Coping with Gulf War combat stress: Mediating and moderating effects.

The authors examined relationships between method of coping with combat-related stress and psychological symptoms among Gulf War Army personnel (N?=?1,058). Participants were surveyed on return from the Gulf region (Time 1) with the Coping Responses Inventory (R. Moos, 1990) and a measure of combat exposure. Outcomes were symptom measures of posttraumatic stress disorder (PTSD) and depression. At Time 2 (18–24 months) participants completed the same symptom measures and an index of postwar stress. Higher proportions of approach-based coping in the war zone were related to lower levels of psychological symptoms. Combat exposure moderated the effects of coping on Time 1 PTSD. Coping predicted changes in symptoms of depression but not PTSD. Combat exposure affected changes in depression through postwar stress but had a direct negative effect on PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional style and combat-related posttraumatic stress disorder.

This study examined the relations of attributions for good and bad events on the one hand and combat-related posttraumatic stress disorder (PTSD) on the other. The sample consisted of 262 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War and were followed 2 and 3 years after their participation in combat. Cross-sectional analyses revealed significant relations between attributions and PTSD at the two points of assessment. Changes in PTSD from Time 1 to Time 2 were also associated with changes in attribution. Theoretical and clinical implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope, coping, and social support in combat-related posttraumatic stress disorder

Dispositional hope, coping, and perceived social support were assessed among Vietnam combat veterans upon admission to and discharge from inpatient treatment for posttraumatic stress disorder (PTSD). Veterans reported lower dispositional hope than any previously described sample, and hope did not increase at discharge from treatment. At admission, higher hope was correlated with greater perceived social support coming from family (this relationship persisted when controlling for depression and PTSD symptoms). At discharge, higher hope was associated with greater perceived social support coming from family and friends and the use of adaptive coping strategies. Results indicate that hope confers a beneficial effect once veterans undergo treatment for combat-related PTSD, a finding that suggests that hope may be "gone but not lost" for these individuals.     

Risk Factors for Course of Posttraumatic Stress Disorder Among Vietnam Veterans: A 14-Year Follow-Up of American Legionnaires.

Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

War Zone stress, personal and environmental resources, and PTSD symptoms in Gulf War Veterans: A longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Objective versus subjective measurement of stress and social support: Combat-related reactions.

Combat intensity, social support, and related stress reactions were studied among two subject groups: 382 soldiers who experienced combat stress reaction (CSR) during the 1982 Israeli-Lebanon War and a matched control group of 334 soldiers who participated in the same military units but who did not experience CSR. Both objective and subjective indicators of stress and social support were predictive of CSR. Subjective indicators, however, were stronger predictors than objective indicators. Soldiers who later developed posttraumatic stress disorder (PTSD) were more likely to have had CSR, to perceive themselves as having been in more intensive combat, and to have perceived themselves as receiving less social support than soldiers who did not develop PTSD. The CSR was clearly the best predictor of PTSD. The effect of the objective versus the subjective experience of stress and social support is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjustment to multiple sclerosis: Application of a stress and coping model.

This study examined the use of a stress and coping model of adjustment to multiple sclerosis (MS). A total of 122 MS patients were interviewed and completed self-administered scales at Time 1 and 12 months later, Time 2 (n?=?96). Predictors included stressful life events, illness (duration, severity, and disability), social support, appraisal (threat and control/challenge), and coping (problem focused and emotion [wishful thinking, self-blame, and avoidance] focused). Adjustment outcomes were Time 2 depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that after controlling for the effects of Time-1 adjustment, better Time-2 adjustment was related to less disability, greater reliance on problem-focused coping, and less reliance on emotion-focused coping. There was limited support for the stress buffering effects of coping and social support. Findings offer some support for the use of a stress and coping model of adaptation to MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.

Relationship adjustment and posttraumatic stress disorder (PTSD) symptoms were assessed across two time points in a sample of 313 married or partnered National Guard soldiers recently returned from combat duty in Iraq. Structural equation modeling using a four-factor model for PTSD found the latent variable dysphoria (reflecting generalized distress including aspects of emotional numbing and arousal) had the strongest independent contribution to predicting relationship adjustment at Time 1 and indirectly predicted poorer relationship adjustment at Time 2. Exploratory analysis of gender differences (n = 33 women; n = 280 men) suggested a different pattern of relations between PTSD factors and relationship adjustment among female soldiers at Time 1, with a trend toward trauma specific avoidance being more highly related to relationship adjustment. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prospective predictors of posttraumatic stress disorder symptoms: Direct and mediated relations.

This study assessed the relations between pretrauma risk (neuroticism, negative affect, prior distress) and protective (self-esteem, optimism) factors and posttraumatic stress disorder (PTSD) symptoms and potential mediators (subjective event-related distress, unsupportive social interactions, perceived control) of those relations. Students (N = 1,528) at four U.S. universities completed online surveys assessing pretrauma risk and protective factors at Time 1 (T1); 84% (N = 1,281) completed a survey 2 months later (T2). PTSD symptoms and the three potential mediators were assessed among those who experienced potentially traumatic events between T1 and T2 (n = 264). PTSD symptoms related to prior traumas were controlled in all analyses. In structural equation modeling (SEM) analyses, the relation between risk factors and PTSD symptoms was mediated by unsupportive social interactions. Protective factors did not independently predict PTSD symptoms when risk factors also were included in the SEM models. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social relationships and PTSD symptomatology in combat veterans.

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problem solving and coping reactions of Vietnam veterans with posttraumatic stress disorder.

In order to assess the relation between posttraumatic stress disorder (PTSD) and interpersonal problem solving and coping, 43 Vietnam veterans were assigned to the following four groups: (a) combat veterans with PTSD, (b) combat veterans with severe adjustment problems but not PTSD-diagnosable (AP), (c) combat veterans who were well adjusted (WA), and (d) veterans with little or no combat exposure who served during the Vietnam era (ERA). Multivariate analyses of variance indicated that both the PTSD and AP groups reported less effective coping reactions and poorer problem solving than both the WA and ERA groups. The PTSD subjects also reported less effective problem solving and less problem-focused coping reactions than the AP veterans. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis.

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N?=?2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and coping among students in India and Canada.

In this cross-cultural study of stress and coping, 198 students in India and 344 in Canada (all Ss aged 16–25 yrs) were compared with respect to stress, coping, and selected psychosocial variables namely, locus of control, self-esteem, life orientation (optimism-pessimism), and social support. The 2 main hypotheses postulated that, compared to the Canadian students, Indian students would experience more stress and would prefer emotion-focused coping strategies for dealing with stress. It was also predicted that the Indian students would have an external locus of control, low self-esteem, pessimistic life orientation, and greater social support satisfaction. The results reveal instead that the Indian students report less stress than the Canadian students and prefer emotion-focused coping strategies. The Indian students score higher on chance control, but are similar to the Canadian students on powerful others and internal control. The Indian students are less satisfied with social support than are their Canadian counterparts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment.

Objective: In this article, we report findings from a 1-year longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. Method: Participants were 468 Army National Guard fathers from a brigade combat team (mean age = 36 years; median deployment length = 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey 1 month before returning home from Operation Iraqi Freedom deployment (Time 1) and again 1 year postdeployment (Time 2). The PTSD Checklist—Military Version (PCL–M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and 2 items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale—7; Sharpley & Rogers, 1984; Spanier, 1976), parent–child relationship quality (4 items from the Social Adjustment Scale—Self-Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results: Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p     

Coping strategies and posttraumatic stress disorder in female victims of sexual and nonsexual assault.

The coping behaviors and (posttraumatic stress disorder [PTSD]) symptoms of 215 female assault victims (103 rape victims and 112 nonsexual assault victims) were assessed within 2 weeks following the assault (Time I), and 133 of them (62%) were followed up 3 mo later (Time 2). Posttrauma symptom severity significantly decreased during the 3-mo study period, but PTSD severity levels at Times I and 2 were highly correlated. Three coping scales were constructed on the basis of exploratory factor analyses: Mobilizing Support, Positive Distancing, and Wishful Thinking. Three mo postassault, rape victims showed higher levels of wishful thinking and PTSD than nonsexual assault victims. Wishful thinking showed a positive association and positive distancing a negative association with PTSD severity, controlling for assault type, initial levels of PTSD severity, and other coping strategies. The clinical relevance of these findings is discussed. (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)     

Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: Correlations with psychophysiologic responses.

Three groups of Vietnam combat veterans, posttraumatic stress disorder (PTSD, n?=?25), anxious (n?=?7) and healthy (n?=?18), completed a battery of psychometric tests. Measurement of psychophysiologic responses to imagery of individualized combat experiences followed the psychometrics. The PTSD Ss differed significantly from the healthy Ss on almost all measures but showed fewer differences from the anxious Ss. The typical PTSD S was characterized as anxious, depressed, prone to dissociation, and external in locus of control. Correlations with the physiologic responses supported the validity of psychometric scales specifically designed to measure PTSD but cast doubt on the interpretation of traditional measures of overreporting or dissimulation in this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative life events, coping responses, and combat-related psychopathology: A prospective study.

This study examined the relations of life events and coping responses to combat-related psychopathology among 255 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War. Follow-ups 1 and 2 years after their participation in combat found (a) significant effects of psychopathology at 1 year after the war on the occurrence of negative life events and the choice of coping responses during the following year; (b) unique and significant effects of negative life events and coping responses on psychopathology at 2 years after the war; (c) a significant interaction between life events and coping responses on psychopathology; and (d) a significant indirect effect of negative life events on psychopathology via the choice of coping responses. Theoretical implications of the findings were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability and resilience to combat exposure: Can stress have lifelong effects?

Examined whether appraisals of desirable and undesirable effects of military service mediated the effect of combat stress on posttraumatic stress disorder (PTSD) symptoms in later life in 1,287 male veterans (aged 44–91 yrs), 40% of whom had been in combat. The men reported more desirable effects of military service (e.g., mastery, self-esteem, and coping skills) than undesirable ones; both increased linearly with combat exposure. Path analysis revealed that the appraisals were independent and opposite mediators, with undesirable effects increasing and desirable effects decreasing the relationship between combat exposure and PTSD, even controlling for depression and response style. Although lifelong negative consequences of combat exposure were observed, perceiving positive benefits from this stressful experience mitigated the effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, coping and psychological illness: A cross-cultural study.

This cross-cultural research study aimed to explore the relationship of stress and coping with psychological illness or symptoms among university students in Canada and India. The predictor variables were stress (hassles and life experience), 8 ways of coping (Folkman & Lazarus, 1988), and selected personal-social variables, namely, locus of control, self-esteem, and social support. The criterion variables were 9 psychological symptoms of the Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982). The results revealed that the Indian students reported more psychological symptoms compared to the Canadian students. Stepwise multiple-regression analyses also revealed considerable differences between the 2 samples with respect to the contribution of predictor variables in accounting for variance in the BSI scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)