Correction to Stover et al. (2010).

Reports an error in "Agreement of parent and child reports of trauma exposure and symptoms in the early aftermath of a traumatic event" by Carla Smith Stover, Hilary Hahn, Jamie J. Y. Im and Steven Berkowitz (Psychological Trauma: Theory, Research, Practice, and Policy, 2010[Sep], Vol 2[3], 159-168). The article contained an incorrect DOI. The correct DOI is as follows: http://dx.doi.org/10.1037/a0019156. The online version has been corrected. (The following abstract of the original article appeared in record 2010-19144-001.) Exposure to violence and potentially traumatic events (PTEs) is a common experience among children and youth. The assessment of necessary intervention relies upon parental acknowledgment of exposure and recognition of their child's distress. Early interventions and treatment are most effective when parents are aware of the nature of the traumatic exposure, understand their child's symptomatic response, and are intimately involved in the treatment process. The present study investigated concordance between parents and exposed children on child trauma history, the subjective report of the impact of the traumas experienced, and presence of posttraumatic stress disorder (PTSD) symptoms. Agreement between parent and child report of traumas experienced was nonsignificant for serious accidents, separation from significant others, and physical assaults. Nonsignificant agreement was also found for avoidance and hyperarousal symptoms of PTSD. Correlations were not significant between parent and child report of the impact of traumas both at the time of the incident and at the time of the interview. Recommendations are suggested for helping parents improve their capacity to understand the potential impact of exposure on the child's psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of the peritraumatic experience in defining traumatic stress.

In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM–IV–TR; American Psychiatric Association, 2000), posttraumatic stress disorder (PTSD) Criterion A2 stipulates that an individual must experience intense fear, helplessness, or horror during an event that threatened the life or physical integrity of oneself or others to be eligible for the PTSD diagnosis. In considering this criterion, we describe its origins, review studies that have examined its predictive validity, and reflect on the intended purpose of the criterion and how it complements the mission of the DSM. We then assert that the predictive validity of Criterion A2 may not be an appropriate metric for evaluating its worth. We also note that the current Criterion A2 may not fully capture all the salient aspects of the traumatic stress response. To support this claim, we review empirical research showing that individuals adapt to extreme environmental events by responding in a complex and coordinated manner. This complex response set involves an individual's appraisal regarding the degree to which the event taxes his or her resources, as well as a range of other cognitions (e.g., dissociation), felt emotions (e.g., fear), physiological reactions (e.g., heart rate increase), and behaviors (e.g., tonic immobility). We provide evidence that these response components may be associated with the subsequent development of PTSD. We then describe the challenges associated with accurately assessing an individual's traumatic stress response. We conclude with a discussion of the need to consider the individual's immediate response when defining a traumatic stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of initial trauma exposure on the symptomatic response to a subsequent trauma.

The effect of initial trauma on the symptomatic response to a subsequent trauma was investigated in a cross-sectional study of urban bus drivers. Comparisons were made among 175 drivers (mean age 42.2 yrs) who had developed either high or low symptoms of posttraumatic stress disorder (PTSD) as a result of the initial trauma, and a third group exposed to only a single trauma. The group with high levels Of PTSD symptoms after the initial trauma reported high PTSD symptoms for a subsequent trauma (75%) significantly more often than the other two groups who did not differ from each other (Low PTSD symptoms group 49%, No prior trauma group 41 %). These results suggest that unless trauma exposure leads to significant PTSD symptoms, it is not a risk factor for high PTSD symptoms after exposure to a subsequent traumatic event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding negative outcomes following traumatic exposure: The roles of neuroticism and social support.

The established literature indicates that an overwhelming majority of adults will experience at least 1 traumatic stressor during their lifetime. Such stressors have been consistently linked to a range of adverse subsequent conditions and span the mood, anxiety, and personality diagnostic categories. Yet, understanding why some individuals experience traumatic reactions and adverse outcomes and others facing significant stressors do not succumb to such problems remains a challenge. In this study, trauma-exposed participants (natural disaster, n = 51; sexual assault, n = 35) completed measures of neuroticism and social support as well as measures of adverse mental health outcomes known to be associated with traumatic exposure. Results indicate that the personality characteristic of neuroticism is generally significantly correlated with symptoms of posttraumatic stress disorder, depression, and general distress. Social support was found to have no impact alone but a differential impact on these outcomes (sometimes helpful, sometimes harmful) depending on the survivor’s level of neuroticism. In considering social support options following traumatic exposure, providers are therefore encouraged to carefully consider the survivor’s neurotic demeanor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms.

Peritraumatic dissociation (PD) and experiential avoidance (EA) have been implicated in the etiology of posttraumatic stress symptomatology (PTSS); however, the function of these two factors in the onset and maintenance of PTSS following a potentially traumatic event is unclear. The temporal relationships between EA, PD, and the four clusters of PTSS proposed by the Simms/Watson dysphoria model (Simms, Watson, & Doebbeling, 2002) were examined in a three-wave prospective investigation of 532 undergraduate women participating in an ongoing longitudinal study at the time of a campus shooting. Path analyses indicated that preshooting EA predicted greater PD, intrusions, and dysphoria symptoms approximately one month postshooting. PD was associated with increased symptomatology across all four clusters 1-month postshooting, while 1-month postshooting EA was associated with higher dysphoria and hyperarousal symptoms eight months postshooting. PD had a significant indirect effect on all four PTSS clusters eight months postshooting via 1-month postshooting symptom reports. The results suggest that both EA and PD show unique influences as risk factors for PTSS following a potentially traumatic event. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A longitudinal study assessing trauma symptoms in sexually abused children engaged in play therapy.

Children who have been sexually abused exhibit a variety of emotional, sexual, behavioral, and psychological problems. A great deal of interest has been generated in the use of play therapy as a clinical approach to intervention with sexually abused children. This study explores the effect of play therapy as a primary treatment modality with sexually abused children. The impact of specific traumatic symptoms and overall treatment is examined. Findings indicate that, overall, trauma symptom severity in children decreased after 6 months of play therapy. In addition, anxiety, depression, post-traumatic stress, and sexual distress scores indicated a significant decrease. Additional research is recommended to develop evaluative and systematic guidelines that will further validate the use of play therapy as an empirically supported assessment and treatment tool. (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)     

Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.

Objective: This study investigated the association between mindfulness, other resilience resources, and several measures of health in 124 urban firefighters. Method: Participants completed health measures of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, physical symptoms, and alcohol problems and measures of resilience resources including mindfulness, optimism, personal mastery, and social support. The Mindful Awareness and Attention Scale (MAAS; Brown & Ryan, 2003) was used to assess mindfulness. Participants also completed measures of firefighter stress, number of calls, and years as a firefighter as control variables. Hierarchical multiple regressions were conducted with the health measures as the dependent variables with 3 levels of independent variables: (a) demographic characteristics, (b) firefighter variables, and (c) resilience resources. Results: The results showed that mindfulness was associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems when controlling for the other study variables. Personal mastery and social support were also related to fewer depressive symptoms, firefighter stress was related to more PTSD symptoms and alcohol problems, and years as a firefighter were related to fewer alcohol problems. Conclusions: Mindfulness may be important to consider and include in models of stress, coping, and resilience in firefighters. Future studies should examine the prospective relationship between mindfulness and health in firefighters and others in high-stress occupations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of posttraumatic distress 1 year after exposure to community violence: The importance of acute symptom severity.

In this longitudinal study of 333 primarily male, Hispanic survivors of community violence, the authors investigated the effects of 4 categories of risk factors on posttraumatic stress disorder (PTSD) symptom severity: demographic characteristics, pretraumatic psychological factors, characteristics of the trauma, and reactions to the trauma. Replicating past research, exemplars from all 4 categories predicted PTSD symptom severity at 12-month follow-up. Acute symptom severity, measured approximately 5 days posttrauma, accounted for the largest proportion of variance among all the predictors included. No other predictors remained significant after 5-day distress was included in the model. These findings suggest that the effects of several purported risk factors for chronic posttraumatic distress may already be reflected in acute distress following trauma exposure. These results bear on current conceptions of the fundamental nature of PTSD and suggest that initial distress during the immediate aftermath of the trauma may be an important target for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of posttraumatic symptoms on women's commitment to a hypothetical violent relationship: A path analytic test of posttraumatic stress, depression, shame, and self-efficacy on investment model factors.

Recent evidence shows that female victims of intimate partner violence utilize a rational-decision making framework for deciding whether to remain involved with or leave an abusive partner. This framework, known as the Investment Model, does not take into consideration intraindividual factors that may affect commitment and stay or leave decisions, as the model is predominately based on relational dynamics between partners. However, it is well-known that many victims of intimate partner violence suffer ill psychological consequences stemming from abuse, such as posttraumatic stress, depression, increased shame, and reduced self-efficacy. These posttraumatic symptoms may potentially interfere with relationship termination as defined by the Investment Model. Using a sample of female undergraduate students and a hypothetical abusive dating relationship vignette, results from path analyses indicated that posttraumatic symptoms predicted commitment through model factors. Posttraumatic stress symptoms impacted the model in expected and unexpected ways. Self-efficacy emerged as a particularly important factor predicting commitment. Directions for future research and clinical implications aimed at increasing women's empowerment are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (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)     

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: Evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination.

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual differences in the emergence of depressive symptoms in children and adolescents: A longitudinal investigation of parent and child reports.

The authors address questions about the rate that depressive symptoms emerge, developmental and gender differences in this rate, and differences between parent and child estimates of this rate. In a 12-wave, cohort-sequential, longitudinal design, 1,570 children (Grades 4-11) and parents completed reports about children's depression. Cross-domain latent growth curve analysis revealed that (a) the rate of symptom growth varied with developmental level, (b) gender differences symptom growth preceded emergence of mean level gender differences, (c) the rate of symptom development varied with age, and (d) parent-child agreement about rate of symptom change was stronger than agreement about time-specific symptoms. The authors suggest that predictability of depressive symptoms varies with age and the dimension under investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of personality disorder symptoms and the risk for partner violence.

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress in children and adolescents exposed to family violence: I. Overview and issues.

Exposure to child physical abuse and parents' domestic violence can subject youth to pervasive traumatic stress and can lead to posttraumatic stress disorder (PTSD). This article presents evolving conceptualizations in the burgeoning field of trauma related to family violence exposure and describes how the often repeating and ongoing nature of family violence exposure can complicate a PTSD diagnosis. In addition, recent literature indicates that children exposed to family violence may experience problems in multiple domains of functioning and may meet criteria for multiple disorders in addition to PTSD. Considerations salient to the recognition of traumatic stress in this population and that inform assessment and treatment planning are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)