Greater Posttraumatic Stress Symptoms Research Articles

Perceived life threat in children during the COVID-19 pandemic: associations with posttraumatic stress, anxiety, and depressive symptoms.

Defining children's "trauma exposure" in the context of the COVID-19 pandemic has been a source of debate. Children were exposed to threatening messaging about COVID-19 but might interpret this information differently than adults. Perceived life threat (PLT), the belief that one's life is in danger, has been identified as a robust predictor of posttraumatic stress symptoms (PTSS), and may be a better predictor of PTSS than actual life threat (ALT). This study investigated parent reports of children's self-PLT (belief that they might die from COVID-19) and family-PLT (belief that a family member might die from COVID-19). The aims were to compare PLT to ALT, evaluate their associations with children's psychological functioning, and identify risk factors associated with PLT. We hypothesized an association between PLT and children's psychological functioning in the context of the COVID-19 pandemic. Parents (N = 140) reported on their child's (M age = 9.81years, 47% female) pandemic experiences, psychological functioning, and both self-PLT and family-PLT. Results revealed self-PLT for 10% of the children and family-PLT for 43% of the children, yet only 6% experienced ALT (i.e., they or their parent tested positive for COVID-19). Children with reported self- or family-PLT had higher PTSS, depressive symptoms, anxiety symptoms, and functional impairment compared to children without these reported beliefs. PLT, but not ALT, was associated with psychological outcomes. Children with only PLT had greater PTSS and impairment than children with ALT. There were differences in parental functioning and pandemic-related information/media exposure between children with and without PLT. Children's perceptions, rather than objective experiences, may be more central to their psychological functioning. This has implications for screening for pandemic-related symptomatology in children as traditional trauma exposure measures may not adequately identify distressed children.

It’s all in the hair: Association between changes in hair cortisol concentrations in reaction to the COVID-19 pandemic and post-traumatic stress symptoms in children over time

After exposure to a stressful/traumatic event, some individuals will develop post-traumatic stress symptoms (PTSS). In adults, low cortisol levels appear to be a risk factor for the development of PTSS. Indeed, both lower pre-trauma cortisol levels and low cortisol levels in the aftermath of a traumatic event have been associated with greater PTSS. In contrast, studies conducted in children showed that elevated cortisol levels shortly after trauma exposure are associated with more severe post-traumatic stress symptomatology. The few studies that have examined how pre-trauma cortisol levels predict PTSS in children have found no effect. Given that a pandemic can induce PTSS in certain individuals, we investigated whether cortisol secretion prior to and in the early stages of the COVID-19 pandemic in Quebec (Canada) predicted PTSS in children. In June 2020, we collected a hair sample from 71 children (8–15 y/o, M = 11.65; 54.93% girls) without a history of psychopathology or exposure to previous traumatic events. Hair samples allowed us to derive cumulative measures of cortisol levels for the months prior to (from mid-December 2019 to mid-March 2020) and at the beginning of the pandemic (from mid-March 2020 to mid-June 2020). PTSS were assessed every 3 months between June 2020 (T1) and March 2021 (T4). The results showed that a greater increase in hair cortisol at the beginning of the pandemic predicted less PTSS at T1, with an increase in these symptoms over time. This study highlights the utility of using hair cortisol during future chronic stressful events to better understand its association with the evolution of distress.

Meaning in life following service among post-9/11 military veterans: A latent growth mixture model analysis.

Meaning in life refers to the "sense made of, and significance felt regarding, the nature of one's being and existence." Meaningful living promotes well-being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct trajectories of meaning using latent growth mixture models and examined prospective predictors of class membership in a military veteran cohort assessed at multiple time points throughout the first 3 years after leaving service. Three trajectories were identified: consistently high meaning (89.5%; n = 7025), diminishing meaning (6.1%; n = 479), and strengthening meaning (4.4%; n = 348). Veterans with greater posttraumatic stress symptoms, depression symptoms, and moral injury experienced increased odds of a less adaptive trajectory (i.e. diminishing and/or strengthening vs. consistently high meaning), whereas veterans who reported greater psychological resilience, community relationship satisfaction, and intimate relationship satisfaction experienced lower odds of a less adaptive trajectory. Several gender differences were also observed. Results provide insight into veteran subgroups that are more likely to experience lower meaning after leaving military service and thus may benefit from additional support to reduce their risk for poor longer-term health and well-being outcomes.

Temperature and socioeconomic vulnerability: associations with cardiac event-induced posttraumatic stress symptoms.

Posttraumatic stress symptoms (PTSS) are common after acute coronary syndrome (ACS) and predict increased morbidity and mortality. Climate change contributes to worse mental and cardiovascular health outcomes, thus, PTSS represent a potential mechanism linking climate change to adverse cardiovascular outcomes. Because people living in areas with lower socioeconomic status (SES) experience greater climate vulnerability, have worse cardiovascular health, and may be more susceptible to PTSS, any effect of temperature on PTSS could be amplified in this population. Spatial regression models were estimated to test the association of temperature and temperature variability (within-day variability, directed change over time, and absolute change over time), census tract-level SES, and their interaction with PTSS 1 month post-hospital discharge in a longitudinal cohort study comprising 956 patients evaluated for ACS at an urban U.S. academic medical center between November 2013-May 2017. PTSS were self-reported in relation to the ACS event that brought the patient to the hospital. Census tract-level was computed as a composite score from the CDC Social Vulnerability Index, with higher values indicating lower SES. No temperature or temperature variability metrics were associated with PTSS. Lower census tract-level SES was associated with greater PTSS at 1 month. There was a marginally significant interaction of SES with ACS status, such that we only observed evidence of an association among those with ACS. Temperature exposures were not associated with acute CVD-induced PTSS, which could be a result of a small sample size, mismatched timescale, or lack of a true effect. Conversely, lower census tract-level SES was associated with developing worse PTSS 1 month after evaluation for an ACS. This association appeared stronger in individuals with a true ACS. Early interventions to prevent PTSS could promote better mental and CVD outcomes in this at-risk population.

The impact of multiple stressful life events on posttraumatic growth in adolescence.

Posttraumatic growth (PTG) has been primarily recognized as a result of experiencing a single life crisis. The current study investigated how PTG may be attributed to experiences of a multitude of highly stressful life events, and how PTG is correlated with PTSD symptoms, the severity of the event, and the total number of childhood traumas experienced. Adolescents (N = 139) participated in a survey that assessed six major life events of childhood trauma and rated the severity of each event, posttraumatic stress symptoms (PTSS), and PTG. The majority of adolescents attributed their PTG experiences to one event, despite experiencing multiple traumas. However, experiencing more events was associated with greater PTSS and some forms of PTG such as changed priorities, increased self-reliance, and establishing a new path in life. Results from regression analyses also showed that trauma severity and PTSS were linearly correlated with PTG, and thus, a curvilinear relationship was not identified. Cumulative traumatic events may lead to increases in a sense of personal growth, while also increasing distress, in nonclinical adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic Cognitions Differ Between Men and Women after Military Sexual Assault Revictimization in Their Contribution to PTSD Symptoms.

Sexual revictimization is heightened among military service members and veterans and is associated with greater posttraumatic stress symptoms (PTSS) and severity. The heightened distress following revictimization may be due to posttraumatic cognitions (PTC), which include negative beliefs about the self and world, and self-blame. Moreover, it is unclear whether men and women experience different levels of PTC. The current study tested PTC (overall and subdomains) as a possible mediator between sexual revictimization and PTSS severity, and gender as a possible moderator of these associations. Revictimization was defined across time periods (military sexual assault [MSA] only vs. premilitary sexual trauma + MSA) and in military rape frequency (0, 1, 2+). Participants were 400 (n = 200 [50%] male) service members/veterans with a history of MSA and completed online, anonymous, self-report questionnaires. PTC mediated the association between revictimization and PTSS severity. A significant interaction of gender suggested that men reported high overall PTC and PTC about the self regardless of revictimization; by contrast, overall PTC and PTC about the self were lower for women in response to MSA only and increased with revictimization. Results also showed men were more sensitive to PTC about self-blame as it pertains to more severe PTSS compared to women. There were no unique gender interactions when assessing revictimization by rape frequency, although PTC (overall, all subdomains) significantly mediated the association between rape frequency and PTSS severity. PTC may be a beneficial target when treating PTSS in men, and may be especially heightened in women who have experienced revictimization.

Posttraumatic Growth and Posttraumatic Stress Symptoms in People with HIV

Receiving a diagnosis of HIV can be challenging. People with HIV (PWH) can experience high levels of distress, as well as some positive psychological changes associated with post-traumatic growth. However, the mechanisms which underlying the association of a highly stressful event (i.e., being diagnosed with HIV) and posttraumatic growth (PTG) and posttraumatic stress symptoms (PTSS) are under-explored, and this is the focus of the study. Cross-sectional survey data were provided by 77 PWH living in New Zealand. An analysis examined the roles of deliberate rumination and coping strategies as serial mediators of the associations between event centrality and PTG and PTSSs. The relationships between event centrality and PTG and PTSSs were found to be sequentially mediated by deliberate rumination and avoidance coping, but not by deliberate rumination and active coping. Further analyses explored active coping and deliberate rumination as parallel mediators, with avoidance coping as a subsequent mediator, between event centrality and PTG and PTSSs. However, these analyses were not supported. The findings indicate that the more participants appraised the HIV diagnosis as central, the greater PTG they perceived; however, the more they deliberately ruminated on it, and the more avoidance coping they adopted, the less PTG and greater PTSSs they perceived. Future studies need to explore the relationships of event centrality and coping and their associations with PTG and PTSSs.

Sleep Disturbances and Delayed Sleep Timing are Associated with Greater Post-Traumatic Stress Symptoms in Youth Following Hurricane Harvey.

Sleep patterns following a natural disaster are associated with mental health difficulties, but research in youth samples has been limited to subjective reports of sleep. Participants (N = 68, 8-17 years old) completed an assessment 6-9 months after Hurricane Harvey, which included subjective measures of sleep, chronotype, hurricane-related post-traumatic stress symptoms, and one week of actigraphy. Prior to the hurricane, parents provided reports on emotional symptoms. Controlling for age, sex, socioeconomic status, participation time, and pre-hurricane emotional symptoms, subjective sleep disturbances and an eveningness chronotype were associated with greater post-traumatic stress, with the strongest effects observed for re-experiencing, negative cognitions/mood, and arousal/reactivity symptoms. Later sleep timing as measured by actigraphy was associated with greater arousal/reactivity symptoms and shorter sleep duration was associated with greater avoidance symptoms. As extreme weather-related events are expected to become more frequent and severe, these findings contribute to models of youth risk and resilience.

Cumulative interpersonal childhood adversity and post-traumatic stress symptoms across heterosexual, cisgender and gender and sexually diverse adolescents: The mediating role of emotion regulation

BackgroundEmotion regulation has been identified as an explanatory factor in the association between interpersonal childhood adversity and post-traumatic stress symptoms (PTSS). However, most studies focused on adults or older adolescents, neglecting youth from the community, especially gender and sexually diverse (GSD) adolescents, who have a higher risk for exposure to adverse events and psychological difficulties, compared to their heterosexual, cisgender (HC) peers. ObjectiveThe present cross-sectional study aimed to examine the mediating role of emotion regulation difficulties in the association between cumulative interpersonal childhood adversity and PTSS across HC and GSD adolescents. MethodsA sample of 2904 ninth grade students (Mage = 14.53, SD = 0.61) completed a self-report survey. Multigroup path analyses were conducted to examine the proposed mediation model in all groups, and comparisons were made using chi-square difference tests. ResultsGreater difficulties in emotion regulation mediated the association between greater cumulative interpersonal childhood adversity (β = 0.36, p < .001) and greater PTSS (β = 0.35, p < .001) – regardless of HC or GSD status – although the direct association between cumulative interpersonal childhood adversity and PTSS was significantly stronger among GSD boys (β = 0.36, p < .001) and GSD girls (β = 0.35, p < .001) than among HC boys (β = 0.21, p < .001) and HC girls (β = 0.25, p < .001). ConclusionsFindings offer a modifiable target for prevention and/or intervention among middle adolescents, as emotion regulation difficulties may partially explain the presence of PTSS following cumulative interpersonal childhood adversity.

COVID-19 media fatigue: predictors of decreasing interest and avoidance of COVID-19–related news

ObjectivesCOVID-19–related news is important for adherence to public health measures. We examined predictors of interest and avoidance of COVID-19 news in Lithuania. Study designThis is an online survey. MethodsAn online survey was conducted between October and December 2020 targeting the general population in Lithuania. Participants rated their interest and avoidance of news about the COVID-19 pandemic, with possible answers ranging from ‘completely agree’ to ‘completely disagree’. The participants were also evaluated for symptoms of depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), post-traumatic stress (Impact of Event Scale-Revised) and COVID-19 fear (COVID-19 Fears Questionnaire). ResultsIn total, 1036 participants (83% women) completed the survey. The results indicated that 37% of participants were losing interest in COVID-19 news, 32% had started avoiding COVID-19 news and 26% had stopped following news about COVID-19. In the multivariate regression analyses, younger age, greater post-traumatic stress symptoms, less fear of COVID-19 and less frequent use of healthcare professionals for COVID-19 information were independent predictors of decreasing/diminished interest and avoidance of COVID-19 news (all P-values <0.005). More frequent use of friends/relatives for COVID-19 information was associated with increasing avoidance and diminished interest in news about COVID-19, while more frequent use of internet news portals for COVID-19 information predicted decreasing/diminished interest in news about COVID-19, independently from other factors considered in this study. ConclusionsDecreasing/diminished interest and avoidance of news about COVID-19 are common and are associated with younger age, greater post-traumatic stress symptoms, less fear of COVID-19 and less frequent use of healthcare professionals for COVID-19 information.

Coping and Post-Traumatic Stress in Children and Adolescents after an Acute Onset Disaster: A Systematic Review.

Acute onset disasters impact children’s and adolescents’ psychological well-being, often leading to mental health challenges. The way a young person copes with the event plays a significant role in development of post-disaster psychopathology. Coping has been widely studied after acute onset disasters, however, difficulties conducting research in post-disaster contexts and the individualized nature of coping make accurate assessment of coping a significant challenge. A systematic literature search of multiple databases and previous reviews was conducted, exploring scholarly documentation of coping measurement and the relationship between coping and post-traumatic stress (PTSS) symptoms after acute onset disasters. A total of 384 peer-reviewed manuscripts were identified, and 18 articles met the inclusion criteria and were included in the current review. The studies examined coping and post-traumatic stress in the wake of acute onset disasters such as terrorist events and natural disasters, such as hurricanes, earthquakes, and wildfires. Greater PTSS symptoms were related to internalizing, externalizing, rumination, and avoidant coping strategies. Coping measurement was constrained due to measurement variance, lack of developmentally and contextually vali-dated instruments, theoretical misalignment, and absence of comprehensive tools to assess coping. Robust and consistent measures of coping should be established to inform research and interventions to reduce the impact of disasters on children’s and adolescents’ well-being.

Parent Perceptions of Infant Symptoms and Suffering and Associations With Distress Among Bereaved Parents in the NICU

ContextHealthcare providers and parents face many challenges caring for infants at the end of life (EOL). Symptom assessment and management in critically ill infants can be especially difficult. However, the impact of the infant's EOL experience on bereaved parents is largely unknown. ObjectiveExplore associations between parental perceptions of infant symptoms and suffering at EOL in the neonatal intensive care unit (NICU) and parent adjustment following the death. MethodsRetrospective, cross-sectional pilot study involving parents of infants who died within the previous five years in a large, Midwestern, level IV NICU. Parents were recruited through mailed invitations, and 40 mothers and 27 fathers participated from 40 families. Parents retrospectively reported on infant symptom burden and suffering during the last week of life and the Impact of Events Scale-Revised (IES-R), and Prolonged Grief-13 (PG-13). Hierarchical regressions examined demographic/medical factors and parent perceptions at EOL in relation to post-traumatic stress symptoms (PTSS) and prolonged grief (PG). ResultsClinical levels of PTSS (Mothers = 18%; Fathers = 11%) and PG (Mothers and Fathers = 3%) were low. Maternal perception of higher symptom burden was associated with greater PTSS, R2 = 0.46, P= 0.001, and PG, R2 = 0.47, P < 0.01. Paternal perception of greater infant suffering was associated with greater PTSS, R2 = 0.48, P= 0.001, and PG, R2 = .38, P < 0.01. ConclusionPerceptions of symptoms and suffering were associated differently with mother and father adjustment after bereavement. While not necessarily causal, better symptom management at EOL could minimize distress for both infants and their parents.

The Development of Post-traumatic Stress Symptoms among Adolescents Who Experience Cyber and Traditional Victimization over Time.

Adolescents' experiences of bullying victimization are positively associated with their post-traumatic stress symptoms. The development of these symptoms alongside experiences of bullying victimization over time, however, are not well understood. The current study used a transactional theory of development to examine the bidirectional associations between adolescents' post-traumatic stress symptoms and experiences of cyber and traditional victimization across three academic years. Participants were 510 Canadian students in grade 7 or 10 (Mage = 13.7, 61.6% girls) who completed surveys annually. The findings show that adolescents' concurrent experiences of cyber and traditional victimization were uniquely associated with their post-traumatic stress symptoms. Over time, greater post-traumatic stress symptoms were associated with more experiences of cyber and traditional victimization among adolescent boys and girls. Prevention and intervention efforts must address the role of post-traumatic stress symptoms that may limit adolescents' ability to develop or maintain healthy relationships.

Abstract 321: Illness Perceptions and Readiness for Discharge Are Associated with Psychological Symptoms in Cardiac Arrest Survivors with Good Neurologic Recovery

Introduction: Understanding the development of psychological symptoms post-arrest is a major research gap. In qualitative studies, cardiac arrest survivors report being poorly equipped to face the numerous sequelae upon returning home, which could in turn exacerbate acute psychological symptoms from the initial cardiac arrest event. In this study, we examined associations between illness perceptions (i.e. cognitive and emotional appraisals of illness and recovery), readiness for discharge, and provider-patient communication with psychological symptoms in cardiac arrest survivors with good neurologic recovery. Methods: We distributed an online survey to cardiac arrest survivors who were members of the Sudden Cardiac Arrest Foundation. Survivors completed the Brief Illness Perception Questionnaire (B-IPQ), Readiness for Hospital Discharge Scale (RHDS), Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), PTSD Checklist-5 (PCL-5), and Patient Health Questionnaire-4 (PHQ-4) which has anxiety and depression subscales. Three multiple regression models examined associations between B-IPQ, RHDS, and QQPPI scores with PCL-5 and PHQ-4 anxiety and depression sores, adjusted for age, sex, time since arrest, self-reported understanding of cardiac arrest and post-arrest symptoms at discharge, self-reported memory at discharge, functional status via the Lawton Instrumental Activities of Daily Living scale, pre-arrest Charlson Comorbidity Index, and income. Results: We obtained full data from 163 survivors (mean age: 50.1 years, 50.3% women, 95.5% white, mean time since arrest: 63.9 months). More threatening illness perceptions (β: .57, p &lt; .01) and lower readiness for discharge (β: -.22, p = .01) were associated with greater posttraumatic stress symptoms. More threatening illness perceptions was associated with greater anxiety (β: .53, p &lt; .01) and depression (β: .5, p &lt; .01) symptoms. Conclusions: Illness perceptions and readiness for discharge were associated with psychological symptoms in cardiac arrest survivors. Future studies should examine the feasibility of in-hospital assessment of survivors’ illness perceptions, readiness for discharge, and psychological symptoms.

Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic.

The number of health workers infected with COVID-19 in Spain is one of the highest in the world. The aim of this study is to analyse posttraumatic stress, anxiety and depression during the COVID-19 pandemic. Associations between burnout, resilience, demographic, work and COVID-19 variables are analysed. Cross-sectional data on 1422 health workers were analysed. A total of 56.6% of health workers present symptoms of posttraumatic stress disorder, 58.6% anxiety disorder, 46% depressive disorder and 41.1% feel emotionally drained. The profile of a health worker with greater posttraumatic stress symptoms would be a person who works in the Autonomous Community of Madrid, in a hospital, is a woman, is concerned that a person he/she lives with may be infected, and thinks that he/she is very likely to be infected. The risk variables for anxiety and depression would be a person that is a woman, working 12- or 24-h shifts, and being worried that a family member could be infected. High scores on emotional exhaustion and depersonalization are risk factors for mental health, with resilience and personal fulfilment being protective variables. Data are provided to improve preventive measures for occupational health workers.

Social Support as a Moderator between Syndemics and Posttraumatic Stress among Women Experiencing Adversity

ABSTRACT Substance Abuse, Violence, and AIDS/HIV (i.e., SAVA) tend to co-occur and the clustering of these adversities may be associated with increased psychopathology. Little is known about how these co-existing adversities affect the mental health of women. Further, few studies have examined protective factors that could weaken the relationship between these SAVA adversities and posttraumatic stress symptoms (PTSS). The current study assessed this relationship, as well as the moderating effect of social support. Participants included 178 women (M age = 35.23, SD = 8.44; 71.0% Black) who were living with HIV, experiencing intimate partner violence, and/or using illicit substances. Women were recruited from community organizations and completed hour-long interviews. Findings indicated that experiencing more than one SAVA was associated with greater PTSS (ß =.28; p =.036). Results also supported the moderating role of social support (F(2,168) = 3.41, p=.035, R2 =.31, f 2 =.45). Among women with higher levels of support, having one SAVA adversity was associated with lower PTSS. However, among women with lower levels of support, having one SAVA was associated with higher PTSS. Results not only underscore how co-occurring adversities exacerbate PTSS, but also highlight the central role of social support as a protective factor among women.

Nonlinear relations between post-traumatic stress symptoms and electrocortical reactivity during emotional face processing in combat-exposed veterans.

Combat-related post-traumatic stress symptoms (PTSS) are prevalent among recently deployed veterans, making identification of biomarkers of PTSS in this population a public health priority. Given the link between threat processing neurobiology and PTSS, the threat-related late positive potential (LPP), an ERP reflective of attentional processing sensitive to emotion and its regulation, may have utility as a cost-effective biomarker. Existing PTSS/threat-related LPP findings are mixed, possibly due to variability in PTSS across samples, but this has never been explicitly tested. To address this gap, LPP amplitudes to angry, fearful, and happy emotional face stimuli were recorded among 81 combat-exposed veterans at a VA hospital. A quadratic relationship between self-reported PTSS and LPP amplitude modulation by angry faces emerged such that greater PTSS was related to a decreased LPP response to angry faces among veterans with subthreshold PTSD and an enhanced LPP response to angry faces among veterans with probable PTSD. These results suggest that prior mixed findings may be due to variability in PTSS severity. In addition, exploratory moderation analysis revealed that PTSS was positively associated with late LPP modulation for veterans reporting low cognitive reappraisal use and negatively associated with late LPP modulation for veterans reporting high cognitive reappraisal use. All results were specific to the 1,000-3,000ms LPP time window. Thus, the functional nature of LPP modulation by direct threat cues may depend upon PTSS severity and/or related variables (e.g., cognitive reappraisal utilization).

The role of sleep quality on the relationship between posttraumatic stress symptoms and pain in women.

Pain frequently co-occurs with elevated posttraumatic stress symptoms (PTSS); women are at elevated risk for their co-occurrence. PTSS and pain are associated with poor sleep quality; yet, little research has examined how sleep impacts their co-occurrence. The current study examines the indirect role of sleep on the relationship between PTSS and pain. A community sample of 182 women completed psychometrically-sound questionnaires assessing PTSS, sleep quality, pain characteristics, depression and anxiety symptoms, and anxiety sensitivity. We examined how sleep quality impacted associations among PTSS and pain intensity and pain interference, while controlling for key psychological factors. Greater PTSS was associated with worse pain interference, and poor sleep quality had a significant indirect effect on this relationship. Sleep may represent a modifiable behavioral mechanism that contributes to the mutual maintenance of PTSS and pain in women. Future research is needed to further clarify the role of sleep quality in their co-occurrence.

Frequency of Interpersonal Trauma Types, Avoidant Attachment, Self-Compassion, and Interpersonal Competence: A Model of Persisting Posttraumatic Symptoms

ABSTRACTGiven limited knowledge about how psychosocial factors interact to modulate posttraumatic stress symptoms, this study evaluated an integrative model proposing that experiencing more interpersonal trauma types (e.g., abuse, assault, rape, etc.) leads to greater avoidant attachment and lower self-compassion, which limits the development and use of effective interpersonal skills. In turn, lower levels of self-compassion and interpersonal competence perpetuate posttraumatic symptoms. Anonymous trauma-experienced adults (n = 132) completed self-report measures in an online study hyperlinked on trauma support websites. Data were subjected to confirmatory factor analysis and structural equation modeling, which provided support for the hypothesized model. Specifically, higher frequency of interpersonal trauma types experienced was linked to higher avoidant attachment and lower self-compassion, which in turn were associated with lower interpersonal competence, which correlated with greater posttraumatic stress symptoms. Although cross-sectional data cannot address directionality of associations, this study’s findings emphasize the potential utility of future longitudinal research designed to examine possible causal relationships among these specific psychosocial factors. For example, study findings suggest that those who experience more types of interpersonal trauma and who are characterized by avoidant attachment and lower self-compassion and interpersonal competence may be the most susceptible to experiencing severe posttraumatic symptoms. However, findings also suggest that efforts to increase self-compassion and interpersonal skills may help reduce symptoms.

Post-traumatic Stress and Trauma-Related Subjective Distress: Comparisons Among Hispanics, African-Americans, and Whites with Severe Mental Illness

We tested the hypothesis with a sample of community mental health clients (N = 132) that Hispanic clients would report significantly greater post-traumatic stress symptoms than African-American or white clients when controlling for gender, psychiatric symptoms of SMI, and subjective distress from six of the most commonly reported trauma in the SMI literature. Results supported our main hypothesis: being self-identified as Hispanic was significantly associated with greater post-traumatic stress symptoms. Subjective distress from having been sexually abused along with being "Hispanic" were the only two significant variables left in the equation. Limitations of this study include its modest sample size.