Current Posttraumatic Stress Symptoms Research Articles

Posttraumatic stress disorders in long-term Egyptian survivors after childhood cancer

Middle East Current Psychiatry 2012, 19:40–47 Background Seventy-five percent of children who are diagnosed with cancer are expected to survive. As this population has grown, the study of the impact of this traumatic event has become increasingly important. Objectives The current study aimed to investigate the prevalence and risk factors of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in long-term childhood cancer survivors. Methods Eighty survivors of childhood cancer who were between 9 and 17 years of age (mean ± SD = 12.9 ± 2.28), had stopped therapy for at least 2 years, had no history of previous central nervous system relapse or cranial irradiation, and did not have premorbid medical diseases, were enrolled in the study. They were assessed in terms of PTSD, PTSS, and Children’s Global Assessment Scale. They were compared with age-matched and sex-matched healthy controls. Results Fourteen survivors (17.5%) met the criteria of lifetime diagnosis of PTSD according to Kiddie-Sads-Present and Lifetime Version diagnostic and clinical versus 5% of the control group (v = 6.26, P = 0.04, odds ratio = 4.03, confidence interval = 1.26–12.84). In the survivor group, current PTSS were severe in 10%; moderate in 32.5%; and mild in 50%, according to the children posttraumatic stress disorder reaction index. None of the children in the control group had severe PTSS. Severe PTSS are associated with older age at diagnosis, older age during study, relapse, increased duration of therapy, and use of chemotherapy plus irradiation and/or surgery. Severe PTSS are associated with lower scores on Children’s Global Assessment Scale. Conclusion Both PTSD and PTSS may be prevalent in cancer survivors even after a complete physical cure. Adequate treatment of traumatic memories, arousal and avoidance, may improve social and psychological functioning, and quality of life. This will lead to better orientation toward health services.

Age, Cumulative Trauma and Stressful Life Events, and Post-traumatic Stress Symptoms Among Older Adults in Prison: Do Subjective Impressions Matter?

The aging prison population in the United States presents a significant public health challenge with high rates of trauma and mental health issues that the correctional system alone is ill-prepared to address. The purpose of this study was to examine the relationship of age, objective, and subjective measures of trauma and stressful life events and post-traumatic stress symptoms among older adults in prison. Data were gathered from 334 prisoners (aged 55+) housed in the New Jersey Department of Corrections, as of September 2010. An anonymous self-report, self-administered survey was mailed to the total population of 1,000 prisoners aged 55 years and older. Objective and subjective trauma was measured using the Life Stressors Checklist-Revised (LSC-R), and post-traumatic stress symptoms were measured using the Civilian Version of the Post-traumatic Stress Scale. Results of a path analysis revealed that past year subjective impressions of traumatic and stressful life events had a positive and significant relationship to current post-traumatic stress symptoms. Age was found to have a significant and inverse relationship to subjective traumatic and stressful life events. That is, younger participants reported higher levels of cumulative traumatic and stressful life events and past year subjective ratings of being bothered by these past events. These findings have significance for interdisciplinary/interprofessional practice and appropriate institutional and community care, including reentry planning of older adults in the criminal justice system.

Correlates of Childhood Sexual Abuse and Intimate Partner Sexual Victimization

This study investigated the relationship between childhood sexual abuse (CSA) and sexual intimate partner violence (IPV) victimization among Chinese university students in Hong Kong, Beijing, and Shanghai. It used a cross-sectional design. To complete a self-report questionnaire, 3,388 university students from Hong Kong, Beijing, and Shanghai were recruited through convenience sampling. The results showed that 28.6% of participants experienced some form of CSA, and no gender difference was found in the prevalence of CSA. Significantly, more female have been reported being victims of sexual IPV than male (24.2% vs. 18.2%); however, when considering severe sexual victimization only, females did not report higher prevalence than men did. Results of the multiphase logistic regression showed that CSA had an independent association with an increased risk of sexual IPV victimization during adulthood. In addition, gender, having had sex with the partner of the referred intimate relationship, and current posttraumatic stress symptoms were associated with sexual IPV victimization when other factors were adjusted. Conclusion: Intervention with IPV should include an assessment of CSA history. Prevention of revictimization for IPV victims with CSA history was discussed.

HADStress: A Somatic Symptom Screen for Posttraumatic Stress Among Somali Refugees

This study assessed whether a simple, readily implemented four-symptom somatic screen would be able to effectively identify current posttraumatic stress symptoms in victimized populations. The sample consisted of 622 Somali community-dwelling refugees who fled widespread violence and trauma occurring in East Africa during 1990-1992. Data were collected during 2000-2003 and included demographic characteristics, number of types of torture and nontorture trauma experienced earlier in Africa, and current self-rated posttraumatic stress symptoms, as measured by the Posttraumatic Stress Disorder Checklist (PCL). The sample was also assessed with the HADStress screen, which was developed for this study, to determine whether the screen was effective in detecting current posttraumatic stress symptoms. The HADStress screen assessed for the presence of four somatic symptoms: Headaches, Appetite change, Dizziness, and Sleep problems. All items were given equal weight. Possible scores on the screen range from 0 to 4, with higher scores indicating more somatic symptoms. Univariate analysis showed that persons who experienced more types of trauma (both torture and nontorture trauma) and persons who had higher PCL scores (indicating more current posttraumatic stress symptoms) had significantly higher HADStress scores. Negative binomial regression analysis showed that PCL scores were the most effective variable in predicting HADStress scores. On the Tukey-B post hoc analysis, a HADStress score of 0 or 1 was associated with a mean PCL score of less than 30, a score of 2 was associated with a mean PCL score of 40.28, and a score of 4 was associated with a mean PCL score of 51.07 (suggesting that over 50% of this group would have active posttraumatic stress disorder). A score of 2 or higher on the HADStress scale among refugees warrants additional evaluation for posttraumatic stress symptoms in clinical settings. For communitywide efforts at early recognition and treatment, a cutoff score of 4 may be more practical and cost-effective.

HADStress: A Somatic Symptom Screen for Posttraumatic Stress Among Somali Refugees

This study assessed whether a simple, readily implemented four-symptom somatic screen would be able to effectively identify current posttraumatic stress symptoms in victimized populations.The sample consisted of 622 Somali community-dwelling refugees who fled widespread violence and trauma occurring in East Africa during 1990-1992. Data were collected during 2000-2003 and included demographic characteristics, number of types of torture and nontorture trauma experienced earlier in Africa, and current self-rated posttraumatic stress symptoms, as measured by the Posttraumatic Stress Disorder Checklist (PCL). The sample was also assessed with the HADStress screen, which was developed for this study, to determine whether the screen was effective in detecting current posttraumatic stress symptoms. The HADStress screen assessed for the presence of four somatic symptoms: Headaches, Appetite change, Dizziness, and Sleep problems. All items were given equal weight. Possible scores on the screen range from 0 to 4, with higher scores indicating more somatic symptoms.Univariate analysis showed that persons who experienced more types of trauma (both torture and nontorture trauma) and persons who had higher PCL scores (indicating more current posttraumatic stress symptoms) had significantly higher HADStress scores. Negative binomial regression analysis showed that PCL scores were the most effective variable in predicting HADStress scores. On the Tukey-B post hoc analysis, a HADStress score of 0 or 1 was associated with a mean PCL score of less than 30, a score of 2 was associated with a mean PCL score of 40.28, and a score of 4 was associated with a mean PCL score of 51.07 (suggesting that over 50% of this group would have active posttraumatic stress disorder).A score of 2 or higher on the HADStress scale among refugees warrants additional evaluation for posttraumatic stress symptoms in clinical settings. For communitywide efforts at early recognition and treatment, a cutoff score of 4 may be more practical and cost-effective.

HADStress screen for posttraumatic stress: replication in ethiopian refugees.

Purpose was to assess whether a 4-symptom somatic screen, shown to correlate with current post-traumatic stress symptoms in 1 refugee group, could function as a screening instrument in another group of refugees. Sample consisted of 512 community-dwelling refugees from Ethiopia. Data collection included demography, types of torture and nontorture trauma experienced a decade earlier in Africa, and current posttraumatic stress symptoms. Somatic symptoms included headaches (H), appetite change (A), dizziness and faintness (D), and sleep problems (S), added with equal weighting into the HADStress Screen, ranging from 0 to 4. Results showed that age, gender, torture, and other trauma experiences from a decade ago, and current posttraumatic stress symptoms predicted current somatic symptoms on univariate analyses. On a negative binomial regression model, current posttraumatic stress symptoms, male gender, and number of torture types predicted a high HADStress score. Post hoc tests supported cut-off levels at 3 and at 4 symptoms. Conclusion is that the HADStress Screen can serve as an efficient, nonthreatening screen for posttraumatic stress symptoms among refugees.

A population‐based study of associations between current posttraumatic stress symptoms and current fatigue

This study explores current experience with posttraumatic stress disorder (PTSD) symptoms and other variables (sociodemographic, mental distress, somatic morbidity, self-rated health, and quality of life [QoL]) in relation to fatigue. A representative sample of the Norwegian population (N = 3,944) was invited to participate in a mailed survey, and 1,857 (47%) returned valid responses on the questionnaire that included the Fatigue Severity Scale and the Posttraumatic Symptom Scale-10. Posttraumatic stress disorder symptoms showed a strong association with fatigue in univariate (β = .41) and multivariate analyses (β = .33). Associations between psychosocial health variables, QoL, and fatigue were confirmed. However, PTSD symptoms showed the strongest association with fatigue in the analyses. Findings need to be replicated in other population samples and in clinical samples with PTSD and fatigue.

Trauma and Current Posttraumatic Stress Symptoms in Elderly German Women Who Experienced Wartime Rapes in 1945

The aim of this study was to determine the persistent trauma impact and significant posttraumatic stress symptoms in a sample of very elderly German women who survived the mass rapes committed by soldiers at the end of World War II. A total of 27 women were recruited, interviewed, and then administered a modified Posttraumatic Diagnostic Scale. They all reported a very severe degree of trauma exposure in 1945; 19% reported significant current posttraumatic stress symptoms indicating a possible posttraumatic stress disorder at the time of the study, and 30% fulfilled the criteria of a current partial posttraumatic stress disorder. The results highlight the necessity for prevention and treatment programs for women exposed to wartime rapes in current conflict settings worldwide, and the need to identify and treat posttraumatic conditions in the elderly generation of all countries exposed to World War II trauma.

Previous Trauma Exposure and PTSD Symptoms as Predictors of Subjective and Biological Response to Stress

The immediate and long-term effects of traumatic exposure and subsequent posttraumatic stress reactions in people in high-risk occupations are well-documented. What is less evident is the impact of this traumatic exposure and subsequent traumatic stress symptoms on workers' response to acute stress situations. This study aimed to examine the association between prior traumatic exposure related to policing, current posttraumatic stress symptoms and biological markers of stress, and subjective appraisal of stress before, during, and after exposure to acutely stressful stimuli. A stressful policing situation was created through the use of a video simulator room. Participants' responses to the simulated emergency were evaluated by monitoring heart rate, collecting salivatory samples for cortisol analysis, and repeated administration of a subjective measure of anxiety. Biological indicators of stress, as measured by cortisol level and heart rate, were not associated with previous trauma exposure or trauma symptoms; however, biological response was associated with subjective anxiety. Vulnerability to psychological stress responses during an acute stress situation was also associated with lower levels of social support, previous traumatic exposures, and preexisting symptoms of traumatic stress. The importance of these factors became more pronounced as time progressed after the event. Previous trauma exposure did not put individuals at increased risk of biological distress during an acute stress situation. However, previous trauma and reduced social supports were associated with continuing psychological distress, confirming previous research and raising concerns about the cumulative negative effects of traumatic exposure on psychological health in emergency responders.

Traumatic events and posttraumatic stress in cross‐cultural mission assignments

In addition to cross-cultural and environmental stressors, aid workers and missionaries are frequently exposed to trauma. We explored the frequency of traumatic events, their mental health impact, and factors associated with posttraumatic stress in two groups of missionaries, one representing a predominantly stable setting (Europe) and the other an unstable setting (West Africa). The 256 participants completed self-report measures assessing lifetime traumatic events, current posttraumatic stress, depressive and anxiety symptoms, resilience, and functioning. The rate of traumatic events was significantly higher in the unstable setting. More-frequent traumatic events were associated with higher posttraumatic stress. Factors associated with the severity of posttraumatic stress were depression, functional impairment, subjective severity and number of traumatic events, and the level of resilience.

Psychopathology and alexithymia in severe mental illness: the impact of trauma and posttraumatic stress symptoms

To empirically investigate whether or not symptoms of posttraumatic stress disorder (PTSD) are essential for transferring the negative effects of trauma on the severity of severe mental illness (SMI) as recently suggested by an interactive model. About 122 inpatients with either schizophrenia or major affective disorder were administered the Posttraumatic Diagnostic Scale, the Symptom Checklist and the Toronto Alexithymia Scale. At least one trauma was reported by 83 participants (68%) and 28 patients (23%) reported symptoms of current PTSD. Those SMI subjects with current PTSD symptoms had significantly more psychopathological distress and alexithymic features than those with a trauma exposure but without PTSD symptoms and those patients without any traumatic experiences. In line with prior research, our data indicate that patients with SMI have frequently been exposed to traumatic events and that a third suffers from current posttraumatic stress symptoms. Despite some methodological limitations our findings support the interactive model, which posits that a comorbid PTSD increases the symptom severity of SMI. More attention should be directed at assessing trauma and PTSD in SMI patients and at developing therapeutic interventions.

Does Altering the Writing Instructions Influence Outcome Associated With Written Disclosure?

This study examined the effect of changing the instructional set for written disclosure on psychological and physical health reports among traumatized college students with current posttraumatic stress symptoms. Eighty-two participants were randomly assigned to one of three writing conditions that focused on emotional expression (EE), insight and cognitive assimilation, or to a control condition. Participants assigned to the EE condition reported significant improvements in psychological and physical health 1 month following the writing sessions relative to the other two conditions. The EE participants also reported and displayed significantly greater initial psychophysiological reactivity and subsequent habituation compared with the other two conditions. These findings suggest the importance of emphasizing emotional expression during written disclosure and underscore the importance of examining how modifying the written disclosure protocol can affect outcome.

Psychobiological dysregulation in violence-exposed mothers: Salivary cortisol of mothers with very young children pre- and post-separation stress

To understand the determinants of frightening/frightened and other atypical maternal behavior, the authors studied a sample of 41 inner-city mothers of very young children (ages 8-50 months), the mothers of whom had lifetime histories of interpersonal violent trauma (i.e., physical or sexual abuse, and domestic violence) and related posttraumatic stress. The authors measured (1) maternal salivary cortisol levels before and 30 minutes after a videotaped play paradigm with their children, involving two separations and reunions; and (2) cortisol reactivity 30 minutes after separation stress. Data were analyzed using Pearson bivariate correlations, ANOVA, and multiple linear regressions. Salivary cortisol "baseline" values were significantly negatively correlated with childhood interpersonal violent trauma severity (i.e., trauma severity prior to age 16). However, cortisol reactivity was not significantly correlated with interpersonal violent trauma severity at this level of analysis. Although baseline salivary cortisol values were not significantly correlated with current overall psychiatric or depressive symptoms, they were negatively correlated with severity of current posttraumatic stress symptoms (PTSS) and with dissociative symptoms. Neither dimensions of negativity nor distortion of maternal attributions showed any significant association with prestress or poststress salivary cortisol levels. Salivary cortisol baseline was negatively correlated with atypical maternal behavior via measurement of the level of disrupted communication, at a trend-level of significance. Violent trauma-associated dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may be a marker for increased risk for intergenerational transmission via parenting behavior with young children. Low salivary cortisol prior to separation stress and blunted cortisol reactivity to separation may also be markers for posttraumatic stress.

Traumatic grief in a convenience sample of victims seeking support services after a terrorist incident.

This report describes traumatic grief in 40 individuals who suffered losses in the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. We administered a self-report instrument 6 months after the bombing to assess demographics; exposure; injury; retrospective report of initial emotional and physiological reaction; and current posttraumatic stress symptoms, grief, safety concerns, and functioning. A strong association was found between posttraumatic stress symptoms and grief. The relationship between grief and difficulty functioning was stronger at higher levels of posttraumatic stress than at lower levels. The results support the construct of traumatic grief and have important implications for the treatment of people exposed to large-scale traumatic events and for the training of mental health professionals.

Posttraumatic Stress Responses in Bereaved Children After the Oklahoma City Bombing

To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.

Traumatic reactions as predictors of posttraumatic stress six months after the Oklahoma City bombing.

This study attempted to identify remembered reactions of Oklahoma City residents at the time of the April 1995 terrorist bombing that predicted later development of posttraumatic stress symptoms. Eighty-six adults who sought help for distress related to the bombing six months after it occurred completed a survey about demographic characteristics, level of exposure to the event, symptoms of grief, retrospective reports of reactions at the time of the trauma, current posttraumatic stress symptoms, and coping strategies. To identify immediate bombing reactions predictive of later distress, retrospective reports of reactions to the trauma were correlated with current posttraumatic stress symptoms. Multiple regression analysis was used to determine which reactions predicted the emergence of posttraumatic stress symptoms. Reactions of being nervous and being upset by how other people acted when the bombing occurred accounted for about one-third of the total variation in posttraumatic stress symptom scores and thus were major predictors of posttraumatic stress. These results differ from those of other studies in which peritraumatic dissociation, or dissociation at the time of the event, was more predictive than anxiety for developing later distress. The results suggest that persons who experience significant anxiety at the time of the traumatic event may continue to experience distress. Those who are overly concerned about others' actions may be showing diminished interpersonal trust, evidence of terrorism's ability to erode social harmony.