscale). CONCLUSIONS: SOC is related to the psychosocial effects of health problems. It may be understood as a mediator between disability and handicap. Prospective studies are needed to clarify whether the SOC scale can be used as an outcome predictor with regard to psychosocial adaptation, in acute as well as in chronic health problems.     

Longitudinal study of observed and perceived family influences on problem-focused coping behaviors of preadolescents with spina bifida

OBJECTIVE: To study coping socialization longitudinally by examining reported and observed family environment and parenting variables in relation to children's problem-focused coping in a sample of 68 families of preadolescents with spina bifida and 68 matched able-bodied comparison families. METHODS: Family environment and parenting variables were assessed with mother and father reports and observational measures. Children's problem-focused coping was self-reported. RESULTS: Prospective analyses revealed that maternal responsiveness, paternal responsiveness, and family cohesion predicted an increase in children's use of problem-focused coping strategies, while change in paternal responsiveness and maternal responsiveness and demandingness was related concurrently to change in coping. Few group (spina bifida vs. able-bodied) or gender differences with respect to parenting and family influences on children's coping behaviors were found. CONCLUSIONS: Multimethod findings suggest that the quality of parenting and family environment is associated with children's problem-focused coping behaviors. We discuss clinical implications.     

Do changes in illness perceptions predict changes in psychological distress among oesophageal cancer survivors?

This study aimed to examine whether changes in the illness perceptions of oesophageal cancer survivors explain changes in their levels of psychological distress relative to demographic and biomedical variables and coping strategies. Oesophageal cancer survivors completed the Illness Perception Questionnaire - Revised, the Cancer Coping Questionnaire and the Hospital Anxiety and Depression Scale at two points in time, 12 months apart. Cluster analysis was used to identify groups of respondents who reported a similar profile of change in their illness perception scores over time. Findings suggested that enhancing control cognitions and encouraging a positive focus coping strategy may be important in improving psychological health.     

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.