Children's predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew

This study examined (a) children's predisaster behavioral and academic functioning as a predictor of posttraumatic stress (PTS) following Hurricane Andrew and (b) whether children who were exposed to the disaster would display a worsening of prior functioning. Fifteen months before the disaster, 92 4th through 6th graders provided self-reports of anxiety; peers and teachers rated behavior problems (anxiety, inattention, and conduct) and academic skills. Measures were repeated 3 months postdisaster; children also reported PTS symptoms and hurricane-related experiences (i.e., exposure). PTS symptoms were again assessed 7 months postdisaster. At 3 months postdisaster, children's exposure to the disaster, as well as predisaster ratings of anxiety, inattention, and academic skills, predicted PTS symptoms. By 7 months, only exposure, African American ethnicity, and predisaster anxiety predicted PTS. Prior anxiety levels also worsened as a result of exposure to the disaster. The findings have implications for identifying and treating children at risk for stress reactions following a catastrophic disaster.     

Posttraumatic symptomatology in children and adolescents after an industrial fire

OBJECTIVE: This investigation evaluated the extent and nature of posttraumatic symptomatology (PTS) in children and adolescents 9 months after an industrial fire at the imperial Foods chicken-processing plant in Hamlet, North Carolina, caused extensive loss of life. METHOD: Using a PTS self-report measure plus self- and teacher reports of comorbid symptoms the authors surveyed 1,019 fourth- to ninth-grade students in the community where the fire occurred. RESULTS: Three factors comprising PTS were identified: reexperiencing, avoidance and hyperarousal. Reexperiencing and avoidance were positively correlated; hyperarousal proved weakly correlated with reexperiencing, perhaps because exposure was largely indirect. Using a T score cutoff of 65 on the reexperiencing factor as indicative of PTS 9.7% of subjects met criteria for PTS; 11.9% met criteria for posttraumatic stress disorder (PTSD) using DSM-III-R PTSD criteria. Degree of exposure was the most powerful predictor of PTS. Race (African-American) and gender (female) posed significant risk factors for PTS. Self-reported internalizing symptoms and teacher-reported externalizing symptoms were positively predicted by intercurrent PTS, and independently of PTS, by degree of exposure. Comorbid symptoms showed interesting interactions with exposure, race, and gender. Lack of self-attributed personal efficacy predicted PTS but did not moderate the effects of race or gender on PTS risk. CONCLUSIONS: This study, which used a population-based sampling strategy, strengthens and extends findings from earlier literature on pediatric PTSD in showing that (1) PTS and comorbid internalizing and externalizing symptoms rise in direct proportion to degree of exposure; (2) gender and race show variable effects on risk for PTS and comorbid symptoms; and (3) comorbid symptoms are positively correlated with PTS and may represent primary outcomes of traumatic exposure in their own right.     

Finding meaning, perceiving growth, and acceptance of tinnitus.

Objectives: The authors test hypotheses derived from current models of growth following adversity in a sample of people with tinnitus. These models assume a process whereby adversity or trauma threatens major assumptions, which, in turn, promotes a search for meaning in the adversity and subsequently growth. Method: Data from a sample of 315 people with tinnitus who completed an online survey were used to assess the relations of reports of negative changes to asking "Why me?" and answering the Why me? question with reports of growth, acceptance, and well-being. Results: indicate that reports of negative changes in goals and philosophy of life predict a search for meaning and that finding meaning is associated with perceived growth. Those who report never searching for meaning are less likely to report growth but report better adjustment and acceptance of their tinnitus than those who have searched for meaning. Discussion: The data are consistent with models of growth that give a central role to meaning-making processes, but they also suggest that a significant minority of people with tinnitus do not report searching for meaning or perceiving growth--yet appear to be coping well. Acceptance of tinnitus is identified as a key construct for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Terrorism and cardiovascular responses to acute stress in children.

A number of studies have considered whether background stress affects cardiovascular responses to acute stress tasks. The present study considers the effect of a potent background stressor with a clear onset, namely the terrorist attacks on September 11, 2001. Specifically, the authors investigated differences among 9.5-year-old children tested before (N = 30) and then following (N = 20) the 9/11 attacks. In addition, a majority of these children (N = 37) were retested approximately 1 year later (i.e., before and after 9/11/2002). Children tested directly following 9/11/2001 exhibited significantly greater stroke volume and cardiac output responses to acute stress tasks compared with their responses 1 year later, and this change in reactivity differed significantly from the change in reactivity exhibited by children tested before 9/11/2001 and again 1 year later. These results suggest that a potent background stressor can temporarily heighten some children's cardiovascular responses to subsequent acute stressors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of cortisol and 3-methoxy-4-hydroxyphenylglycol responses in the acute aftermath of rape

BACKGROUND: Prospective studies of trauma survivors can provide information about the relationship between rape characteristics and the development of subsequent symptoms. METHODS: The present study examined the relationship of prior assault, rape severity, posttraumatic stress disorder (PTSD) symptoms following rape, and subsequent PTSD diagnosis, to the acute cortisol and 3-methoxy-4-hydroxyphenylglycol (MHPG) response to this traumatic event in 20 women. RESULTS: Women with a history of prior physical or sexual assault showed a significantly attenuated cortisol response to the acute stress of rape compared to women without such a history. MHPG appeared to be associated with injury-related rape characteristics, and symptoms of active avoidance, but not prior history. PTSD status at the 3-month follow-up was predicted by both a prior history of assault and high injury rape, but was not directly predicted by either cortisol or MHPG levels. MHPG and cortisol were not correlated in the sample as a whole, but were correlated among individuals who did not subsequently develop PTSD (p = .04) CONCLUSIONS: The results suggest that different neuroendocrine systems may mediate different components of the response to traumatic stress.     

Acute stress disorder in diplomats, military, and civilian Americans living abroad following the September 11 terrorist attacks on America.

Can expatriates witnessing the attack of their country from afar develop acute and posttraumatic stress reactions? In Brussels 50 expatriate Americans were surveyed in the 10 weeks following September 11. Of the sample, 10% (n=5) showed acute stress disorder in the 1st week, and 4% (n=2) persisted with traumatic stress indications in the following weeks. All participants showed symptoms of distress, including derealization, reexperiencing the event, avoidance, heightened arousal, trouble working, and assault on world assumptions. For most, symptoms diminished over time. Increased psychological readiness in terms of assessment, prevention, and treatment methods is called for in response to mass terrorism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of loss and benefiting from the experience: two construals of meaning

Theoretical models of the adjustment process following loss and trauma have emphasized the critical role that finding meaning plays. Yet evidence in support of these models is meager, and definitions of meaning have been too broad to facilitate a clear understanding of the psychological process involved. Using a prospective and longitudinal study of people coping with the loss of a family member, we differentiate 2 construals of meaning--making sense of the event and finding benefit in the experience--and demonstrate that both independently play roles in the adjustment process following the loss. Results indicate that making sense of the loss is associated with less distress, but only in the 1st year postloss, whereas reports of benefit finding are most strongly associated with adjustment at interviews 13 and 18 months postloss.     

Patterns of Posttraumatic Stress Symptoms in Parents of Childhood Cancer Survivors.

Posttraumatic stress (PTS) symptoms have been reported in mothers and fathers of childhood cancer survivors; however, little is known about patterns of PTS in these families. Cluster analysis was applied to the Posttraumatic Stress Disorder (PTSD) Reaction Index scores of 98 couples parenting adolescent childhood cancer survivors to describe patterns of PTS in families, yielding the following 5 clusters: Minimal PTS, Mothers Elevated, Disengaged, Fathers Elevated, and Elevated PTS. The clusters were validated using data from a structured psychiatric interview, an additional self-report measure of PTS, and an index of family functioning. These clinically meaningful patterns reveal that a majority of families had at least one parent with moderate to severe PTS, which supports development of family-based interventions for this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hurricane-related exposure experiences and stressors, other life events, and social support: Concurrent and prospective impact on children's persistent posttraumatic stress symptoms.

Objective: We investigated the influence of hurricane exposure, stressors occurring during the hurricane and recovery period, and social support on children's persistent posttraumatic stress (PTS). Method: Using a 2-wave, prospective design, we assessed 384 children (54% girls; mean age = 8.74 years) 9 months posthurricane, and we reassessed 245 children 21 months posthurricane. Children completed measures of exposure experiences, social support, hurricane-related stressors, life events, and PTS symptoms. Results: At Time 1, 35% of the children reported moderate to very severe levels of PTS symptoms; at Time 2, this reduced to 29%. Hurricane-related stressors influenced children's persistent PTS symptoms and the occurrence of other life events, which in turn also influenced persistent PTS symptoms. The cascading effects of hurricane stressors and other life events disrupted children's social support over time, which further influenced persistent PTS symptoms. Social support from peers buffered the impact of disaster exposure on children's PTS symptoms. Conclusions: The effects of a destructive hurricane on children's PTS symptoms persisted almost 2 years after the storm. The factors contributing to PTS symptoms are interrelated in complex ways. The findings suggest a need to close the gap between interventions delivered in the immediate and short-term aftermath and those delivered 2 years or more postdisaster. Such interventions might focus on helping children manage disaster-related stressors and other life events as well as bolstering children's support systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic stress and posttraumatic stress disorders.

Examined the relationship between chronic stress and symptoms of posttraumatic stress (PTS) syndrome in 52 people living within 5 miles of the Three Mile Island (TMI) nuclear power station. 35 residents of a town 80 miles from TMI were used as a control population. Chronic stress levels were evaluated using self-report, behavioral, and biochemical measures. Symptoms of PTS were also measured. Measures included the SCL-90 (Revised) and the Sensation Seeking Scale. TMI-area residents experienced more symptoms of chronic stress as well as more symptoms of PTS than the control group. Residents at TMI were particularly bothered by intrusive thoughts about the damaged reactor. There was a strong relationship between self-report, behavioral, and psychological measures of chronic stress and characteristics central to PTS as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Data provide evidence of substantive links between chronic stress and development of mild symptoms of PTS disorder. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facets of spirituality as predictors of adjustment to cancer: Relative contributions of having faith and finding meaning.

Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms and victimization among Japanese American women.

This study of Japanese American women and immigrant women from Japan investigated the relationship between posttraumatic stress (PTS) symptoms and the perceived abusiveness of partners' emotional and physical violence, with a community-based random sample. Women who experienced injuries and/or fear for their lives, in addition to partners' emotional and physical violence, had significantly higher PTS symptom counts than those with no lifetime experience of partners' violence. Victimization by nonintimates also increased PTS symptom counts. Satisfaction with social support significantly mitigated the negative effect of childhood abuse for reexperiencing and avoidance symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benefit finding, affective reactions to diabetes stress, and diabetes management among early adolescents.

Objective: To examine whether benefit finding was associated with better adjustment among adolescents with diabetes by buffering negative affective reactions to diabetes stress and by promoting positive affective reactions. Design: Early adolescents aged 10–14 with Type 1 diabetes (n = 252) described recent diabetes stressors, affective reactions, and perceived coping effectiveness. They also completed measures of benefit finding, depressive symptoms, and adherence. Metabolic control (i.e., HbA1c) was obtained from medical records. Main Outcome Measures: The main outcome measures were perceived coping effectiveness, depressive symptoms, adherence, and HbA1c. Results: Benefit finding was associated with lower depressive symptoms, higher perceived coping effectiveness and better adherence, and with higher positive as well as negative affective reactions to diabetes stress. Benefit finding interacted with negative affective reactions to predict depressive symptoms and HbA1c. Negative affective reactions to stress were associated with poorer adjustment among those with low benefit finding, but were unrelated or more weakly related to poor adjustment among those with high benefit finding. Positive affective reactions did not mediate associations between benefit finding and any outcome. Conclusions: Consistent with a stress-buffering process, benefit finding may be a resource that buffers the disruptive aspects of negative affective reactions to stress for adolescents' diabetes management. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of war exposure on air force personnel's mental health, job burnout and other organizational related outcomes.

Longitudinal data from a stratified representative sample of U.S. Air Force personnel (N = 1009) deployed to the wars in Iraq, Afghanistan, and other locations were analyzed in this study. Using structural equation models, we examined the effects of war exposure on traumatic experiences, Post Traumatic Stress (PTS) symptoms, resource loss, and on subsequent functioning, perceived health, and on job and organizationally relevant outcomes. The job and organizational outcomes included job burnout, job involvement, job strain, job satisfaction, work-family conflict, organizational commitment, deployment readiness, and intention to reenlist. We found that deployment to the theater of the war increased risk of exposure to trauma, which in turn, predicted elevated PTS symptoms and resource loss. PTS symptoms predicted later loss of resources and deterioration in perceived health and functioning. In turn, resource loss predicted negative job and organizational outcomes. Exposure to trauma fully mediated the effects of deployment to the theater of war on PTS symptoms and resource loss and had additional significant indirect effects on several job and organizational relevant outcomes. For returning veterans, deployment to the theater of war, exposure to trauma, PTS symptoms, and resource loss represents a “cascading” chain of events that over time results in a decline of health and functioning as well as in adverse job and organizationally relevant outcomes that may affect organizational effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to McNally and Breslau (2008).

Replies to comments by McNally and Breslau (see record 2008-05553-016) on the current authors' article (see record 2007-07130-003). McNally and Breslau expressed skepticism about the validity of multiple, independent studies showing that thousands of persons who were not directly exposed to the 9/11 attacks nevertheless developed posttraumatic stress disorder (PTSD) symptoms. They mistakenly asserted that these studies are all based on acute symptoms, whereas in fact several studies document symptoms at six months and beyond, post-9/11. Throughout their comment, they reframed the 9/11 experience of persons across the country as a virtual trauma. This is a strategy not usually seen in scientific discourse. The critical point of our review is that many people can develop concerns about safety and other issues following a terrorist attack, and these can be fueled by the media and other influences. It was not our claim that concerns about flying, being in tall buildings, or visiting public monuments after the attacks were necessarily pathological. However, it is difficult to understand why McNally and Breslau (2008) wanted to minimize this and other extraordinary ripple effects of the 9/11 attacks in the first place. Our aim was to develop a model that might be useful in trying to understand and reduce the economic and psychological costs of terrorism. Should we not, as mental health professionals, contribute our expertise toward alleviating this level of fear and its consequences? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer.

This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted lower social support and higher avoidance coping I month pretransplant predicted greater PTS symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Addition analyses indicated the presence of a significant interaction between social support and avoidance coping with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve guide future intervention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and relationships of posttraumatic stress in families experiencing pediatric spinal cord injury.

Objective: To investigate the severity of posttraumatic stress (PTS) and the prevalence of posttraumatic stress disorder (PTSD) in individuals with pediatric spinal cord injury (SCI) and their parents and to assess relationships among family members' degree of PTS and PTSD diagnoses. Study Design: Cross-sectional mail survey. Setting: A pediatric orthopedic surgical and rehabilitation hospital. Participants: A volunteer sample of 64 pediatric SCI patients (59% male and 41% female), 64 mothers, and 49 fathers. Main Outcome Measures: The Posttraumatic Diagnostic Scale was used for parents and for patients more than 18 years of age and the Child Posttraumatic Stress Scale was used for patients 18 years of age and under. Results: Sixteen (25.4%) patients, 25 (41%) mothers, and 16 (35.6%) fathers reported current PTSD. Mothers' total PTS scores statistically predicted patients' and fathers' PTS scores, and patients' PTS scores statistically predicted mothers' PTS scores. In addition, mothers' and patients' PTSD diagnoses related significantly. Conclusions: PTSD may be among the most prevalent psychological comorbidities in families experiencing pediatric SCI. Screening and treatment for PTSD appear warranted as part of standard psychosocial care for these families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obstruction of proximal tubules initiates cytoresistance against hypoxic damage

Following acute tubular necrosis (ATN), cytoresistance to further renal injury results. However, the initiating events and the subcellular determinants of this phenomenon have not been defined. Since tubular obstruction is a consequence of ATN, this study evaluated whether it alters tubular susceptibility to hypoxic damage. Extrarenal obstruction (ureteral ligation in rats) was used for this purpose to dissociate obstructive effects from those of ATN. Twenty-four hours following ureteral ligation or sham surgery, cortical proximal tubular segments (PTS) were isolated and subjected to hypoxic (15 or 30 min)/reoxygenation injury. Since oxidant stress, cell Ca2+ overload, and PLA2 attack are purported mediators of hypoxic/reoxygenation injury, degrees of FeS04, Ca2+ ionophore, and phospholipase A2-induced PTS damage also were assessed. The cell injury (% LDH release) which resulted from each of the above was consistently less in PTS obtained from obstructed kidneys. This cytoresistance: (a) did not require prior uremia to develop (seen with unilateral obstruction); (b) it did not appear to correlate with a tubular proliferative response (assessed by proliferating cell nuclear antigen expression); (c) it was uninfluenced by early tubular repair (unchanged by 24 hrs of obstruction release); and (d) it occurred without increased heat shock protein (HSP-70) or antioxidant enzyme (superoxide dismutase, catalase) expression. Total adenylate pools were higher in obstructed versus control PTS during injury; however, this appeared to be a correlate of the protection, rather than a mediator of it. In contrast, obstructed tubules manifested a primary increase in plasma membrane resistance to PLA2 attack (approximately 3-fold less lysophosphatidylcholine and free fatty acid generation in obstructed vs. control PTS during incubation with exogenous PLA2). In sum, these results indicate that: (1) tubular obstruction protects PTS from injury, suggesting that its development during ATN may initiate cytoresistance; and (2) this cytoresistance appears to be mediated, at least in part, by a direct increase in plasma membrane resistance to PLA2 and potentially other forms (such as, oxidant stress, cytosolic Ca2+ loading) of attack.     

How Does Negative Life Change Following Disaster Response Impact Distress Among Red Cross Responders?

The American Red Cross is the largest nongovernmental organization responding to disasters in the United States. This study investigated the impact of negative life change occurring in the year following the September 11, 2001, terrorist attacks on levels of distress among 757 Red Cross Disaster Services Human Resources (national disaster team) employees and volunteers who responded to this disaster. Negative life change in the year following disaster response fully mediated the relationship between disaster response and symptoms of depression and partially mediated the responses between disaster response and posttraumatic stress and anxiety symptoms. Results highlight the importance of life experiences in the year following disaster response and, therefore, the education and follow-up services provided to disaster workers prior to and following disaster assignment. Suggestions for monitoring disaster-related stress during and following assignment are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of children's family structure status on the development of stereotypes by teachers.

The possibility that teacher ratings of children may indicate a stereotype on the part of teachers was investigated by showing 30 teachers a videotape that focused on the social interaction of an 8-yr-old boy. Half of the teachers were given a background information sheet indicating that he was from a divorced home, while the other half were told he was from an intact home. Ss rated the boy on a wide range of 11 personality traits and predicted what his behavior would be like in 5 different school situations (e.g., copes with stress and popularity). The Bonferroni multiple-comparisons procedure indicated that the teachers rated the divorced child more negatively on the following 3 variables reflecting affective state or relations: happiness, emotional adjustment, and copes with stress. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)