Intervening Processes Between Youths’ Exposure to Community Violence and Internalizing Symptoms Over Time: The Roles of Social Support and Coping

The roles of social support and coping as intervening processes between exposure to community violence and internalizing symptoms were examined longitudinally among a community sample of 667 middle school students in the inner city. After controlling for potential confounders (e.g., social desirability, victimization and witnessing of family violence, guardian's psychological symptomatology), internalizing symptoms at Year 2 were predicted by hypothesized changes over 1 year, such that increased community violence exposure, decreased guardian and peer support, and increased use of defensive and confrontational behavioral coping were related to more internalizing symptoms of anxiety, depression and PTSD, although some of these relations varied by gender. The relations between internalizing symptoms at Year 3 and increased changes in exposure to community violence over 2 years were moderated by social support and/or coping, such that decreased guardian support and increased use of defensive and confrontational coping were generally associated with more symptoms for boys exposed to community violence. Girls who witnessed increased community violence and who increased their use of defensive or confrontational coping experienced more internalizing symptoms. The findings underscore the importance of developmental and contextual considerations in the design and implementation of interventions.     

Child Psychosocial Functioning and Parent Quality of Life Among Clinically Referred Children

We examined factors that account for quality of life among parents of clinically referred children. Families (N = 201) of children (ages 3-14) referred for oppositional, aggressive, and antisocial behavior participated. Parent and family contextual factors and child psychosocial functioning (symptoms and impairment) were predicted to influence parents' quality of life. As predicted, socioeconomic disadvantage, parent stress and psychopathology, poor interpersonal relations, and limited social support were related to lower levels of quality of life. Once these factors were controlled, child psychosocial functioning also contributed positively to quality of life. Further research on quality of life in the family can have important implications for understanding the context of both child and parent functioning.     

Understanding psychological distress in Meniere's disease: a systematic review

It has long been suspected that psychological disturbance is common in Meniere's disease (MD), but there has been no systematic review of research on this topic since 1977. The aim of this review was to investigate whether components of post-traumatic stress disorder (PTSD) or health anxiety contribute to distress, so that support and psychological therapy can be tailored better to the particular problems of people with MD. We systematically identified all studies of psychological factors associated with MD between 1977 and 2004. We then tabulated the findings from each of the 28 studies to match them to the components of PTSD and health anxiety. Levels of psychosocial impairment and distress were comparable to patients with similar illness. Evidence was found for some of the components of both PTSD and health anxiety. We conclude that more specific research into PTSD-like symptoms and health anxiety in MD is needed. There was a general lack of research into psychological mechanisms contributing to distress in this population, many studies had methodological weaknesses, and only one qualitative and one longitudinal study had been carried out.     

Expectancy bias and the persistence of posttraumatic stress

Anxious individuals tend to overestimate the probability that encounters with anxiogenic stimuli (CS) will be followed by aversive consequences (UCS). This study examined whether such (biased) UCS expectancies predict the persistence of PTSD symptoms. A total of 265 soldiers were recruited before a four-month deployment to Iraq in 2004. About 2-5 months after deployment, 171 (65%) soldiers completed self-report scales about adverse events in Iraq and PTSD symptoms, and a UCS expectancy task. In this task, participants were exposed to a series of deployment-related and deployment-unrelated (control) picture stimuli. For each trial, the participants indicated the subjective probability that a particular slide would be followed by an imminent loud noise. Around 15 months after deployment, 130 (76%) soldiers completed surveys about PTSD symptoms again. Only a small group of participants had high levels of PTSD symptoms. Regression analyses showed that the level of PTSD symptoms at 15 months was predicted by earlier PTSD symptoms, but also and independently by an enhanced UCS expectancy to deployment-related stimuli. The findings support the notion that UCS expectancy bias contributes to the persistence of PTSD symptoms.     

The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers

During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.     

Prospective Associations Between Peer Victimization and Internalizing Symptoms in Adolescence: The Protective Role of Hope

Youth who experience aggression at the hands of peers are at an increased risk for a variety of adjustment difficulties, including depressive and anxiety symptoms and lower self-esteem. The links between peer victimization and internalizing problems are robust, but less work has been done to identify individual-level protective factors that might mitigate these outcomes. The current study investigated whether hope served as a moderator of the prospective links from peer victimization to depressive and anxiety symptoms and self-esteem during adolescence. Participants included 166 high school students (64% female; 88% Black/African American). Youth completed self-report measures at three different time points across the Spring semester of an academic year. As predicted, hope interacted with peer victimization to predict changes in depressive and anxiety symptoms over the course of the semester. That is, for youth with low levels of hope, peer victimization predicted more stable patterns of depressive and anxiety symptoms. For adolescents with average levels of hope, however, peer victimization did not influence anxiety and depressive symptoms over time. Finally, for adolescents with high levels of hope, peer victimization predicted greater decreases in anxiety symptoms over time. Hope did not interact with peer victimization to predict self-esteem. Rather, hope uniquely predicted higher levels of self-esteem, whereas peer victimization uniquely predicted lower levels of self-esteem. The current study provides initial support for the notion that hope can serve as a protective factor among youth who are victims of peer aggression.

     

Symptoms of Post-Traumatic Stress Disorder in Bereaved Children and Adolescents: Factor Structure and Correlates

This study investigated the factor structure and correlates of posttraumatic stress-disorder (PTSD) symptoms among children and adolescents confronted with the death of a loved one. Three hundred thirty-two bereaved children and adolescents (aged 8–18; 56.9 % girls) who all received some form of psychosocial support after their loss, completed self-report measures of PTSD, together with measures tapping demographic and loss-related variables, depression, prolonged grief, and functional impairment. Parent-rated indices of impairment were also collected. We first evaluated the fit of six alternative models of the factor structure of PTSD symptoms, using confirmatory factor analyses. Outcomes showed that the 4-factor numbing model from King et al. (Psychological Assessment 10, 90–96, 1998), with distinct factors of reexperiencing, avoidance, emotional numbing, and hyperarousal fit the data best. Of all participants, 51.5 % met DSM-IV criteria for PTSD. PTSD-status and scores on the PTSD factors varied as a function of age and gender, but were unrelated to other demographic and loss-related variables. PTSD-status and scores on the PTSD factors were significantly associated symptom-levels of depression, prolonged grief, and functional impairment. Findings complement prior evidence that the DSM-IV model of the factor structure of PTSD symptoms may not represent the best conceptualization of these symptoms and highlight the importance of addressing PTSD symptoms in children and adolescents seeking help after bereavement.     

The role of postdeployment social factors in linking deployment experiences and current posttraumatic stress disorder symptomatology among male and female veterans

Background and Objectives: The postdeployment social context is likely highly salient in explaining mental health symptoms following deployment. The aim of this study was to examine the role of postdeployment social factors (social support and social reintegration difficulty) in linking deployment-related experiences (warfare exposure, sexual harassment, concerns about relationship disruptions, and deployment social support) and posttraumatic stress disorder (PTSD) symptomatology in male and female veterans.

Design: A survey was administered to 998 potential participants (after accounting for undeliverable mail) who had returned from deployment to Afghanistan or Iraq. Completed surveys were received from 469 veterans, yielding a response rate of 47%.

Methods: Hypotheses were examined using structural equation modeling.

Results: For male and female veterans, deployment factors predicted later PTSD symptoms through postdeployment social support and social reintegration, with lower support and higher social reintegration difficulty both associated with higher PTSD symptomatology. While the final models for women and men indicated similar risk mechanisms, some differences in pathways were observed. Sexual harassment presented more of a risk for women, whereas lower social support was a greater risk factor for men.

Conclusions: Postdeployment social factors appear to represent potentially important targets for interventions aiming to reduce the potential impact of stressful deployment experiences.     

Social support, coping, life events, and posttraumatic stress symptoms among former peacekeepers: a prospective study

This study examined both cross-sectionally and longitudinally the relationship between social support, coping strategies, additional stressful life events, and symptoms of posttraumatic stress disorder (PTSD) among Dutch former peacekeeping soldiers. Two groups of peacekeepers were investigated: 311 peacekeepers who participated in the peacekeeping operation in Lebanon between 1979 and 1985, and 499 peacekeepers who were deployed after 1990. These peacekeepers completed a questionnaire in 1996 and again in 1998. The results show that more negative social contacts and fewer positive social contacts were associated with more PTSD symptom severity. More use of the coping strategies ‘wishful thinking’ and ‘accepting responsibility’ was related to more PTSD symptoms. Conversely, more planful problem solving and seeking social support was related to less PTSD symptom severity. In addition, a bilateral relationship was found between additional stressful life events and PTSD symptom severity. The results indicate that social support and coping strategies may be valuable aspects of prevention and intervention programs.     

Complex Trauma Symptoms in Former Ugandan Child Soldiers

Children exposed to repeated interpersonal trauma often develop symptoms that exceed those documented in criteria for post-traumatic stress disorder (PTSD) and are better described with the emerging concept of developmental trauma disorder (DTD). This study examines complex trauma symptoms in a sample of 330 former Ugandan child soldiers (age 11–17 years, 49% female). Prevalence rates were 33.0% for PTSD, 36.4% for depression, and 78.2% for DTD. Whereas PTSD symptoms were significantly related to traumatic war experiences and depression, DTD symptoms were significantly associated with experiences of domestic violence, community violence, social support, and depression. Assessment tools and tailored interventions for DTD are urgently needed.     

Coping, locus of control, social support, and combat-related posttraumatic stress disorder: a prospective study

We examined the relations between coping, locus of control, and social support and combat-related posttraumatic stress disorder (PTSD). The sample consisted of 262 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon war and were followed 2 and 3 years after their participation in combat. Cross-sectional analyses revealed significant relations between locus of control, coping, and social support and PTSD at the two points of assessment. Changes in PTSD from Time 1 to Time 2 were also associated with changes in coping. We discuss theoretical and methodological implications of the findings.     

Race,psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder

Background/Objectives: Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health. Methods/Design: Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD. Results: Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only. Conclusions: Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.     

Emotional/Behavioral Problems and Functional Impairment in Clinic- and Community-Based Children with Attention-Deficit/Hyperactivity Disorder in Taiwan

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6–15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children’s ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent’s perceived child functional impairment, teacher’s perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.     

Community reintegrating former child soldiers in Northern Uganda: A qualitative study on the road to recovery

This study aimed to profile the qualities of a holistic community reintegration program for former child soldiers (FCS) in the Lira region of Northern Uganda. Informants were a convenience sample of 37 FCS (age range 17 to 34, mean age 23.86, SD = 4.715 years; females = 29.73%). FCS completed semi-structured interviews on their current living situations and existing resources. This was aimed at assessing how they were transitioning back into the community and identifying gaps in resources. About 24% of FCS reported feeling unwelcome in their communities, suggesting a need for additional support and resources through the community integration models. Thematic analysis of the data suggests that the FCS would benefit from a holistic community reintegration program with the following qualities: psychosocial support, workforce development training, and job placement. FCS emphasised the need for skills training and employment opportunities over health and wellness; suggesting that mental health support and health care are not sufficient alone for them to successfully reintegrate into the community. FCS community integration policies and practices should prioritise holistic approaches.     

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.     

Coping with Gulf War combat stress: mediating and moderating effects

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N = 1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18-24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD.     

Linking family characteristics with poor peer relations: The mediating role of conduct problems

Parent, teacher, and peer ratings were collected for 75 grade school boys to test the hypothesis that certain family interaction patterns would be associated with poor peer relations. Path analyses provided support for a mediational model, in which punitive and ineffective discipline was related to child conduct problems in home and school settings which, in turn, predicted poor peer relations. Further analyses suggested that distinct subgroups of boys could be identified who exhibited conduct problems at home only, at school only, in both settings, or in neither setting. Boys who exhibited cross-situational conduct problems were more likely to experience multiple concurrent problems (e.g., in both home and school settings) and were more likely than any other group to experience poor peer relations. However, only about one-third of the boys with poor peer relations in this sample exhibited problem profiles consistent with the proposed model (e.g., experienced high rates of punitive/ineffective home discipline and exhibited conduct problems in home and school settings), suggesting that the proposed model reflects one common (but not exclusive) pathway to poor peer relations.     

The Importance of Assessing Impairment Associated With Limited Prosocial Emotions

Limited prosocial emotions (LPE) are characterized by a lack of remorse or guilt, callousness/lack of empathy, being unconcerned about performance, and shallow/deficient affect. While previous research has largely focused on the presence or absence of LPE in youth, there is considerable evidence that symptom presence/absence and symptom impairment are separable dimensions, where impairment often is found to play a significant, unique role in assessing child psychopathology. The current study utilized a newly developed questionnaire with the purpose of exploring its psychometric properties and better understand the dual and potentially differential role LPE symptom presence and LPE-related impairment have in youth. Mothers (n = 265) of children (M_age = 8.04, SD = 2.07) completed questionnaires assessing LPE impairment, LPE symptoms, externalizing disorder symptoms, and functional impairment. Results demonstrated strong support for the psychometric properties of the newly developed measure of LPE impairment. Importantly, LPE-related impairment uniquely predicted all impairment domains above-and-beyond the effects of LPE symptoms, oppositional defiant disorder, and CD symptoms (as well as child age and sex covariates). Moreover, youth in the top 25th percentile on both LPE symptoms and LPE-related impairment (compared to youth only in the top 25th percentile in LPE symptoms) had greater mean externalizing symptoms and functional impairment. The preliminary evidence provided suggests researchers and clinicians may benefit from assessing both LPE symptoms and LPE-related impairment when attempting to identify youth with high levels of conduct problem symptoms and/or psychosocial impairment. Future research should aim to replicate and expand our findings to other clinical populations.     

Suicide and War: The Mediating Effects of Negative Mood, Posttraumatic Stress Disorder Symptoms, and Social Support among Army National Guard Soldiers

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N = 4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.     

Weekly Changes in Blame and PTSD Among Active-Duty Military Personnel Receiving Cognitive Processing Therapy

Both negative posttraumatic cognitions and posttraumatic stress disorder (PTSD) symptoms decrease over the course of cognitive-behavior therapy for PTSD; however, further research is needed to determine whether cognitive change precedes and predicts symptom change. The present study examined whether weekly changes in blame predicted subsequent changes in PTSD symptoms over the course of cognitive processing therapy (CPT). Participants consisted of 321 active duty U.S. Army soldiers with PTSD who received CPT in one of two clinical trials. Symptoms of PTSD and blame were assessed at baseline and weekly throughout treatment. Bivariate latent difference score modeling was used to examine temporal sequential dependencies between the constructs. Results indicated that changes in self-blame and PTSD symptoms were dynamically linked: When examining cross-construct predictors, changes in PTSD symptoms were predicted by prior changes in self-blame, but changes in self-blame were also predicted by both prior levels of and prior changes in PTSD. Changes in other-blame were predicted by prior levels of PTSD, but changes in other-blame did not predict changes in PTSD symptoms. Findings highlight the dynamic relationship between self-blame and PTSD symptoms during treatment in this active military sample.