Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.

A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r=.17) and peritraumatic dissociation the largest (weighted r=.35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control predicts later symptoms of posttraumatic stress disorder.

Self-control, often defined as the ability to control one's thoughts and actions, is one of the most important constructs in psychology. However, the relationship of self-control to clinical disorders has rarely been directly examined. The current study sought to explore this relationship by examining whether self-control predicted posttraumatic stress disorder (PTSD) symptoms in a longitudinal study of 65 inner-city women. Results showed that baseline levels of self-control predicted PTSD symptoms at 3-month follow-up above and beyond other variables in the model. This research combines clinical and social psychological research to reveal the potential role of self-control in protecting against future symptoms of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of risk and resilience factors associated with posttraumatic stress symptoms and depression symptoms among Jews and Arabs exposed to repeated acts of terrorism in Israel.

In the first prospective study, to our knowledge, of the impact of ongoing terrorism and political violence, we analyzed nationally representative data from 560 Jews and 182 Arabs in Israel over a 6-month period. Based on Conservation of Resources (COR) theory (Hobfoll, 1989, 1998), we predicted that exposure to terrorism and political violence would result in psychosocial and economic resource loss and resource lack, which in turn, would be primary predictors of increases in symptoms of posttraumatic stress (PTS) and depression. We also predicted that trauma exposure and PTS symptoms, in particular, would be related to ethnocentrism and support for political violence. Furthermore, based on theory and prior research, we predicted that posttraumatic growth (PTG) would be related to a worsening of symptoms of distress and that distress would be related to increased ethnocentrism and support for extreme political violence for their “cause.” Women, older individuals, and Arabs (compared with Jews) were more likely to have continued psychological distress over time. In addition, using simultaneous equation modeling, we found good fit for a structural model that partially supported our hypotheses. Psychosocial resource loss, PTG, and social support had direct and indirect effects on psychological distress. Political attitudes tended to harden over time but were not prospectively related to PTS or depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger and posttraumatic stress disorder symptoms in crime victims: A longitudinal analysis.

Among trauma-exposed individuals, severity of posttraumatic stress disorder (PTSD) symptoms is strongly correlated with anger. The authors used 2 longitudinal data sets with 282 and 218 crime victims, respectively, to investigate the temporal sequence of anger and PTSD symptoms following the assault. Cross-lagged regression analyses indicated that PTSD symptoms predicted subsequent level of anger, but that anger did not predict subsequent PTSD symptoms. Testing alternative models (common factor model, unmeasured 3rd variable model) that might account for spuriousness of the relation strengthened confidence in the results of the cross-lagged analyses. Further analyses suggested that rumination mediates the effect of PTSD symptoms on anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder.

This study tested the proposal that negative appraisals represent a risk factor for developing posttraumatic stress disorder (PTSD) after trauma. Trainee firefighters (N = 68) were assessed during training (before trauma exposure) for PTSD, history of traumatic events, and tendency to engage in negative appraisals. Firefighters were reassessed 4 years later (N = 52), after commencing firefighter duty (after trauma exposure), for PTSD and depression using the Posttraumatic Stress Disorder Scale (E. B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and the Beck Depression Inventory (Version 2; A. T. Beck, R. A. Steer, & G. K. Brown, 1996). At follow-up, 12% met criteria for PTSD. Pretrauma negative appraisals about oneself accounted for 20% of variance in PTSD severity at follow-up. These data provide the first evidence that preexisting negative appraisals are a risk factor for PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms and subclinical cardiovascular disease in police officers.

The present study examined associations of posttraumatic stress disorder (PTSD) symptoms with subclinical cardiovascular disease in police officers. A stratified sample of 100 police officers was randomly selected from the Buffalo, New York, Police Department. Cardiovascular disease biomarkers were assessed by ultrasound of the brachial artery (flow-mediated dilation [FMD]). PTSD symptoms were measured with the Impact of Event Scale (IES). FMD was lowest in the severe PTSD symptom category when compared to the mild PTSD symptom category (1.91 vs. 5.15% increase, respectively; p=.21) even after adjustment for lifestyle and demographics. In conclusion, higher PTSD symptomatology in this police sample was associated with a nearly twofold reduction in brachial artery FMD, a biomarker for subclinical cardiovascular disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and physical health symptoms among women seeking help for relationship aggression.

This study examined associations between intimate partner aggression and physical health symptoms among a sample of help-seeking women experiencing relationship aggression (N = 388). Using a structural equation modeling framework, the authors found posttraumatic stress disorder (PTSD) symptoms to fully mediate the associations of both physical and psychological aggression with physical health symptoms. The influence of PTSD symptoms on physical health symptoms was partially mediated by anger/irritability. Results were consistent with studies from other trauma groups suggesting that PTSD is pivotal with respect to explaining the effects of trauma on health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The developmental mental-disorder histories of adults with posttraumatic stress disorder: A prospective longitudinal birth cohort study.

Clinical and epidemiologic studies have established that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, such studies have largely relied on adults' retrospective reports to ascertain comorbidity. The authors examined the developmental mental health histories of adults with PTSD using data on mental disorders assessed across the first 3 decades of life among members of the longitudinal Dunedin Multidisciplinary Health and Development Study; 100% of those diagnosed with past-year PTSD and 93.5% of those with lifetime PTSD at age 26 had met criteria for another mental disorder between ages 11 and 21. Most other mental disorders had first onsets by age 15. Of new cases of PTSD arising between ages 26 and 32, 96% had a prior mental disorder and 77% had been diagnosed by age 15. These data suggest PTSD almost always develops in the context of other mental disorders. Research on the etiology of PTSD may benefit from taking lifetime developmental patterns of comorbidity into consideration. Juvenile mental-disorder histories may help indicate which individuals are most likely to develop PTSD in populations at high risk of trauma exposure. (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)     

Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: A meta-analysis.

This meta-analysis synthesizes the available data on the strength of association between anger and posttraumatic stress disorder (PTSD) and between hostility and PTSD, covering 39 studies with trauma-exposed adults. Effect sizes did not differ for anger and hostility, which could therefore be combined; effect sizes for anger expression variables were analyzed separately. The analyses revealed large effects. The weighted mean effect size (r) was .48 for anger-hostility, .29 for anger out, .53 for anger in, and -.44 for anger control. Moderator analyses were conducted for anger-hostility, showing that effect sizes were substantially larger with increasing time since the event and that effect sizes were larger in samples with military war experience than in samples that had experienced other types of traumatic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced autobiographical memory specificity predicts depression and posttraumatic stress disorder after recent trauma.

In this prospective longitudinal study, the authors examined the relationship between reduced specificity in autobiographical memory retrieval and the development of depression, posttraumatic stress disorder (PTSD), and specific phobia after injury in an assault. Assault survivors (N = 203) completed the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986) at 2 weeks after the trauma as well as structured clinical interviews at 2 weeks and 6 months. Participants with acute stress disorder or major depression at 2 weeks, but not those with phobia, retrieved fewer specific autobiographical memories than those without the respective disorder. Reduced memory specificity at 2 weeks also predicted subsequent PTSD and major depression at 6 months over and above what could be predicted from initial diagnoses and symptom severity. Moderator analyses showed that low memory specificity predicted later depression in participants with prior episodes of major depression but not in those without prior depression. Mediation analyses suggested that rumination partly mediated and perceived permanent change fully mediated the effects of low memory specificity on posttrauma psychopathology at follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms.

Converging lines of evidence have called into question the validity of conceptualizations of posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and suggested alternative structural models of PTSD symptomatology. We conducted a meta-analysis of 40 PTSD studies (N = 14,827 participants across studies) that used a DSM-based measure to assess PTSD severity. We aggregated correlation matrices across studies and then applied confirmatory factor analysis to the aggregated matrices to test the fit of competing models of PTSD symptomatology that have gained support in the literature. Results indicated that both prominent 4-factor models of PTSD symptomatology yielded good model fit across subsamples of studies; however, the model comprising Intrusions, Avoidance, Hyperarousal, and Dysphoria factors appeared to fit better across studies. Results also indicated that the best fitting models were not moderated by measure or sample type. Results are discussed in the context of structural models of PTSD and implications for the diagnostic nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A diathesis-stress model of posttraumatic stress disorder: Ecological, biological, and residual stress pathways.

The symptoms captured within the contemporary diagnostic definition of posttraumatic stress disorder (PTSD) have been studied for more than 100 years. Yet, even with increasingly advanced discoveries regarding the etiology of PTSD, a comprehensive and up-to-date etiological model that incorporates both medical and psychological research has not been described and systematically studied. The diathesis-stress model proposed here consolidates existing medical and psychological research data on etiological factors associated with PTSD into 3 causal pathways: residual stress, ecological, and biological. In combination, these pathways illuminate how PTSD might develop and who might be at higher risk for developing the disorder. Research and treatment implications related to the diathesis-stress model are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of personality disorders in individuals with posttraumatic stress disorder.

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM–IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mindfulness in the treatment of posttraumatic stress disorder among military veterans.

How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder.

This study examined how change in posttraumatic stress disorder (PTSD) symptoms relates to change in quality of life. The sample consisted of 325 male Vietnam veterans with chronic PTSD who participated in a randomized trial of group psychotherapy. Latent growth modeling was used to test for synchronous effects of PTSD symptom change on psychosocial and physical health-related quality of life within the same time period and lagged effects of initial PTSD symptom change on later change in quality of life. PTSD symptoms were associated with reduced quality of life before treatment. There were synchronous effects of symptom change on change in quality of life but no significant lagged effects. Results indicate the importance of measuring quality of life in future investigations of PTSD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)