Perceived Social Support and Secondary Traumatic Stress Symptoms in Emergency Responders

This study investigated prevalence rates of secondary traumatic stress symptoms in Israeli Police forensic technicians, and the relationship between these symptoms and perceived social support as well as perceived severity of prior trauma (combat, work, personal). Ninety technicians from the Israeli Police Forensic Investigation Unit participated in the study. Intrusion and avoidance measured within the medium range of severity, whereas distress symptoms were below clinical threshold. Intrusion was significantly related to avoidance, distress, and the perceived severity of prior personal and work-related exposure. No significant relationship was found between perceived social support and secondary traumatic stress symptoms. The data suggest that this cohort utilized avoidance effectively as a defense against intrusion.     

Post‐traumatic reactions among rescue personnel before and after exposure to trauma: a brief report

There are only a few studies that check rescue personnel before and after exposure to trauma. Peritraumatic dissociation and post‐traumatic reactions were examined among rescue personnel in a rescue course and 36–48h after exposure to a gas pipe explosion in Tel Aviv. The entire rescue personnel were examined for peritraumatic dissociation and post‐traumatic reactions. Only those with prior measurements of peritraumatic dissociation and post‐traumatic reactions were eligible for analysis. The results showed that the only significant increase among rescue personnel was in peritraumatic dissociation between before in comparison to after exposure to trauma. No significant change was found in avoidance, intrusion, and post‐traumatic symptoms. These results correspond with previous studies that found increased peritraumatic dissociation among rescue personnel as a function of exposure severity. Explanations for these results are discussed. Copyright © 2006 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.     

Traumatic Grief and Traumatic Stress in Survivors 12 Years after the Genocide in Rwanda

The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B = 0.06, R = 0.6, R² = 0.36 and ß = 0.6, t = 7.54, p = 0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. Copyright © 2011 John Wiley & Sons, Ltd.     

Social Support Moderates Effects of Natural Disaster Exposure on Depression and Posttraumatic Stress Disorder Symptoms: Effects for Displaced and Nondisplaced Residents

Social support is a known protective factor against the negative psychological impact of natural disasters. Most past research has examined how the effects of exposure to traumatic events influences whether someone meets diagnostic criteria for depression and posttraumatic stress disorder (PTSD); it has also suggested sequelae of disaster exposure depends on whether survivors are displaced from their homes. To capture the full range of the psychological impact of natural disasters, we examined the buffering effects of social support on depressive symptoms and cluster‐specific PTSD symptoms, with consideration of displacement status. In a survey conducted 18 to 24 months after Hurricane Katrina, 810 adults exposed to the disaster reported the number of Katrina‐related traumatic events experienced, perceived social support 2 months post‐Katrina, and cluster‐specific PTSD and depressive symptoms experienced since Katrina. Analyses assessed the moderating effects of social support and displacement and the conditional effects of displacement status. Social support significantly buffered the negative effect of Katrina‐related traumatic events on depressive symptoms, B = ?0.10, p = .001, and avoidance and arousal PTSD symptoms, B = ?0.02, p = .035 and B = ?0.02, p = .042, respectively. Three‐way interactions were nonsignificant. Conditional effects indicated social support buffered development of depressive symptoms across all residents; however, the moderating effects of support on avoidance and arousal symptoms only appeared significant for nondisplaced residents. Results highlight the protective effects of disaster‐related social support among nondisplaced individuals, and suggest displaced individuals may require more formal supports for PTSD symptom reduction following a natural disaster.     

Symptoms of post-traumatic stress: intrusion and avoidance 6 and 12 months after TBI

PRIMARY OBJECTIVES: (1) To examine survivors with traumatic brain injury (TBI) for symptoms of avoidance and intrusion, two dimensions of post-traumatic stress (PTS) at 6 and 12 months post-injury. (2) To identify risk factors associated with these symptoms. RESEARCH DESIGN: Prospective follow-up study. METHODS AND PROCEDURES: Georgia and North Carolina Model Brain Injury Systems participants (n = 198) with mild (19%), moderate (21%) and severe (60%) TBI were interviewed by telephone at 6 and 12 months post-injury. The Impact of Event Scale (IES) was used to identify intrusion and avoidance symptoms. RESULTS: Symptoms consistent with severe PTS increased from 11% at 6 months to 16% 12 months post-injury (p < 0.003). African-Americans (p < 0.01) and women (p < 0.05) reported greater symptomatology at 12 months compared to their counterparts. TBI severity and memory of the event were not associated with PTS-like symptoms. Symptoms increased over time when examined by race, injury intent, gender and age (p < 0.05). CONCLUSIONS: Regardless of severity, survivors with TBI are at risk for developing symptoms consistent with PTS. Amnesia for the injury event was not protective against developing these symptoms. African-Americans appear to be at greatest risk.     

Religiosity and secondary traumatic stress in Israeli-Jewish body handlers

This study investigated the relationship between religiosity and levels of secondary traumatic stress in Israeli-Jewish body handlers. The Impact of Event Scale (IES), the General Health Questionnaire, 12 Items (GHQ-12), and a prior exposure severity tool were used to assess secondary traumatic stress symptoms in 63 ultraorthodox male body handlers as they compared to 86 secular forensic identification technicians from the Israeli police. Excluding possible confounders of age and number of years at the job, there was no significant difference between the religious and nonreligious groups on the intrusion and avoidance scores, whereas the GHQ-12 scores were significantly higher among the religious group. Religiosity did not seem to have a salutary effect on secondary traumatic stress in this cohort.     

Indirect Exposure to Captivity Details Is Not Related to Posttraumatic Stress Symptoms Among the Spouses and Offspring of Former Prisoners of War

Indirect exposure to the aversive details of the primary victim's traumatic event(s) has been introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013) as a new event criterion (Criterion A4). However, this new criterion has been criticized for its significant emphasis on the exposure to trauma “details” or trauma narrative. This study assessed the associations between reported exposure to details about captivity and posttraumatic stress symptoms (PTSS) among 2 groups of family members of former prisoners of war (ex‐POWs): spouses (n = 115) and adult offspring (n = 78). Results show that in both groups exposure to details regarding captivity was not significantly related to the severity of total PTSS and specifically, high levels of exposure to captivity details were related to lower avoidance symptoms among ex‐POWs' spouses. Among offspring, exposure to paternal behaviors stemming from the fathers' posttraumatic stress disorder was related to PTSS, above and beyond negative life events, quality of relationship with the father, and exposure to captivity details (R² = .34). These results suggest that behavioral displays of the fathers' posttraumatic symptoms, rather than the recounting of trauma‐related details, is related to PTSS among ex‐POWs' offspring.     

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.     

The Validity of Posttraumatic Stress Disorder Among Vietnamese Refugees

The aim of this study was to examine the validity of posttraumatic stress disorder (PTSD) among Vietnamese refugees. The study population included 74 Vietnamese refugees who had resettled in the metropolitan Boston area. The previously validated Harvard Trauma Questionnaire was used to assess traumatic events and trauma-related symptoms. The number of traumatic events experienced was positively correlated with the severity of PTSD-related symptoms in this population. Internal consistency estimates and principal components analysis provided results that generally supported DSM-IV symptom dimensions of arousal, avoidance, and reexperiencing. However, the emergence of two separate dimensions of avoidance reflected the important contribution of depression to the traumatic response.     

Women's Sexual Desire,Trauma Exposure,and Posttraumatic Stress Disorder

Research suggests that posttraumatic stress disorder (PTSD) is associated with sexual dysfunction; however, there is a paucity of research examining the relations among trauma exposure, PTSD, and low sexual desire, specifically. Thus, the goal of the present study was to investigate whether women with hypoactive sexual desire disorder (HSDD; n = 132) were more likely to meet criteria for a diagnosis of current or lifetime PTSD relative to women with no sexual desire concerns (n = 137). We also sought to compare the type, frequency, and intensity of PTSD symptoms between the two groups. Finally, we examined whether women in the two groups were exposed to more, or different types of, potentially traumatic events. Compared to women with no sexual health concerns, women with HSDD were more likely to meet criteria for current PTSD, odds ratio (OR) = 5.50, 95% CI [1.18, 25.61]; and lifetime PTSD, OR = 2.78, 95% CI [1.56, 4.94]. Women in the HSDD group also had higher odds of meeting criteria for avoidance (5.10 times) and hyperarousal symptoms (4.48 times) and scored higher on measures of past-month PTSD symptom frequency, d = 0.62, and intensity, d = 0.57. No group differences were observed regarding reexperiencing symptoms, the associated features of PTSD, or type or frequency of exposure to potentially traumatic events. The findings indicate PTSD symptomatology may be a predisposing or perpetuating contributor to low sexual desire, and low sexual desire and PTSD may be related through an alteration in stress adaptability.     

Adult trauma survivors and post-traumatic stress sequelae: An analysis of reexperiencing,avoidance, and arousal criteria

The relationship of traumatic events to DSM-III criteria symptoms for post-traumatic stress disorder was examined in a randomized community survey (N=2,364) of Los Angeles residents. Multivariate analysis of covariance revealed that both demographic factors and the type of traumatic event influenced respondents' reports of reexperiencing, avoidance, and arousal symptoms after the event.     

Ongoing exposure versus intense periodic exposure to military conflict and terror attacks in Israel

The manifestation of posttraumatic stress disorder (PTSD) symptoms in two clinical samples in Israel (N = 212) was examined. Individuals suffering ongoing exposure to shelling were compared with subjects exposed to intense periodic exposure. Elevated arousal and avoidance symptoms, but not intrusion were reported in the ongoing exposure group. When compared by age, young participants in the ongoing exposure group had significantly lower PTSD scores, whereas no differences were found between participants among the intense periodic exposure age groups. No gender differences in symptoms were found among participants from intense periodic exposure, whereas in the other ongoing group the difference was in avoidance. Results are discussed in light of past research on exposure to terrorism.     

The relationship among cognitive schemas,job-related traumatic exposure,and posttraumatic stress disorder in journalists

American newspaper journalists (N = 906) participated in a study examining a cognitive mediational model for explaining the relationship between exposure to work-related traumatic events and work-related posttraumatic stress disorder (PTSD). Results indicated (a) greater exposure to work-related traumatic events was associated with work-related PTSD symptoms, as well as negative cognitive schemas; (b) cognitive beliefs partially accounted for PTSD symptoms, but the full cognitive mediational model was not supported. Implications include targeting interventions for journalists who experience traumatic stress and modifying theories about PTSD symptoms in journalists.     

The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type

Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum‐seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = ?0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = ?0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = ?0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees.     

Attachment Dimensions and Post‐traumatic Symptoms Following Interpersonal Traumas versus Impersonal Traumas in Young Adults in Taiwan

Greater risk of post‐traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty‐two trauma‐exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety‐related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd.     

Adolescent survivors of massive childhood trauma in Cambodia: Life events and current symptoms

Cambodian adolescents who survived massive trauma as children were studied to examine the relation of current trauma symptoms to sex, age, trauma exposure, and other current symptoms. Exposure to traumatic life events was expected to be very high, to relate to age and to other symptoms of current psychological functioning. Questionnaires assessed traumatic life events, post-traumatic stress disorder (PTSD) and other psychiatric symptoms, and current functioning. Results document high levels of stress exposure and current trauma symptoms. Based on self-reports of PTSD symptoms, 37% of the subjects were estimated to fulfill DSM-III-R criteria for PTSD. Trauma symptoms were correlated with exposure (r=.31), although not with symptoms of depressed mood, anxiety, or dissociation. Age was related to high levels of recollected trauma exposure (r=.56). Further studies are needed to identify factors associated with better outcomes and to plot the differential course of PTSD symptom clusters over time.     

The Role of Depressive Symptoms in Substance Use Among African American Boys Exposed to Community Violence

Adolescents exposed to community violence (CV) are at increased risk for alcohol, marijuana, and tobacco use. The disproportionate exposure to CV among African American boys heightens their susceptibility to substance use and related problems. Depressive symptoms are linked to both CV exposure and adolescent substance use; however, their role in the link between CV exposure and substance use in African American male adolescents has received little attention. The current study examined whether depressive symptoms mediate or moderate the associations between CV exposure and substance use among African American male adolescents. Participants were 225 African American adolescent boys in Baltimore, Maryland who completed measures of CV exposure and depressive symptoms in 10th grade and measures of substance use in 10th and 11th grades. Hierarchal linear regression analyses indicated that depressive symptoms moderated associations between violent victimization and alcohol and tobacco use, R² = .21–.30, ps < .001. There was a positive association between CV victimization and alcohol and tobacco use among those who reported high levels of depressive symptoms but not low levels. Depressive symptoms also moderated the link between witnessing CV and alcohol use such that witnessing CV was negatively related to alcohol use among those who reported high levels of depressive symptoms only. The findings suggest that depressive symptoms may play an important role in differentiating alcohol and tobacco use outcomes in CV-exposed African American boys. Prevention efforts should assess for depressive symptoms to identify adolescent boys with the highest risk of substance use.     

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.     

Predicting Avoidance Symptoms in U.S. Latino Youth Exposed to Community Violence: The Role of Cultural Values and Behavioral Inhibition

Not all youth exposed to violence are at equal risk for developing posttraumatic stress disorder (PTSD), reflecting potential variability in risk factors influencing the development of PTSD beyond exposure to violence. In particular, Latino youth have been found to be at a higher risk for developing PTSD after exposure to violence. Similarly, youth with high levels of behavioral inhibition appear to be at greater risk of developing PTSD following exposure to violence. In this study, we examined how Latino cultural values might be associated with behavioral inhibition and how these two factors together may interact to predict risk for developing PTSD avoidance symptoms, specifically. Data from a longitudinal sample of 168 Latino adolescents (11–15 years of age) indicated that Latino values were positively associated with behavioral inhibition, r = .26, p < .001, and that Latino values moderated the association between behavioral inhibition and avoidance symptoms, β = .16, p = .009, such that the association was stronger as Latino cultural values increased. Results from this study highlight the importance of considering cultural, individual, and contextual factors for understanding risk for PTSD. Future research should further assess the biological and cultural correlates of behavioral inhibition in order to improve understanding of risk and increase effectiveness of individualized intervention approaches.