Prevalence of traumatic events and peritraumatic predictors of posttraumatic stress symptoms in a nonclinical sample of college students

This study investigated lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) symptoms among 937 college students. Participants rated their lifetime experiences of traumatic events and, in response to their "most stressful" event, completed measures of objective stressor dimensions, PTSD, and peritraumatic reactions. Approximately 67% of respondents reported at least one traumatic event. An estimated 4% of the full sample (12% of traumatized individuals) met PTSD criteria within the past week. After controlling for vulnerability factors and objective characteristics, peritraumatic reactions remained strongly predictive of PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.     

Gender differences in the sensitivity to posttraumatic stress disorder: An epidemiological study of urban young adults.

The authors examine the relationship between 2 separate but interrelated findings in the epidemiology of posttraumatic stress disorder (PTSD): women's greater PTSD risk following traumatic events and the sensitizing effects of a prior trauma on the PTSD response to a subsequent trauma. Data come from a representative sample of 1,698 young adults from a large U.S. city. Analysis was conducted on the subset exposed to traumatic events. Women's risk for PTSD following assaultive violence was higher than men's. When assaultive violence preceded a later nonassaultive trauma in women, there was an increased risk (relative risk = 4.9) for PTSD, which was not observed in men. The relative risk estimate in women was significantly higher than in men. These findings suggest that assaultive violence elicits women's PTSD response directly and by sensitizing them to the effects of subsequent traumatic events of lesser magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing traumatic event exposure: Comparing the Traumatic Life Events Questionnaire to the Structured Clinical Interview for DSM-IV.

Post-traumatic stress disorder (PTSD) diagnosis requires first identifying a traumatic event, but very few studies have evaluated methods of potential traumatic event assessment and their impact on PTSD diagnosis. The authors compared a behaviorally specific comprehensive multiple-item traumatic event measure with a single-item measure to determine their impact on traumatic event identification and subsequent PTSD diagnosis. In a within-subject, counterbalanced design, the Traumatic Life Events Questionnaire (TLEQ; E. S. Kubany et al., 2000) was compared with the single-question traumatic event assessment in the Structured Clinical Interview for DSM–IV (SCID; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1998) in 129 participants in opioid-dependence treatment. The TLEQ produced a 9-fold higher rate of traumatic events reported by the participants, compared with the SCID. As a result, PTSD diagnoses in the sample increased to 33% after the TLEQ measure from 24% after the SCID. The increase in potential traumatic event identification and PTSD diagnosis was greater in women than in men. This study provides strong support for the use of comprehensive traumatic event assessments to measure traumatic events and PTSD diagnoses, particularly in women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory in posttraumatic stress disorder: Properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective examination of PTSD symptoms as risk factors for subsequent exposure to potentially traumatic events among women.

Previous research has suggested that both exposure to potentially traumatic events (PTEs) and emotional reactions to such events act as risk factors for subsequent exposure. Although some studies have implicated posttraumatic stress disorder (PTSD) symptoms as risk factors, extant research suffers from a number of methodological limitations, including the use of cross-sectional designs and student populations. The present study sought to address these limitations using a 2-year, 3-wave national probability household sample of 2,863 adult women. After controlling for demographic characteristics, prior exposure to PTEs, and Wave 1 depression and substance abuse, PTSD reexperiencing symptoms at Wave 1 predicted subsequent exposure to interpersonal violence victimization (IPVV) perpetrated by a nonintimate perpetrator; however, PTSD symptoms did not predict intimate partner IPVV. In addition, PTSD hyperarousal symptoms were unique predictors of subsequent exposure to other traumatic stressors. Findings suggest that efforts to prevent PTEs should focus attention on both prior exposure and PTSD symptoms in response to such exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study.

The authors examined symptoms of posttraumatic stress in 3rd–5th grade children during the school year after Hurricane Andrew. From a conceptual model of the effects of traumatic events, 442 children were evaluated 3, 7, and 10 months postdisaster with respect to (a) their exposure to traumatic events during and after the disaster, (b) their preexisting demographic characteristics, (c) the occurrence of major life stressors, (d) the availability of social support, and (e) the type of coping strategies used to cope with disaster-related distress. Although symptoms of posttraumatic stress disorder (PTSD) declined over time, a substantial level of symptomatology was observed up to 10 months after the disaster. All 5 factors in the conceptual model were predictive of children's PTSD symptoms 7 and 10 months postdisaster. Findings are discussed in terms of the potential utility of the model for organizing thinking about factors that predict the emergence and persistence of PTSD symptoms in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary traumatization in Dutch couples of World War II survivors.

This study examined whether signs of secondary traumatic stress were present in a community sample of couples who experienced World War II. The authors hypothesized that symptoms of posttraumatic stress disorder (PTSD) in either spouse may be predicted not only by his or her own war experiences but also by the war experiences and posttraumatic symptoms of the partner. Approximately 50 years after the end of World War II, 444 couples from a community sample of elderly Dutch citizens answered a questionnaire. A multilevel regression analysis was performed with symptoms of PTSD as the dependent variable. The most important predictors of PTSD symptoms were the number of war events reported by the participant and the current level of PTSD symptoms of his or her spouse. The results lend empirical support to the notion that posttraumatic stress reactions of both members of a couple are not independent from each other. Several explanations of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptomatology after childhood traumatic brain injury

The purpose of this study was to quantify and to identify predictors of posttraumatic stress disorder (PTSD) symptomatology after traumatic brain injury (TBI). Fifty children aged 6 to 14 years, hospitalized after TBI, were assessed soon after TBI regarding injury severity and preinjury psychiatric, socioeconomic, family functioning, and family psychiatric history status; neuroimaging was also analyzed. Psychiatric assessments were repeated 3, 6, 12, and 24 months after TBI. Only 2 of 46 (4%) subjects with at least one follow-up assessment developed PTSD. However, the frequency with which subjects experienced at least one PTSD symptom ranged from 68% in the first 3 months to 12% at 2 years in assessed children. The presence of an internalizing disorder at time of injury followed by greater injury severity were the most consistent predictors of PTSD symptomatology. It is apparent, therefore, that PTSD and subsyndromal posttraumatic stress disturbances occur despite neurogenic amnesia. These problems should be treated, particularly if symptoms persist beyond 3 months.     

Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological adjustment of a sample of New York City preschool children 8–10 months after September 11, 2001.

This investigation compared the adjustment of two groups of New York City preschool children 8–10 months after September 11, 2001. One group was within 1 mile (1.61 km) of the World Trade Center and exposed to one or more traumatic events. The second group was 2 to 14 miles (3.28–22.54km) away and not exposed to traumatic events. Parents evaluated their children by marking a DSM–IV based PTSD questionnaire and a standardized norm-referenced index of childhood adjustment. Parents also rated their personal adjustment by completing self-report measures of PTSD, anxiety, and depression. None of the trauma-exposed children warranted a current, probable PTSD diagnosis. Moreover, scores on the norm-referenced measure of childhood adjustment did not significantly vary between groups. These outcomes were consistent after adjusting for the potentially confounding influence of parental PTSD, anxiety, and depression symptoms. The findings suggest that the traumatized children in this sample were relatively resilient to the events of September 11, 2001 at the diagnostic level and on a norm-referenced index of childhood psychopathology. The outcomes may also suggest that the DSM–IV PTSD avoidance-symptom diagnostic threshold may have been too high to reflect morbidity at the diagnostic level for this sample. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Posttraumatic stress disorder and drug disorders: testing causal pathways

BACKGROUND: Although there is a high degree of comorbidity between posttraumatic stress disorder (PTSD) and drug use disorders, little is known about causal relationships between PTSD, exposure to traumatic events, and drug use disorders. METHODS: In a longitudinal study in southeast Michigan, 1007 adults aged 21 to 30 years were initially assessed in 1989 and were followed up 3 and 5 years later, in 1992 and 1994. Psychiatric disorders according to DSM-III-R criteria were measured by the National Institute of Mental Health Diagnostic Interview Schedule. To take into account temporal sequencing, the associations between PTSD, traumatic events, and drug use disorders were analyzed by using Cox proportional hazards models with time-dependent covariates. RESULTS: Posttraumatic stress disorder signaled an increased risk of drug abuse or dependence (hazards ratio, 4.5; 95% confidence interval, 2.6-7.6, adjusted for sex), whereas exposure to traumatic events in the absence of PTSD did not increase the risk of drug abuse or dependence. The risk for abuse or dependence was the highest for prescribed psychoactive drugs (hazards ratio, 13.0; 95% confidence interval, 5.3-32.0). There was no evidence that preexisting drug abuse or dependence increased the risk of subsequent exposure to traumatic events or the risk of PTSD after traumatic exposure. CONCLUSION: The results suggest that drug abuse or dependence in persons with PTSD might be the inadvertent result of efforts to medicate symptoms, although the possibility of shared vulnerability to PTSD and drug use disorders cannot be ruled out.     

When disaster strikes, acute stress disorder may follow

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.     

Disclosure of emotional events in groups at risk for posttraumatic stress disorder.

The disclosure of emotional events to various social intimates (disclosure targets) was measured in 2 samples (soldiers and first responders) at risk for posttraumatic stress disorder (PTSD), as well as a comparison sample of college students. These 3 groups completed survey measures of disclosure, and at risk groups also completed measures of PTSD symptoms and social support. Groups at risk for PTSD were less likely to disclose emotions related to potentially traumatic events than were college students reporting general emotional disclosure. Overall, disclosure of positive emotions was more likely than disclosure of negative emotions. Furthermore, amount of disclosure depended on the person to whom the individual disclosed. Within groups at risk for PTSD, social support was associated with lower levels of PTSD. However, this relationship was mediated by emotional disclosure to each target. Disclosure of positive emotions generally was associated with lower levels of PTSD, and disclosure of negative emotions to those with similar at-risk status was associated with greater levels of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The latent structure of posttraumatic stress disorder: A taxometric investigation of reactions to extreme stress.

Mental health professionals have debated whether posttraumatic stress disorder (PTSD) can be qualitatively distinguished from normal reactions to traumatic events. This debate has been fueled by indications that many trauma-exposed individuals evidence partial presentations of PTSD that are associated with significant impairment and help-seeking behavior. The authors examined the latent structure of PTSD in a large sample of male combat veterans. Three taxometric procedures--MAMBAC, MAXEIG, and L-Mode--were performed with 3 indicator sets drawn from a clinical interview and a self-report measure of PTSD. Results across procedures, consistency tests, and analysis of simulated comparison data all converged on a dimensional solution, suggesting that PTSD reflects the upper end of a stress-response continuum rather than a discrete clinical syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous remission from PTSD depends on the number of traumatic event types experienced.

As exposure to different types of traumatic stressors increases, the prevalence of PTSD increases. However, little is known about the effects of cumulative exposure to traumatic stress on the maintenance and remission from PTSD. In 2006/2007, we investigated 444 refugees from the 1994 Rwandan genocide, assessing exposure to traumatic events, current and lifetime PTSD, and PTSD symptom severity. Higher trauma exposure was associated with higher prevalence of current and lifetime PTSD, with lower probability of spontaneous remission from PTSD, and with higher current and lifetime PTSD symptom severity in clear dose-response effects. The results suggest traumatic load as a root cause of both PTSD chronicity and symptom severity and support the hypothesis of a neural fear network in the etiology of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open capsulorrhaphy with suture anchors for recurrent anterior dislocation of the shoulder

OBJECTIVE: The aim of this study was to index the frequency of occurrence of acute stress disorder following mild traumatic brain injury and to determine its utility in predicting posttraumatic stress disorder (PTSD). METHOD: Consecutive adult patients who sustained a mild traumatic brain injury following a motor vehicle accident (N = 79) were assessed for acute stress disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured clinical interview based on DSM-IV criteria. Patients were followed up 6 months after the trauma (N = 63) and were administered the PTSD module of the Composite International Diagnostic Interview. RESULTS: Acute stress disorder was diagnosed in 14% of patients, and at follow-up 24% satisfied criteria for PTSD. Six months after the trauma PTSD was diagnosed in 82% of patients who had been diagnosed with acute stress disorder and in 11% of those who had not been diagnosed with acute stress disorder. CONCLUSIONS: These findings point to the frequency of PTSD following mild traumatic brain injury. While the criteria for acute stress disorder are useful in identifying those individuals who are at risk of developing chronic PTSD, the findings suggest that current criteria require modification in order to optimally predict PTSD following mild traumatic brain injury.     

Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress?

Combat-related posttraumatic stress disorder (PTSD) is linked with elevated psychological distress in service members'/veterans' spouses. Researchers use a variety of terms to describe this distress, and recently, secondary traumatic stress and secondary traumatic stress disorder (STS/STSD) have become increasingly commonly used. Although STS/STSD connotes a specific set of symptoms that are linked to service members'/veterans' symptoms, researchers often use general measures of distress or generically worded measures of PTSD symptoms to assess STS/STSD. To determine how often scores on such measures appear to be an accurate reflection of STS/STSD, we examined responses to a measure of PTSD symptoms in 190 wives of male service members with elevated levels of PTSD symptoms. Wives rated their own PTSD symptoms, and then answered questions about their attributions for the symptoms they endorsed. Fewer than 20% of wives who endorsed symptoms on the PTSD measure attributed these symptoms completely to their husbands' military experiences. Moreover, compared with wives who attributed symptoms only to events in their own lives, wives who attributed symptoms completely or partially to their husbands' military experiences had a greater overlap between some of their responses on the PTSD measure and their responses to a measure of general psychological distress. These results suggest that most wives of service members/veterans with PTSD experience generic psychological distress that is not conceptually consistent with STS/STSD, although a subset does appear to endorse a reaction consistent with this construct. Implications of these findings for intervention and research with this vulnerable population are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans

OBJECTIVE: The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). METHOD: A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. RESULTS: The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. CONCLUSIONS: These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.     

Psychological factors in the development of mood disorders with a seasonal pattern

The psychiatric records of a 7-year period were searched for cases with seasonal mood disorders. Among 358 cases with a mood disorder there were 41 patients with 3 or more admissions, 4 of which were demonstrating a seasonal pattern. It was found that the depressive or manic episodes of these patients were anniversary reactions associated with intense traumatic experiences in childhood, adolescence or adulthood. The seasonal pattern of the depressive episodes fulfilled the DSM-IV diagnostic criteria. The time and sometimes the place of the traumatic event acted as triggers eliciting the clinical symptoms. This study showed that anniversary reactions may constitute a subgroup of seasonal mood disorders manifesting both depressive and manic episodes, which are precipitated primarily by psychological factors rather than climatic conditions.     

Empirical study on the healing nature of mandalas.

Mandalas were first used in therapy by Carl Jung, who found that the act of drawing mandalas had a calming effect on patients while at the same time facilitating psychic integration. There is a scarcity of controlled empirical studies of the healing impact of mandalas on mental health. Based on the efficacy of James Pennebaker's written disclosure paradigm in promoting mental well-being (Pennebaker, 1997a, 1997b), the purpose of our study was to examine the benefits for those suffering from post traumatic stress disorder (PTSD) of processing traumatic events through the creation of mandalas. Benefits to participants were measured in terms of changes in the variables of PTSD symptoms, depressive symptoms, anxiety, spiritual meaning, and the frequency of physical symptoms and illness. Relative to those in the control condition, individuals assigned to the experimental mandala-creation group reported greater decreases in symptoms of trauma at the 1-month follow up. There were no other statistically significant outcome differences. Alternative modes of processing traumatic events (e.g., visually symbolically) may serve individuals who are either reluctant or unable to write about their experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)