Peritraumatic distress: its relationship to posttraumatic stress and complicated grief symptoms in sudden death survivors

Although sudden death has been linked to posttraumatic stress disorder (PTSD), its role in complicated grief (CG) and sudden death survivors is unknown. This questionnaire study investigated the role of peritraumatic distress in PTSD and CG symptoms in adults (n = 125) an average of 28.37 months (SD = 3.12) after a loved one's sudden death. The Peritraumatic Distress Inventory, Impact of Event Scale-Revised, and Inventory of Complicated Grief were administered to assess symptoms of peritraumatic distress, PTSD, and CG, respectively. Peritraumatic distress was the strongest correlate of both PTSD (β = .42, p < .001) and CG (β = .39, p < .001) symptoms, in a model containing current distress (Hopkins Symptom Checklist-21). Peritraumatic distress may be a key mechanism in the development of both PTSD and CG, therefore suddenly bereaved individuals reporting higher peritraumatic distress may be at risk of both adverse trauma and grief reactions.     

Peritraumatic Assessment of Autobiographical Memory After Exposure to a Traumatic Event

Posttraumatic stress disorder (PTSD) is commonly acknowledged to be associated with reduced specificity of autobiographical memory (AM). However, very few studies have assessed AM in the peritraumatic phase. The aim of the present study was to examine whether the AM impairment reported in PTSD is present a few days after a traumatic event. We assessed AM in 41 participants who had recently been exposed to trauma, and 34 controls who had never experienced a traumatic situation. The trauma‐exposed participants also completed the Impact of Event Scale‐R (IES‐R), the Inventory of Peritraumatic Distress, and the Peritraumatic Dissociative Experiences Questionnaire. Results showed that autobiographical memories cued by negative words were significantly less specific in the group of trauma‐exposed participants than in the control group (p = .008; d = 0.40). Thus, mild AM impairment was already present three days after trauma exposure, long before acute PTSD set in.     

Duty-related trauma exposure in 911 telecommunicators: considering the risk for posttraumatic stress

Peritraumatic distress may increase the risk for posttraumatic stress disorder (PTSD) in police officers. Much less is known about emotional reactions and PTSD symptomatology in 911 telecommunicators. The current study assessed duty-related exposure to potentially traumatic calls, peritraumatic distress, and PTSD symptomatology in a cross-sectional, convenience sample of 171 telecommunicators. Results showed that telecommunicators reported high levels of peritraumatic distress and a moderate, positive relationship was found between peritraumatic distress and PTSD symptom severity (r = .34). The results suggest that 911 telecommunicators are exposed to duty-related trauma that may lead to the development of PTSD, and that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this population.     

Depression Suppresses Treatment Response for Traumatic Loss–Related Posttraumatic Stress Disorder in Active Duty Military Personnel

There are multiple well‐established evidence‐based treatments for posttraumatic stress disorder (PTSD). However, recent clinical trials have shown that combat‐related PTSD in military populations is less responsive to evidence‐based treatments than PTSD in most civilian populations. Traumatic death of a close friend or colleague is a common deployment‐related experience for active duty military personnel. When compared with research on trauma and PTSD in general, research on traumatic loss suggests that it is related to higher prevalence and severity of PTSD symptoms. Experiencing a traumatic loss is also related to the development of prolonged grief disorder, which is highly comorbid with depression. This study examined the association between having traumatic loss–related PTSD and treatment response to cognitive processing therapy in active duty military personnel. Participants included 213 active duty service members recruited across two randomized clinical trials. Results showed that service members with primary traumatic loss–related PTSD (n = 44) recovered less from depressive symptoms than those who reported different primary traumatic events (n = 169), B = ?4.40. Tests of mediation found that less depression recovery suppressed recovery from PTSD symptoms in individuals with traumatic loss–related PTSD, B = 3.75. These findings suggest that evidence‐based treatments for PTSD should better accommodate loss and grief in military populations.     

Posttraumatic Stress,Somatization, and Quality of Life Among Ivorian Refugees

The present study examined the relationship between peritraumatic reactions, posttraumatic stress disorder (PTSD) symptoms, somatization, and quality of life (QoL) in a sample of refugees, two years after the 2011 Ivory Coast sociopolitical crisis. Participants were 101 Ivorian adult refugees (mean age = 31.61 years, SD = 7.84; 45.5% women) who completed several questionnaires relating to peritraumatic reactions, PTSD symptoms, somatization, and QoL. Most participants (86.1%) scored above the cutoff for probable PTSD. Peritraumatic dissociation and peritraumatic distress were significantly associated with PTSD symptoms, (r = .64, p < .001) and (r = .60, p < .001), respectively, and somatization, (r = .21, p = .038) and (r = .35, p < .001), respectively, as well as with QoL, (r = –.20, p = .045) and (r = –.21, p = .037), respectively. Similarly, QoL was significantly negatively correlated with PTSD symptoms (r = −.33, p < .001) and somatization (r = −.39, p < .001). In multivariate analyses, somatization was the strongest predictor of QoL (β = −.31, p = .003). Finally, somatization statistically mediated the association between peritraumatic distress and QoL. These findings suggest that PTSD may be frequent among Ivorian refugees, and that somatization may be an important feature of the traumatic experiences. Targeting somatization in conjunction with trauma‐centered therapy may improve outcomes in sub‐Saharan Africans with PTSD.     

Peritraumatic reactions and posttraumatic stress disorder in psychiatrically impaired youth

Although peritraumatic dissociation and other subjective peritraumatic reactions, such as emotional distress and arousal, have been shown to affect the relationship between a traumatic event and the development of posttraumatic stress disorder (PTSD) in adults, systematic studies with youth have not been done. In a mixed ethnic and racial sample of 90 psychiatrically impaired youth (ages 10-18, 56% boys), we investigated the contributions of peritraumatic dissociation, emotional distress, and arousal to current PTSD severity after accounting for the effects of gender, trauma history, trait dissociation, and psychopathology (attention-deficit/hyperactivity disorder and depression). Peritraumatic dissociation emerged as the only peritraumatic variable associated with current PTSD severity assessed both by questionnaire and interview methods (β = .30 and .47 p < .01). Peritraumatic dissociation can be rapidly assessed in clinical practice and warrants further testing in prospective studies as a potential mediator of the trauma-PTSD relationship in youth.     

The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self

Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies. Cognitive theory suggests that interpretations of traumatic events and reactions underlie the persistence of PTSD. The present study examined the associations among peritraumatic dissociation, posttraumatic cognitions, and PTSD symptoms in a group of trauma‐exposed adults (N = 169). Results indicated that, after accounting for overall symptom severity and current dissociative tendencies, peritraumatic dissociation was significantly predictive of negative beliefs about the self (R ² = .06, p < .001). Other categories of maladaptive posttraumatic cognitions did not show a similar relationship (R ² = .01 to .02, nonsignificant). Negative thoughts about the self partially mediated the association between peritraumatic dissociation and PTSD severity (completely standardized indirect effect = .25). These findings lend support to cognitive theories of PTSD and point to an important area for clinical intervention.     

A Longitudinal Investigation of Changes to Social Resources Associated With Psychological Distress Among Kurdish Torture Survivors Living in Northern Iraq

Social resources can buffer against psychological distress following potentially traumatic events. Psychological distress can also lead to social resource deterioration. This longitudinal study evaluated whether baseline psychological distress symptoms and changes in these symptoms were associated with changes in social resources 5 months later among 96 adult male (52.6%) and female treatment‐seeking torture survivors residing in Kurdistan, Iraq. Adapted versions of the Hopkins Symptom Checklist‐25, Harvard Trauma Questionnaire, and a traumatic grief measure were used. Locally derived scales measured perceived social support, social integration, and frequency of social contact. Multinomial logistic regression models assessed the association between symptoms and loss or gain in social resources. We hypothesized that higher mental health symptoms would relate to decreased social resources. Higher baseline depression (adjusted conditional odds ratio [ACOR] = 1.14), posttraumatic stress disorder (PTSD; ACOR = 1.09), and traumatic grief symptoms (ACOR = 1.14) increased the odds of loss of social integration. For some, higher traumatic grief symptoms were associated with increased social integration (ACOR = 1.17). Increased anxiety (ACOR = 1.23) and PTSD symptoms (ACOR = 1.07) was associated with declines in social contact; decreased depression (ACOR = 1.06) and PTSD symptoms (ACOR = 1.04) were related to gaining social contact. This study highlights the complex relationship between mental health symptoms and losses and gains in social resources among torture survivors.     

Peritraumatic distress,posttraumatic stress disorder symptoms,and posttraumatic growth in victims of violence

This study explored whether peritraumatic distress and posttraumatic stress disorder (PTSD) symptoms are curvilinearly related to posttraumatic growth in victims of violence several years after victimization (Time 1; n = 678) and 6 months later (Time 2, n = 205). At both time points, curve estimation revealed linear and quadratic associations between peritraumatic distress and posttraumatic growth and quadratic associations between PTSD symptoms and posttraumatic growth. In multivariate regressions controlling for background variables, the linear peritraumatic distress and quadratic PTSD symptom terms remained significant predictors of posttraumatic growth Time 1 scores. For Time 2, the linear peritraumatic distress term remained significant, though only prior to controlling for posttraumatic growth Time 1 scores. The results suggest that peritraumatic distress enables growth after substantial time has elapsed since victimization.     

The latent structure of the Peritraumatic Dissociative Experiences Questionnaire

This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.     

Peritraumatic distress across the lifespan: Clinical implications of age differences during the COVID-19 pandemic

The Peritraumatic Distress Inventory (PDI) is a well-known self-report questionnaire indexing the distress experienced during and shortly after a most stressful or traumatic event. Although sociodemographic factors contributing to peritraumatic distress have been previously investigated, no research has examined the nature and severity of peritraumatic distress reactions in a non-clinical, community sample as a function of age. An international sample of 5621 adult participants were grouped according the World Health Organization's age stratification protocol. Mean scores and item endorsement on the PDI were compared across groups with respect to their worst experience of the COVID-19 pandemic. A significant between-group difference was found, F(55,615) = 30.74, p < 0.001, n² = 0.027 whereby participants aged 18–39 years old reported the highest levels of peritraumatic distress. This group also endorsed a higher proportion of items on the PDI's two main factors (emotional distress and physical reactions), and were more likely to endorse feelings of helplessness, than older participants. It appears that severity of peritraumatic distress during the pandemic has affected younger people the most. Results are discussed in light of clinical implications.     

Prevalence of Traumatic Events and Peritraumatic Predictors of Posttraumatic Stress Symptoms in a Nonclinical Sample of College Students

This study investigated lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) symptoms among 937 college students. Participants rated their lifetime experiences of traumatic events and, in response to their most stressful event, completed measures of objective stressor dimensions, PTSD, and peritraumatic reactions. Approximately 67% of respondents reported at least one traumatic event. An estimated 4% of the full sample (12% of traumatized individuals) met PTSD criteria within the past week. After controlling for vulnerability factors and objective characteristics, peritraumatic reactions remained strongly predictive of PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.     

A study of the validity of a screening instrument for traumatic stress in earthquake survivors in Turkey

The validity of a Traumatic Stress Symptom Checklist (TSSC), which was developed as part of a Screening Instrument for Traumatic Stress in Earthquake Survivors (SITSES), was examined in 130 survivors of the recent earthquake in Turkey. Data were obtained on the TSSC, which consists of 17 DSM-IV posttraumatic stress disorder (PTSD) items and 6 symptoms of depression. The Clinician-Administered PTSD Scale and the Major Depressive Episode module of the Semistructured Clinical Interview for DSM-IV were used for comparison with the TSSC. The results indicated that the TSSC has high internal consistency and satisfactory sensitivity and specificity in predicting the diagnosis of PTSD and major depression. The SITSES appeared to be a useful instrument in screening earthquake survivors for PTSD, major depression, illness severity, and risk factors associated with traumatic stress responses.     

A Randomized Trial of Modified Prolonged Exposure to Prevent the Development of Posttraumatic Stress Disorder in Patients Hospitalized With Traumatic Injuries

Individuals who require hospitalization after traumatic injuries are at increased risk for developing posttraumatic stress disorder (PTSD); however, few early behavioral interventions have been effective at preventing PTSD within this population. The aim of this pilot study was to assess the feasibility and effectiveness of modified prolonged exposure therapy (mPE) to prevent PTSD and depression symptoms among patients hospitalized after a DSM‐5 single‐incident trauma. Hospitalized patients were eligible if they screened positive for PTSD risk. Participants (N = 74) were randomly assigned in a parallel‐groups design to receive mPE (n = 38) or standard of care treatment (SoC; n = 36) while admitted to the hospital after a traumatic injury. Individuals randomized to the intervention condition received one (42.1%), two (36.8%), or three sessions (15.8%) of mPE, mainly depending on length of stay. There were no significant differences between groups regarding PTSD or depression severity at 1‐ or 3‐months posttrauma, except for more PTSD diagnoses in the intervention group after 1 month, ? = ?.326. Intervention differences were nonsignificant when we took baseline PTSD symptoms and the nonindependence of the repeated measurements within the data into account. No adverse events were reported. Overall, mPE was no more effective than SoC for hospitalized, traumatic injury survivors with a high PTSD risk. The results may point to a need for a stepped‐care approach, where intervention protocols focus on first briefly treating individuals who are actively exhibiting acute stress reactions, then extensively treating those whose symptoms do not decrease over time.     

Clinical Manifestations of Trauma Exposure in Fibromyalgia: The Role of Anxiety in the Association Between Posttraumatic Stress Symptoms and Fibromyalgia Status

Little research has investigated how traumatic experiences relate to fibromyalgia (FM). We explored the presence of trauma exposure in a sample of Spanish participants with FM and examined the associations between (a) the number and type of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms and (b) the severity of clinical manifestations in FM, testing for possible mediation models. Participants were 173 FM patients and 53 healthy controls aged 24 to 66 years. Traumatic event type (physical trauma, physical and sexual abuse, psychological trauma), PTSD symptoms, pain intensity, sleep disturbance, anxiety, depression, coping style, and daily functioning were evaluated via self-report. Fibromyalgia patients reported a higher percentage of trauma exposure than controls, more traumatic experiences (mainly emotional and physical trauma), and more PTSD symptoms, Hedges’ gs/Cohen's ds = 0.42–0.76. Most FM patients reported having experienced their most distressing traumatic experience and PTSD symptoms before FM diagnosis. PTSD symptom severity was associated with more pain, sleep disturbances, anxiety, depression, coping style, and functional impairment, rs = .23–.33, ps = .025–.008. A multiple mediation analysis showed a significant indirect effect of anxiety in the association between PTSD symptoms and daily functioning. In a subset of FM patients, PTSD symptoms were associated with major clinical symptoms. The results suggest future research should explore the effectiveness of trauma-focused therapy compared to standard cognitive behavioral therapy for these patients.     

Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors

To test the predictive power of peritraumatic dissociation for the development of psychopathology, the authors assessed symptoms of peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire; PDEQ), posttraumatic stress disorder (Clinician-Administered PTSD Scale; CAPS), anxiety and depression (Hospital Anxiety and Depression Scale; HADS) in a sample of 214 accident victims 5 days postaccident (T1). Six months later (T2), CAPS and HADS were administered again. Acute stress disorder (ASD) and PTSD symptom levels were surprisingly low. In sequential regression analyses, initial reexperiencing and hyperarousal significantly predicted PTSD symptom level (T2) over several possibly confounding variables controlled for. Peritraumatic dissociation explained less than 3% of variance. For PTSD scores, 38% overall variance explanation was obtained; the variance for HADS scores was low. Possible explanations for the low-predictive power of peritraumatic dissociation for posttraumatic psychopathology in the sample are discussed.     

Psychological Impact and Prevalence of Traumatic Events in a Student Sample in Israel; The Effect of Multiple Traumatic Events and Physical Injury

The prevalence of exposure and the psychological impact of traumatic events were studied in 983 Israeli university students. The psychological effects of exposure to single versus multiple traumatic events, and the effects of trauma-related physical injury were also examined. It was found that 67% of the respondents reported having been exposed to at least one traumatic event. Of those exposed, 6% were diagnosed as having posttraumatic stress disorder (PTSD). Men were more at risk for exposure, but women were more at risk for PTSD. Women and the physically injured showed more psychological distress following exposure. Being exposed to one type of traumatic event was associated with increased psychological distress, but being exposed to multiple types of traumatic events was associated with lowering of distress. The results are discussed in comparison with similar studies from the United States.     

National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM‐IV and DSM‐5 Criteria

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM‐5; 2013) and fourth edition (DSM‐IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self‐administered survey. Traumatic event exposure using DSM‐5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past‐12‐month, and past 6‐month PTSD prevalence using the Same Event definition for DSM‐5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM‐5 prevalence estimates were slightly lower than their DSM‐IV counterparts, although only 2 of these differences were statistically significant. DSM‐5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM‐IV criteria, but not DSM‐5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.     

Introduction to the Special Issue: Network Analysis of Traumatic Stress

Network analysis has emerged as a promising new statistical methodology for traumatic stress studies. The present special issue of the Journal of Traumatic Stress amalgamates the reports of 10 studies that employed network analysis to further the field's understanding of traumatic stress. The current issue includes reports of network analyses that sought to better understand the impact of different kinds of traumatic events, including childhood and gender-based trauma exposure, on PTSD symptomatology as defined under the DSM-5 and ICD-11, and examined the relation between PTSD symptoms and trauma-related dissociative experiences as well as the impact of psychological treatment on trauma recovery. A variety of research designs from a diverse group of international samples were employed, including concurrent, longitudinal, experience-sampling, and treatment outcome studies. Finally, a commentary on the articles included in this special issue was provided by Dr. Carl Weems.     

Heart rate of motor vehicle accident survivors in the emergency department, peritraumatic psychological reactions, ASD, and PTSD severity: a 6-month prospective study

This small-scale study investigates the relationships between the heart rate of motor vehicle accident survivors presenting in the emergency department (ED) and acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) symptom severity. It also examines the relationships between the survivor's heart rate in the ED and peritraumatic dissociation and peritraumatic distress reported 2 weeks posttrauma. Fifty motor vehicle accident (MVA) survivors were assessed 2 weeks, 1 (N = 42), 3 (N = 37), and 6 months (N = 37) post-MVA. The heart rate in the ED predicted self-reported ASD symptom severity and clinician-rated PTSD symptom severity at 6 months but not at 1 or 3 months. Survivors' heart rate in the ED was significantly correlated with peritraumatic dissociation but not peritraumatic distress. These findings support the role of elevated ED heart rate as a predictor of both ASD and chronic PTSD symptom severity and may help to clarify the discrepant findings of previous research.