Posttraumatic stress disorder in the general population after mass terrorist incidents: considerations about the nature of exposure

Epidemiologically, disasters represent multiple forms of possible exposures, including exposure type (eg, natural versus human-made), intensity, and duration. It has been suggested that the consequences of human-made disasters (eg, terrorist incidents) may be more severe than those of natural disasters; recent evidence suggests that there may be a high prevalence of posttraumatic stress disorder (PTSD) among both direct survivors of such attacks and in the general population. Several studies after the September 11, 2001, terrorist attacks found that the prevalence of PTSD was higher in New York City than it was in the rest of the US and that there was a substantial burden of PTSD among persons who were not directly affected by the attacks. This raises important questions about the meaning of "exposure" to a disaster. Using data from an assessment of PTSD in the first 6 months after September 11th we considered the nature of the PTSD experienced by persons who were not directly affected by the September 11th attacks. These data suggest that persons in the general population may have clinically important posttraumatic stress symptomatology after a mass terrorist incident. Future research should consider mechanisms through which persons in the general population may be at risk for PTSD after such incidents.     

Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center

This study examined the relationship between individual differences in adult attachment and psychological adaptation in a sample of high-exposure survivors of the terrorist attacks on the World Trade Center on September 11, 2001. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed via self-report 7 and 18 months after the attacks. In addition, friends and relatives were asked to provide evaluations of participants' adjustment before and after the attacks. Findings indicate that securely attached individuals exhibited fewer symptoms of PTSD and depression than insecurely attached individuals and were viewed by friends and relatives as showing an increase in adjustment following the attacks. Highly dismissing adults were viewed by their friends and family as showing neither increments nor decrements in adjustment, despite the fact that highly dismissing people self-reported relatively high levels of PTSD and depression.     

Gay male sexual assault survivors: the relations among internalized homophobia, experiential avoidance, and psychological symptom severity

This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample of 74 gay male sexual assault survivors. Results indicated that IH is associated with both depressive and posttraumatic stress disorder (PTSD) symptom severity. IH accounted for more variance than assault severity in predicting both PTSD and depression symptom severity. IH and experiential avoidance similarly predicted PTSD symptom severity. In comparison with IH, however, experiential avoidance is a stronger predictor of depression symptom severity. Results also showed that experiential avoidance partially mediated the relation between IH and both depressive and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.     

The Relationship Between Posttraumatic Stress Symptoms and Suicide Ideation Among Child Survivors Following the Wenchuan Earthquake

The association between posttraumatic stress disorder (PTSD) symptoms and suicide ideation was examined in a sample of 2,298 child survivors of the Wenchuan earthquake. Results indicated that intrusion, avoidance, hyperarousal symptom clusters, and PTSD total score were significantly associated with suicide ideation. Except for intrusion, other measures of PTSD remained as statistically significant correlates of suicide ideation even after controlling for age, gender, direct exposure, indirect exposure, and depression. Furthermore, results showed that PTSD symptoms had an indirect influence on suicide ideation that was mediated by depression. The findings suggest that avoidance and hyperarousal symptom clusters of PTSD may be two important indicators of suicide ideation among child survivors of the Wenchuan earthquake. Implications of the results for intervention and prevention of suicide behavior are discussed.     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

Event centrality and posttraumatic outcomes in the context of pervasive violence: a study of teachers in El Salvador

It is well established that the importance assigned to a trauma can affect one's recovery and psychological health in numerous ways. Event centrality is an increasingly popular construct that captures the tendency among survivors to reevaluate and possibly accommodate their worldviews posttrauma. The centrality given to trauma appears to serve as a “double-edged sword” in that this construct might factor prominently in both posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Focusing on 257 violence-exposed teachers from educational departments throughout El Salvador, we examined whether the centrality assigned by the teachers to stressful life events uniquely predicted both PTSD symptomatology and PTG. Results revealed that event centrality was positively related to both PTSD and PTG, even when controlling for demographic factors, violence exposure, and depression. In addition, PTSD symptomatology and PTG were not associated with one another in this sample. In summary, these findings support the role of event centrality as a contributing factor for PTSD and PTG among persons exposed to pervasive trauma.     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

PSYCHOLOGICAL OUTCOMES AMONG LESBIAN SEXUAL ASSAULT SURVIVORS: AN EXAMINATION OF THE ROLES OF INTERNALIZED HOMOPHOBIA AND EXPERIENTIAL AVOIDANCE

This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample of 72 lesbian sexual assault survivors. Results indicated that IH is associated with both experiential avoidance and posttraumatic stress disorder (PTSD) symptom severity. In addition, experiential avoidance is related to both PTSD and depression symptom severity. Finally, experiential avoidance completely mediated the relation between IH and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.     

Behavioral Activation as an Early Intervention for Posttraumatic Stress Disorder and Depression Among Physically Injured Trauma Survivors

This paper describes an adaptation of behavioral activation (BA) for the early intervention of posttraumatic stress disorder (PTSD) and depression among physically injured survivors of traumatic injury, and presents pilot data on a small randomized effectiveness trial (N = 8). The application of BA to PTSD is based on the theory that increases in guided activity may break patterns of avoidance that can maintain PTSD. Compared to treatment as usual (TAU), those who received BA showed improvement in PTSD symptom severity from pre- to posttreatment, and there was a trend for the BA group to score better than the TAU group on physical functioning. Contrary to expectation, this brief adaptation did not have an impact on depression. Implications of these results for the effective early intervention after trauma are discussed.     

Enhanced priming for trauma-related words predicts posttraumatic stress disorder

There is preliminary evidence that enhanced priming for trauma-related cues plays a role in posttraumatic stress disorder (PTSD). A prospective study of 119 motor vehicle accident survivors investigated whether priming for trauma-related stimuli predicts PTSD. Participants completed a modified word-stem completion test comprising accident-related, traffic-related, general threat, and neutral words at 2 weeks post-trauma. Priming for accident-related words predicted PTSD at 6 months follow-up, even when initial symptom levels of PTSD and depression and priming for other words were controlled. The results are in line with the hypothesis that enhanced priming for traumatic material contributes to the development of chronic PTSD.     

Holocaust survivors in a primary care setting: fifty years later

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.     

The psychological effects of parental mental health on children experiencing disaster: the experience of Bolu earthquake in Turkey

Disasters affect families as a whole, and symptoms displayed by a family member may lead to secondary traumatizations for other members of the family, especially the children. This study examines the effects of parental psychopathology and family functioning on children's psychological problems six months after the earthquake in Bolu, Turkey. Forty-nine children aged between 7 and 14 and their parents were randomly chosen from among 800 families living in a survivor camp in Bolu. Both the children and parents were assessed by trained psychiatrists and psychologists using self-report measures for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms six months after the earthquake. Family functioning in survivor families was also assessed using the Family Assessment Device (FAD). The results showed that the severity of PTSD in children was mainly affected by the presence of PTSD and the severity of depression in the father. State and trait anxiety scores of children were related to general family functioning. The constellation of PTSD symptomatology was different in fathers than in mothers: the most common type of symptoms was "externalizing" in fathers with PTSD. This study supports the notion that the mere presence of PTSD in parents may not be enough to explain the relational process in families experiencing trauma. Our findings with earthquake survivors suggest that when fathers become more irritable and detached because of PTSD symptoms, their symptoms may affect children more significantly.     

汶川地震30个月后中小学生的身心状况研究

通过对汶川地震极重灾区的中小学生进行问卷调查,考察其在地震30个月后的创伤后应激障碍、抑郁、学习倦怠和创伤后成长等身心状况。结果发现：（1）震后30个月的中小学生创伤后应激障碍和抑郁情况较为严重,发生率分别达到6.6%和69.5%,女生和高年级学生是其高危人群;（2）学习倦怠总体情况比较轻微,学习的低效能感相对较严重;（3）创伤后成长的程度较高,且性别和年级间差异与创伤后应激障碍相似;（4）创伤后应激障碍、抑郁及学习倦怠等3个消极变量和创伤后成长之间分别为正相关、零相关和零相关。建议心理疏导人员将重心放在降低创伤后应激障碍和抑郁的程度及激发受灾学生的创伤后成长方面,并充分意识到创伤后成长程度较高的学生也有出现心理不良状况的可能性。     

Appraisals of Fear, Helplessness, and Perceived Life-Threat During Emergent Cardiac Surgery: Relationship to Pre-surgical Depression, Trauma History, and Posttraumatic Stress

Depression and posttraumatic stress (PTS) have been linked to medical/psychological outcomes following coronary artery bypass graft (CABG) surgery. This study assessed pre-surgical trauma history, PTS, and depression; and peri-surgical appraisals of fear, helplessness, and perceived life-threat among 110 patients. All CABGs were emergent, rather than elective, surgeries. In hierarchical multiple regressions, total severity score for pre-surgical PTS predicted fear regarding the cardiac event and the CABG, and perceived life-threat regarding the cardiac event and the CABG. Pre-surgical depression predicted perceived helplessness regarding the cardiac event and the CABG, and contributed to prediction of perceived life-threat. Trauma history contributed to prediction of fear and perceived helplessness regarding surgery (but not regarding the cardiac event necessitating surgery). When posttraumatic stress disorder diagnosis (PTSD) was entered, rather than total severity of PTS, PTSD did not predict any appraisals, and depression showed stronger prediction of fear, helplessness, and perceived life-threat than did PTSD.     

Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.     

Unwanted memories of assault: what intrusion characteristics are associated with PTSD?

Intrusive memories are common in the immediate aftermath of traumatic events, but neither their presence or frequency are good predictors of the persistence of posttraumatic stress disorder (PTSD). Two studies of assault survivors, a cross-sectional study (N=81) and a 6-month prospective longitudinal study (N=73), explored whether characteristics of the intrusive memories improve the prediction. Intrusion characteristics were assessed with an Intrusion Interview and an Intrusion Provocation Task. The distress caused by the intrusions, their "here and now" quality, and their lack of a context predicted PTSD severity. The presence of intrusive memories only explained 9% of the variance of PTSD severity at 6 months after assault. Among survivors with intrusions, intrusion frequency only explained 8% of the variance of PTSD symptom severity at 6 months. Nowness, distress and lack of context explained an additional 43% of the variance. These intrusion characteristics also predicted PTSD severity at 6 months over and above what could be predicted from PTSD diagnostic status at initial assessment. Further predictors of PTSD severity were rumination about the intrusive memories, and the ease and persistence with which intrusive memories could be triggered by photographs depicting assaults. The results have implications for the early identification of trauma survivors at risk of chronic PTSD.     

Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack

Research on adult reactions to potentially traumatic events has focused almost exclusively on posttraumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n= 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.     

Positive Metacognitions and Meta-Emotions as Predictors of Posttraumatic Stress Disorder and Posttraumatic Growth in Survivors of a Natural Disaster

ABSTRACT

Exposure to natural disasters can lead to both negative and positive mental health consequences (i.e., posttraumatic stress disorder [PTSD] and posttraumatic growth [PTG]). While there is evidence linking metacognition to these outcomes, the focus is mostly on maladaptive metacognitions. The present study investigated the role of positive metacognitions and meta-emotions (i.e., confidence in extinguishing perseveration [Extinguishing], confidence in interpreting emotions as cues [Interpreting], and confidence in setting flexible and attainable hierarchies of goals [Setting]) on PTSD and PTG among Filipino typhoon survivors. Findings supported a model wherein Extinguishing and Setting, but not Interpreting, predicted PTSD and PTG through posttraumatic cognitions.     

术后乳腺癌患者体象对创伤后应激障碍和创伤后成长的影响：反刍的中介作用

为探讨乳腺癌患者反刍这一认知情绪调节方式在体象和创伤后应激障碍（PTSD）、创伤后成长（PTG）之间的中介作用，采用体象量表（BIS）、认知情绪调节问卷中文版（CERQ-C）、创伤后应激障碍量表（PSS）和创伤后成长问卷（PTGI）对150名乳腺癌术后患者进行研究。结果发现：（1）乳腺癌患者的体象可以正向预测PTSD和PTG；（2）乳腺癌患者的反刍在体象和PTSD的闯入性症状、回避性症状中起中介作用，在体象与PTG中的中介作用不显著。结果表明，体象既可以正向预测乳腺癌患者的PTSD和PTG，也可以通过反刍的中介作用影响PTSD。     

The impact of posttraumatic growth,transformational leadership,and self-efficacy on PTSD and depression symptom severity among combat Veterans

Previous research has established self-efficacy as essential to postdeployment adjustment among Veterans, and perceived transformational leadership is well known for its positive effects on follower outcomes across contexts. However, little is known regarding how transformational leadership may relate to posttraumatic growth and self-efficacy in fostering psychological wellbeing among combat Veterans. The purpose of this study was to examine the role of transformational leadership in predicting posttraumatic stress disorder (PTSD) and depression symptoms among combat Veterans, as well as how posttraumatic growth and postdeployment coping self-efficacy may influence these relations. The study sample consisted of 130 combat Veterans recruited from a university, Veterans Affairs medical center, and the greater community. Path analysis based on bootstrapped resampling revealed postdeployment coping self-efficacy and perceived transformational leadership as predictors of lower PTSD and depression symptom severity. In addition, mediation modeling revealed that postdeployment coping self-efficacy mediated the relation between transformational leadership and both PTSD and depression, while posttraumatic growth did not predict PTSD symptoms. These findings may aid in the prediction of PTSD and depression symptoms among Veterans, which may then influence pre-deployment leadership training among military personnel as well as clinical treatment protocols for Veterans.