创伤后成长评定量表的修订及信效度分析

目的将创伤后成长评定量表(PTGI)引入我国意外创伤者的心理评估与干预,以新视角促进伤者身心康复。方法对PTGI进行翻译回译、文化调适及语义分析,在意外创伤者中使用,检验其信效度。结果各维度及总量表一致性信度Cronbach′sα系数为0.611~0.874,因子分析显示为5个维度。结论该量表具有良好的信效度,适用于我国意外创伤者的创伤后成长研究。     

The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma

The development of the Posttraumatic Growth Inventory, an instrument for assessing positive outcomes reported by persons who have experienced traumatic events, is described. This 21-item scale includes factors of New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life. Women tend to report more benefits than do men, and persons who have experienced traumatic events report more positive change than do persons who have not experienced extraordinary events. The Posttraumatic Growth Inventory is modestly related to optimism and extraversion. The scale appears to have utility in determining how successful individuals, coping with the aftermath of trauma, are in reconstructing or strengthening their perceptions of self, others, and the meaning of events.     

Use of the revised Posttraumatic Growth Inventory for Children

Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children (PTGI-C-R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI-C-R demonstrated good reliability. Analyses focused on trauma-related variables in predicting PTG. Child-reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow-up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI-C-R may assist efforts to understand children's responses posttrauma.     

The Complex Trauma Inventory: A Self‐Report Measure of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder

The work group revising the criteria for trauma‐related disorders in the International Classification of Diseases (ICD‐11) made several changes. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). These proposed changes to taxonomy require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (the Complex Trauma Inventory; CTI) according to the proposed domains, creating several items to assess each domain. We examined the factor structure of the CTI in two separate samples of diverse college students (n ₁ = 391; n ₂ = 391) who reported exposure to at least one traumatic event and at least occasional functional impairment. After reducing the original 50 items in the item pool to 20 items, confirmatory factor analyses supported two highly correlated second‐order factors—PTSD and disturbances in self‐organization (DSO)—with PTSD (i.e., reexperiencing, avoidance, sense of threat) and DSO (i.e., affect dysregulation, negative self‐concept, and disturbances in relationships), each loading on three of the six ICD‐11‐consistent first‐order factors, root mean square error of approximation (RMSEA) = .056, 95% confidence interval (CI) [.048, .064], comparative fit index (CFI) = .956, Tucker‐Lewis index (TLI) = .948, standardized root mean square residual (SRMR) = .043, Bayesian information criterion (BIC) = 641.55, χ²(163) = 361.02, p < .001. Internal consistencies for PTSD and DSO were good to excellent (Cronbach's αs = .89 to .92). Supplementary analyses supported the gender invariance of the CFA model, as well as convergent and discriminant validity of the CTI. The validity of the CTI supports the distinction between CPTSD and PTSD. Moreover, the CTI will assist clinicians with diagnosis, symptom tracking, treatment planning, and assessing outcomes.     

Posttraumatic Stress Symptoms and Posttraumatic Growth in Children and Adolescents Following an Earthquake: A Latent Transition Analysis

This study examined the transitions in classes of posttraumatic stress symptoms and posttraumatic growth in a sample of children and adolescents (N = 757), between 8 and 20 months after the 2013 Ya'an earthquake in China. Using latent profile analysis, three classes of symptoms (resilient, thriving, and struggling) were identified at 8 and 20 months after the earthquake. Latent transition analysis indicated that the majority of survivors remained in the same class during the period, while others showed a transition between different classes over time. The transition was mainly characterized by three paths: from struggling to resilient, and from thriving to either resilient or struggling. Of the survivors who were classified as thriving at 8 months, those transitioning to the struggling class at 20 months were more likely to experience higher levels of loss and injury compared with those transitioning to the resilient class (Cohen's d = 0.72) or remaining in the thriving class (Cohen's d = 0.36) at 20 months postearthquake. Survivors who remained stable in the struggling class were older than those who remained stable in the thriving class (Cohen's d = 0.41) or those who moved from thriving at 8 months to resilient at 20 months after the earthquake (Cohen's d = 0.39). It is recommended that clinicians consider the classes of posttraumatic stress symptoms and posttraumatic growth, and the potential development paths and associated factors, when implementing interventions for children and adolescents after a natural disaster.     

Thinking About Trauma: The Unique Contributions of Event Centrality and Posttraumatic Cognitions in Predicting PTSD and Posttraumatic Growth

Researchers have been investigating possible pathways to negative (posttraumatic stress disorder [PTSD]) and positive (posttraumatic growth [PTG]) reactions to trauma in recent decades. Two cognitive constructs, event centrality and posttraumatic cognitions, have been implicated to uniquely predict PTSD symptoms in an undergraduate sample. The current pair of studies attempted to (a) replicate this finding in an undergraduate sample, (b) replicate this finding in a treatment‐seeking sample, and (c) explore whether these 2 cognitive constructs uniquely predict PTG. The first study consisted of 500 undergraduate students, whereas the second study consisted of 53 treatment‐seeking clients. Results indicated both posttraumatic cognitions and event centrality uniquely predicted PTSD in the undergraduate (R² = .46) and treatment‐seeking samples (R² = .46). These 2 cognitive constructs also predicted PTG in the undergraduate sample (R² = .37), but only posttraumatic cognitions predicted PTG in the treatment‐seeking sample (R² = .17). The relationships between PTG varied, depending on whether PTG for high or low event‐centrality events were assessed. The original model was supported within both populations for PTSD symptoms, and its extension to PTG was supported within the treatment‐seeking sample. These results underscore cognitive and narrative factors in the progression of trauma.     

The Curvilinear Association Between Posttraumatic Distress and Posttraumatic Growth Among Pellet Gun Victims: The Moderating Roles of Time Since Trauma and Age

Since 2010, the use of pellet guns in Indian-administered Kashmir has led to serious physical and psychological consequences among a growing number of victims. However, no research to date has examined the association between posttraumatic distress and posttraumatic growth (PTG) within this population. Previous research conducted on other types of trauma exposure has yielded inconsistent findings regarding the nature and directionality of this association; namely, whether it is linear or curvilinear. Moreover, this inconsistency may also be due to the effects of other variables, such as time since trauma and age. In the present study, we investigated whether the association between posttraumatic distress and PTG among pellet gun victims is best explained as linear or curvilinear and tested whether this association was moderated by time since trauma and/or age. Using purposive sampling, 120 pellet gun victims were recruited from Indian-administered Kashmir. The results of quadratic hierarchical regression suggested that an inverted U-shaped curvilinear association, sr² = 0.07 (medium effect), was a better fit over and above a linear term, sr² = 0.06 – 0.08 (medium effect). The moderation test further revealed that this effect was present across time but became apparent, as an inverted U-shape, 18 to 24 months posttrauma, sr² = 0.04 (small effect); age, however, was not found to influence this association. These findings held even after controlling for the effects of confounding variables. The present findings suggest that across time, moderate levels of posttraumatic distress are associated with the highest levels of PTG.     

Patterns of Posttraumatic Stress Disorder and Posttraumatic Growth Among Adolescents After the Wenchuan Earthquake in China: A Latent Profile Analysis

Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) often coexist in the survivors of traumatic events. The current study examined the coexisting patterns of PTSD and PTG using latent profile analysis in a sample of 591 adolescent survivors of the May 12, 2008 Wenchuan earthquake in China. Logistic regression analysis was used to examine the effects of traumatic exposure on specific coexisting patterns. A three‐class solution characterized by a growth group (39.6%), a low symptoms group (10.3%), and a coexistence group (50.1%) fitted the data best. Members of the low symptoms group were more likely to be male, odds ratio (OR) = 2.67, 95% CI [1.48, 4.81]; and adolescents in the coexistence group were more likely to be older, OR = 1.22, 95%CI [1.09, 1.37], and to have had experienced serious indirect exposure, OR = 1.07, 95% CI [1.02, 1.12], and posttraumatic fear, OR = 1.20, 95% CI [1.11, 1.31].     

Posttraumatic Growth in Breast Cancer Survivors: Constructive and Illusory Aspects

This study investigated the impact of a building‐resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two‐sided Janus face model (Maercker & Zoellner, 2004). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8‐session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self‐report questionnaires at baseline and at 6 months follow‐up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η² = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors.     

Antidepressant Treatment, Posttraumatic Stress Disorder, Survivor Guilt, and Spiritual Awakening

A patient with posttraumatic stress disorder (PTSD) had a major depressive episode that was responsive to treatment with the antidepressant fluoxetine. In contrast to the remission of other symptoms of depression, the associated feature of survivor guilt became more dramatically obvious. Individualized treatment of survivor guilt may be needed for patients with PTSD and major depression.     

A Systematic Review of DNA Methylation and Gene Expression Studies in Posttraumatic Stress Disorder,Posttraumatic Growth,and Resilience

Most people will experience a traumatic event within their lifetime. One commonly recognized response to trauma exposure is posttraumatic stress disorder (PTSD). The biological underpinnings of PTSD, including epigenetic mechanisms of DNA methylation and gene expression, have been studied intensively. However, psychological posttrauma responses vary widely and can include positive outcomes, such as posttraumatic growth (PTG) and, more commonly, resilience. The aim of this systematic review was to summarize the current DNA methylation and gene expression data with respect to three potential posttrauma responses: PTSD, PTG, and resilience. A literature search identified 486 studies, 51 of which were deemed eligible for inclusion (total N = 10,633). All included studies examined PTSD and consistently implicated DNA methylation and gene expression changes in hypothalamic–pituitary–adrenal axis and inflammatory genes. Ten studies acknowledged resilience as a posttrauma response, but only two studies examined epigenetics and gene expression using a scale to measure resilience. Low resilience was associated with gene expression patterns in immune and dopamine genes, and high resilience was associated with a blunted inflammatory response. No studies examined epigenetic or gene expression changes associated with PTG. These findings highlight a focus on pathogenic research, which has failed to adequately acknowledge and measure positive posttrauma outcomes of PTG and resilience. Future research should examine DNA methylation and gene expression changes associated with PTG and resilience in addition to PTSD in order to gain a more comprehensive picture of an individual's well-being following exposure to trauma.     

Posttraumatic Growth Following Cancer: Links to Quality of Life

This study examined the linkage of posttraumatic growth (PTG) to quality of life (QOL) among individuals newly diagnosed with cancer. Individuals (26 men, 36 women) reported PTG 3 months postdiagnosis (T1) and 3 months later (T2). Cross‐sectional analyses revealed a linear association between PTG and QOL—more PTG was related to worse mental health at T1 (β = ?.28). PTG, however, revealed a quadratic relationship with depressive symptoms at T1 and physical health at T2: Individuals with high or low levels of PTG had fewer depressive symptoms and better QOL than those with moderate levels. Longitudinal analyses revealed a linear association between PTG and QOL; more PTG at T1 predicted better physical health at T2. There were no longitudinal curvilinear associations. Although the linear links of PTG to QOL were contradictory within this study, both of the curvilinear relations, although not robust, confirm previous research. Further analyses differentiated low, medium, and high PTG groups in terms of perceiving cancer as stressful, intrusive thoughts, and coping strategies. Overall, relations of PTG to adjustment may be more complex and dynamic than previously assumed. Clinicians should consider the notion that more growth may sometimes, but not always, be better.     

A Correlational Test of the Relationship Between Posttraumatic Growth,Religion, and Cognitive Processing

The present study examined the degree to which event related rumination, a quest orientation to religion, and religious involvement is related to posttraumatic growth. Fifty-four young adults, selected based on prescreening for experience of a traumatic event, completed a measure of event related ruminations, the Quest Scale, an index of religious participation, and the Posttraumatic Growth Inventory. The three subscales of the Quest Scale, the two groups of rumination items (soon after event/within past two weeks), and the index of religious participation were entered in a standard multiple regression with the total score of the Posttraumatic Growth Inventory as the dependent variable. The degree of rumination soon after the event and the degree of openness to religious change were significantly related to Posttraumatic Growth. Congruent with theoretical predictions, more rumination soon after the event, and greater openness to religious change were related to more posttraumatic growth. Present findings offer some confirmation of theoretical predictions, and also offer clear direction for further research on the relationships of religion, rumination, and posttraumatic growth.     

Change in Event Centrality and Posttraumatic Stress Disorder Symptoms During Intensive Treatment

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure‐based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM‐5 (PCL‐5) scores were associated with change (i.e., decrease) in PCL‐5 scores, p < .001, as well as with posttreatment PCL‐5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL‐5 scores explained 31% of the variance in PCL‐5 change and 34% of the variance in posttreatment PCL‐5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.     

中文版灵性应对问卷的修订及在晚期癌症患者中的信效度检验

目的对灵性应对问卷进行汉化、修订和信效度检验,为晚期癌症患者提供灵性测评工具。方法对英文版灵性应对问卷进行翻译、专家咨询、文化调适等形成中文版灵性应对问卷,调查广州市3所三甲医院442例晚期癌症患者检验中文版问卷的信效度。结果中文版灵性应对问卷共26个条目,7个维度,包括积极灵性应对(个人、社会、环境、超越),消极灵性应对(个人、社会、超越)2个分量表。内容效度为0.933;7个公因子累积方差贡献率为73.251%;验证性因子分析显示χ²/df=1.982,CFI=0.926,IFI=0.927,TLI=0.910,RMSEA=0.067,RMR=0.047;分量表的内部一致性Cronbach′sα系数分别为0.884和0.908,重测信度分别为0.933和0.938。结论中文版灵性应对问卷具有良好的信效度,可用于测量我国晚期癌症患者的灵性应对方式。     

Dissociation and Posttraumatic Stress Disorder: A Latent Profile Analysis

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013 ) contains a dissociative subtype for posttraumatic stress disorder (PTSD) characterized by significant depersonalization and derealization. In this study the PTSD dissociative subtype was examined using latent profile analysis in a sample of 541 trauma‐exposed college students. Items from the PTSD Checklist and Multiscale Dissociation Inventory were used as latent class indicators. Results supported a 3‐class solution including a well‐adjusted class, a PTSD class, and a PTSD/dissociative class characterized by elevated symptoms of PTSD, depersonalization, and derealization. Significant class differences were found on a number of measures of related psychopathology with Cohen's d effect size estimates ranging from 0.04 to 1.86. Diagnostic and treatment implications regarding the dissociative subtype are discussed.     

Posttraumatic stress disorder and smoking relapse: A theoretical model

Posttraumatic stress disorder (PTSD) is associated with a high prevalence of cigarette smoking, heavy cigarette consumption, and low cessation rates. To date, little is known about mechanisms impeding smoking cessation among this recalcitrant group of smokers. An important first step in improving smoking cessation treatment efficacy is the assessment of knowledge about mechanisms pertinent to relapse. This theoretical study addresses the gap in the literature regarding factors potentially influencing smoking relapse among individuals with PTSD. Mechanisms reviewed that may be particularly relevant to smoking relapse among PTSD smokers include negative affect, positive affect, attention, anxiety sensitivity, distress tolerance, and self-efficacy. Treatment implications as well as methodological advances that may be relevant to examining the proposed relapse model are discussed.     

Posttraumatic Stress Trajectories in World Trade Center Tower Survivors: Hyperarousal and Emotional Numbing Predict Symptom Change

There is a paucity of knowledge concerning the underlying symptomatology of heterogeneous posttraumatic stress symptom (PTSS) trajectories following mass trauma, such as a terrorist attack. This study examined longitudinal PTSS trajectories using latent growth mixture modeling in 2,355 World Trade Center (WTC) tower survivors surveyed by the WTC Health Registry an average of 2.5, 5.5, and 10.5 years after the September 11, 2001 terrorist attacks. Covariates included sociodemographic characteristics, WTC‐related exposure, and other traumas/stressors. Four curvilinear PTSS trajectories were identified: low symptom (74.9%), recovering (8.0%), worsening (6.7%), and chronic (10.4%). The majority of WTC survivors (85.3%) maintained stable symptom trajectories over time, with PTSS changes occurring less often. Although WTC‐related exposure was associated with initial PTSS severity, exposure was not associated with chronicity or change of PTSS over time. Male gender and a higher number of post‐WTC disaster life‐stressors were associated with worsening symptom severity over time. Individuals with more severe hyperarousal symptoms at Wave 1, particularly of anxious arousal, were more likely to have PTSS that worsened over time, adjusted odds ratio (aOR) = 1.55. Less severe emotional numbing symptoms, particularly of dysphoria, at Wave 1, were marginally significantly associated with subsequent PTSS recovery, aOR = 0.75. Interventions that target hyperarousal and emotional numbing symptoms may mitigate a worsening of symptoms and facilitate posttraumatic recovery following future mass traumas, such as terrorist attacks. Further clinical implications are discussed.