Higher Posttraumatic Stress Symptoms Research Articles

Who Reports What? A Comparison of Child and Caregivers\xb4 Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics

Identifying trauma-related symptoms is important for treatment planning at child and adolescent mental health services (CAMHS), and routine trauma screening may be a first step to ensure appropriate treatment. Studies with community samples have found modest agreement between children’s and caregivers´ report of exposure to potentially traumatizing events (PTEs). However, studies from clinical populations are scarce and the evidence base for screening recommendations is insufficient. The current study explores child and caregiver agreement on the child’s exposure to PTEs and its relationship with the child’s post-traumatic stress symptoms (PTSS) and functional impairment. The sample consist of 6653 caregiver-child dyads referred to Norwegian CAMHS between 2012–2017. The children were 6 to 18 years of age (M = 12.03, SD = 3.14) and 47% were boys and 45% were girls (8% missing). Children reported significantly more exposure to accidents or illness, community violence, and sexual abuse than their caregiver, but there were no differences for reports of domestic violence. Kappa results were fair to moderate, with the highest agreement rate for reports of sexual abuse, followed by domestic violence, community violence, and lowest agreement for accidents or illnesses. There were higher agreement rates among caregivers and older children, and caregivers and girls. In general, the child had higher PTSS and functional impairment scores when child exposure to PTEs were reported by both the caregiver and the child. Both children and caregivers should be included in trauma screening procedures at CAMHS to collect a more complete picture of the child’s experiences and treatment needs.

World Trade Center Exposure and Posttraumatic Growth: Assessing Positive Psychological Change 15 Years after 9/11.

We evaluated the presence of posttraumatic growth (PTG) among survivors of the 9/11 terrorist attack and how indicators of psychosocial well-being, direct 9/11-related exposure, and posttraumatic stress symptoms (PTSS) relate to PTG. PTG was examined among 4934 participants using the Posttraumatic Growth Inventory (PTGI). A confirmatory factor analysis (CFA) was conducted to determine if the original factor structure of the PTGI fits our data and principal component analysis (PCA) to identify the appropriate factor structure. Multivariable linear regression models were used to examine the association between PTG and indicators of psychosocial well-being, 9/11-related exposure, and PTSS, controlling for covariates. CFA identified a two-factor structure of the PTGI as a better fit than the original five-factor model. Participants who experienced very high 9/11-related exposure level (ß = 7.72; 95% CI: 5.75–9.70), higher PTSS at waves 1 (ß = 0.13; 95% CI: 0.08–0.18) and 2 (ß = 0.09; 95% CI: 0.05–0.14), high social integration (ß = 5.71; 95% CI: 4.47, 6.96), greater social support (ß = 0.49; 95% CI: 0.37, 0.61), and higher self-efficacy (ß = 1.26; 95% CI: 1.04, 1.48) had higher PTGI scores. Our findings suggest PTG is present, 15 years following the 9/11 terrorist attack. Very high-level 9/11 exposure, PTSS, and indicators of psychosocial well-being were associated with PTG.

The Intergenerational Transmission of Chronic Pain from Parents to Survivors of Childhood Cancer.

Background: Among youth with chronic non-cancer pain, 50% have parents with chronic pain. These youth report significantly more pain interference and posttraumatic stress symptoms (PTSS), and worse health-related quality of life (HRQL) than youth whose parents do not have chronic pain. Additionally, parent chronic pain is linked to increased child anxiety and depressive symptoms. Survivors of childhood cancer (SCCs) are at risk of pain and negative psychosocial outcomes and therefore may be especially vulnerable if their parents have chronic pain. Thus, the aims of the current study were to (1) identify rates of chronic pain among parents of SCCs, (2) test group differences in psychological symptoms in parents with chronic pain versus without, and (3) test group differences in pain interference, HRQL, anxiety, depression, and PTSS in SCCs with parents with chronic pain versus without. Methods: 122 SCCs (Mean age = 15.8, SD = 4.8, 45.7% male, Mean age at diagnosis = 5.9, SD = 4.7) and their parents were recruited from across Canada to complete online questionnaires. Parents were asked if they have had pain for at least three consecutive months and completed the brief symptom inventory (BSI) as a measure of psychological symptomatology. Survivors completed the pain questionnaire, patient reported outcomes measurement information system (PROMIS)—pain interference, anxiety, and depression measures, child posttraumatic stress scale, posttraumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, and the pediatric quality of life inventory. Results: Forty-three (39%) parents of SCCs reported having chronic pain. Of the 29 survivors who had chronic pain, 14 (48%) also had parents with chronic pain. Parents with chronic pain reported significantly higher scores on the BSI than parents without chronic pain, F(1, 116) = 5.07, p = 0.026. SCCs with parents with versus without chronic pain reported significantly higher PTSS F(1, 105) = 10.53, p = 0.002 and depressive symptoms F(1, 102) = 6.68, p = 0.011. No significant differences were found across the other variables tested. Conclusions: Findings suggest that survivors’ parents’ own pain is prevalent and is related to survivors’ increased depressive symptoms and PTSS, but not anxiety, pain interference, or HRQL. Future research should explore whether parents may benefit from psychological intervention after their child has been diagnosed with cancer and how this could improve outcomes for their child.

Hidden wounds of violence: Abnormal motor oscillatory brain activity is related to posttraumatic stress symptoms

Victims of urban violence are at risk of developing Posttraumatic Stress Disorder (PTSD), one of the most debilitating consequences of violence. Considering that PTSD may be associated with inefficient selection of defensive responses, it is important to understand the relation between motor processing and PTSD. The present study aims to investigate the extent to which the severity of posttraumatic stress symptoms (PTSS) is related to motor preparation against visual threat cues in victims of urban violence. Participants performed a choice reaction time task while ignoring a picture that could be threating or neutral. The EEG indices extracted were the motor-related amplitude asymmetry (MRAA) in the alpha frequency range, and the lateralized readiness potential (LRP). We observed a linear relation between longer LRP latency and a slower reaction time, selectively during threat processing (compared to neutral) in low PTSS, but not in high PTSS participants. Alpha MRAA suppression and the PTSS were also linearly related: the smaller the alpha MRAA suppression in the threat condition relative to neutral, the greater the PTSS. These results provide evidence that threatening cues affect motor processing that is modulated by the severity of PTSS in victims of urban violence.

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.

The Impact of Family Separation and Worry About Family on Psychological Adjustment in Refugees Resettled in Australia.

Few reliable predictors of postarrival psychological adjustment have been identified with regard to refugees once they arrive in their host country. We investigated the association between family separation and psychological symptoms in refugees resettled in Australia from 2013 to 2016. Participants were 1,495 adult refugees (M = 38.9 years, SD = 12.7) who participated in the Building a New Life in Australia population-based study across 4 years. Participants were assessed for psychological distress and posttraumatic stress symptoms (PTSS) using the Kessler Psychological Distress Scale (K6) and Posttraumatic Stress Disorder-8 (PTSD-8), respectively. We used latent class growth analysis (LCGA) to identify latent longitudinal trajectories and binary logistic regression to assess the contribution of family predictor variables toward PTSD-8 and K6 symptom trajectory class membership. The LCGA supported a four-class solution for PTSS, categorized as improving PTSS (18.4%), persistently high PTSS (11.5%), resilient PTSS (57.3%), and deteriorating PTSS (12.6%). For the K6, LCGA supported a four-class solution comprising classes categorized as persistently high psychological distress (PD; 7.0%), improving PD (17.3%), resilient PD (61.1%), and deteriorating PD (14.6%). Separation from family members did not independently predict the course of psychological symptoms; however, worry about family and friends contributed to the persistence of high PTSD-8 scores, OR = 1.75, and deteriorating K6 scores, OR = 1.57. The current findings suggest persistently high or worsening psychological symptom trajectories during the postsettlement phase may be marked by worry about family and friends, in addition to older age and female gender, rather than separation alone.

Anxiety Buffer Disruption: Self-Evaluation, Death Anxiety, and Stressor Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Research driven by terror management theory suggests sociocultural anxiety-buffer systems typically protect against existential anxiety, whereas anxiety buffer disruption theory suggests traumatic experiences may disrupt that process. Method: Following posttraumatic stress (PTS) symptom screening (n = 4097), individuals with low (n = 149) and high (n = 120) PTS engaged in either negative or positive self-evaluations, then reported death anxiety and appraised life's stressors as negative/threatening or positive/challenging. Results: When low PTS participants contemplated their worst (vs. best) selves, they experienced moderately heightened death anxiety yet appraised life's stressors as more positive/challenging than harmful/threatening, reflecting effective existential anxiety buffers. However, high PTS participants reported high death anxiety in both the best-self and worst-self conditions—indicating anxiety buffer disruption—and the worst-self (vs. best self) prompt increased their appraisal of life's stresses as a harmful threat and decreased appraisal as positive/challenging opportunities for growth and well-being. Discussion: Theoretical and clinical implications are discussed.

An examination of attentional control on posttraumatic stress symptoms and problematic alcohol use

Trauma-exposed individuals, specifically those with higher posttraumatic stress symptoms (PTSS), are at elevated risk of developing alcohol-related problems. One mechanism via which PTSS may contribute to problematic alcohol use is poor attentional control (AC). AC theory suggests that increases in PTSD-related distress will reduce AC, which could then yield greater problematic alcohol use. An alternative path suggests poor AC amplifies PTSS, thereby promoting alcohol abuse. To date, no research has simultaneously evaluated these two pathways. Trauma exposed participants (N = 339) completed self-report measures on trauma related symptoms, AC, and alcohol use. Cross-sectional analyses tested direct effects of PTSS and AC on problematic alcohol use as well as indirect effects of PTSS on alcohol use via AC and AC on alcohol use via PTSS. Results revealed AC mediated the relationship between PTSS and problematic alcohol use, however PTSS did not mediate the relationship between AC and alcohol use. Current results demonstrate specificity for AC as a mediator in the relationship between PTSS and alcohol use. Future work is needed to determine if the observed statistical mediation effects extend to inform causal models of posttraumatic stress disorder (PTSD) and AUD comorbidity, and if intervening on AC mitigate PTSD and AUD symptomology.

Patterns of posttraumatic stress disorder and posttraumatic growth among breast cancer patients in China: A latent profile analysis.

The aim of this study was to identify the patterns of posttraumatic responses among breast cancer (BC) patients, to explore the variables associated with these patterns, and to compare anxiety and depression on various posttraumatic response patterns. A questionnaire survey was conducted with a sample of 612 BC patients who were currently undergoing treatment. The questionnaire package included Posttraumatic Stress Disorder Symptom Scale (PSS), Posttraumatic Growth Inventory (PTGI), Network of Relationships Inventory, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Modeling was performed using a latent profile analysis (LPA) to explore patterns of posttraumatic responses among BC patients. Based on the fitting indicators of LPA, three-class patterns model of posttraumatic responses was optimal. Resisting group (34.6%): patients reported mild posttraumatic stress symptoms (PTSS) and mild posttraumatic growth (PTG). Growth group (47.4%): patients showed mild PTSS and high PTG. Struggling group (18.0%): patients showed high PTSS and high PTG. BC patients with lower income were more likely to belong to Resisting group and Struggling group. BC patients with high levels of social support were more likely to belong to Growth group. Patients in Struggling group had the highest levels of anxiety and depression. This study showed that there was heterogeneity in posttraumatic response patterns of BC patients. The results provided theoretical base guiding the development of health care schemes and psychological interventions for patients, suggesting the necessity of differentiated health care for BC patients with different posttraumatic response patterns.

The Effect of Traumatic Loss on Posttraumatic Growth Among 2011 Van Earthquake Survivors: The Mediating Role of Posttraumatic Stress.

Posttraumatic growth (PTG), defined as a positive change after a traumatic event, has become the subject of various studies, and its relationship with posttraumatic stress symptoms (PTSS) has been extensively investigated. However, studies have indicated differences in the relationship between PTG and PTSS. Therefore, this study aimed to investigate the mediating role of PTSS in the relationship between the number of traumatic losses and PTG among the 2011 Van earthquake survivors. The sample of this study consisted of 917 participants who experienced the 2011 Van earthquake. A personal information form, impact of event scale-revised (IES-R), and posttraumatic growth inventory (PTGI) were used as data collection tools. Survivors with traumatic loss were found to have higher PTSS and PTG than survivors without traumatic loss. The mean scores of the PTGI subscales were higher among survivors with traumatic loss except for changes in self-perception. A positive correlation was found between IES-R and PTGI total scores. In the regression analysis, it was found that PTSS played a mediating role in the relationship between the number of traumatic losses and PTG. This study revealed that PTG is possible with the presence of PTSS. Mental health professionals assisting survivors with traumatic loss should take the enhancement of PTG into consideration in addition to their efforts to reduce PTSS.

The moderating effect of exposure to robbery on the relationship between post-traumatic stress and job satisfaction

Research has disregarded the boundary conditions of the effects of post-traumatic stress symptoms (PTSS) at work. Addressing this issue, the present study examines the moderating impact of the (shared vs. isolated) exposure to robbery on the relationship between PTSS and employee job satisfaction. Drawing on the conservation of resources theory, we argue that PTSS would positively affect employee job satisfaction when the robbery is experienced collectively. To test our predictions, we conducted a two-wave study—with a lag of two months between measurements—on 140 employees from a national bank in Italy. Results from hierarchical regression analyses supported our prediction: the exposure to robbery moderated the relationship between PTSS and job satisfaction. While within the “isolated exposure” group the job satisfaction score was higher among less symptomatic victims, within the “shared exposure” group those with high PTSS reported higher job satisfaction levels than those with low PTSS. We discuss the implications of these findings for theory and practice.

The social cognitive appraisal of trustworthiness in individuals with dimensional levels of post-traumatic stress symptoms: a translational study

ABSTRACT Background: Misappraisals in evaluating the trustworthiness of others may be one mechanism contributing to the interpersonal difficulties individuals with posttraumatic stress disorder (PTSD) face. Objective: This study used a translational experimental design to examine the behavioural and neural correlates underlying the appraisal of facial stimuli morphed on dimensions of trustworthiness across three groups: individuals with high posttraumatic stress symptoms (HPTS), low posttraumatic stress symptoms (LPTS), and healthy controls (HC). Methods: Participants (N = 70) rated how trustworthy to untrustworthy they perceived three facial morphs (trustworthy, neutral, and untrustworthy) while undergoing electroencephalography (EEG). Results: Behavioural results showed that the HPTS group rated the untrustworthy morph as more untrustworthy than the HC group (β = 0.20, SE = .07, 95% CI [0.06, 0.33], z = 2.88, p = .004). The HPTS group also showed no variation in response time across morphs ((2) = 0.92, p = 0.63), while the LPTS and HC groups did ((2) = 9.60, p = .008; (2) = 23.62, p < .001). EEG data revealed significant group by morph interactions at the N170 latency and the Vertex Positive Potential (VPP): the HPTS and LPTS identified the untrustworthy morph faster than the HCs, but diverged to the degree to which they encoded each facial morph. Conclusions: Taken together our results suggest that HPTS individuals demonstrate an early attentional avoidance of faces morphed on dimensions of trustworthiness. This early, preconscious, avoidance may be one mechanism contributing to the miscalculations individuals with PTSD make in interpersonal situations.

Aggravating factors and assessment tools for Posttraumatic Stress Disorder in children after hospitalization.

Posttraumatic stress disorder (PTSD) is a mental disorder caused by several distressing events that are related with psychotrauma. It is very frequent in childhood and untreated traumatic stress symptoms in children and adolescents often result in debilitating consequences on development with increased risks for a variety of physical and mental disorders. Ιt has been found that PTSD symptoms are reduced as soon as therapeutic interventions have been applied. The aim of the present review was to summarize the available literature regarding aggravating factors associated with the development of PTSD in children after hospitalization and assessment tools for a quick and reliable screening of children who are at risk for developing PTSD. A review of published papers was conducted until April 10, 2019 to identify articles that discuss the aggravating factors and the assessment tools for PTSD in children after hospitalization published in English, German or Greek language. Search was performed on PubMed with the following combination of key-words: "PTSD" and "children" and "hospitalization", using the filters ''human'' and "Publication date from 30/11/2007 to 09/04/2019" and choosing "all fields'' in PubMed Advanced Search Builder. Of the 115 articles reviewed, 16 relevant articles were included, 10 of them referred to the aggravating factors and the remaining 6 were related to the assessment tools. Significant aggravating factors associated with the development of PTSD were: traumatic injuries and illness/ medical-related hospital admission, previous health problems, Pediatric Intensive Care Unit (PICU) hospitalization, attendance at a hospital for child and adolescent psychiatry, female gender and psychotherapy and initial high Posttraumatic Stress Symptoms (PTSS) in parents. As for assessment tools, it was observed that the Child Trauma Screening Questionnaire (CTSQ)-Heart Rate (HR), the alternative PTSD algorithm (PTSD-AA), the Child Stress Disorders Checklist-Short Form (CSDC-SF), the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) model for PTSD symptom categories, the Posttraumatic Stress Disorder Semi-Structured Interview (PTSDSSI), the Preschool Children's Assessment of Stress Scale (PCASS) and the diagnostic interview for children and adolescents (DICA-P) led to the identification of children who were likely to develope or had already developed PTSD symptoms, in the study population wherein each was implemented. The greatest limitation - but also a significant finding - of this review is the scarceness of published studies on this topic. Overall, there is a variety of aggravating factors associated with the development of PTSD in children after hospitalization. Assessment tools should be able to identify immediately the children who are likely to or have already developed PTSD symptoms.

Postnatal debriefing: women's need to talk after birth

Background There is a lack of evidence of the clinical benefit of postnatal debriefing, but qualitative studies show that women value talking to a midwife after birth. However, a very small proportion of women accepted a postnatal discussion meeting at the district general hospital where the author worked. Aim To determine why some women need to talk to a professional after giving birth. Method A postal survey was sent to a sample of 447 women who gave birth during one calendar month at an NHS Trust in England. This instrument also included the impact of events scale (IES), which assessed women's feelings in relation to their recent experience of giving birth. A total of 170 women (38%) returned the completed form. Findings Some women need to talk about their birth experience after they have left the hospital. Women with symptoms of post-traumatic stress (PTS), measured by a high IES, were more likely to want to talk after giving birth and more likely to rate their experience of birth negatively, compared with those with a low IES. Approximately one-third of women who responded experienced high PTS symptoms. Conclusions Maternity providers should consider offering a postnatal listening service to meet women's needs in relation to understanding their experience of giving birth. This will also serve to identify women with PTS symptoms and offer further support.

Anxiety buffer disruption: Worldview threat, death thought accessibility, and worldview defense among low and high posttraumatic stress symptom samples.

Decades of research suggest that people are able to function effectively in the world and maintain mental health and well-being, at least in part, by relying on effective sociocultural anxiety buffer systems to shield against the awareness of death. However, according to anxiety buffer disruption theory, posttraumatic stress reflects anxiety buffer disruption, signaling that sociocultural belief systems have been rendered unable to buffer the individual against death awareness. As such, we would not expect to see the normal responses to death awareness meant to bolster and defend those belief systems in participants with posttraumatic stress. To test these hypotheses, we screened for posttraumatic stress in U.S. participants (n = 4,150) and recruited individuals with low (n = 193) and high (n = 205) posttraumatic stress symptoms. Each group was randomly assigned to a worldview-threat or -support condition, followed by a standardized measure of death-thought accessibility (DTA) and worldview defense. In the nonthreat (worldview-support) condition, individuals with high (vs. low) posttraumatic stress had elevated DTA. Further, among individuals with low posttraumatic stress, worldview threat (vs. -support) increased DTA, which in turn mediated an increase in worldview defense; however, among those with high posttraumatic stress, worldview threat did not increase DTA and its effect on worldview defense was substantially reduced. These findings supported the present hypotheses derived from anxiety buffer disruption theory, are important for understanding the existential dimension of posttraumatic stress, and may have implications for mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Commentary: I thought I was going to die and the world is not safe-how to help children recover after trauma? Reflections on Meiser-Stedman etal. (2019).

Children all over the world experience exposure to trauma. Why do only some young people have significant traumatic stress symptoms in the days and weeks immediately post-trauma while others do not, and why do some youth then recover without treatment while others go on to suffer from persistent PTSD? This important question is examined in a comprehensive study by Meiser-Stedman etal., (2019). In a sample of single-event trauma exposed youth, they investigate the role cognitive processes may have in shaping early reactions and in maintaining post-traumatic stress symptoms (PTSS) over time. For the onset of PTSS, perceived threat and feeling overwhelmed and confused during the traumatic event was associated with significant PTSS. For the maintenance of PTSS, poorly elaborated, sensory-based memories, dissociation, rumination, and negative appraisals were associated with higher PTSS. The newly revised International Society for Traumatic Stress Studies' guidelines for the prevention and treatment of PTSS found no strong evidence to recommend any of the evaluated preventive or early intervention programs. This commentary highlights how understanding different trajectories for the onset and maintenance of post-traumatic stress may inform our development of prevention and early intervention strategies. Cognitive processes seem to play an important role in the development of PTSS but these may play out differently in youth exposed to single events and youth with interpersonal trauma experiences. Knowledge on memory processing, meaning making, the role of social support and maladaptive cognitions need to be implemented in systems of trauma-informed care.

Anxiety Buffer Disruption: Relationship Threat, Death Anxiety, and Coping Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Prior work suggests that people function effectively in the world, in part, by relying on sociocultural anxiety-buffer systems to protect against death anxiety. However, traumatic experiences may overwhelm and disrupt those systems, and this work tests whether posttraumatic stress symptoms reflect a vulnerability to death anxiety and risk of coping failure.Method: Following posttraumatic stress screening (n = 4129), individuals with low (n = 187) and high (n = 186) posttraumatic stress symptoms engaged in either an anxiety-buffer stressor task (contemplating relationship problems) or control task. Participants subsequently reported death anxiety and made coping appraisals.Results: Results supported four key hypotheses. Among individuals with low posttraumatic stress: (1) death anxiety was low under control conditions but moderately increased after contemplating relationship problems; and (2) perceived coping ability remained high in both conditions. However, among those with high posttraumatic stress: (3) death anxiety was exceptionally high in both the relationship problems prime and the control conditions—indicating anxiety buffer disruption; and (4) perceived coping ability was low in the control condition, and even lower after contemplating relationship problems.Conclusions: These findings support the hypotheses and make novel contributions, in that prior research on the existential implications of PTSD have not considered that anxiety buffer disruption may be associated with failure to cope with new challenges after traumatic experiences. Future research should determine whether therapies can improve the core dimensions of functional worldviews, a sense of meaning and self-esteem, and whether such improvements result in improvements to perceived coping abilities.

The long-term effects of early-life trauma on psychological, physical and physiological health among the elderly: the study of Holocaust survivors

Objectives: To study post-traumatic stress symptoms and post-traumatic growth and heart rate variability among elderly Holocaust survivors and a matched comparison group and the mediational effect of post-traumatic stress symptoms and post-traumatic growth on the association between Holocaust experience and heart rate variability.Method: 159 Holocaust survivors and 87 matched participants without Holocaust experience answered post-traumatic stress symptoms and post-traumatic growth questionnaires. Heart rate variability time and frequency parameters were measured for a subsample of N = 133.Results: Holocaust survivors reported higher levels of post-traumatic stress symptoms and post-traumatic growth. Most heart rate variability measures were similar in the two groups, except for better heart rate variability measured by the ratio of low frequency/high frequency among Holocaust survivors. Structural equation modeling showed that belonging to the Holocaust survivor group was associated with higher post-traumatic stress symptoms and higher post-traumatic growth, as well as better heart rate variability scores (standard deviation of normal to normal R-R intervals, high frequency and the ratio of low frequency/high frequency) through the mediation of post-traumatic stress symptoms and post-traumatic growth.Conclusions: The study emphasized the duality of the association between post-traumatic stress symptoms and post-traumatic growth and their integrated effect on heart rate variability.

Supplemental Material for Anxiety Buffer Disruption: Worldview Threat, Death Thought Accessibility, and Worldview Defense Among Low and High Posttraumatic Stress Symptom Samples

Supplemental Material for Anxiety Buffer Disruption: Worldview Threat, Death Thought Accessibility, and Worldview Defense Among Low and High Posttraumatic Stress Symptom Samples

The association between the degree of nausea in pregnancy and subsequent posttraumatic stress

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.