Affective personality type,post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence

The current study explored the differential association between affective personality type, post‐traumatic stress disorder (PTSD) symptom severity, and post‐traumatic growth (PTG) in victims of violence (N = 113). Relying on previous research, median cut off‐scores on the Positive and Negative Affect Schedule Short Form were used to classify participants as high affective [i.e. high positive affectivity (PA) and high negative affectivity (NA)], self‐actualizing (i.e. high PA and low NA), self‐destructive (i.e. low PA and high NA) and low affective (i.e. low PA and low NA). Results indicated that the self‐destructive and high affective personality styles were strongly associated with increased PTSD symptoms severity. High affective personality type was found to be the only significant predictor of PTG. Results, study limitations and directions for future research were discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Coping with post‐traumatic stress symptoms following relationship dissolution

The aim of this paper is to investigate the relationship between post‐traumatic stress symptoms resulting from relationship dissolution and coping style. The hypothesis was that some degree of post‐traumatic stress symptoms would be evident among the sample and that the coping strategies of seeking social support, escape–avoidance, self‐controlling and accepting responsibility would be associated with such symptoms. Eighty‐eight university students who had experienced the dissolution of a romantic relationship over the preceding 24 months participated in the research. They were interviewed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ) and the Ways of Coping Questionnaire (WOC). The results showed that the mean score of intrusion was slightly higher than that of avoidance. The sample scored significantly higher in the IES items than one standardized sample of medical students but significantly lower in intrusion than another standardized sample of clinical patients. Fifty‐one per cent of the sample scored above the cut‐off of the GHQ. The results also showed that both intrusion and avoidance were significantly correlated with all GHQ items. The sample used the self‐controlling coping strategy the most, followed by escape–avoidance and positive reappraisal. The sample also employed coping strategies of distancing and seeking social support. Stepwise multiple regression analyses showed that escape–avoidance, distancing, seeking social support and planful problem solving were significant predictors to the IES total. Escape–avoidance and accepting responsibility were significant predictors to the IES intrusion. Escape–avoidance and distancing were significant predictors to the IES avoidance. Escape–avoidance was the only significant predictor to the GHQ total. Copyright © 2003 John Wiley & Sons, Ltd.     

Safety and efficacy of sildenafil citrate in treating erectile dysfunction in patients with combat‐related post‐traumatic stress disorder: a double‐blind,randomized and placebo‐controlled study

OBJECTIVE

To evaluate the safety and efficacy of sildenafil citrate for treating erectile dysfunction (ED) in patients with combat‐related post‐traumatic stress disorder (PTSD).

PATIENTS AND METHODS

In all, 266 combat‐exposed war veterans with ED (aged 37–59 years) were recruited. They met the Diagnostic and Statistical Manual of Mental Disorders‐IV criteria for PTSD according to the Structured Clinical Interview for Patients, Investigator Version. The patients were also evaluated with the Clinician‐Administered PTSD Scale, both to establish the diagnosis of PTSD and to measure symptom severity. Only patients with psychogenic ED were included in the study. Patients with comorbid conditions (diabetes mellitus, hypercholesterolaemia, hypertension, Peyronie’s disease) and smokers of more than five cigarettes daily were excluded. The patients were randomly divided into a group of 133 who received 100 mg of on‐demand sildenafil 0.75–2 h before sexual stimulation, and 133 who received placebo. Patients were asked to use ≥16 doses or attempts at home. The efficacy of the treatments was assessed every four attempts during treatment, and at the end of the study, using responses to the 15‐question International Index of Erectile Function (IIEF), Sexual Encounter Profile diary questions 2 and 3, Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, patients’ event logs of sexual activity, and a Global Assessment Question about erections.

RESULTS

Sildenafil did not produce significantly and substantially greater improvement than placebo in each of the primary and secondary outcome measures (P = 0.08). A normal EF domain score (≥26) at endpoint was reported by 13 (9.8%), and 11 (8.3%) of patients on the sildenafil and placebo regimens, respectively (P = 0.09). Patients treated with sildenafil had no statistically significantly greater improvement in the five sexual function domains of the IIEF questionnaire than those treated with placebo (P = 0.08). The incidences of treatment‐emergent adverse events were significantly greater in the sildenafil arm than in the placebo group (P = 0.01).

CONCLUSIONS

Sildenafil is no better than placebo in treating PTSD‐emergent ED. Further randomized clinical trials are warranted in combat veterans and other populations with PTSD to better elucidate the role of phosphodiesterase type 5 inhibitors in treating PTSD‐emergent ED.     

A retrospective study of ketamine administration and the development of acute or post‐traumatic stress disorder in 274 war‐wounded soldiers

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post‐traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010–2012). The diagnosis of post‐traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post‐traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post‐traumatic stress disorder and 89 (32%) had received ketamine. Fifty‐four patients (55%) in the post‐traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3–13 [1–26]) vs. 3 (2–4 [1–6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post‐traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post‐traumatic stress disorder in the military trauma setting.     

Memory functioning in post‐traumatic stress disorder: objective findings versus subjective complaints

Although memory complaints are common in post‐traumatic stress disorder (PTSD), the only published study of objective and subjective memory in PTSD by Roca and Freeman indicates that subjective complaints may not accurately reflect objective performance. The present study examined memory in 21 PTSD patients, 20 combat controls and 23 non‐combat controls using two objective memory measures (Rey Auditory Verbal Learning Test; Backward Digit Span) and one subjective measure (Memory Functioning Questionnaire). Analysis of variances (ANOVAs) and analysis of co‐variances generally did not reveal group differences for objective memory performance. For subjective memory complaints, ANOVAs indicated group differences; PTSD participants reported more memory problems than controls. These differences disappeared, however, when depression was included as a covariate. Also, we provide some preliminary evidence that depression may mediate the relationship between PTSD symptomatology and subjective memory complaints. Findings suggest that reductions in depressive symptomatology in PTSD may be associated with decreased subjective memory complaints. Copyright © 2010 John Wiley & Sons, Ltd.     

Relation of post‐traumatic stress disorder symptom severity to the efficacy of an animal‐assisted intervention for stress reduction after military aeromedical evacuation

Animal‐assisted interventions (AAIs) have been found to decrease stress in some settings, but it is not known if AAI is feasible in an aeromedical staging facility or effective in reducing stress following aeromedical evacuation (AE) of military personnel. An experimental design was used to evaluate the efficacy of AAI at reducing stress in AE military patients (N = 120). Patients participated in a 20‐min AAI (n = 60) or 20‐min informational session about assistance dogs as an attention‐control group (n = 60). Demographics, post‐traumatic stress symptom severity (PTSSS), and stress biomarkers (cortisol, alpha‐amylase, and immunoglobulin A) were collected regular intervals. AAI was found feasible and efficacious at reducing stress. Cortisol decreased significantly (p < .05) in the AAI group compared with the attention‐control group. PTSSS moderated the immunoglobulin A responses to AAI as demonstrated by the interaction of PTSD Checklist–Military Version score, group, and time, F(1, 111.23) = 4.15 p = .044; effect size: d = 0.31. This research supports AAI as a stress‐reducing modality in AE patients, particularly those who report higher PTSSS. Implications for future research are discussed.     

Stressful life events and posttraumatic growth among police officers: A cross‐sectional study

Police officers often continue to face numerous threats and stressors in the aftermath of a disaster. To date, posttraumatic growth (PTG) has been studied primarily in the context of significant trauma; thus, it is not known whether stressful life events are associated with PTG. This study investigated the development of PTG among 113 police officers working in the New Orleans area following Hurricane Katrina. Hierarchical regression was used to evaluate if gratitude, social support, and satisfaction with life moderated the relationship between stressful life events (as measured by the total life stress score) and PTG, after adjustment for age, sex, race, level of involvement in Hurricane Katrina, and alcohol intake. Results indicate that stressful life events are independently associated with PTG. Gratitude, satisfaction with life, and social support were seen to moderate this relationship; as stressful life events increased so too did PTG—particularly among officers with higher levels of gratitude (B = 0.002, p ≤ .05), satisfaction with life (B = 0.002, p ≤ .05), and social support (B = 0.001, p ≤ .05). These findings suggest that promoting satisfaction with life, interpersonal support, and gratitude may be beneficial to those who are regularly at risk of trauma exposure.     

Longitudinal relationships between self‐efficacy,post‐traumatic distress and salivary cortisol among motor vehicle accident survivors

The present study tested if post‐traumatic distress following a motor vehicle accident (MVA) and MVA‐related self‐efficacy beliefs were associated with diurnal salivary cortisol in the early post‐traumatic period. Cortisol was collected upon awakening and at 1, 4 and 12 h after waking. Collection days were 1 week, 1 month and 3 months after MVA. A total of 30 participants provided their cortisol samples across all measurement points. Two methods for computing the area under the cortisol curve were used. Higher post‐traumatic distress at 1 month predicted lower cortisol area under the curve (AUC) with respect to increase (AUC_I, reflecting changes in cortisol secretions during daytime) at 3 months. AUC with respect to ground (AUC_G, reflecting total cortisol release during daytime), measured at 1 month after trauma, predicted higher post‐traumatic distress at 3 months. The results showed that self‐efficacy at 1 week indirectly predicted 3‐month AUC_I through 1‐month post‐traumatic distress. These findings highlight the importance of self‐efficacy and post‐traumatic distress in explaining longitudinal diurnal patterns of cortisol secretion after trauma. Copyright © 2011 John Wiley & Sons, Ltd.     

Post‐traumatic stress disorder and subthreshold post‐traumatic stress disorder in recent male asylum seekers: An expected but overlooked “European” epidemic

The literature shows an increased risk for post‐traumatic stress disorder (PTSD) among illegal migrants. We aimed to estimate the prevalence of PTSD, subthreshold PTSD, the degree of disability, and differences in sociodemographic and anamnestic characteristics associated with these clinical conditions in a sample of newly arrived migrants. Two hundred male asylum seekers from West sub‐Saharan Africa were evaluated for traumatic life events, PTSD symptoms, and disability through the Life Events Checklist for DSM‐5 (LEC‐5), the Primary Care PTSD Screen, the PTSD Checklist for DSM‐5, and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The current prevalence of PTSD and subthreshold PTSD was 9.5% and 12.0%, respectively. PTSD and subthreshold PTSD subgroups presented higher WHODAS 2.0 scores and LEC‐5 events, an over‐representation of individuals with childhood adversities and an excess of premigration psychiatric contacts unrelated to PTSD spectrum disorders and peri‐migration offences. Witnessing a traumatic event and disability in understanding and communication predicted both the presence of PTSD symptoms and PTSD status. PTSD spectrum disorders should be considered among the clinical emergencies associated with asylum seeker condition, and targeted interventions also involving the host citizens should be predisposed.     

Post‐traumatic stress and psychological health following infidelity in unmarried young adults

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity‐related post‐traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity‐related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post‐traumatic cognitions mediated the associations between infidelity‐related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity‐related PTSD. Whether used as continuous or categorical predictor, infidelity‐related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post‐traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post‐traumatic cognitions.     

Long‐Term Maternal Stress and Post‐traumatic Stress Symptoms Related to Developmental Outcome of Extremely Premature Infants

In this study, we examined the relations between the severity of developmental outcomes of extremely low birth weight (ELBW) children and their mothers' stress and post‐traumatic stress disorder (PTSD) symptoms, 4–16 years after birth. Israeli mothers (N = 78) of a cohort of extremely premature infants (24–27 weeks) born 4–16 years earlier were asked to report about the medical and developmental condition of their child and their current perceived stress and PTSD symptoms. Results show that mothers of ELBW children with normal development reported the lowest perceived stress compared with mothers of ELBW children with developmental difficulties. We also found that 25.6% of the mothers had the potential to suffer from PTSD following the birth of an ELBW child. Furthermore, the severity of prematurity developmental outcomes made a significant contribution to mothers' perceived stress. To sum, mothers of ELBW infants' perceived stress is related to their children's severity of prematurity developmental outcomes, 4–16 years after birth. Clinical implications of these findings are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Work‐related dimensions and job stress: the moderating effect of coping strategies

The aim of this paper is to examine the moderating effect of coping strategies on the relationship between work‐related dimensions (i.e. work routinization, role clarity, relationships with others and promotional opportunity) and job stress. For the study, a convenience sample of 385 white‐collar employees, full‐time employed in various types of private sector organizations, belong to different industries and ranked at different levels within the organizations responded. The factor analysis led to identify four broad coping strategies that individuals use, namely, individual positive coping, workplace initiatives, workplace informal support and individual destructive coping. It was found that both individual positive coping and workplace initiatives moderate the relationship between ‘relationships with others’ and job stress. However, none of the coping strategies have moderated the relationship between job stress and the other three work‐related dimensions. Copyright © 2010 John Wiley & Sons, Ltd.     

Coping Behaviours and Post‐traumatic Stress in War‐affected Eastern Congolese Adolescents

This study explores coping strategies used by war‐affected eastern Congolese adolescents across age and sex, and the association between post‐traumatic stress symptoms and engagement and disengagement coping. Cross‐sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13–21 years (M = 15.83, standard deviation = 1.81) participated in self‐report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post‐traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war‐affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences. Copyright © 2013 John Wiley & Sons, Ltd.     

Covering traumatic news stories: Factors associated with post‐traumatic stress disorder among journalists

The current study examined personal and environmental factors that placed 167 U.S. journalists from diverse media organizations at risk for post‐traumatic stress disorder (PTSD) after covering work‐related traumatic stories. These factors included exposure to traumatic stressors in their personal lives, work‐related traumatic stressors, and general organizational stressors. Further, personality attributes and coping styles associated with risk and resiliency were examined. Regression analyses identified avoidant emotional coping, higher levels of perceived organizational stressors, intensity of exposure to work‐related traumatic stressors, and personal trauma history as statistically significant risk factors for PTSD. The results provide empirical support for the negative impact of organizational stressors and avoidant emotional coping on journalists covering trauma‐related stories. Understanding the organizational climate journalists are working in, as well as the manner in which journalists manage work‐related stressors, is important in the development of a more comprehensive model of who may develop work‐related PTSD symptoms. Opportunities for news organizations to reduce PTSD risk among journalists are discussed.     

A scale to measure non‐traumatic military operational stress

Military operations involve both traumatic and non‐traumatic stressors. The authors developed a scale to measure non‐traumatic operational stressors. In Study 1, a list of stressors identified by military personnel was compared across responses from two operations in East Timor. Exploratory factor analysis yielded three similar factors for each dataset. A confirmatory factor analysis on the combined data determined item placement. Item analysis then reduced the questionnaire to 22 items. In Study 2, the questionnaire was administered to personnel from operations in the Middle East. Correlations with similar scales measured the content validity of the three subscales (work concerns, operational concerns and separation concerns). The authors conclude the questionnaire is a robust measure of operational non‐traumatic stressors applicable across operations. Copyright © 2008 John Wiley & Sons, Ltd.     

Post‐traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post‐traumatic stress disorder (PTSD) is characterized by avoidance of trauma‐related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma‐exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north‐eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender‐sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.     

Job stress,job satisfaction and stress‐related illnesses among South African educators

The aim of this study was to explore the relationship between self‐reported job stress and job satisfaction, and the prevalence of stress‐related illnesses and risk factors among educators. A cross‐sectional survey was conducted in a representative sample of 21,307 educators from public schools in South Africa. Results indicate that the prevalence of stress‐related illnesses were 15.6 per cent for hypertension, 9.1 per cent stomach ulcer, 4.5 per cent diabetes, 3.3 per cent minor mental distress, 3.1 per cent major mental distress and 3.5 per cent asthma. The study found considerably high stress levels among educators. Job stress and lack of job satisfaction were associated with most stress‐related illnesses (hypertension, heart disease, stomach ulcer, asthma, mental distress, tobacco and alcohol misuse). From three components of the demand‐control model, two, namely work stress from teaching methods and low peer support, were related to hypertension but not to heart disease. The components of the effort‐reward model of low socio‐economic status and lack of career advancement were both not related to heart disease, and only lack of career advancement was inversely related to hypertension. Most components assessed here of the demand‐control model (including stress with teaching methods and educational system and low peer support) and effort‐reward model (including job insecurity and lack of career advancement) were related to stomach ulcer and mental distress. Copyright © 2008 John Wiley & Sons, Ltd.     

No association between the brain‐derived neurotrophic factor gene Val66Met polymorphism and post‐traumatic stress disorder

Post‐traumatic stress disorder (PTSD) is a chronic anxiety disorder that follows exposure to traumatic events. The etiology of PTSD is unknown, although exposure to a traumatic event constitutes a necessary but not sufficient factor. Recent studies have demonstrated that the brain‐derived neurotrophic factor (BDNF) is related to stress‐related psychiatric conditions. In this study, therefore, the genotype and allele frequencies of the BDNF gene Val66Met polymorphism were analyzed in 106 PTSD patients and 161 unrelated healthy controls using a case‐control design. The genotype and allele frequencies for the BDNF gene polymorphism did not differ between the two groups. These findings suggest that the BDNF polymorphism investigated herein does not play a major role in the susceptibility to PTSD at least in the Korean population. Further studies designed to explore the relationship between genetic variations of BDNF and the incidence of PTSD in a larger population may be warranted. Copyright © 2006 John Wiley & Sons, Ltd.     

Trauma in antiquity: 4000 year old post‐traumatic reactions?

‘The lamentation over the destruction of Ur’ and ‘The death of Urnamma’ are probably the earliest documented evidence of post‐traumatic reactions in recorded history. The author of this article suggests extending the time line for the known existence of post‐traumatic reactions back to 2000–2100 BC. The author would like to present a new perception relating to the existence of ancient knowledge regarding psychological trauma. This article is based on cuneiform tablets found in the ruins of the Sumerian city, Ur. The author found that reactions to traumatic events elicit post‐traumatic symptoms have not changed dramatically over the millennia. These data support the thesis that reaction to traumatic events leading to psychological trauma was a known concept in antiquity. Future implications to the study of traumatic reactions are discussed. Copyright © 2004 John Wiley & Sons, Ltd.