Differences in the association of spirituality,forgiveness, PTSD and stress among social workers and social work students treating trauma survivors

ABSTRACT

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.     

From soldiers to children: developmental sciences transform the construct of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) was first included in the American Psychiatric Association's Diagnostic and statistical manual of mental disorders in 1980. Long used to describe the reactions of soldiers affected by stress in combat situations, PTSD is now recognised as a disorder affecting abused and neglected infants and children, survivors of assault and domestic violence, and disaster victims of all ages. How did a construct so distinctly associated with the experiences of adult combat veterans come to describe behaviours seen in children, and even infants? This transformation can be understood by examining the way clinical researchers have applied the developmental sciences (child and adolescent development, neuroscience, and cognitive science) to the study of trauma. Each of the developmental sciences has contributed to our understanding of children's reactions to traumatic situations, and each plays an integral part in the effort to understand PTSD as a disorder of children as well as adults.     

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an increasingly recognized and potentially preventable condition. Certain factors, especially the severity of the trauma, perceived lack of social support and peri-traumatic dissociation have been associated with its development. In recent years, a more robust evidence base regarding the management of individuals involved in traumatic events has emerged. Immediately after a traumatic event, simple practical, pragmatic support provided in a sympathetic manner by non-mental health professionals seems most likely to help. For individuals who develop persisting PTSD, trauma-focused cognitive behavioural therapy (TFCBT) may be beneficial within a few months of the trauma. For those who develop chronic PTSD, TFCBT and eye movement desensitization and reprocessing are best supported by the current evidence. Some anti-depressants appear to have a modest beneficial effect and are recommended as a second-line treatment. The current evidence base has allowed the development of guidelines that now require implementation. This has major implications in terms of planning and developing services that allow appropriately qualified and trained individuals to be available to cater adequately for the needs of survivors of traumatic events.     

交通事故幸存者创伤后应激障碍的流行情况及预测因素分析

目的了解交通事故幸存者创伤后应激障碍(post traumatic stress disorder,PTSD)的流行情况,并分析相关的预测因素。方法选择2010年10月—2011年5月206例交通事故幸存者,其中,男168例,女38例,年龄(39.8±12.5)岁。采用17项PTSD检测表——特定事件版(PTSD checklist-specific stressor version,PCL-S)进行评估。结果 206例交通事故幸存者中共有51例为可能的PTSD患者,发生率为24.8%;PTSD症状比较女性较男性严重,男性PCL-S得分(26.90±7.70)分,女性(31.46±8.87)分,男女比较差异有统计学意义(P0.05),已婚者较单身者严重,已婚PCL-S得分(28.72±8.07)分,单身(23.00±5.47)分,二者比较差异有统计学意义(P0.05)。结论 PTSD在我国交通事故幸存者中是一种常见的心理疾患,其主要的预测因素包括:性别、年龄、婚姻状况、评估距离创伤时间间隔、躯体康复状况。     

Relationship between sense of coherence and post-traumatic stress disorder symptoms among firefighters

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, the post-traumatic stress disorder (PTSD) is diagnosed when a person: (a) is exposed to a traumatic event that is well outside the range of usual human experience accompanied by intense fear or horror; (b) reexperiences the event in his/her thoughts, dreams and daily life; (c) avoids the stimuli associated with the trauma and numbs his/her emotions; (d) demonstrates symptoms of increased arousal; and (e) manifests these disturbances for a longer period than one month. Since the 1980s, it has been pointed out that PTSD may occur not only among survivors of severe traumatic events but also among those who have rescued the victims of those events. Members of fire brigades constitute a large occupational group exposed to traumatic experiences. The aim of our study was to find an answer to the question of what are the relationships between the level of PTSD symptoms and the sense of coherence (and its three dimensions). In all, 464 firemen were interviewed. PTSD-Interview developed by Watson et al. was used to assess the level of PTSD symptoms and the presence]absence of PTSD. The higher level of PTSD symptoms was associated with the lower level of the sense of coherence. A small group (3.9%) of subjects who experienced traumatic events met DSM-IV diagnostic criteria for PTSD. The sense of coherence of these people was significantly lower than that of others.     

Post-traumatic stress disorder in children and adolescents

Post-traumatic stress disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of trauma, avoidance of reminders of the trauma and increased hyperarousal. Although the condition is well established in adults, there is little research into PTSD in children and adolescents. The available research shows that young people experience similar symptoms to adults. Risk factors include family dysfunction, peer problems, greater exposure to the trauma and the presence of pre-existing psychiatric disorder such as anxiety. Protective factors include good coping skills, good relationship with a parent and support from others in the community. This article reviews treatment approaches to PTSD in young people in particular the use of cognitive behavioural therapy (CBT).     

常见危重病患者人群并发创伤后应激障碍研究进展

既往对创伤后应激障碍(Posttraumatic Stress Disorder,PTSD)的研究主要集中于战争、自然灾害和人为灾害相关的创伤事件。近年来,人们逐渐开始认识到危及生命的疾病同样可视为导致PTSD的应激源。一些危重病并发PTSD不仅不利于患者危重病自身的治疗,还严重影响其生存质量。为尽可能降低危重病并发PTSD的可能性,提高危重病患者的生存质量,本文就一些常见危重病诱发PTSD进行初步探讨,以期对危重病患者并发PTSD进行早期预警及早期干预。     

Challenges in treating post-traumatic stress disorder and attachment trauma

Treating women suffering from trauma poses significant challenges. The diagnostic prototype of post-traumatic stress disorder (PTSD) is based on single-event trauma, such as sexual assault in adulthood. Several effective cognitive- behavioral treatments for such traumas have been developed, although many treated patients continue to experience residual symptoms. Even more problematic is the complex developmental psychopathology stemming from a lifetime history of multiple traumas, often beginning with maltreatment in early attachment relationships. A history of attachment trauma undermines the development of capacities to regulate emotional distress and thereby complicates the treatment of acute trauma in adulthood. Such complex trauma requires a multifaceted treatment approach that must balance processing of traumatic memories with strategies to contain the intense emotions this processing evokes. Moreover, conducting such treatment places therapists at risk for secondary trauma such that trauma therapists also must process this stressful experience and implement strategies to regulate their own distress.     

The aftermath of road trauma: survivors' perceptions of trauma and growth

For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented in relation to posttraumatic growth and posttraumatic stress experiences, as measured by the Posttraumatic Growth Inventory and the Impact of Event Scale. Data were collected from 79 anonymous self-administered postal surveys from participants who had received treatment in an Australian rehabilitation center following serious orthopedic injury. One-third of these survivors continued to experience serious psychological distress in the aftermath of road trauma and a range of other psychosocial consequences four years after their accident. Although 87 percent of the sample continued to experience posttraumatic stress difficulties, 99 percent reported experiences of posttraumatic growth. Implications of these findings for social work practice are discussed.     

Enduring mental health morbidity and social function impairment in world trade center rescue, recovery, and cleanup workers: the psychological dimension of an environmental health disaster

BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. OBJECTIVES: Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. METHODS: Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. RESULTS: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. CONCLUSIONS: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.     

Posttraumatic stress disorder among paramedics: exploring a new solution with occupational health nurses using the Ottawa Charter as a framework

Paramedics have the highest rate of posttraumatic stress disorder (PTSD) among emergency service workers, higher than police or firefighters. This disorder can be detrimental to their personal and family lives, as well as their careers. Current biomedical, behavioral, and socioenvironmental interventions do not address paramedics' work environment, which contributes to the high rate of PTSD. Occupational health nurses can influence the triad of factors contributing to PTSD among paramedics by facilitating social support and emotional expression while advocating for reduced job exposure to traumatic events. This goal can be accomplished by using a component of the Ottawa Charter, creating a supportive work environment, as a framework. Occupational health nurses, together with management and paramedics, can facilitate a sustainable and supportive work environment that initiates change from within the trauma membrane of paramedics' workplaces to prevent PTSD.     

Women's experience of traumatic stress in cancer treatment

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.     

WOMEN'S EXPERIENCE OF TRAUMATIC STRESS IN CANCER TREATMENT

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.     

Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center

Although the September 11, 2001, terrorist attacks were the largest human-made disaster in US history, there is little extant research documenting the attacks' consequences among those most directly affected, that is, persons who were in the World Trade Center towers. Data from a cross-sectional survey conducted 2-3 years after the attacks ascertained the prevalence of long-term, disaster-related posttraumatic stress symptoms and probable posttraumatic stress disorder (PTSD) in 3,271 civilians who evacuated World Trade Center towers 1 and 2. Overall, 95.6% of survivors reported at least 1 current posttraumatic stress symptom. The authors estimated the probable rate of PTSD at 15.0% by using the PTSD Checklist. Women and minorities were at an increased risk of PTSD. A strong inverse relation with annual income was observed. Five characteristics of direct exposure to the terrorist attacks independently predicted PTSD: being on a high floor in the towers, initiating evacuation late, being caught in the dust cloud that resulted from the tower collapses, personally witnessing horror, and sustaining an injury. Working for an employer that sustained fatalities also increased risk. Each addition of an experience of direct exposure resulted in a 2-fold increase in the risk of PTSD (odds ratio = 2.09, 95% confidence interval: 1.84, 2.36). Identification of these risk factors may be useful when screening survivors of large-scale terrorist events for long-term psychological sequelae.     

Coverage of Posttraumatic Stress Disorder in the New York Times, 1950–2012

Posttraumatic stress disorder (PTSD) is a mental health disorder that occurs for some individuals following a traumatic experience and that can cause significant health, mental health, and functioning problems. The concept of PTSD has multiple components (cause, reactions, and treatment), which provides for great variety in the experience of an individual with PTSD. Given this complexity, the news media's construction of PTSD is likely an important influence in determining how the public understands PTSD, but research has yet to investigate how the news media depict PTSD. This study addresses that gap in the literature by examining New York Times coverage of PTSD from 1950 to 2012. Results indicate that the number of PTSD articles during this time period increased, with coverage spikes related to U.S. military conflicts and the September 11, 2001, terrorist attacks. Almost half (49.14%) of all PTSD articles included military service as a PTSD cause. Military PTSD articles were more likely than civilian PTSD articles to depict the disorder as causing anger/irritability/rage, homicide/violence/rape, suicide, substance abuse, and home/work/relationship problems. PTSD news stories were almost always (94.8%) situated in the current time and most frequently (46.6%) used a community frame. Implications for public understanding of PTSD are discussed.     

Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence

Our study examines the association between Adverse Childhood Experience (ACE) exposure and posttraumatic stress disorder (PTSD) symptoms among survivors of violence. In this cross-sectional study, an ACE questionnaire and PTSD Checklist for DSM-5 (PCL-5) were completed by 147 participants ≤ 3 months after presenting to a Philadelphia, PA emergency department between 2014 and 2019 with a violent injury. This study treated ACEs, both separate and cumulative, as exposures and PTSD symptom severity as the outcome. Most participants (63.3%) met criteria for provisional PTSD, 90% reported experiencing ≥ 1 ACE, and 39% reported experiencing ≥ 6 ACEs. Specific ACEs were associated with increasing PCL-5 scores and increased risk for provisional PTSD. Additionally, as participants’ cumulative ACE scores increased, their PCL-5 scores worsened (b = 0.16; p < 0.05), and incremental ACE score increases predicted increased odds for a positive provisional PTSD screen. Results provide further evidence that ACEs exacerbate the development of PTSD in young survivors of violence. Future research should explore targeted interventions to treat PTSD among survivors of interpersonal violence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00628-4.     

Associations Between General Perceptions of COVID-19 and Posttraumatic Stress Disorder in Korean Hospital Workers: Effect Modification by Previous Middle East Respiratory Syndrome Coronavirus Experience and Occupational Type

ObjectivesThis study investigated associations between perceptions of coronavirus disease 2019 (COVID-19) and the prevalence of posttraumatic stress disorder (PTSD) in workers at hospitals designated to treat COVID-19, as well as the difference in the magnitude of these associations by occupational type and previous Middle East respiratory syndrome coronavirus (MERS-CoV) experience.MethodsThe participants were workers at hospitals designated to treat COVID-19 who completed a questionnaire about their perceptions related to COVID-19, work experience during the previous MERS-CoV outbreak, and symptoms of PTSD ascertained by the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders. Participants’ characteristics were compared using the chi-square test. Multivariable logistic regression was performed to evaluate the associations between perceptions and the prevalence of PTSD, stratified by occupational type and previous MERS-CoV experience.ResultsNon-medical personnel showed stronger associations with PTSD than medical personnel according to general fear (odds ratio [OR], 6.67; 95% confidence interval [CI], 1.92 to 23.20), shortages of supplies (OR, 1.29; 95% CI, 1.07 to 1.56), and issue-specific fear (OR, 1.29; 95% CI, 1.05 to 1.59). Those with prior MERS-CoV quarantine experience were more prone to PTSD than those without such experience in terms of general fear (OR, 1.70; 95% CI, 1.22 to 2.37), shortages of supplies (OR, 1.24; 95% CI, 1.10 to 1.40), and issue-specific fear (OR, 1.21; 95% CI, 1.06 to 1.38). ConclusionsDuring the COVID-19 pandemic, non-medical personnel tended to have higher odds of being categorized as having PTSD. Workers with prior MERS-CoV experience were more susceptible than those without such experience. These findings suggest the need for timely interventions to manage human resources for a sustainable quarantine system.     

Human-initiated disaster,social disorganization and post-traumatic stress disorder above Nigeria’s oil basins

Survivors of human-initiated disaster are at high risk for mental disorder, most notably post-traumatic stress disorder (PTSD). Studies of PTSD have tended to focus on soldiers returning home after combat or on refugees living in resettlement countries under conditions of relative safety. However, most survivors of human-initiated disasters continue to live in or near the places where they initially experienced trauma. Insufficient attention has been paid to social disorganization in situations of continuing unrest and to its role in creating or stabilizing the symptoms of PTSD. The current study took place in the Niger Delta region of Nigeria, the scene of long-standing violence and human rights abuse that reached its apogee in 1995. The investigation, which took place in 2002, focused on two villages, one that was heavily exposed to the conflict (A, the affected village), the other relatively spared (NA, not affected). Probability samples of 45 adult residents from A and 55 from NA were interviewed with a schedule that contained the PTSD module from the WHO Diagnostic Interview Schedule. The schedule also contained a measure of exposure to the violence and abuses during the height of the conflict, as well as measures of structural and social capital that are components of community resilience. These included economic security, a sense of moral order, a sense of safety and perceived social support. The six month period prevalence of PTSD was 60 percent in A, and 14.5 percent in NA. Degree of exposure to stress as well as compromised sense of moral order, not feeling safe, and perceived lack of social support were independent predictors of PTSD. In places like the Niger Delta, where people do not physically escape from past trauma, sociocultural disintegration may interfere with communal functioning, thereby eroding community capacity to promote self-healing.     

Life events and posttraumatic stress in Hanshin-Awaji earthquake victims

Stress induced by disaster is experienced to varying degrees by all respondents, and is known to evoke psychophysiological reactions. In this study, we investigated the relationships between earthquake-related life events and posttraumatic stress symptoms. A total of 380 adults were surveyed one year after the 1995 Hanshin-Awaji earthquake in Japan. The questionnaire included items concerning earthquake-related life events, emotional support and posttraumatic stress disorder (PTSD) symptoms. As a result, after controlling for demographic variables, earthquake-related life events were significantly related to the grade of posttraumatic stress and its three components: re-experience, avoidance and arousal, in both male and female subjects. Male subjects who currently had lower emotional support showed higher scores of posttraumatic stress and arousal. In conclusion, a higher experience of earthquake-related life events appears to be an important risk factor for development of poor mental health status following an earthquake disaster.     

Trauma Exposure and Posttraumatic Stress Disorder among Incarcerated Men

Trauma exposure and trauma-related symptoms are prevalent among incarcerated men, suggesting a need for behavioral health intervention. A random sample of adult males (N = 592) residing in a single high-security prison were screened for trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Trauma was a universal experience among incarcerated men. Rates of current PTSD symptoms and lifetime PTSD were significantly higher (30 to 60 %) than rates found in the general male populations (3 to 6 %). Lifetime rates of trauma and PTSD were associated with psychiatric disorders. This study suggests the need for a gender-sensitive response to trauma among incarcerated men with modification for comorbid mental disorders and type of trauma exposure. Developing gender-sensitive trauma interventions for incarcerated men and testing them is necessary to improve the behavioral health outcomes of incarcerated men who disproportionately return to urban communities.