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.     

Relationships among Dispositional Attributional Style,Trauma-Specific Attributions,and PTSD Symptoms

The learned helplessness model and its various revisions suggest that causal attributions influence responses to events. This study examined relationships among the 3-factor symptom clusters of posttraumatic stress disorder (PTSD) represented in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994) and the individual dimensions of dispositional attributional style and trauma-specific attributions (i.e., internal–external, stable–unstable, global–specific). Relationships among attributions and clusters of PTSD symptoms represented by the 4-factor dysphoria model were also examined. Trauma-specific attributions were most predictive of PTSD symptoms, with higher associations for avoidance and numbing symptoms compared to arousal symptoms in the three-factor model and higher associations for dysphoria symptoms compared to arousal and avoidance symptoms in the four-factor dysphoria model. Results suggest that cognitive vulnerabilities could underlie the comorbidity between PTSD and depression and might represent a high-impact target for treatment.     

An inventory to measure helplessness, hopelessness, and haplessness

Using a sample of 69 undergraduates, scales were devised to measure helplessness, hopelessness, and haplessness and shown to have good reliability. Briefer scales were also developed whose scores were independent of one another in a factor analysis. Scores for 19 male and 50 female undergraduates on the 4-item scales of Helplessness and Hopelessness were associated with two different measures of depression, but scores on Hopelessness provided the stronger correlate.     

Preliminary Development of a Measure to Assess Children's Trauma Attributions

ABSTRACT

The Trauma Attribution Checklist (TAC) is a brief self-report measure of children's trauma-related attributions. A preliminary study with school-aged children, 12 months after exposure to a series of tornadoes, demonstrated significant correlations between TAC items and the Reaction Index, a measure of posttraumatic distress. Children with higher posttraumatic distress scores made more attributions of responsibility for negative tornado-related events, were more concerned with making attributions, had higher expectations of a tornado recurrence, and were more hypervigilant than children with less severe symptoms. Regression analyses indicated that items addressing expectations of recurrence and hypervigilance explained 53.3% of the variance in posttraumatic distress, with having made an attribution of responsibility for a tornado-related event accounting for an additional 5.6% of the variance.     

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma

Background and Objectives: Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT. Design: The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth. Methods: Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables. Results: Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships. Conclusions: Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.     

Do Children’s Attributions Mediate the Link Between Parental Conditional Regard and Child Depression and Emotion?

Both parental conditional regard for academics and depressogenic attributions are related to detrimental psychological outcomes for children. Here we examine associations among parental conditional negative regard, child depressogenic attributions, child depressive symptoms, and emotion reactivity in children between the ages of 8 and 12, as well as whether children’s self-reported and behavioral attributions for negative events mediate associations between parental conditional negative regard for academics with children’s depressive symptoms and emotion reactivity. In Study 1 (N?=?108, M _age ?=?9.73, 50 male), children’s self-reported attributions for hypothetical events mediated the link between parental conditional negative regard and child depressive symptoms. In Study 2 (N?=?104, M _age ?=?10.28, 54 male), children attempted an impossible puzzle task while their skin conductance level was monitored, after which they completed an interview that was coded for spontaneous attributions for failure. Children’s spontaneous attributions mediated the link between parental conditional negative regard and child emotion reactivity, but not depressive symptoms. Findings suggest that children’s attributions may be a mechanism through which parental conditional negative regard is related to children’s depressive symptoms and emotion reactivity during a performance challenge. These results have implications for developmental models of depression risk and potential areas for clinical interventions with both children and their parents.     

Using Event Centrality to Predict Depressive Symptoms after a Romantic Conflict: A Prospective Design

Using cross‐sectional analyses, event centrality has been shown to be related to a number of poor psychological outcomes, including depressive symptoms and posttraumatic stress disorder symptoms. In the current study, we examined the ability of event centrality of a recent conflict in or breakup of a romantic relationship to prospectively predict depressive symptoms. Replicating previous findings, ratings of event centrality to a recent romantic conflict or breakup were significantly associated with depressive symptoms and posttraumatic stress disorder symptoms at Time 1. These relationships remained significant after controlling for closure and perceived insight. In addition, Time 1 event centrality prospectively predicted Time 2 depressive symptoms, particularly for participants who were split from their romantic partners at Time 2. This prediction remained significant after controlling for Time 1 depressive symptoms. The results of the study suggest that levels of event centrality for romantic conflicts prospectively predict subsequent mental health outcomes. Copyright © 2014 John Wiley & Sons, Ltd.     

Talking about daily emotional events: Psychological well-being moderates the intensity–disclosure link

The intensity of distressing events predicts people’s disclosure of those events at between-person and within-person levels. Depression symptoms seem to attenuate the within-person relation, but past research has not taken a multidimensional view of depression as a moderator. The authors tested whether two constructs related to depression-general psychological well-being and life satisfaction-account for depression’s moderating effects. In a daily diary study, college students (N = 116) rated the intensity of the day’s most unpleasant event and their disclosure of the event each day for 14 days. Participants completed measures of disclosure tendencies, depression symptoms, well-being, and life satisfaction prior to the diary portion of the study. Multilevel modeling analyses revealed moderating effects of disclosure tendencies and depression on the within-person intensity–disclosure relation. However, when psychological well-being and life satisfaction were entered, depression was no longer a significant moderator, but well-being was. Psychological well-being therefore determines the expression of individual differences in the disclosure of daily emotional events.     

Mindfulness and Forgiveness Buffer Distress: Associations With Interpersonal Transgression Blameworthiness

This study examined psychopathological symptom outcomes in victims of interpersonal transgressions (IPTs) based on differences in offender blameworthiness attributions. Mindfulness and forgiveness were hypothesized to serve as protective factors against depression, anxiety, and stress symptoms. The results highlight the buffering influence of dispositional mindfulness and forgiveness on symptoms of depression, anxiety, and stress. These results provide initial evidence that mindfulness‐ and forgiveness‐based procedures may have beneficial therapeutic outcomes for individuals who experience psychopathology as the result of IPTs, specifically IPTs deemed intentional by the victim.     

Treating an HIV/AIDS Patient’s PTSD and Medication Nonadherence With Cognitive-Behavioral Therapy: A Principle-Based Approach

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a patient with HIV/AIDS who was unable to adhere to his antiretroviral medication regimen primarily because of PTSD and depressive symptoms resulting from a sexual assault that had caused his seroconversion. Exposure-based cognitive-behavioral therapy was instrumental in helping the patient overcome his PTSD and depressive symptoms so that he could tolerate his HIV medications. The patient’s symptom relief was evidenced by improved scores on the Impact of Event Scale and Beck Depression Inventory. The article discusses the importance of accurate assessment, therapist flexibility, and principle-based treatment versus strict adherence to manual-based protocols.     

Applying a traumatic stress approach to understanding PCS following pediatric mild TBI

Pediatric traumatic brain injury is a significant public health concern affecting hundreds of thousands of children each year. The majority of children who sustain traumatic brain injuries are classified as having a mild traumatic brain injury, and a subset of these children go on to experience persistent physical, cognitive, and emotional symptoms. These symptoms, known as postconcussive symptoms, can endure for months and even years after injury. The outcomes of mild traumatic brain injury are variable and not well understood for a small percentage of children who experience persistent symptoms. The current article explores the potential influence of children’s posttraumatic stress symptoms on persistent postconcussive symptoms. Despite the high incidence of posttraumatic stress symptoms after pediatric accidental injury, they have not yet been identified as an important factor for consideration in the understanding of pediatric postconcussive outcomes. The article will review the literature on posttraumatic stress and postconcussive symptoms after pediatric injury and consider neurobiological and cognitive factors to propose a model explaining a pathway through which posttraumatic stress reactions may serve as the mechanism for the expression and maintenance of postconcussive symptoms after mild traumatic brain injury. The clinical implications for the proposed relationship between posttraumatic stress symptoms and postconcussive symptoms are considered prior to the conclusion of the article, which acknowledges limitations in the current literature and provides suggestions for future research.     

Attributions for Different Types of Traumatic Events and Post-Traumatic Stress Among Women

This study investigated the relationship of attributions to post-traumatic stress symptoms among women exposed to different types of traumatic events. Participants were 424 female undergraduates who previously experienced a serious accident, natural disaster, child abuse, or adult interpersonal violence. Path analysis indicated a significant indirect pathway from event type to post-traumatic stress through global attributions. Interpersonal-violence survivors exhibited the highest levels of global attributions and post-traumatic stress symptoms. Regression analyses revealed significant interactions between event type and attributions in predicting post-traumatic stress. Stable attributions were associated with increased symptoms in sexual-assault survivors and decreased symptoms in natural-disaster survivors. These findings have implications for improving cognitive interventions for survivors of different types of traumatic events.     

Adult Children’s Caregiver Burden and Depression: The Moderating Roles of Parent–Child Relationship Satisfaction and Feedback from Others

The issue of elderly care has generated great interest because today, most of us live in an aging society. It has been found that caring for one’s elderly parents is a stressful experience that is related to negative outcomes. In addition, accompanied with the decline in fertility may make adult children feel heavier caregiver’s burden. Therefore, the current study investigates moderators that may help reduce the caregiver burden. Following the conservation of resources theory (COR), we hypothesized that feedback from others and a good parent–child relationship serve as resources that may help the individual manage the stress associated with caring for his or her elderly parents. To examine our hypotheses, we collected data from 502 adult children who were primary caregivers for their elderly parents. All participants completed the Burden Assessment Scale (BAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Feedback from Others Scale, and the Parent–Child Relationship Satisfaction Scale. Supporting our prediction, we found a positive correlation between the caregiver’s burden and the caregiver’s levels of depression. Furthermore, both moderation effects were significant. Consistent with our hypotheses, the relationship between caregiver burden and his or her level of depression was weaker when participants had high feedback from others or had a better parent–child relationship. Our findings highlight the view that possessing more resources may help the individual manage the stress associated with caring for elderly parents. Implications for issues related to elderly care are discussed.     

Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial

Halvorsen, J.Ø. & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology 51, 495–502. Torture has severe mental health effects, especially in terms of posttraumatic stress disorder (PTSD) and depression. However, there is still a lack of empirical treatment studies. The present paper presents data on 16 torture survivors receiving 10 sessions of narrative exposure therapy (NET). Symptoms of PTSD and depression, assessed by Clinician‐Administered PTSD Scale (CAPS) and Hamilton Rating Scale for Depression (HRSD), decreased significantly from pre‐treatment to 6‐month follow‐up, with Cohen’s d effect sizes of 1.16 and 0.84, respectively. Although treatment gains were moderate, further research on evidence‐based treatments for PTSD and depression in refugee torture survivors is warranted.     

Caregiver Attributions for Late‐Life Depression and Their Associations with Caregiver Burden

Late‐life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person‐centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression‐specific burden. Intention attributions were significantly associated with general burden, but not depression‐specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.     

Relationship of depression and anxiety to cancer patients' medical decision-making

The purpose of this study was to examine the relation of depression and anxiety to cancer patients' medical decision-making. Participants were 79 rural and urban cancer patients undergoing chemotherapy. The four decisional styles of the Decisional Processing Model were the independent variables. Dependent variables were anxiety and depression, measured by Spielberger's State-Trait Anxiety and the Center for Disease Control Depression Scale, respectively. Consistent with the Decisional Processing Model, analysis suggested that patients make medical decisions by information seeking, information processing, advice following, or ruminating. Decisional style did not vary according to type or stage of cancer, prognosis, time elapsed since initial diagnosis, or whether cancer was initial or recurrent. Decisional style did not systematically vary with depression and anxiety suggesting how a person makes decisions is a stable personality trait. Thus, decision-making may follow a cognitive schema. It is likely that patients' decisional styles help to manage anxiety and depression when confronted with life-threatening illness. Implications for informed consent and patients' involvement in decision-making are discussed.     

Cognitive content-specificity in future expectancies: role of hopelessness and intolerance of uncertainty in depression and GAD symptoms

The present study examined cognitive content-specificity in future-event predictions associated with symptoms of depression and generalized anxiety disorder (GAD). College undergraduates (N=284) completed measures of depression, GAD, and rated their certainty that a given set of positive and negative outcomes were or were not likely to happen in their future. Participants also completed measures of hopelessness and intolerance of uncertainty (IU). Individuals (N=263) completed the same measures again 6 weeks later. Certainty in an absence of positive future outcomes was associated with symptoms of depression but not GAD, and hopelessness mediated this relationship - concurrently and when examining change scores over 6 weeks. Certainty in negative outcomes was concurrently associated with both symptoms of depression and GAD, and hopelessness partially mediated these relationships. IU predicted concurrent increases in depression and GAD symptoms, and negative-outcome certainty partially mediated the IU-depression but not the IU-GAD symptom relationship. Change in certainty did not mediate the relationship between changes in IU and GAD symptoms but partially mediated the relationship between change in IU and depression symptoms over time. Hopelessness appears to play a unique role in the relationship between reduced anticipation of positive future outcomes and depression. Although less clearly suggested by the data, IU may contribute to both depression and GAD symptoms but may do so through different pathways.     

Autobiographical memory for shame or guilt provoking events: Association with psychological symptoms

The diagnostic criteria for posttraumatic stress disorder (PTSD) specify that a qualifying traumatic stressor must incite extreme peritraumatic fear, horror, or helplessness. However, research suggests that events inciting guilt or shame may be associated with PTSD. We devised a web-based survey in which non-clinical participants identified an event associated with shame or guilt and completed questionnaire measures of shame, guilt, PTSD, and depression. In addition, we assessed characteristics of memory for the event, including visual perspective and the centrality of the memory to the participant’s autobiographical narrative (CES). Shame predicted depression and PTSD symptoms. There was no association between guilt and psychological symptoms after controlling statistically for the effects of shame. CES predicted the severity of depression and PTSD symptoms. In addition, CES mediated the moderating effect of visual perspective on the relationship between emotional intensity and PTSD symptoms. Our results suggest shame is capable of eliciting the intrusive and distressing memories characteristic of PTSD. Furthermore, our results suggest aversive emotional events are associated with psychological distress when memory for those events becomes central to one’s identity and autobiographical narrative.     

Relations between Loss of Services and Psychiatric Symptoms in Urban and Non-Urban Settings following a Natural Disaster

Disasters have been associated with both acute and prolonged distress and significant post-disaster psychiatric symptoms. These outcomes may be further complicated by extended periods without vital services and supplies, such as electricity and drinking water. The present study investigated the relations between post-disaster loss of services and psychiatric symptoms in urban/non-urban disaster victims. Random-digit?Cdial methodology was used to interview 1,249 victims of Hurricane Ike, a strong storm that hit Galveston, TX in 2008. Findings demonstrated significant relations between loss of services and post-disaster symptoms of posttraumatic stress disorder (PTSD), depression, and worry. These relations varied by urban/non-urban settings; there were significant positive relations between loss of services and symptoms of depression in non-urban settings, but not in urban settings. Similarly, a stronger relation between loss of services and symptoms of PTSD also was demonstrated in non-urban compared to urban settings. Findings highlight the potential importance of pre-disaster preparation, post-disaster restoration of services, and post-disaster community support in post-disaster psychiatric outcomes, with a particular emphasis in non-urban settings.     

POSTPARTUM BONDING DIFFICULTIES AND ADULT ATTACHMENT STYLES: THE MEDIATING ROLE OF POSTPARTUM DEPRESSION AND CHILDBIRTH‐RELATED PTSD

Despite decades of research demonstrating the role of adult attachment styles and early mother–infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth‐related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant‐focused anxiety, mediated by postpartum depression but not childbirth‐related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth‐related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth‐related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.