Traumatic Stress Responses Research Articles

Beyond PTSD: Mental Health Consequences of Violence Against Women

This article proposes that we move beyond posttraumatic stress disorder (PTSD) in our conceptualization of traumatic stress responses of victimized women exposed to serial forms of unrelenting violence, such as intimate partner violence and stalking. It is argued that the traditional PTSD framework is ill fitting in the context of some forms of violence against women (VAW), and these limits have consequences for developing appropriate interventions for some victimized women. The article further suggests going beyond PTSD by developing a more nuanced understanding of the ways in which PTSD and other mental health symptoms contribute to the vast array of deleterious personal, societal, and economic costs of VAW.

LONG-TERM TRAUMATIC STRESS RESPONSES OF SURVIVORS OF THE AUGUST 1999 EARTHQUAKE IN TURKEY

On August 17, 1999, the Marmara earthquake in Turkey led to a total collapse of two big cities, resulting in a death toll of 18,000. Although the scars of this earthquake can never be erased, the calamity can lead to a better understanding of the effects of earthquake on the survivors. We examined long-term traumatic stress responses, including symptoms of posttraumatic stress disorder (PTSD) and depression, in 107 survivors using a qualitative research method. We found that most of the survivors met diagnostic criteria for PTSD. High percentages of PTSD symptoms and hopelessness may reflect the effect of accumulating stressors related to resource loss.

Point-Counterpoint: Two Views on Traumatic Memories and Posttraumatic Stress Disorder

Recent books by Brewin (2003) and McNally (2003b) each reviewed the empirical literature on traumatic memories and posttraumatic stress disorder (PTSD). Although these authors reached similar conclusions on several topics, they differed on a number of important and controversial issues. In this article, Drs. Brewin and McNally are interviewed on these issues, and asked to comment on one another's conclusions. Issues discussed include the nature of traumatic events and traumatic stress responses, the problem of malingering in PTSD research, the relative merits of contemporary cognitive models of PTSD, the issues of whether body memories and satanic cult abuse are genuine phenomena, and the question of whether memories can be repressed and later recovered. Implications for the assessment and treatment of PTSD are also discussed. The arguments for and against the various opinions provide fertile ground for stimulating further research into these controversial topics.

Point-Counterpoint: Two Views on Traumatic Memories and Posttraumatic Stress Disorder

Recent books by Brewin (2003) and McNally (2003b) each reviewed the empirical literature on traumatic memories and posttraumatic stress disorder (PTSD). Although these authors reached similar conclusions on several topics, they differed on a number of important and controversial issues. In this article, Drs. Brewin and McNally are interviewed on these issues, and asked to comment on one another’s conclusions. Issues discussed include the nature of traumatic events and traumatic stress responses, the problem of malingering in PTSD research, the relative merits of contemporary cognitive models of PTSD, the issues of whether body memories and satanic cult abuse are genuine phenomena, and the question of whether memories can be repressed and later recovered. Implications for the assessment and treatment of PTSD are also discussed. The arguments for and against the various opinions provide fertile ground for stimulating further research into these controversial topics.

Secondary Traumatic Stress Response in Fire Fighters in the Aftermath of 9/11/2001.

On September 11, 2001, 343 fire fighters died in the line of duty responding to the terrorist attacks, explosions, fires, and collapse of the World Trade Center Towers. Coincidentally, a convenienc...

Secondary Traumatic Stress Response in Fire Fighters in the Aftermath of 9/11/2001

Secondary Traumatic Stress Response in Fire Fighters in the Aftermath of 9/11/2001

A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth

The main goal of this paper is to articulate a biopsychosocial evolutionary approach to understanding the traumatic stress response. The secondary goal of this paper is to draw out the general clinical implications of this approach. I articulate seven interconnected and overlapping empirically grounded theoretical conclusions: (1) Stress is best understood as a prerational form of biopsychological feedback regarding the organism's relationship with its environment; (2) The normal outcome of traumatic stress is growth, rather than pathology; (3) Most psychopathology is a function of the maladaptive modulation of the stress response; (4) Trauma always leaves the individual transformed on a biological, as well as psychological, level; (5) The general biological process underlying stress responses is universal, but the specific dynamics are always a function of the unique sociocultural environment and psychological makeup of the individual; (6) The biology underlying stable psychopathological symptoms may change even as the psychological symptoms remain the same; and (7) Rationality is humanity's evolutionarily newest and most sophisticated stress-reduction behavioral mechanism, and the most important aspect of restoring psychological health to the trauma victim.

Traumatic stress responses in earthquake survivors in Turkey.

This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31 %, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Emergency mental health management in bioterrorism events

The United States has not suffered significant psychosocial or medical consequences from the use of biological weapons within its territories. This has contributed to a "natural" state of denial at the community level. This denial could amplify the sense of crisis, anxiety, fear, chaos, and disorder that would accompany such a bioterrorist event. A key part of primary prevention involves counteracting this possibility before an incident occurs. Doing so will require realistic information regarding the bioterrorism threat followed by the development of a planned response and regular practice of that response. Unlike in natural disasters or other situations resulting in mass casualties, emergency department physicians or nurses and primary care physicians (working in concert with epidemiologic agencies), rather than police, firemen, or ambulance personnel, will be most likely to first identify the unfolding disaster associated with a biological attack. Like community leaders, this group of medical responders must be aware of its own susceptibility to mental health sequelae and performance decrement as the increasing demands of disaster response outpace the availability of necessary resources. A bioterrorist attack will necessitate treatment of casualties who experience neuropsychiatric symptoms and syndromes. Although symptoms may result from exposure to infection with specific biological agents, similar symptoms may result from the mere perception of exposure or arousal precipitated by fear of infection, disease, suffering, and death. Conservative use of psychotropic medications may reduce symptoms in exposed and uninfected individuals, as may cognitive-behavioral interventions. Clear, consistent, accessible, reliable, and redundant information (received from trusted sources) will diminish public uncertainty about the cause of symptoms that might otherwise prompt persons to seek unnecessary treatment. Training and preparation for contingencies experienced in an attack have the potential to enhance delivery of care. Initiating supportive social, psychotherapeutic, and psychopharmacologic treatments judiciously for symptoms and syndromes known to accompany the traumatic stress response can aid the efficient treatment of some patients and reduce long-term morbidity in affected individuals. Preventive strategies and planning must take into account the idea that specific groups within the population are at higher risk for psychiatric morbidity. First responders comprise one group at psychologic risk in this situation, and healthcare providers comprise another. These and other high-risk groups will benefit from the same supportive interventions developed for the community as a whole.

Family Secondary Trauma on the Pediatric Critical Care Unit

Abstract This study utilized the Delphi methodology to collect the opinion of experts in the clinical treatment and study of physically traumatized children and their families on the Pediatric Intensive Care Unit (PICU). Nurses, social workers, psychologists, a physician, and a family therapist were asked to identify sources of stress, response patterns, and coping mechanisms exhibited by family members following a physically traumatizing event and during the child's subsequent treatment on a PICU. Conclusions indicate that a secondary traumatic stress response may be experienced by these individuals, as well as a systemic traumatic stress reaction experienced within the family system. Recommendations for future research and clinical implications of the research findings are also discussed. This study was one of the first to utilize the Internet as it's primary means of expert recruitment and data collection. A full description of the methodology is included.

Responses of football fans to relegation of their team from the English Premier League: PTS?

To measure the level of psychological distress caused to supporters of a football team by relegation from the English Premier League. The relationship between age, sex and psychological distress are examined. Opportunity sample cross-sectional survey. Participants were approached through networks of fans and through e-mail networks. Participants were supporters (n = 65) of two relegated premiership football teams. Participants completed the Impact of Event Scale. Mean total Impact of Event Scale scores indicated a clinically significant degree of psychological distress for the majority of respondents. Age or sex of the participants did not predict Impact of Event Scale scores. The results are discussed in terms of the magnitude of Impact of Event Scale scores in relation to other stressors. It is concluded that the impact of such sporting events is psychologically significant. The psychological literature has considered traumatic stress responses to a number of stressors such as threats to life, threats to psychological well-being, threats to physical/ psychological well-being of others, witnessing traumatic events and involvement in a human or natural disaster.

Neurobiological findings in posttraumatic stress disorder: a review

Since posttraumatic stress disorder (PTSD) was first recognized as a psychiatric disorder, it has generated a great deal of scientific interest. Recent studies on the neurobiology of PTSD provide evidence that PTSD is biologically distinct from other types of traumatic and nontraumatic stress responses. This paper reviews three important directions of neurobiological research in PTSD: noradrenergic axis changes and associated alterations in autonomic responsivity neuroendocrine changes involving the hypothalamic-pituitary-adrenocortical (HPA) axis, and neuroanatomy changes involving the hippocampus. Each section reviews the salient aspects of preclinical research on the biology of stress and their bearing on the understanding of PTSD, and summarizes prominent findings from clinical biological studies of PTSD, Tentative models that integrate current findings from the clinical study of PTSD are reviewed. To conclude, the important methodological and empirical issues that need to be addressed by future studies are indicated.

Prevalence and predictors of early traumatic stress reactions in assaulted psychiatric nurses

The effects of workplace violence were investigated in a group of 39 psychiatric nurses. Comparisons were made between assaulted nurses and a control group matched for age and occupational grade. The dependent variables were traumatic stress responses, general psychological distress, concurrent stressors and workplace danger. Most assaults were physically minor but two participants (5%) met the criteria for a diagnosis of post-traumatic stress disorder (PTSD). Assaulted staff reported poorer mental health than controls and poorer anger control than at baseline. Psychological distress was higher following assaults resulting in physical injury and staff who were repeatedly assaulted reported either significantly higher or significantly lower distress than those assaulted once. This may indicate early differentiation into violence-distressed and violence-habituated groups.

Pilot evaluation of hypnotic medication during acute traumatic stress response.

Early intervention aimed at secondary prevention is a high priority for posttraumatic stress disorder (PTSD) research. Disrupted sleep may have a role in the initiation and maintenance of PTSD. Three of the participants were recruited from a surgical trauma service, and one had sought treatment in a psychiatric setting. All were within 1-3 weeks of trauma exposure and had acute PTSD symptoms that included disturbed sleep. Temazepam, a benzodiazepine hypnotic, was administered for 5 nights, tapered for 2 nights, and then discontinued. Evaluations 1-week after the medication had been discontinued revealed improved sleep and reduced PTSD severity. These observations suggest an approach that may be clinically useful and a need for more systematic trials.

Traumatic grief as a risk factor for mental and physical morbidity.

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Traumatic distress symptoms in early breast cancer. II: Outcome six weeks post surgery

One hundred and six consecutive patients with a confirmed diagnosis of breast cancer were studied before and after surgery with a clinical psychiatric interview and questionnaires (Impact of Event Scale, General Health Questionnaire and Clinical Global Impression scale). The traumatic stress response after six weeks was related to sociodemographic factors, premorbid health problems, negative life events and clinical-oncological parameters. Symptoms of traumatic distress were significantly reduced post-surgery compared to acutely, and most so among patients with no premorbid health problems and negative life events according to pre-surgery interview and self-report data. Eighteen percent of the patients reported a high level (>19) of intrusive symptoms and 14%, avoidance symptoms. Patients with premorbid impairment in work, family and social functioning and patients who during the last year had experienced the death of a close relative or a serious illness other than cancer showed the greatest distress. Previous consultations for nervous problems, age, marital status, stage of disease, type of surgery (breast-conserving versus mastectomy) and adjuvant cytostatic treatment did not influence the traumaticstress response six weeks after surgery. The level of acute posttraumatic stress response to breast cancer surgery seems best predicted by premorbid variables.

Appraisal of life threat and acute trauma responses in pediatric bone marrow transplant patients.

Although traumatic responses in children are well-documented following exposure to a variety of life-threatening circumstances, little is known about the subjective appraisal of children during the acute exposure. This paper presents both descriptive and quantifiable data regarding the responses of children during the acute phase of hospitalization for bone marrow transplantation, an extremely aggressive treatment for otherwise fatal illnesses. Children were able to appreciate the life-threatening nature of their illness and its treatment. They reported few symptoms consistent with a traumatic stress response. These findings are in contrast to recent data on survivors of childhood cancer, who generally report that they did not understand that their illness posed a threat to their lives, while reporting moderate levels of posttraumatic stress symptoms up to 10 years after completion of successful treatment. Implications of these findings are discussed.

Traumatic distress symptoms in early breast cancer I: Acute response to diagnosis

In this study, the concept of ‘acute traumatic stress response’ was applied to breast cancer diagnosis. A total of 106 patients were studied before surgery, by means of a psychiatric interview and questionnaires (Impact of Event Scale, General Health Questionnaire and Clinical Global Impression Scale). The traumatic stress response was related to age, marital status, occurrence of breast cancer in first-degree relatives, previous physical and psychological health parameters, social support and life events during the last year. Of the patients, 44% reported a high level of intrusive symptoms (mean score 17.2) and 29% of avoidance symptoms (mean score 15.0). Younger age and being married were positively correlated with intrusive symptomology while patients with a first-degree relative with breast cancer had less intrusive distress. Previous physical and psychiatric health parameters showed no association to acute traumatic stress symptoms except for those who had experienced ‘a serious illness/accident/hospitalisation last year’ who had some more avoidant symptomology. Multiple regression showed a statistically significant effect for age only on intrusive symptoms when other factors were controlled for in this analysis.

Traumatic distress symptoms in early breast cancer I: Acute response to diagnosis

In this study, the concept of ‘acute traumatic stress response’ was applied to breast cancer diagnosis. A total of 106 patients were studied before surgery, by means of a psychiatric interview and questionnaires (Impact of Event Scale, General Health Questionnaire and Clinical Global Impression Scale). The traumatic stress response was related to age, marital status, occurrence of breast cancer in first-degree relatives, previous physical and psychological health parameters, social support and life events during the last year. Of the patients, 44% reported a high level of intrusive symptoms (mean score 17.2) and 29% of avoidance symptoms (mean score 15.0). Younger age and being married were positively correlated with intrusive symptomology while patients with a first-degree relative with breast cancer had less intrusive distress. Previous physical and psychiatric health parameters showed no association to acute traumatic stress symptoms except for those who had experienced ‘a serious illness/accident/hospitalisation last year’ who had some more avoidant symptomology. Multiple regression showed a statistically significant effect for age only on intrusive symptoms when other factors were controlled for in this analysis.

Appraisal of life threat and acute trauma responses in pediatric bone marrow transplant patients

AbstractAlthough traumatic responses in children are well‐documented following exposure to a variety of life‐threatening circumstances, little is known about the subjective appraisal of children during the acute exposure. This paper presents both descriptive and quantifiable data regarding the responses of children during the acute phase of hospitalization for bone marrow transplantation, an extremely aggressive treatment for otherwise fatal illnesses. Children were able to appreciate the life‐threatening nature of their illness and its treatment. They reported few symptoms consistent with a traumatic stress response. These findings are in contrast to recent data on survivors of childhood cancer, who generally report that they did not understand that their illness posed a threat to their lives, while reporting moderate levels of posttraumatic stress symptoms up to 10 years after completion of successful treatment. Implications of these findings are discussed.