Posttraumatic Psychological Distress Research Articles

Moving From Traumatic Events to Traumatic Experiences in the Study of Traumatic Psychopathology.

Trauma is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an event that includes "actual or threatened death, serious injury, or sexual violence" (p. 271). The list of traumatic events included in the DSM-5 represents a long history of psychiatry and psychology's attempts to define trauma and differentiate these events from less severe stressors. In this commentary, we suggest that this strict distinction between traumatic events and stressful events is not useful for public health. The current DSM-5 list of traumatic events may work well for identifying people with the most severe experiences and highest conditional probability of distress who need clinical care. However, the public health field has different priorities. If we think about posttraumatic psychological distress on a population scale, it is not only helping those with the most severe experiences that is needed; rather, public health requires paying attention to all people experiencing distressing stress and trauma reactions. We propose that context is crucial to the development of a population-relevant definition of trauma and provide examples of situations in which stressors have resulted in posttraumatic psychological distress and in which traumatic event reactions have been mitigated by the context in which they occur. We discuss trauma context from an epidemiologic perspective and conclude with recommendations for the field. This article is part of a Special Collection on Mental Health.

Reconsidering the definition of trauma

The definition of trauma has evolved and expanded over the past four decades as knowledge regarding life experiences that cause psychological distress has grown. Concurrently, the field has repeatedly grappled with what exactly constitutes trauma. There is an important, and in many respects obvious, disconnect between the definition of trauma in the DSM-5 and the experiences reported by people who have symptoms of post-traumatic stress disorder (PTSD) and related disorders. The events that researchers, clinicians, and policy makers have defined as traumatic do not capture all events reported by people who have post-traumatic psychological distress.

Mental health help-seeking experiences and service use among Australian first responders

ABSTRACT Objective: This study aimed to determine patterns of help-seeking among first responders for conditions such as post-traumatic stress disorder (PTSD) and psychological distress. Method: Data from Answering the Call, the Australian national survey of the mental health and wellbeing of police and emergency services, was analysed to determine mental health help-seeking associations, as well as to measure patterns of service use. This encompassed 14,868 employees across the ambulance, fire and rescue, police, and state emergency services sectors. Results: Over half of employees needing help for a mental health issue neither sought nor received help. First responders with severe mental distress who delayed seeking help reported that they needed a lot more help than they received. Poor help-seeking behaviour and experiences were found to be associated with high levels of PTSD and psychological distress, low levels of mental health literacy, and career concerns. No significant differences were found between the sectors with all employees exhibiting high levels of poor help-seeking behaviour. For organisation-sourced services and programmes, usage levels and perceptions of usefulness were consistently low. Conclusions: Findings support the importance of early help-seeking amongst first responders with emerging mental health conditions. All sectors exhibited sub-optimal help-seeking behaviour and experiences. The problems go beyond the organisational structures, policies and programmes of any individual sector and are likely to be systemic. While all organisations provide mental health and wellbeing programmes and services, they are either not well taken-up, or are not considered sufficiently useful by the people they are designed to help. KEY POINTS What is already known about this topic: First responders are known to be at high risk of developing mental health conditions. The rate of PTSD in Australian first responders is twice that in the general population. Early and appropriate treatment is essential in preventing mental health conditions from worsening or becoming chronic. What this study adds: This study shows consistently high levels of sub-optimal help-seeking behaviour and experiences among Australian emergency services employees across all sectors. Over half of emergency services employees needing help for a mental health issue neither sought nor received help. Usage and perceived usefulness of organisational mental health and wellbeing programs/services are very low.

THE NATURE OF PSYCHO EMOTIONAL DISORDERS IN WOMEN, EXPOSED DURING THE CHERNOBYL ACCIDENT

The accident at the 4th Power Unit of the Chernobyl NPP on April 26, 1986 is estimated worldwide as one of the most severe disasters in the history of nuclear energy, which resulted in the irradiation of various population categories. Pregnant women represent a special category of victims, since external and internal radiation affected not only the female body, but also the developing fetus. The study of such irradiation consequences is extremely important, since long-term monitoring of the state of health will make it possible to find out the main mechanisms of post-radiation effects on female and children. The aim of this work was to assess the psycho-emotional characteristics in 2 women groups. The first group is women who were irradiated due to the incorporation of radioactive iodine by the thyroid gland in April-May 1986 and were at different pregnancy stages. The second group was analyzed as a control, identical in basic parameters to the first, except that at the time of radiation exposure to iodine-131 they have not been pregnant. The severity of post-traumatic stress disorder was analyzed using a self-reporting technique using the PCL-S questionnaire. The psychological distress degree was determined using the K-6 questionnaire. The analysis of the relationship of post-traumatic stress disorder and psychological distress was carried out, the factor structure with the assessment of the contribution of latent factors, as well as inter-factor relationships were studied. A relationship between most factors of posttraumatic stress disorder and psychological distress was revealed, which may indicate the possibility of a causal relationship between the psychological status of women and the risk of somatic pathology in them. It was revealed that radiation is the direct cause of psychological maladaptation in studied women.

The relationship between dispositional empathy, psychological distress, and posttraumatic stress responses among Japanese uniformed disaster workers: a cross-sectional study

BackgroundDisaster workers suffer from psychological distress not only through the direct experience of traumatic situations but also through the indirect process of aiding disaster victims. This distress, called secondary traumatic stress, is linked to dispositional empathy, which is the tendency for individuals to imagine and experience the feelings and experiences of others. However, the association between secondary traumatic stress and dispositional empathy remains understudied.MethodsTo examine the relationship between dispositional empathy and mental health among disaster workers, we collected data from 227 Japan Ground Self-Defense Force personnel who engaged in international disaster relief activities in the Philippines following Typhoon Yolanda in 2013. The Impact of Event Scale-Revised and the Kessler Psychological Distress Scale were used to evaluate posttraumatic stress responses (PTSR) and general psychological distress (GPD), respectively. Dispositional empathy was evaluated through the Interpersonal Reactivity Index, which consists of four subscales: Perspective Taking, Fantasy, Empathic Concern, and Personal Distress. Hierarchial linear regression analyses were performed to identify the variables related to PTSR and GPD.ResultsHigh PTSR was significantly associated with high Fantasy (identification tendency, β = 0.21, p < .01), high Personal Distress (the self-oriented emotional disposition of empathy, β = 0.18, p < .05), and no experience of disaster relief activities (β = 0.15, p < .05). High GPD was associated with high Personal Distress (β = 0.28, p < .001), marital status (married, β = 0.22, p < .01), being female (β = 0.18, p < .01), medical unit (β = 0.18, p < .05), and no experience of disaster relief activities (β = 0.13, p < .05).ConclusionsAmong Japanese uniformed disaster workers, high PTSR was associated with two subtypes of dispositional empathy: the self-oriented emotional disposition of empathy and high identification tendency, whereas high GPD was associated with high identification tendency. Educational interventions that aim to mitigate these tendencies might be able to relieve the psychological distress of disaster workers.

Exploring the gold-standard: Evidence for a two-factor model of the Clinician Administered PTSD Scale for the DSM-5.

The latent factor structure of posttraumatic stress disorder (PTSD) remains a source of considerable variability. The current study compared several a priori factor structures, as well as a novel 2-factor structure of posttraumatic psychological distress as measured by the Clinician Administered PTSD scale for the DSM-5 (CAPS-5). In addition, variability in diagnostic rates according to the divergent DSM-5 and ICD-11 criteria were explored. The setting for this study was a Level 1 trauma center in a U.S. metropolitan city. Data were pooled from 2 studies (N = 309) and participants were administered the CAPS-5 at 1 (n = 139) or 6 months postinjury (n = 170). Confirmatory factor analysis (CFA) was used to compare several factor models, and prevalence rates based on DSM-5 and ICD-11 criteria were compared via z tests and kappa. CFAs of 5 factor structures indicated good fit for all models. A novel 2-factor model based on competing models of PTSD symptoms and modification indices was then tested. The 2-factor model of the CAPS-5 performed as well or better on most indices compared to a 7-factor hybrid. Comparisons of PTSD prevalence rates found no significant differences, but agreement was variable. These findings indicate that the CAPS-5 can be seen as measuring 2 distinct phenomena: posttraumatic stress disorder and general posttraumatic dysphoria. This is an important contribution to the current debate on which latent factors constitute PTSD and may reduce discordance. (PsycINFO Database Record

Assessing posttraumatic growth, complicated grief, and psychological distress in bereaved atheists and believers

ABSTRACTThe present study examines how meaning and belief in God or god(s) is related to bereavement outcomes. Data from 299 participants residing in the United States indicated that the variables of search for meaning, presence of meaning, and belief in God or god(s) were significantly related to posttraumatic growth, complicated grief, and psychological distress. Results from this study can be used to identify appropriate clinical strategies for mental health practitioners working with bereaved clients and will expand the breadth of literature on bereavement with atheist populations in the United States.

Examining Trauma and Readiness to Change among Women in a Community Re-Entry Program

ABSTRACTBackground: Posttraumatic stress disorder (PTSD) and co-occurring substance use disorders (SUDs) are common among women who are incarcerated. Objective: The purpose of this study was to examine the relationship between trauma and readiness to change substance use behaviors. Methods: This study used data from 103 participants enrolled in a residential re-entry program for women with SUDs and trauma history. Women reporting clinically elevated Trauma Symptom Inventory (TSI) subscale scores were compared to those without elevated scores on the University of Rhode Island Change Assessment (URICA) readiness to change instrument. Primary analyses included t-tests and ANCOVA to control for age and ethnicity. Results: In general, women with clinically elevated trauma scores also reported greater readiness to change. The analyses revealed significant differences on the URICA Readiness to Change scores between women who had elevated Defensive Avoidance and Impaired Self-Reference according to the TSI. Results approached significance for women who had elevated TSI subscale scores for Sexual Concerns and Dissociation. Conclusions: These results point to a need to further understand links between trauma and readiness to change, particularly, the role of posttraumatic growth and psychological distress. This study has implications for social workers and clinicians delivering evidence-based treatment. Women who had high trauma symptoms were more willing to address change. Findings also suggest a need to tailor interventions to include motivational components that are also trauma-informed.

Mental health among older refugees: the role of trauma, discrimination, and religiousness

ABSTRACTObjectives: The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma.Method: Participants were 128 older (50–80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90).Results: Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees.Conclusion: Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

The Effect of Emotional Closeness and Exchanges of Support Among Family Members on Residents’ Positive and Negative Psychological Responses After Hurricane Sandy

Introduction: This study examines how changes in emotional closeness and exchanges of support among family members after Hurricane Sandy affected residents' psychological outcomes both positively and negatively.Methods: The working sample included 130 family ties reported by 85 respondents recruited from community and shelter residents on Staten Island after it was seriously damaged by the 2012 Hurricane Sandy. Regression with robust standard errors was used to examine how changes in emotional closeness and exchanges of support with adult family members affected respondents' posttraumatic psychological distress and posttraumatic growth.Results: Results showed psychological distress was significantly increased with higher levels of instrumental support received from family members; whereas posttraumatic growth was significantly increased with greater improved emotional closeness with family members. In addition, having higher levels of education was associated with lower levels of psychological distress and respondents from shelters showed higher levels of posttraumatic growth than those who were from the community.Discussion: It is suggested that after a significant disaster, although a family may be the best to take care of its members' emotional needs, it should not be expected to satisfy the instrumental needs of its members. In addition, posttraumatic psychological distress and growth are not necessarily opposite to each other; the psychological well- being of residents after a disaster needs to be carefully examined from both perspectives.

Childhood maltreatment and adult mental health

Background: The relationship between reported childhood maltreatment and general psychological and post-traumatic distress was examined in a sample of 551 adults from different risk samples. Aims: Exposure to childhood maltreatment was assessed using the Childhood Trauma Questionnaire Short Form, which detects physical, emotional and sexual abuse and past physical and emotional neglect. Methods: The participants’ current levels of post-traumatic stress symptoms and general psychological stress symptoms were measured with the Impact of Event Scale – Revised and the Symptom Checklist 90 – Revised, respectively. Results: The results reveal a high prevalence of reported childhood maltreatment in both men and women, and the severity levels of the five types of childhood maltreatment showed significant associations with the extent of current post-traumatic and general psychological distress. Conclusion: The findings emphasize the need for appropriate procedures for identifying childhood maltreatment.

Attention bias in earthquake-exposed survivors: An event-related potential study

The Chinese Wenchuan earthquake, which happened on the 28th of May in 2008, may leave deep invisible scars in individuals. China has a large number of children and adolescents, who tend to be most vulnerable because they are in an early stage of human development and possible post-traumatic psychological distress may have a life-long consequence. Trauma survivors without post-traumatic stress disorder (PTSD) have received little attention in previous studies, especially in event-related potential (ERP) studies. We compared the attention bias to threat stimuli between the earthquake-exposed group and the control group in a masked version of the dot probe task. The target probe presented at the same space location consistent with earthquake-related words was the congruent trial, while in the space location of neutral words was the incongruent trial. Thirteen earthquake-exposed middle school students without PTSD and 13 matched controls were included in this investigation. The earthquake-exposed group showed significantly faster RTs to congruent trials than to incongruent trials. The earthquake-exposed group produced significantly shorter C1 and P1 latencies and larger C1, P1 and P2 amplitudes than the control group. In particular, enhanced P1 amplitude to threat stimuli was observed in the earthquake-exposed group. These findings are in agreement with the prediction that earthquake-exposed survivors have an attention bias to threat stimuli. The traumatic event had a much greater effect on earthquake-exposed survivors even if they showed no PTSD symptoms than individuals in the controls. These results will provide neurobiological evidences for effective intervention and prevention to post-traumatic mental problems.

Psychological Effects of Disaster Relief Activities on Japan Ground Self-Defense Force Personnel Following the 2011 Great East Japan Earthquake

Objective: Disaster relief workers are potentially exposed to severe stressors on the job, resulting in a variety of psychological responses. This study aims to clarify the psychological effects of disaster relief activities on Japan Ground Self-Defense Force (JGSDF) personnel following the 2011 Great East Japan Earthquake.Method: A self-report questionnaire was administered to 606 JGSDF personnel one month after completing the disaster relief mission. Posttraumatic stress responses and general psychological distress were assessed using the Impact of Event Scale-Revised (IES-R) and the K10 scales. Associations between outcome variables and independent variables (age, gender, military rank, length of deployment, and exposure to dead bodies) were measured with univariate analyses and subsequent multiple logistic regression analyses.Results: The mean (± SD) IES-R score was 6.2 (± 8.1), and the mean K10 score was 12.8 (± 4.4). In the univariate analyses, exposure to dead bodies and age were identified as significant factors for IES-R and K10 scores, (p < 0.01). However, the multiple logistic regression analyses did not reveal any significant factors although body handlers’ exposure approached significance for IES-R.Conclusions: The subjects reported very low psychological responses despite the severe nature of their disaster relief activities. Several factors may account for the low levels of psychological distress and posttraumatic symptoms observed in this study.

Socio-ecological correlates of mental health among ethnic minorities in areas of political conflict: A study of Druze adolescents in Israel

Children and youths living in areas of political conflict are at increased risk of mental health problems, but little is known about psychosocial adjustment among ethnic minorities living in war-afflicted settings. This cross-sectional study used an ecological approach to investigate the unique contributions of child, family/social, and minority related factors as well as traumatic exposure and perceived discrimination to the mental health of 167 Druze adolescents in Northern Israel. Outcome measures included participants' self-reported posttraumatic stress disorder symptoms, psychological distress, and emotional and behavioral problems. Adolescents reported high indirect exposure, moderate discrimination, strong ethnic identity and high religious involvement. Regression analyses showed that female gender, number of traumatic events, and perceived discrimination were associated with more severe mental health outcomes. In addition, low social support and high religious involvement predicted increased PTSD symptom severity, while stronger ethnic identity was associated with less emotional and behavioral problems. Findings are discussed in terms of the cultural characteristics of the Druze community and highlight the need to consider additional stressors, such as discrimination, when working with ethnic minority youth in conflict zones.

Posttraumatic Stress Disorder and psychological distress following medical and surgical abortion

Objective: Abortion can be a difficult event to cope with and can lead to the development of psychological disturbance. The aim of this prospective and longitudinal study was to assess and to predict Posttraumatic Stress Disorder (PTSD) symptoms following abortion. Moreover, this study aimed to assess whether the type of abortion had an impact on women’s experience. Method: Eighty-six women were approached a few hours after the abortion and then 6 weeks later. Several questionnaires were completed: the Impact of Event Scale Revised (IES-R), the Multidimensional Scale of Social Support (MSPSS), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the Peritraumatic Emotions List (PEL), the Hospital Anxiety and Depression Scale (HADS), the Perinatal Grief Scale (PGS) and the Texas Grief Inventory (TGI). Results: Six weeks after the abortion, 38% of women reported a potential PTSD and a significant decrease of the anxious symptomatology was also highlighted. Peritraumatic dissociation and peritraumatic emotions were the main predictors of the intensity of post-abortum PTSD symptoms. Compared to surgical abortion, medical abortion was associated with increasing the risk of developing a possible PTSD. Conclusion: By providing evidence on some of the main risk factors, this study highlights the need for psychological support for women and strategies of prevention to be developed.

Posttraumatic Psychological Distress and Resettlement: The Need for a Different Practice in Assisting Refugee Families

Social work practitioners are increasingly confronted with couples and families who have come from war-torn countries. Refugees may have experienced genocide, organized violence, ethnic wars, displacement, and losses of various kinds. Such experiences will often be carried through the post-migratory period and obscure legitimate individual and family processes that are often evaluated through a psychopathology lens. In this context, there is a pressing need to be attentive to refugee situations around the world and to issues related to forced migration and its impact on families. In an attempt to fill the gap in the literature on intervention with refugee families, this article presents two of the most compelling aspects of the refugee experience that can have a lasting impact on families and couples: premigration traumatic events and their potential impact on the refugee resettlement experience, and postmigration social and psychological experiences. The concept of “trauma” is presented within the context of resettlement of asylum seekers and refugees. Key stressors documented as having an impact on the long-term well-being of individuals, families, and communities who have been touched by war and conflict are outlined. Multiple-family group intervention is discussed as one of the promising approaches for helping families cope with pre- and postmigration trauma.

Selective mutism due to a dog bite trauma in a 4-year-old girl: a case report

IntroductionA child experiencing an event of threatening or catastrophic nature may experience considerable post-traumatic psychological distress. Dog bites present an important public health problem and are a frequent cause of physical trauma in children. Physicians who manage paediatric trauma may not be vigilant of the high risk of psychological stress in children exposed to a physical injury.Case presentationA 4-year-old white girl of Greek origin, with a dog-bite related trauma was admitted to the University Hospital of Crete, Greece, for surgical repair and intravenous antibiotic therapy due to extensive lesions. Exposure to the traumatic event triggered the onset of an unusual psychological response, selective mutism and acute post-traumatic stress disorder.ConclusionThere is limited literature discussing the psychological effect of dog bites in children. Parents and physicians involved in pediatric physical trauma need to be more familiar with post-traumatic behavioral reactions. Awareness of the potential development of such reactions may result in early detection and effective management of children at risk.

The Interplay of Perceived Social Support and Posttraumatic Psychological Distress Following Orofacial Injury

Social support is believed to mediate psychosocial recovery in vulnerable populations after trauma. In this study, we examine the relationships between perceived social support and posttraumatic stress disorder symptoms in a cohort of 287 socio-economically disadvantaged adults with orofacial injury, using 3 waves of data collected over a period of 1 year after the injury. Using structural equation modeling process, we evaluated the cross-lagged effects between perceived social support (PSS) and posttraumatic stress disorder (PTSD) symptoms. We found that PSS had a direct influence on PTSD only when examined concurrently. After controlling the covariates, the model supports the cross-lagged effect for PTSD symptoms on PSS at T2 and T3, which suggests a reciprocal contribution between symptoms and support as time progressed. Our data suggest that, over time, high rates of PTSD symptoms are related to a diminished perception of available social support.

Should Psychoeducation Be Embraced or Dismissed?

Should Psychoeducation Be Embraced or Dismissed?

Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree.

This longitudinal study of physical injury survivors examined the degree to which Hispanic and non-Hispanic Caucasians reported similar posttraumatic stress disorder (PTSD) symptoms. Adult physical trauma survivors (N = 677) provided information regarding posttraumatic distress by completing an interview-administered version of the PTSD Symptom Checklist (Civilian version) at 3 time points: within days of trauma exposure and again at 6 and 12 months posttrauma. Structural equation modeling with propensity weights was used in analyzing data. Results replicated prior research indicating that Hispanics report greater overall PTSD symptom severity. However, the size of this effect varied significantly across the 17 individual PTSD symptoms, and several symptoms were not reported more highly by Hispanics. Relative to non-Hispanic Caucasians, Hispanics tended to report higher levels of symptoms that could be regarded as exaggerated or intensified cognitive and sensory perceptions (e.g., hypervigilance, flashbacks). In contrast, few differences were observed for symptoms characteristic of impaired psychological functioning (e.g., difficulty concentrating, sleep disturbance). Findings suggest that the pattern of PTSD symptoms experienced most prominently by Hispanics differs in kind and not merely in degree. Results have implications for theory aimed at explaining this ethnic disparity in posttraumatic psychological distress as well as for clinical intervention with trauma-exposed Hispanics.