Prediction of work functioning following accidental injury: The contribution of PTSD symptom severity and other established risk factors

Responses to a mail survey were used to investigate the contribution of PTSD symptom severity to work functioning in 69 previously employed adult survivors of accidental injury approximately 8 months post‐hospitalization. Associations of PTSD symptom severity with other established risk factors for poor work functioning were also examined. Participants were initially divided into three groups based on PTSD symptom severity and analysis of variance undertaken to determine the differences in work functioning between survivors with PTSD, subclinical PTSD, and no PTSD. As anticipated, survivors with PTSD reported significantly poorer work functioning than those with subclinical PTSD and no PTSD. Those with subclinical PTSD, however, reported significantly lower levels of work functioning than survivors with no PTSD, suggesting that this population may also be at risk of poor outcomes and in need of vocational interventions post‐accident. To determine the influence of PTSD symptom severity on work functioning over and above other established risk factors, a two‐model hierarchical regression that included the established risk factors in the first model and PTSD in the final model was undertaken. Results revealed that PTSD symptom severity uniquely predicted work functioning after controlling for the influence of other contributing risk factors. A composite of seven risk factors, including PTSD symptom severity, was shown to predict 62% (57% adjusted) of the variance in work functioning but only pre‐accident occupation, physical functioning, and PTSD severity significantly contributed to the prediction. Findings suggest that the rehabilitation management of people with PTSD or subclinical PTSD following accidental injury would benefit from early identification by the established predictors together with an integrated approach to physical, psychological, and vocational interventions.     

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.     

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.     

Posttraumatic stress disorder and psychosocial functioning within two samples of MVA survivors

To examine criterion F variables of PTSD, the psychosocial functioning of two samples of motor vehicle accident (MVA) survivors was investigated. Within each sample, comparisons between MVA survivors with and without PTSD were conducted on four psychosocial functioning indices at three time points. In addition, the relationships between specific PTSD symptom clusters and psychosocial functioning indices were examined. The study revealed that, in general, MVA survivors with PTSD evidenced poorer psychosocial functioning than did survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the most consistent predictors of the psychosocial functioning indices. The implications of these findings to the comprehensive treatment of PTSD are discussed.     

Cultural differences in levels of autonomous orientation in autobiographical remembering in posttraumatic stress disorder

This study investigated cultural differences in levels of autonomous orientation (the tendency to express autonomy and self‐determination) in autobiographical remembering in those with and without posttraumatic stress disorder (PTSD). Trauma survivors with PTSD and without PTSD from individualistic and collectivistic cultures (N = 101) provided self‐defining, everyday and trauma autobiographical memories. Memories were coded for levels of autonomous orientation and interdependence. It was found trauma survivors from individualistic cultures with PTSD had lower levels of autonomous orientation in their autobiographical remembering than trauma survivors from individualistic cultures without PTSD. In contrast, trauma survivors from collectivistic cultures with PTSD had higher levels of autonomous orientation in their autobiographical remembering than trauma survivors from collectivistic cultures without PTSD. The results suggest the cultural distinction in self‐impacts on the relationship between the nature of autobiographical remembering and posttraumatic psychological adjustment. Copyright © 2010 John Wiley & Sons, Ltd.     

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information.     

Attentional bias to violent images in survivors of dating violence

This study investigated the time-course characteristics of attentional bias, such as vigilance and maintenance, towards violent stimuli in dating violence (DV) survivors. DV survivors with PTSD symptoms (DV-PTSD group; n=14), DV survivors without PTSD symptoms (Trauma Control group; n=14), and individuals who were never exposed to dating violence (NDV group; n=15) viewed slides that presented four categories of images (violent, dysphoric, positive, and neutral) per slide, for ten seconds. Our results revealed that the DV-PTSD group spent more time on violent stimuli than did the Trauma Control or NDV groups. The DV survivors, both with and without PTSD symptoms, spent more time on dysphoric stimuli and less time on happy stimuli than did the NDV group. In addition to the effects of PTSD, researchers should also be considering the effects of simple traumatic exposure.     

Attentional bias to violent images in survivors of dating violence

This study investigated the time-course characteristics of attentional bias, such as vigilance and maintenance, towards violent stimuli in dating violence (DV) survivors. DV survivors with PTSD symptoms (DV-PTSD group; n=14), DV survivors without PTSD symptoms (Trauma Control group; n=14), and individuals who were never exposed to dating violence (NDV group; n=15) viewed slides that presented four categories of images (violent, dysphoric, positive, and neutral) per slide, for ten seconds. Our results revealed that the DV-PTSD group spent more time on violent stimuli than did the Trauma Control or NDV groups. The DV survivors, both with and without PTSD symptoms, spent more time on dysphoric stimuli and less time on happy stimuli than did the NDV group. In addition to the effects of PTSD, researchers should also be considering the effects of simple traumatic exposure.     

Characteristics and organization of the worst moment of trauma memories in posttraumatic stress disorder

It has been proposed that the organization of the worst moment in traumatic memories (“hotspots”) is of particular importance for the development of PTSD. However, current knowledge regarding the organization and content of worst moments is incomplete.In the present study, trauma survivors with (n = 25) and without PTSD (n = 54) were asked to indicate the worst moment of their trauma and to give a detailed narrative of the traumatic event. The worst moment and the remaining narrative were analyzed separately with regard to organization and emotional content.Results indicated that worst moments of trauma survivors with PTSD differed from the remaining narrative and from worst moments described by trauma survivors without PTSD in that they were characterized by more unfinished thoughts, more use of the present tense and lower levels of cognitive processing. However, hypotheses regarding differentiating emotional content were not supported. Implications for our theoretical understanding of PTSD and potential therapeutic interventions are discussed.     

Brief Report: Comparing the Autobiographical Remembering of Iranian Immigrant Trauma Survivors with That of Iranian and British Trauma Survivors

This study investigated how culture and posttraumatic stress disorder (PTSD) influence the autobiographical remembering of Iranian trauma survivors living in Britain compared to the remembering of British trauma survivors living in their host culture (Britain) and Iranians in their culture of origin (Iran). Iranian immigrants with and without PTSD completed measures of autobiographical remembering. Data was compared to previously collected data from British and Iranian trauma survivors with and without PTSD. It was found that the memory‐content of Iranian immigrants' memories resembled that of Iranian trauma survivors in Iran, while the phenomenological properties of their autobiographical remembering more closely resembled that of British trauma survivors. Moreover, there were pan‐cultural distortions and deficits in the autobiographical remembering of those with PTSD. The findings suggest that immigrants with PTSD have similar disruptions and distortions in their autobiographical remembering as that of individuals with PTSD living in their host culture and culture of origin.Copyright © 2016 John Wiley & Sons, Ltd.     

Social problem solving and autobiographical memory in posttraumatic stress disorder

This study investigated the relationship between overgeneral autobiographical memory and social problem solving in posttraumatic stress disorder (PTSD). Civilian trauma survivors with and without PTSD (N=41) provided autobiographical memories of events in response to positive and negative cue words. Participants also completed the means-end problem-solving (MEPS) procedure. PTSD participants reported more overgeneral memories, regardless of cue valence, than non-PTSD participants. Individuals with PTSD also displayed poorer problem solving than those without PTSD. Overgeneral autobiographical memory was strongly associated with deficits in problem solving. This study suggests that deficient problem solving in PTSD is associated with impaired retrieval of specific autobiographical memories.     

The Importance of Assessing for Childhood Abuse and Lifetime PTSD in Bariatric Surgery Candidates

For bariatric surgery candidates, history of child abuse and PTSD may be under-recognized or under-reported at pre-surgical evaluation. On a range of clinically relevant factors, we studied 3045 candidates for bariatric surgery: (1) those with a history of childhood abuse compared to those without such history; and (2) among candidates with a history of abuse, those with a lifetime diagnosis of PTSD compared to those without that diagnosis. We compared them on current and lifetime eating disorders, physical health problems, health behaviors, physical functioning, psychosocial functioning, psychiatric disorders, emotional wellness, body satisfaction, and self-esteem. We hypothesized that patients with a history of childhood abuse, and within that group, those with a lifetime PTSD diagnosis, would display greater overall impairment. Patients were interviewed with semi-structured interviews and completed self-report questionnaires. Results showed that (1) patients with a history of childhood abuse exhibited significantly greater impairment than those without abuse; and (2) among candidates with a history of abuse, those with a lifetime history of PTSD displayed significantly greater impairment than those without a PTSD diagnosis. The findings suggest that a history of both childhood abuse and lifetime PTSD should be thoroughly assessed for at pre-surgical evaluation, and that greater attention be paid to the experience of PTSD symptoms in abuse survivors presenting for bariatric surgery.     

PTSD symptom trajectories: from early to chronic response

This study aimed to identify posttraumatic stress disorder (PTSD) symptom trajectories across the first 12 months following traumatic injury. Three hundred and seven consecutively admitted injury survivors were assessed for severity of PTSD symptoms just prior to discharge, and at 3 and 12 months postinjury. Growth modeling was used to determine the curve that best fit the trajectory for each symptom cluster over the 12-month period. Individuals with 12-month PTSD showed significantly higher re-experiencing, arousal, and avoidance symptoms at eight days posttrauma relative to those without, and these symptoms escalated over time. Those without PTSD maintained their relatively low symptom levels. These findings highlight that individuals who will go onto develop PTSD have a distinctly different symptom course than those who recover.     

Traumatic memories and pseudomemories in posttraumatic stress disorder

Intrusive imagery was investigated in survivors of motor vehicle accidents with (a) posttraumatic stress disorder (PTSD) and accurate recall of the trauma, (b) PTSD and amnesia of the trauma, (c) no PTSD, or (d) control participants who simulated PTSD. Imagery was precipitated by presentation of an audiotape of a motor vehicle accident. Whereas the traumatic imagery of participants who had accurate recall of their trauma was consistent with third party accounts of the trauma, the imagery of amnesic participants was inconsistent with these accounts. Participants were then interviewed about cognitive and emotional aspects of their responses. All participants with PTSD and simulators reported similar levels of imagery detail, involuntariness, re-experiencing, and emotional response, and reported higher levels than participants with no PTSD. Findings are discussed in terms of cognitive and contextual factors that can mediate accurate and inaccurate traumatic imagery. © 1998 John Wiley & Sons, Ltd.     

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Romantic partners’ accommodation of trauma survivors’ posttraumatic stress disorder (PTSD) symptoms (e.g., taking on tasks, survivors avoid participating in social withdrawal) is associated with lower relationship satisfaction for both partners and survivors. Little is known about associations of partner accommodation with other aspects of relationship functioning, like intimacy. Sixty‐four male military veterans with at least subclinical PTSD and their partners participated in a 2‐week daily diary study. Veterans completed nightly measures of PTSD symptoms, while female partners completed nightly measures of accommodating behaviors performed that day. Both partners reported feelings of intimacy each night. Multilevel models revealed that accommodation was significantly, negatively associated with feelings of intimacy, with stronger effects for partners (t = ?8.70) than for veterans (t = ?5.40), and stronger effects when veterans had lower (t = ?7.43) rather than higher (t = ?5.20) levels of daily PTSD symptoms. Therapists should consider accommodating behaviors as a potential impediment to relationship intimacy, particularly when veterans have less severe symptoms of PTSD. Accommodating behaviors are an ideal treatment target in behavioral couple therapies.     

Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling

Post-traumatic stress disorder (PTSD) is of great interest to public health, due to the high burden it places on both the individual and society. We meta-analyzed randomized-controlled trials to examine the effectiveness of early trauma-focused cognitive-behavioral treatment (TFCBT) for preventing chronic PTSD. Systematic bibliographic research was undertaken to find relevant literature from on-line databases (Pubmed, PsycINFO, Psyndex, Medline). Using a mixed-effect approach, we calculated effect sizes (ES) for the PTSD diagnoses (main outcome) as well as PTSD and depressive symptoms (secondary outcomes), respectively. Calculations of ES from pre-intervention to first follow-up assessment were based on 10 studies. A moderate effect (ES = 0.54) was found for the main outcome, whereas ES for secondary outcomes were predominantly small (ES = 0.27–0.45). The ES for the main outcome decreased to small (ES = 0.34) from first follow-up to long-term follow-up assessment. The mean dropout rate was 16.7% pre- to post-treatment. There was evidence for the impact of moderators on different outcomes (e.g., the number of sessions on PTSD symptoms). Future studies should include survivors of other trauma types (e.g., burn injuries) rather than predominantly survivors of accidents and physical assault, and should compare early TFCBT with other interventions that previously demonstrated effectiveness.     

Is John Henryism a resilience factor in women experiencing intimate partner violence?

Background: Research suggests that posttraumatic stress disorder (PTSD) and depression are two common mental health problems in intimate partner violence (IPV) survivors. Research has found that while Black women consistently report higher rates of victimization than White women, they also report less severe PTSD and depressive symptoms, suggesting that Black IPV survivors might be more resilient to PTSD and depression than are White survivors. Design: We implemented a correlational study with 81 Black and 100 White female survivors of IPV to determine if John Henryism (JH; i.e., a predisposed active coping mechanism) contributes to the resilience observed in Black IPV survivors. Methods: Participants completed the John Henryism Active Coping Scale, Center for Epidemiological Studies Depression Scale, Davidson Trauma Scale, and the Abusive Behavior Inventory. Results: Results demonstrated that White woman endorsed more severe depressive symptoms as compared to Black women. Severity of PTSD symptoms and JH was not significantly different between races. JH did not moderate the relationship between race and depression; however, for PTSD, JH was found to be protective of PTSD in White women, while demonstrating little impact on Black women. Conclusions: The implications of these findings are discussed in terms of the minority stress model.     

Brain-derived neurotrophic factor Val66met polymorphism and plasma levels in road traffic accident survivors

Background: Alterations in brain-derived neurotrophic factor (BDNF) expression and release may play a role in the pathogenesis of post-traumatic stress disorder (PTSD). Design: This study evaluated road traffic accident (RTA) survivors to determine whether PTSD and trauma-related factors were associated with plasma BDNF levels and BDNF Val66Met carrier status following RTA exposure. Methods: One hundred and twenty-three RTA survivors (mean age 33.2 years, SD?=?10.6 years; 56.9% male) were assessed 10 (SD?=?4.9) days after RTA exposure. Acute stress disorder (ASD), as assessed with the Acute Stress Disorder Scale, was present in 50 (42.0%) of the participants. Plasma BDNF levels were measured with enzyme-linked immunosorbent assay and BDNF Val66Met genotyping was performed. PTSD, as assessed with the Clinician-Administered PTSD Scale, was present in 10 (10.8%) participants at 6 months follow-up. Results: Neither BDNF Val66Met genotype nor plasma BDNF was significantly associated with the presence or severity of ASD or PTSD. Plasma BDNF levels were, however, significantly correlated with the lifetime number of trauma exposures. Conclusions: In RTA survivors, plasma BDNF levels increased with increasing number of prior trauma exposures. Plasma BDNF may, therefore, be a marker of trauma load.     

Longitudinal Associations Among Service Members’ PTSD Symptoms,Partner Accommodation,and Partner Distress

Romantic partners’ accommodation of trauma survivors’ posttraumatic stress disorder (PTSD) symptoms (e.g., participating in avoidance and safety behaviors, not expressing one’s thoughts and feelings) is a putative mechanism linking PTSD symptoms and partner distress, but this hypothesis has never been empirically tested. The current study investigated this proposed within-couple mediation process from service members’ PTSD symptoms to partners’ depressive symptoms and relationship satisfaction through partner accommodation, as well as between-couple associations among these constructs and the possible moderating role of partners’ conflict avoidance and helplessness (CAH) motivations for accommodating service members’ PTSD symptoms. We examined these questions in 272 male service member/female civilian couples assessed four times over an 18-month period using the multiple-group version of the random intercept cross-lagged panel model. Within couples, service members’ higher levels of PTSD symptoms at one time point significantly predicted partners being more accommodating at the next time point (βs = .14–.19), which, in turn, significantly predicted higher levels of partner depressive symptoms at the subsequent time point (βs = .09–.19) but did not predict partners’ subsequent relationship satisfaction. At the between-couple level, partner accommodation was significantly positively associated with partners’ depressive symptoms only among those endorsing high CAH motivations for accommodation (r = .50). In addition, accommodation was significantly negatively associated with partners’ relationship satisfaction regardless of CAH motivation level (rs = −.43 to −.49). These findings are discussed in light of the potential for couple-based treatments for PTSD to enhance partner individual and relational well-being.     

Assessment and treatment of PTSD after a motor vehicle collision: Empirical findings and clinical observations

Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with Acute Stress Disorder that are designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed, in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response, as well as augment individual-based treatment formats.