The Role of Beliefs in the Relationship Between Health Problems and Posttraumatic Stress in Adolescent and Young Adult Cancer Survivors

In addition to the potential for ongoing health concerns, adolescent and young adult (AYA) childhood cancer survivors frequently report posttraumatic stress symptoms (PTSS). The current study examines whether beliefs about health moderate the relationship between the number of health problems and PTSS 2 months later in 140 survivors. Beliefs, as measured by scales of the Health Competence Beliefs Inventory (HCBI), negatively related to PTSS while health problems positively related to PTSS. Three scales of the HCBI-health perceptions, satisfaction with healthcare and cognitive competence—were significant moderators. The relationship between health problems and PTSS was stronger in the presence of less adaptive beliefs. These beliefs represent potentially malleable intervention targets for reducing PTSS in childhood cancer survivors.     

Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive,behavioral, and emotional outcomes

Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine’s true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent “cure” that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer – namely, the presence of a life-threatening disease and endurance of invasive medical procedures – has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.     

Posttraumatic Stress in Survivors of Childhood Cancer and Mothers: Development and Validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS)

This study presents initial data validating the use of a new instrument, the Impact of Traumatic Stressors Interview Schedule (ITSIS), to assess the occurrence of cancer-related posttraumatic stress in childhood cancer survivors and their mothers. Sixty-six child/adolescent cancer survivors and 64 of their mothers, as well as 130 young adult survivors, completed the ITSIS and other measures of posttraumatic stress and general distress. Five ITSIS factors were identified for the mothers and for the young adult survivors, and three ITSIS factors were identified for the child/adolescent survivors. Factors in all three samples reflected symptoms of posttraumatic distress, concern over medical late effects, communication, and changes in self due to cancer. Only young adult survivors had a factor reflecting a positive engagement with the cancer history. Factors correlated with validation measures in predicted ways. The findings further the conceptualization of posttraumatic stress in pediatric cancer by describing the traumatic experience for survivors and mothers. Comparing factors across samples allows an examination of different influences of cancer within families and over the course of development.     

The role of stressful life events on the cortisol reactivity patterns of breast cancer survivors

Objective: Atypical patterns of cortisol secretion following an acute stressor have been commonly reported in breast cancer survivors. Stressful life events have been associated with blunted acute cortisol levels in other populations. The purpose of this study was to explore the role of stressful life events on cortisol secretion patterns of breast cancer survivors following an acute stressor.

Design: The Trier Social Stress (TSST) was used to elicit a moderate stress response in breast cancer survivors (n = 19) and a control group (n = 17). Saliva samples were collected before, during and after the TSST to provide cortisol concentrations. During recovery, we recorded the frequency and subjective impact of stressful life events in the past year using the Life Experience Survey.

Results: Simple regressions analyses were performed; results suggest no group differences between the total number of stressful life events and their subjective impact. However, the total number of stressful life events as well as their subjective impact correlated negatively with the peak cortisol concentration in breast cancer survivors.

Conclusions: The cumulative effect of stressful life events, positive and negative, may impact the endocrine stress system of breast cancer survivors more so than that of women with no history of cancer.     

Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

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.     

Traumatization,Marital Adjustment,and Parenting among Veterans and Their Spouses: A Longitudinal Study of Reciprocal Relations

Despite considerable research on secondary traumatization, the ramifications of veterans’ and their wives’ posttraumatic stress symptoms (PTSS) for the family system remain largely uninvestigated. Beginning to fill this gap, the current study aims to investigate the reciprocal relations between both spouses’ PTSS and marital adjustment, and the implications these bear for their parental functioning. Two hundred and twenty‐five Israeli veterans (mean age = 58.62, SD = 7.6) from the 1973 Yom Kippur War and their wives (mean age = 58.28, SD = 5.79) were examined at two points in time: 30 (T1) and 35–37 years after the war (T2). Analysis included longitudinal actor–partner interdependence modeling and sequential mediation analyses. The results show that higher PTSS among the wives at T1 predicted higher PTSS among husbands at T2, and vice versa, and predicted their husbands’ marital adjustment at T2. Moreover, wives’ PTSS at T1 had a significant effect on parental overinvolvement of both parents at T2, but neither their PTSS nor their husbands’ PTSS had an impact on positive parenting. In the intrapersonal domain, better marital adjustment at T1 predicted positive parenting among both spouses in subsequent measurement. Interpersonally, wives’ lower marital adjustment at T1 predicted husbands’ higher parental functioning, but not vice versa. Furthermore, marital adjustment mediated the association between PTSS and positive parenting for both spouses. The results emphasize the detrimental ramifications of war trauma on the interpersonal domains in veterans’ families. Hence, both marital and parental consequences of trauma should be considered in clinical family interventions.     

Flashbulb memories and posttraumatic stress reactions across the life span: age-related effects of the German occupation of Denmark during World War II

A representative sample of older Danes were interviewed about experiences from the German occupation of Denmark in World War II. The number of participants with flashbulb memories for the German invasion (1940) and capitulation (1945) increased with participants' age at the time of the events up to age 8. Among participants under 8 years at the time of their most traumatic event, age at the time correlated positively with the current level of posttraumatic stress reactions and the vividness of stressful memories and their centrality to life story and identity. These findings were replicated in Study 2 for self-nominated stressful events sampled from the entire life span using a representative sample of Danes born after 1945. The results are discussed in relation to posttraumatic stress disorder and childhood amnesia.     

Attentional bias towards emotional facial expressions in survivors of dating violence

This study identified components of attentional bias (e.g. attentional vigilance, attentional avoidance and difficulty with disengagement) that are critical characteristics of survivors of dating violence (DV). Eye movements were recorded to obtain accurate and continuous information regarding attention. DV survivors with high post-traumatic stress symptoms (DV-High PTSS group; n = 20) and low post-traumatic stress symptoms (DV-Low PTSS group; n = 22) and participants who had never experienced DV (NDV group; n = 21) were shown screens displaying emotional (angry, fearful and happy) faces paired with neutral faces and negative (angry and fearful) faces paired with happy faces for 10 s. The results indicate that the DV-High PTSS group spent longer dwelling on angry faces over time compared with the DV-Low PTSS and NDV groups. This result implies that the DV-High PTSS group focused on specific trauma-related stimuli but does not provide evidence of an attentional bias towards threatening stimuli in general.     

The Dimensionality of Cognitive Appraisal and Its Relationship to Physical and Psychological Well-Being

In current adjustment models, an individual's appraisal of life events has been included as an important determinant in the stress-illness process. In particular, these events have been defined in terms of a variety of unidimensional concepts, such as desirability, controllability, or as having the potential for threat or challenge. The present study investigated the multidimensional nature of cognitive appraisal and its relationship to physical and psychological well-being. Residents of a Canadian community (N = 184) responded to an extensive survey on life-event stress, appraisal, alcohol consumption, health status, and depression. A principal-axis factor analysis of 19 appraisal dimensions revealed five factors accounting for 60% of the variance: Undesirability/Threat, Gain/Challenge, Need for Information, Familiarity, and Need to Accept. Entered with total number of life events and coping behavior as predictors in a series of stepwise regressions, these appraisal factors differentially predicted aspects of well-being.     

Children's Adjustment in a Climate of Political Violence: Comparing Mother and Child Reports

There is a dearth of research on parent and child reports regarding a parent’s parenting and its contribution to a child’s adjustment. Therefore, the current study examined: (a) the differences between mother and child reports of aspects of maternal parenting (i.e., care and control), among both boys and girls; (b) which parenting report (i.e., mother’s or child’s) makes a stronger contribution to mother and child reports of the child’s adjustment in the context of political violence. One hundred and twenty-one mother-child dyads (children aged seven to 12 years old (M?=?10.02, SD?=?1.03)), who were exposed to prolonged political violence, participated in this study. Maternal care and control were assessed by mother and child reports on the Parental Bonding Instrument. Child’s adjustment was assessed both by mother’s report of child’s total difficulties and child’s self-report of posttraumatic stress symptoms (PTSS). Results revealed that both the mothers of girls and the girls themselves reported higher care, in comparison to mothers of boys and the boys themselves, while mothers of boys and the boys themselves reported higher control. Higher maternal control, as reported by the child, was associated with the child’s self-reported PTSS. Higher maternal control, as reported by the mother, was associated with the child’s total difficulties, as reported by the mother. However, maternal care, whether reported by mother or child, was not found to be associated with the child’s adjustment. School-aged children and their mothers were in agreement regarding maternal dimensions and their contribution to children’s adjustment.     

Posttraumatic Growth, Posttraumatic Stress Symptoms and Mental Health Among Coronary Heart Disease Survivors

The present study aimed to estimate posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among heart disease survivors and examine whether PTG moderates the association between PTSS and mental health. Data from 82 myocardial infarction and acute coronary artery bypass graft survivors (aged 46–82) was obtained at admission to a cardiac rehabilitation unit. Mental status was assessed by the PTSD Inventory, Posttraumatic Growth Inventory (PTGI), Mental Health Inventory and Health Related Quality of Life (HRQOL). 17.1 % of the participants suffered significantly from PTSS and most of the study sample (71.2 %) reported PTG. PTSS were positively associated with PTG and psychological distress and negatively with well-being and HRQOL. PTG moderated the association between PTSS and most mental health outcomes. We conclude that posttraumatic growth may attenuate the negative effect of posttraumatic stress symptoms on mental health.     

Predictors of post-traumatic stress symptoms following occupational accidents: A longitudinal study

Objective: Occupational accidents are highly stressful events that frequently occur and impact both the physical and mental health of workers. The aim of this study was to longitudinally assess a predictive model of posttraumatic stress symptoms (PTSS) in workers who have suffered a recent accident. Method: Two hundred and forty-four workers (77.8% men), aged 18 to 73 years, who had experienced an accident during the last month that resulted in hospitalization and/or ten or more days of sick leave, were surveyed. A second survey was carried out six months later. Regression analyses included psychological predictors (i.e. subjective severity of event, brooding and positive and negative religious coping), along with objective predictors (i.e. hospitalization, sick leave days and unemployment). Results: It was found that the main predictors of PTSS were brooding, negative religious coping, days of sick leave and unemployment, with a large effect size (R²?=?.45). Conclusions: The discussion is based on the usefulness of including selected psychological and objective predictors for detecting people more susceptible to developing psychopathology due to the stress following an accident. Identifying at-risk people for developing PTSS after an accident may help to introduce selective preventive strategies or early interventions in this population.     

日常生活事件对中学生社会适应的影响：社会问题解决能力的中介作用

采用问卷法,对2157名中学生日常生活事件的特点,及其与社会适应、社会问题解决能力的关系进行研究。结果发现：（1）学业压力与人际冲突是中学生所遇到的最主要的日常生活事件,低年级经历的事件显著少于高年级,女生经历的事件显著少于男生;（2）中学生日常生活事件显著负向预测积极适应,显著正向预测消极适应;（3）社会问题解决能力在日常生活事件和社会适应之间起到部分中介作用,其中问题趋近、问题回避的作用尤其突出。     

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.     

Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation

Background and Objectives: Stressful life events are known to contribute to development of depression; however, it is possible this link is bidirectional. The present study examined whether such stress generation effects are greater than the effects of stressful life events on depression, and whether stress generation is also evident with anxiety. Design: Participants were two large age cohorts (N = 732 aged 44 years; N = 705 aged 63 years) from the West of Scotland Twenty-07 study. Methods: Stressful life events, depression, and anxiety symptoms were measured twice five years apart. Cross-lagged panel analysis examined the mutual influences of stressful life events on depression and on anxiety over time. Results: Life events predicted later depressive symptomatology (p = .01), but the depression predicting life events relationship was less strong (p = .06), whereas earlier anxiety predicted life events five years later (p = .001). There was evidence of sex differences in the extent to which life events predicted later anxiety. Conclusions: This study provides evidence of stress causation for depression and weaker evidence for stress generation. In contrast, there was strong evidence of stress generation for anxiety but weaker evidence for stress causation, and that differed for men and women.     

Self-efficacy moderates the relationship between stress appraisal and quality of life among rescue workers

Abstract

Rescue workers are frequently exposed to highly stressful situations during their everyday work activity. Stress and coping theory emphasizes the interaction between primary and secondary appraisal in determining coping responses to stressful events and quality of life. According to Social Cognitive Theory, stress reactions depend on self-appraisal of coping capabilities.

The present study investigated whether self-efficacy moderates the relationship between stress appraisal and professional quality of life. A self-administered questionnaire was submitted to a sample of 451 Italian rescue workers (firefighters, paramedics, and medical technicians), including the Professional Quality of Life Scale, which measures three dimensions of emergency workers' quality of working life: compassion fatigue, burnout, and compassion satisfaction. Multiple regression analyses indicated that the relationship between stress appraisal and professional quality of life was significant only among rescue workers with low levels of self-efficacy but not among those with higher levels of self-efficacy. These results confirmed the expectations based on Social Cognitive Theory that self-efficacy buffers the impact of perceived stressful encounters on professional quality of life. Results suggest the usefulness of interventions aimed at increasing rescue workers' psychosocial skills.     

Gender differences in posttraumatic stress symptoms among former prisoners of wars’ adult offspring

Objectives: The lifetime risk for posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS) among primary and secondary female victims is known to be higher than for male. This study assessed gender differences in PTSS among former prisoners of war’s (ex-POWs) adult offspring and the associations with their fathers’ and mothers’ PTSS and the parental bonding with them.

Design: A correlative study.

Methods: A sample of 79 Israeli father–mother-offspring ex-POW triads from the 1973 Yom Kippur War completed self-report measures. Fathers were assessed in 2008, mothers were assessed in 2011 and their adult offspring took part in 2014.

Results: Sons of ex-POWs reported higher levels of PTSS as compared to daughters of ex-POWs. However, fathers’ PTSS was positively related to daughters’ PTSS, but not significantly related to sons’ PTSS. Daughters’ PTSS were also associated with both parents’ lower care and higher overprotection, while sons’ PTSS were associated only with fathers’ lower care and higher overprotection.

Conclusions: Among adult offspring of ex-POWs, sons are at greater risk for psychological distress in the form of PTSS. Nevertheless, the intergenerational transmission of captivity-related PTSS from both fathers and spouses to their offspring is more prominent among daughters of ex-POWs.     

Latent classes of posttraumatic stress and growth

Background and Objectives: Potentially traumatic events may lead to different patterns of posttraumatic stress symptoms and posttraumatic growth. The objective of the present study was to identify subgroups with different patterns of posttraumatic reactions, and to determine whether these subgroups differed in terms of personal and social resources and indicators of adjustment. Design: This study used survey data collected 10 months after the 2011 Oslo bombing attack to investigate patterns of reactions among ministerial employees (N = 1970). Methods: We applied latent class analyses with covariates to extract subgroups of individuals. Results: Three classes of individual reactions were extracted, and these were similar among those who were and those who were not physically proximate to the bombing attack: “High stress/high growth” (27% and 11%, respectively), “Low stress/high growth” (74% and 42%, respectively), and “Low stress/low growth” (only among the not physically proximate: 47%). The classes differed in terms of gender, neuroticism, and social support as well as life satisfaction and daily functioning. Conclusions: Heterogeneous patterns of posttraumatic reactions were found. Physical proximity is not necessary to experience posttraumatic stress or growth after political violence. Among individuals with low stress, posttraumatic growth may not encompass higher life satisfaction or functioning.