Lower Posttraumatic Stress Symptoms Research Articles

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.

Personal growth initiative and posttraumatic stress among survivors of transportation accidents: Mixture modeling indicating changes in group membership over time.

The current study explored subgroups in reported personal growth initiative (PGI) and posttraumatic stress symptoms (PTSS) and examined the changes in class memberships among survivors of a transportation accident. Participants at Time 1 were 602 adults who reported directly experiencing a transportation accident within the past year (Mmonths = 6.36; SDmonths = 3.20). Of these participants, 171 adults completed the follow-up survey after 3 months (Time 2). Finite mixture modeling was conducted to identify the heterogeneity of PTSS in relation with PGI at each time point. At Time 1, a four-class model was the best-fitting model, and at Time 2, a three-class model was the best-fitting model. As hypothesized, when examined cross-sectionally, various subgroups were identified at each time point, finding subgroups with moderate to high levels of PGI but differing in their PTSS. However, when examining the longitudinal changes in class membership from Time 1 to Time 2, members of subgroups with higher PGI skills at Time 1 were more likely to be assigned to subgroups with lower PTSS at Time 2. The current study suggests a potential application of PGI skills in alleviating PTSS after a transportation accident and having a critical role in adjustment after hardship.

Early Exposure to Cardiac Treatment and Distress Among Patients and Their Caregiving Partners.

Background: The experience of an acute coronary event (ACE), including early care and evaluation, can be a distressing and traumatic experience for patients and their romantic partners, who also act as caregivers. We hypothesized that, among partners who were present during the ACE, those who were also present during (1) transportation to the hospital and (2) initial medical treatment would experience greater (a) anxiety early post-event and (b) posttraumatic stress symptoms (PSS) related to the event 4 months later. The associations between partner presence with patient anxiety and PSS were also explored.Methods: Participants were ACE patients and their partners recruited between March 2015 and December 2016 from the Intensive Cardiac Care Unit (ICCU) of the Sheba Medical Center in Israel (N = 143; all patients were males and partners were females). Partners self-reported whether or not they were present during the cardiac event, the hospital drive, and initial care. Patients and partners self-reported anxiety in-hospital and PSS, keyed to the ACE, an average of 4 months later. Data were analyzed using General Estimating Equations (GEE) and Multilevel Modeling.Results: Neither patient anxiety nor PSS differed according to partner presence during the drive to the hospital. In contrast, partners had higher anxiety when they were not present at all (difference = 3.65, p = 0.019) and when present during the event and during the drive (difference = 2.93, p = 0.029) as compared to when they were present for the event but not for the drive. Partners who were present during the event, but not the drive, had lower PSS than those who were present for both the event and the drive (difference = −4.64, p = 0.026).Conclusions: Partners who accompany patients on the drive to the hospital may inadvertently put themselves at risk for greater distress following their loved one’s cardiac event. Future research should enroll couples in an acute care context to inform couple-targeted tailored interventions to reduce distress in patients and their caregiving partners.

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.

Childbirth Narratives of Women With Posttraumatic Stress Symptoms in the Postpartum Period

ObjectiveTo examine cognitive, emotional, and perceptual differences in the childbirth narratives of women with high levels of posttraumatic stress symptoms (PTSS) compared with women with low levels of PTSS in the postpartum period. DesignA cross-sectional design. Participants were retrospectively assigned to the high or low PTSS group on the basis of their scores on the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) administered at 1 week and 3 months after childbirth. SettingParticipants' homes and Internet survey. ParticipantsTwenty-five women were included in the high PTSS group (PPQ score ≥ 12), and 25 were included in the low PTSS group (PPQ score ≤ 1). MethodsParticipants completed the PPQ and a writing task about the birth experience 1 week after birth and completed an online version of the PPQ 3 months after birth. Characteristics of the narratives were analyzed and compared between the two groups using the Linguistic Inquiry Word Count. ResultsCompared with participants with low levels of PTSS, participants with high levels of PTSS reported more negative emotions, including horrific images connected to labor and birth and fewer positive emotions. Participants with high levels of PTSS used more sensory and perceptual terms (tactile, visual, and auditory). In contrast, women with low levels of PTSS described more active participation during birth and used more future tense verbs. ConclusionOur findings suggest the aspects that are involved in the development and maintenance of PTSS after birth and may be considered for use in clinical practice to improve quality of care and women's health during the postpartum period.

The role of perceived threat during emergency department cardiac evaluation and the age-posttraumatic stress disorder link

Evaluation for acute coronary syndrome (ACS) can trigger posttraumatic stress symptoms (PSS). Research suggests that younger, versus older, individuals may be at elevated risk for PSS after ACS evaluation. It has been proposed that younger individuals may be at greater risk because they perceive the suspected ACS event as more threatening than their older counterparts; however, this has yet to be tested. We examined whether perceived threat during ACS evaluation mediated the association between age and PSS after ACS evaluation in an observational cohort study of patients presenting to the emergency department (ED) with suspected ACS. Demographics and perceived threat were assessed in the ED. PSS were measured upon inpatient transfer or by phone 3days later. The analytic sample comprised 871 adult participants. Multiple linear regression was used to examine (1) associations of age and perceived threat with PSS and (2) whether perceived threat mediated the association. Bootstrapping with percentile-based confidence intervals (CIs) was used to test the indirect effect. Each year of age was associated with lower PSS (b=-0.12, p<.001), independent of covariates. Older age was associated with lower perceived threat during ACS evaluation (b=-0.05, p<.001). Greater threat perceptions predicted greater PSS (b=0.94, p<.0001). The indirect effect (-0.04) was statistically significant (95% CI -0.07, -0.02). Younger, versus older, individuals are at risk for greater PSS after ACS evaluation, and elevated perceived threat partially mediated this association. Understanding age differences in PSS development risk and the potential impact of age on threat perceptions may help inform ED treatment.

Drumming to a New Beat: A Group Therapeutic Drumming and Talking Intervention to Improve Mental Health and Behaviour of Disadvantaged Adolescent Boys

Background:This research examined the impact of a programme integrating therapeutic music and group discussions (Holyoake's DRUMBEAT programme) on disadvantaged adolescents’ mental wellbeing, psychological distress, post-traumatic stress symptoms and antisocial behaviour.Method:Students displaying antisocial behaviours in grades eight to ten at three socio-economically disadvantaged secondary schools in Perth, Western Australia were invited to participate in a 10-week DRUMBEAT programme (incorporating drumming with djembes, therapeutic discussions and a final performance). Eight DRUMBEAT programmes were held in 2014. Pre- and post-intervention questionnaires measured mental wellbeing (Warwick–Edinburgh Mental Wellbeing Scale), psychological distress (Kessler-5), post-traumatic stress symptoms (Abbreviated Post-Traumatic Stress Disorder Checklist- Civilian Version) and antisocial behaviours (Adapted Self-Reported Delinquency Scale).Results:Of the 62 students completing DRUMBEAT, 41 completed pre- and post-questionnaires. Post-programme boys scored an average 7.6% higher mental wellbeing (WEMWBS) (p= .05), 19.3% lower post-traumatic stress symptoms (A PCL-C) (p= .05) and 23.9% lower antisocial behaviour (ARSDC) (p= .02). These changes were not evident for girls. No significant differences were detected for differences in psychological distress for either gender.Conclusion:This research highlights the potential of the DRUMBEAT programme as an effective, targeted strategy to reduce post-traumatic stress symptoms and antisocial behaviour and increase mental wellbeing in socio-economically disadvantaged adolescent boys.

Beta Blocker Administration During Emergency Department Evaluation for Acute Coronary Syndrome Is Associated With Lower Posttraumatic Stress Symptoms 1‐Month Later

We examined whether beta blocker administration in the emergency department (ED) during evaluation for suspected acute coronary syndrome (ACS) was associated with posttraumatic stress disorder (PTSD) symptoms 1-month later. Participants (N = 350) were enrolled in the Reactions to Acute Care and Hospitalization (REACH) study, an ongoing observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected ACS. Beta blockade during evaluation in the ED was extracted from medical records, and PTSD symptoms in response to the experience of suspected ACS were assessed 1-month later via telephone. Beta blockade in the ED was associated with lower PTSD symptoms 1-month later, b = -2.80, β = -.09, p = .045, after adjustment for demographics, preexisting psychological and medical covariates, and participants' distress during ED evaluation. Despite small effects, findings suggest that beta blockade during ED evaluation for suspected ACS-a time period relevant to fear consolidation of the memory of this potentially life-threatening event-may have protective effects for later psychological health.

Assessing the Impact of Post-Traumatic Stress Symptoms on the Resting-State Default Mode Network in a Military Chronic Mild Traumatic Brain Injury Sample.

The relationship between post-traumatic stress disorder (PTSD) and chronic symptoms of mild traumatic brain injury (mTBI) is difficult to discern and poorly understood. An accurate differential diagnosis, assessment, and treatment of mTBI and PTSD are challenging due to significant symptom overlap and the absence of clearly established biomarkers. The objective of this work is to examine how post-traumatic stress influences task-free default mode network in chronic mTBI subjects. Control subjects (N = 44) were compared with chronic mTBI subjects with low (N = 58, PTSD Checklist-Civilian Version [PCL-C] total < 30), medium (N = 124, PCL-C total = 31-49), and high (N = 105, PCL-C total ≥ 60) post-traumatic stress symptoms (PTSS). The results indicate significant differences in Brodmann area 10 for all mTBI subject groups, indicating potential mTBI-related disruptions with regulation of emotions and decision-making. The effects of PTSS were observed in the anterior cingulate and parahippocampus, suggesting possible disruptions pertaining to memory regulation, encoding, and retrieval. The overall results indicate the presence of aberrant connectivity patterns between controls and chronic mTBI subjects with low, medium, and high PTSS. Furthermore, the findings suggest a disruption in attention relating to a network of brain regions involved with emotional regulation and memory coding, rather than a fear-related response. Taken together, the results suggest these regions form a network that could be a target for future research pertaining to PTSD and chronic mTBI. Furthermore, the use of clinical measures, task-based imaging studies, or multimodal imaging could help further elucidate specific neural correlates of PTSS and mTBI.

Keeping a healthy distance: Self-differentiation and perceived health among ex-prisoners-of-war's wives

ObjectiveWar captivity may affect spouses of former-prisoners-of-war (ex-POWs) in many ways, including posttraumatic stress symptoms (PTSS) and somatic difficulties manifested in negative perceived health. This is generally known as secondary traumatization. Theory suggests that development of secondary traumatization occurs through the relationship with the primary trauma survivor Figley (1986) , thus implying that the ability to keep balanced emotional distance in the relationship may play a pivotal role. Notwithstanding, the contribution of self-differentiation to secondary somatic disturbances remains largely uninvestigated. The current study fills this gap. MethodsEx-POWs' wives (n=143) and control former-combatants' wives (n=102), were assessed prospectively 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Self-differentiation and PTSS were assessed at both time-points, while perceived health measures were assessed at T2. ResultsWives of ex-POWs endorsed higher PTSS, lower self-differentiation and negative perceived health, compared to control wives. Indirect exposure to war captivity was related to low self-differentiation and elevated PTSS, which predicted negative perceived health. Furthermore, self-differentiation characterized by fusion-with-others fully mediated the relation between indirect exposure to war captivity and perceived health, beyond the effects of PTSS as a mechanism. ConclusionResults suggest that tendencies towards fusion-with-others within the marital relationship, act as a risk factor not only for psychological distress but also for somatic distress among secondary trauma survivors. Hence, clinical interventions may seek to improve indirect trauma survivor's self-differentiation capacities, thus potentially facilitating the prevention of secondary somatic distress.

Perceived clinician-patient communication in the emergency department and subsequent post-traumatic stress symptoms in patients evaluated for acute coronary syndrome.

Evaluation for a potentially life-threatening cardiac event in the emergency department (ED) is a stressful experience that can result in symptoms of post-traumatic stress disorder, which are associated with increased risk of morbidity and mortality in patients. No study has tested whether good clinician-patient communication in the ED is associated with better psychological outcomes in these individuals and whether it can mitigate other risk factors for post-traumatic stress symptoms (PSS) such as perception of life threat and vulnerability in the ED. Data were analysed from 474 participants in the Reactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected acute coronary syndrome. Participants were recruited from November 2013 to January 2015 at a single-site academic medical centre (New York-Presbyterian-Columbia University Medical Center). Participants reported threat perceptions in the ED and provided information on their perceptions of clinician-patient communication using the Interpersonal Process of Care Survey. PSS were assessed using the Acute Stress Disorder Scale during follow-up. 474 subjects were enrolled in the study. Median length of follow-up was 3 days after ED presentation, range 0-30 days, 80% within 8 days. Perceptions of good clinician-patient communication in the ED were associated with lower PSS, whereas increased threat perception was associated with higher PSS. A significant interaction between clinician-patient communication and threat perception on PSS suggested that patients with higher threat perception benefited most from good clinician-patient communication. Our study found an association between good clinician-patient communication in the ED during evaluation of potentially life-threatening cardiac events and decreased subsequent post-traumatic stress reactions. This association is particularly marked for patients who perceive the greatest degree of life threat and vulnerability during evaluation.

The suppression of brain activation in post-deployment military personnel with posttraumatic stress symptoms.

Previous research using cognitive paradigms has found task-related activation that includes prefrontal brain structures and that is attenuated in association with posttraumatic stress symptoms (PTSS). The present investigation used a cognitive control paradigm, the Arrows Task, to study subjects who had not sustained a traumatic brain injury during deployment and who had a wide range of scores on the Posttraumatic Stress Disorder Checklist (PCL). During the Arrows Task there was no significant activation within the full sample of 15 subjects, but deactivation was found within areas that are likely to be involved in cognitive control, including the dorsal anterior cingulate gyrus and parietal cortex. Exploratory analyses were also conducted to compare subjects with relatively high PTSS (HIGH PTSS, n = 7) to those with lower severity or no symptoms (LOW PTSS, n = 8). LOW PTSS subjects exhibited activation in nonfrontal brain areas and their activation was greater relative to the HIGH PTSS subjects. In contrast, the HIGH PTSS group had extensive deactivation and there was a negative relationship between activation and PCL scores within subcortical structures, the cerebellum, and higher-order cortical association areas. For the HIGH PTSS group there was also a positive relationship between PCL scores and activation within basic sensory and motor areas, as well as structures thought to have a role in emotion and the regulation of internal bodily states. These findings are consistent with widespread neural dysfunction in subjects with greater PTSS, including changes similar to those reported to occur with acute stress and elevated noradrenergic activity.

Brain reactivity to unpleasant stimuli is associated with severity of posttraumatic stress symptoms.

Despite the impressive progress in the biological research of posttraumatic stress disorder (PTSD), little is known about the neurobiological correlates of emotional reactions in healthy people with posttraumatic stress symptoms (PTSS). The present study investigated whether PTSS are related to the electrocortical processing of unpleasant pictures in a sample of undergraduate students. Participants were instructed to judge whether images were unpleasant or neutral while an EEG was taken. The late positive potential (LPP) to unpleasant relative to neutral was more positive for people with high PTSS than with low PTSS. Additionally, a temporospatial principal components analysis (PCA) for the whole sample identified positivities that were directly correlated with PTSS. These results provide evidence that brain reactivity to unpleasant cues would predict PTSS intensity and thus be a biomarker of PTSS severity.

Attentional bias towards emotional facial expressions in survivors of dating violence

This study identified components of attentional bias (e.g. attentional vigilance, attentional avoidance and difficulty with disengagement) that are critical characteristics of survivors of dating violence (DV). Eye movements were recorded to obtain accurate and continuous information regarding attention. DV survivors with high post-traumatic stress symptoms (DV-High PTSS group; n = 20) and low post-traumatic stress symptoms (DV-Low PTSS group; n = 22) and participants who had never experienced DV (NDV group; n = 21) were shown screens displaying emotional (angry, fearful and happy) faces paired with neutral faces and negative (angry and fearful) faces paired with happy faces for 10 s. The results indicate that the DV-High PTSS group spent longer dwelling on angry faces over time compared with the DV-Low PTSS and NDV groups. This result implies that the DV-High PTSS group focused on specific trauma-related stimuli but does not provide evidence of an attentional bias towards threatening stimuli in general.

Optimism predicts resilience in repatriated prisoners of war: A 37‐year longitudinal study

Resilience, exhibiting intact psychological functioning despite exposure to trauma, is one perspective as to why some people who are exposed to trauma do not develop symptoms. This study examines the prisoner of war experience to expand our understanding of this phenomenon in extreme cases of trauma such as prolonged captivity, malnourishment, and physical and psychological torture. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. A logistic regression analysis using resilience, defined as never receiving any psychiatric diagnosis over a 37-year follow-up period, as the outcome was performed (n = 224 with complete data). Six variables showing at least small effects emerged: officer/enlisted status, age at time of capture, length of solitary confinement, low antisocial/psychopathic personality traits, low posttraumatic stress symptoms following repatriation, and optimism. Odds ratios (ORs) and confidence intervals (CIs) confirmed the significance and relative strength of these variables, with a range from OR = 0.54, 95% CI [0.13, 2.29] to OR = 1.11, 95% CI [1.04, 1.17]. When all variables were examined continuously and categorically, dispositional optimism was the strongest variable, accounting for 17%, continuously, and 14%, categorically. We discuss optimism as a protective factor for confronting trauma and the possibility of training to increase it.

Stress and Coping Strategies Among Firefighters and Recruits

This study compared psychological distress and coping strategies for three different permanent firefighter groups in South-East Queensland, Australia: recruits (n = 42), on-shift firefighters (n = 51), and firefighters who had recently attended one of 13 fatal incidents (n = 52). Older firefighters reported more general distress but no increase in posttraumatic stress symptoms. Coping strategies tended to be associated with higher distress and posttraumatic stress, but once this general tendency was taken into account, seeking instrumental support was associated with lower posttraumatic stress symptoms. Results support previous findings that cumulative exposure and events outside work contribute to distress in firefighters.

Prematurity, maternal posttraumatic stress and consequences on the mother–infant relationship

Objective Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother–infant dyadic interactions. Methods The study enrols 47 preterm (GA < 34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index. Results Full-term mothers were more likely to follow a “Cooperative” dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a “Controlling” dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a “Heterogeneous” group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads. Conclusion Premature birth affects both mother–infant interaction characteristics and maternal representations of attachment with the infant. In particular, a “Controlling” dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent–infant relationship in order to plan supportive, preventive interventions in the neonatal period.

Chronic Pain and Posttraumatic Stress Symptoms in Litigating Motor Vehicle Accident Victims

There has been little research examining chronic pain and posttraumatic stress symptoms in persons injured in motor vehicle accidents. The purpose of this study was to evaluate differences in physical injury and impairment, psychological distress, and pain coping strategies in litigating chronic pain patients low and high in motor vehicle accident-related posttraumatic stress symptoms. A total of 160 consecutive chronic pain patients referred for psychological-legal assessment underwent semistructured interview and testing. The testing battery included the Minnesota Multiphasic Personality Inventory-2, the Multidimensional Pain Inventory, the Sickness Impact Profile, and the Coping Strategies Questionnaire. Using the sample-specific median split of 18 posttraumatic stress symptoms on the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder scale, chronic pain patients were categorized as evidencing low or high levels of posttraumatic stress symptoms. The findings indicate that participants evidencing high posttraumatic stress symptoms had more physical impairment, psychological distress, and maladaptive pain coping strategies and were more likely to be treated with antidepressants, other medications, and psychological management than participants evidencing low posttraumatic stress symptoms. A discriminant function analysis was performed using the full combination of physical injury and impairment, psychological distress, and pain coping variables in the prediction of posttraumatic stress symptom-defined group membership. The resulting discriminant function accounted for 61% of the between-group variance and correctly classified 92% of participants who were low in posttraumatic stress symptoms and 88% of participants who were high in posttraumatic stress symptoms. Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims are associated with increased physical and psychological morbidity.