Variance In Posttraumatic Stress Disorder Symptoms Research Articles

Exposure, Agency, Perceived Threat, and Guilt as Predictors of Posttraumatic Stress Disorder in Veterans

Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.

Correlations Between Sexual Abuse Histories, Perceived Danger, and PTSD Among Intimate Partner Violence Victims.

Intimate partner violence (IPV), childhood abuse, and sexual assault in adulthood are profound public health concerns, particularly for women. Exposure to trauma can contribute to long-standing health problems and escalated medical costs. Unfortunately, these experiences are often intertwined. Sexual assault often occurs in intimate relationships in which there is concurrent IPV; likewise, many victims of IPV have experienced childhood abuse. The prevalent intersections of these struggles can lead to posttraumatic stress disorder (PTSD) symptoms. This article examines the contributions of childhood abuse histories and sexual assault to PTSD symptoms among women experiencing IPV. Findings suggest childhood abuse experiences account for more variance in PTSD symptoms than adult sexual assault. Clinical implications are discussed.

Age differences in PTSD among Canadian veterans: age and health as predictors of PTSD severity.

ABSTRACT Background: To date, few studies have investigated age differences in posttraumatic stress disorder (PTSD) symptoms and none has examined age differences across symptom clusters: avoidance, re-experiencing, and hyperarousal. The first objective of this study was to investigate age differences in PTSD and its three symptom clusters. The second objective was to examine age and indices of health as predictors of PTSD symptom severity. Methods: Participants were 104 male veterans, aged 22 to 87 years, receiving specialized mental health outpatient services. Assessments included measures of health-related quality of life, pain severity, number of chronic health conditions, and symptoms of PTSD, both in total and on the symptom clusters. Results: There were significant age differences across age groups, with older veterans consistently reporting lower PTSD symptom severity, both in total and on each of the symptom clusters. Hierarchical regression analyses indicated that the inclusion of health indices accounted for significantly more variance in PTSD symptoms over and above that accounted for by age alone. Pain severity was a significant predictor of PTSD total and the three symptom clusters. Conclusions: This is the first study to report lower levels of PTSD severity among older veterans across symptom clusters. These findings are discussed in relation to age differences in the experiencing and processing of emotion, autobiographical memory, and combat experiences. This study also emphasizes the importance of assessing pain in those with symptoms of PTSD, particularly older veterans who are less likely to receive specialized mental healthcare.

Acceptance and Action Questionnaire—II scores as a predictor of posttraumatic stress disorder symptoms among war veterans.

Although much is known regarding predictors of posttraumatic stress disorder (PTSD), little of this knowledge directly informs treatment. This study examined whether higher scores on the Acceptance and Action Questionnaire—II (AAQ–II), a self-report measure that purportedly assesses experiential avoidance and psychological inflexibility, accounted for unique variance in PTSD symptoms compared with personality factors and other established predictors of PTSD. In addition, this study examined whether the construct measured by the AAQ–II accounts for unique variance in PTSD severity over and above the avoidance symptoms of PTSD. A sample of 109 trauma-exposed veterans of the wars in Iraq and Afghanistan, approximately half of whom met current PTSD criteria on the Clinician-Administered PTSD Scale (CAPS), completed self-report measures of PTSD, combat exposure, perceived life threat, peritraumatic dissociation, recent life stress, perceived postdeployment social support, and personality. Higher AAQ–II scores, which indicate higher levels of psychological inflexibility and experiential avoidance, accounted for unique variance in PTSD symptom severity after controlling for all other predictors (small effect size [ES] on the CAPS; large ES on the self-report PTSD measure). Significant effects for AAQ–II scores remained after controlling for the avoidance symptoms of PTSD (small ES on the CAPS; medium ES on the self-report measure). Scores on the AAQ–II appears to be an important predictor of PTSD that warrants further investigation. Research should continue to examine the malleability of the constructs assessed by the AAQ–II, which may be useful targets in treatment.

Predicting post‐traumatic stress disorder following first onset acute coronary syndrome: Testing a theoretical model

This research identified which theoretically predicted factors (Joseph, Williams, & Yule, 1997) were associated with the severity of post-traumatic stress disorder (PTSD) symptoms 1 and 6 months following onset of acute coronary syndrome (ACS). Predictor variables included event factors, peri-traumatic distress; and maintaining factors including coping strategies, social support, re-appraisal of event threat, and beliefs about the nature of ACS. Associations with alexithymia were also explored. One hundred and fifty participants completed questionnaires in hospital and at 1- and 6-month follow-up. Hierarchical multiple regression including both baseline and contemporaneous variables explained 52 and 42% of the variance in PTSD symptoms at each follow-up. At 1-month follow-up, predictors of PTSD symptoms were as follows: peri-traumatic distress, concern over symptoms, illness comprehension, and lack of social support. At 6-month follow-up, predictors were: peri-traumatic distress, lack of social support, use of problem-focused coping, and continued symptoms. The Joseph et al. model was generally supported. The data allow some degree of prediction of high risk individuals and suggest some possible interventions.

Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation

Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.

Killing versus witnessing in combat trauma and reports of PTSD symptoms and domestic violence

Active participation in combat trauma increased reports of posttraumatic stress disorder (PTSD) symptoms over passive witnessing of trauma. Using archival data from 376 U.S. soldiers who took part in the family interview component of the 1988 National Vietnam Veteran Readjustment Study (NVVRS), findings are that even after statistically accounting for witnessing combat trauma, U.S. soldiers who likely killed enemy soldiers in combat reported elevated levels of PTSD symptoms. Both inference and direct self-reports were used to measure killing in combat, and both measures accounted equally well for variance in PTSD symptoms. The likelihood of a soldier killing enemy combatants was also weakly related to his spouse's report of physical domestic violence in the past year. Diagnosing the mental health symptoms of combat soldiers should specifically assess whether they actively participated in wounding or killing the enemy.

A prospective study on personality and the cortisol awakening response to predict posttraumatic stress symptoms in response to military deployment

Few prospective studies on pre-trauma predictors for subsequent development of posttraumatic stress disorder (PTSD) have been conducted. In this study we prospectively investigated whether pre-deployment personality and the cortisol awakening response (CAR) predicted development of PTSD symptoms in response to military deployment. Furthermore, we hypothesized that potential effects of age, childhood trauma and previous deployment on development of PTSD symptoms were mediated via pre-deployment personality, CAR and PTSD symptoms.Path analysis was performed on data from 470 male soldiers collected before and six months after a 4-month deployment to Afghanistan. Before deployment, personality was assessed with the short-form Temperament-Character Inventory and the Cook-Medley Hostility scale. In addition, pre-deployment saliva sampling for assessment of the CAR was performed immediately after awakening and 15, 30 and 60min thereafter.Pre-deployment high hostility and low self-directedness represented intrinsic vulnerabilities for development of PTSD symptoms after deployment. The CAR assessed before deployment did not predict PTSD symptoms after deployment. Pre-deployment low-to-moderate PTSD symptoms were associated with PTSD symptoms after deployment. As hypothesized, the effects of age and childhood trauma on PTSD symptoms after deployment were mediated via personality and pre-deployment PTSD symptoms. However, the number of previous deployments was not related to development of PTSD symptoms. The total model explained 24% of variance in PTSD symptoms after military deployment.

Alexithymia and posttraumatic stress: subscales and symptom clusters

This study examined the relationship between the emotion-regulating factor alexithymia and the occurrence of posttraumatic stress disorder (PTSD) after critical incidents in a nonclinical sample of 136 nurses and ambulance personnel working in military facilities. The results showed that alexythima accounts for variance in PTSD symptoms. Breaking PTSD into its 4 symptom clusters, alexithymia was found to predict numbing and hyperarousal symptoms but not avoidance or reexperiencing symptoms. Finally, the rarely investigated, but clinically relevant, distinctive subdimensions of alexithymia were examined in relation to the 4 PTSD clusters. The difficulty identifying feelings subscale contributed most to the numbing and hyperarousal PTSD subscales. Clinical implications and future research directions are discussed.

Posttraumatic stress disorder symptoms in adolescents: risk factors versus resilience moderation

Background Exposure to community violence and trauma, stress, and childhood abuse and neglect have been identified as risk factors for the development of posttraumatic stress disorder (PTSD) symptoms among adolescents. Although evidence suggests that resilience may moderate the relationship between some of these risk factors and PTSD symptoms, no studies to date have examined these risk factors collectively. Aims Our first aim was to examine the relationship between exposure to community violence, childhood abuse and neglect, perceived stress, and PTSD symptoms. Our second aim was to examine the extent to which resilience moderated the relationship between risk factors and PTSD symptoms. Method A convenience sample of 787 participants was drawn from 5 public secondary schools in the Cape Town metropole of South Africa. The participants were invited to complete a battery of questionnaires on a single occasion. Results Of the participants, 48.3% were Black, 58.6% were female, and 31.6% were in grade 8. After controlling for covariates, we found that exposure to community violence, perceived stress, and childhood abuse and neglect together accounted for 33.4% of the variance in PTSD symptoms ( F 8,778 = 71.06, P < .001). Nevertheless, resilience moderated the relationship between childhood abuse and symptoms of PTSD ( β = .09, t 786 = 2.88, P < .001), where the independent effect of childhood abuse and neglect on PTSD symptoms was significantly reduced with increasing resilience. Resilience did not, however, interact with exposure to community violence or perceived levels of stress to influence PTSD symptoms. Conclusion High levels of exposure to community violence, perceived stress, and childhood abuse and neglect may contribute to the development of PTSD symptoms in South African adolescents. However, high levels of resilience may buffer the negative effects of childhood abuse and neglect.

Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims

The present study examined the relationship between trauma history characteristics (number and type of traumas, age at first trauma, and subjective responses to prior traumas) and the development of posttraumatic stress disorder (PTSD) symptoms following a motor vehicle accident (MVA). One hundred eighty-eight adult MVA victims provided information about prior traumatization and were evaluated for PTSD symptoms 6 weeks and one year following the MVA. Results indicated that after controlling for demographics and depression, prior trauma history characteristics accounted for a small, but significant amount of the variance in PTSD symptoms. Distress from prior trauma and number of types of prior traumas were the most meaningful trauma history predictors. Results encourage further evaluation of trauma history as a multifaceted construct.

Predictors of Enduring PTSD After an Industrial Disaster

Back to table of contents Previous article Next article LetterFull AccessLetterPhilippe J. Birmes M.D., Ph.D.Laetitia Daubisse M.D.Alain Brunet Ph.D.Philippe J. Birmes M.D., Ph.D.Search for more papers by this authorLaetitia Daubisse M.D.Search for more papers by this authorAlain Brunet Ph.D.Search for more papers by this authorPublished Online:1 Jan 2008https://doi.org/10.1176/ps.2008.59.1.116AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Predictors of Enduring PTSD After an Industrial DisasterTo the Editor: Only a few studies have examined the long-term effects (more than one year) of mass trauma on victimized communities ( 1 , 2 ). On September 21, 2001, a petrochemical plant exploded in the city of Toulouse, France. Victims were surveyed by using self-report questionnaires that assessed peritraumatic distress and dissociation and acute stress. A hierarchical multiple regression conducted with survey data gathered six months after the explosion indicated that all three constructs explained unique variance, accounting for 62% of the variance in symptoms of posttraumatic stress disorder (PTSD) ( 3 ). Here we report the results of a follow-up survey conducted 15 months after the explosion. The survey used the same predictors plus a measure of depression. Five to ten weeks after the explosion, 892 potential study participants were sent self-report questionnaires to assess symptoms of acute stress (Stanford Acute Stress Reaction Questionnaire) and depression (Beck Depression Inventory). The 391 persons who responded were sent another self-report questionnaire six months after the explosion. The second survey retrospectively assessed peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire) and distress (Peritraumatic Distress Inventory) as well as current PTSD symptoms (Posttraumatic Stress Disorder Checklist). Fifteen months after the explosion, the 200 participants who responded to the second survey were sent the same questionnaire assessing PTSD symptoms, and 129 persons responded to this third survey.To analyze the relationship between predictors and PTSD symptoms at 15 months, we computed Pearson correlations. Strong correlations with PTSD symptoms were found for peritraumatic dissociation (r=.50, p<.01), peritraumatic distress (r=.58, p<.01), acute stress symptoms (r=.71, p<.01), and depression symptoms (r=.61, p<.01). We computed a hierarchical multiple linear regression with PTSD symptom score as the dependent variable. Peritraumatic dissociation was entered first, followed by peritraumatic distress in the second step, symptoms of acute stress in the third step, and symptoms of depression in the fourth step. The model accounted for 59% of the variance in PTSD symptoms. All of our predictors were strongly correlated with persistent PTSD symptoms 15 months after exposure. The number of dropouts and retrospective ratings of the peritraumatic responses should be acknowledged as potentially limiting the generalizability of these results. However, the study found that peritraumatic dissociation and distress, acute stress, and depression were related to the development and persistence of PTSD symptoms after an industrial disaster. Loss of control and helplessness-anger, measured with the Peritraumatic Distress Inventory, were strong predictors of posttraumatic stress one year after the World Trade Center disaster ( 4 ). Acknowledgments and disclosuresThe authors report no competing interests.Dr. Birmes is affiliated with the Traumatic Stress Laboratory, Young Unit 2511, Toulouse III University, and the University Hospital of Toulouse, Toulouse, France. Dr. Daubisse is with Mixed Research Unit S558, National Institute of Health and Medical Research (INSERM), and Toulouse III University. Dr. Brunet is with Douglas Hospital Research Center and McGill University, Montreal.

Pathways to PTSD, Part I: Children With Burns

The goal of this study was to develop a model of risk factors for posttraumatic stress disorder (PTSD) in a group of acutely burned children. Seventy-two children between the ages of 7 and 17 who were admitted to the hospital for an acute burn were eligible for study. Members of families who consented completed the Child PTSD Reaction Index, the Multidimensional Anxiety Scale for Children, and other self-report measures of psychopathology and environmental stress both during the hospitalization and 3 months following the burn. A path analytic strategy was used to build a model of risk factors for PTSD. Two pathways to PTSD were discerned: 1) from the size of the burn and level of pain following the burn to the child's level of acute separation anxiety, and then to PTSD, and 2) from the size of the burn to the child's level of acute dissociation following the burn, and then to PTSD. Together these pathways accounted for almost 60% of the variance in PTSD symptoms and constituted a model with excellent fit indices. These findings support a model of complex etiology for childhood PTSD in which two independent pathways may be mediated by different biobehavioral systems.

Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping

There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.

The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women

This study examines whether experiences with four different types of intimate partner violence (IPV) increase risk for posttraumatic stress disorder (PTSD) symptoms. We examined impacts of physical, sexual, psychological, and stalking victimization by a current partner on PTSD symptoms, the extent to which each type of IPV accounted for significant variance in PTSD symptoms when controlling for other forms, and the increase in PTSD symptoms from multiple forms of IPV. Findings reveal that all types of violence were associated with increased PTSD symptoms. When controlling for other types of violence, physical, psychological, and stalking violence were still associated with PTSD symptoms. There was evidence of a dose response in which the more types of violence experienced, the more PTSD symptoms.

Studies of the vicarious traumatization of college students by the September 11th attacks: effects of proximity, exposure and connectedness

From mid-October 2001 through the end of November 2001, we collected fairly large sets of questionnaires from undergraduates at three public universities (Albany, NY, n=507, Augusta, GA, n=336, Fargo, ND, n=526) to assess rate of acute stress disorder (ASD) and level of ASD symptoms following the September 11th attacks, rate of current posttraumatic stress disorder (PTSD) and level of PTSD symptoms, and current level of depressive symptoms resulting from the September 11th attacks. We also gathered information on exposure to media coverage of the attacks, connectedness to the World Trade Center (WTC) and personnel there, and degree of engagement in reparative acts such as giving blood, attending vigils. We found higher levels of ASD, ASD symptoms, PTSD and PTSD symptoms as a function of geographical proximity to New York City (and within the Albany site, proximity of students’ homes) and gender. Exposure (hours of TV watched) was a predictor in some instances as was connectedness to WTC victims. ASD symptoms were the strongest predictor of subsequent PTSD symptoms. Path models accounted for over 60% of the variance in PTSD symptoms.

Prediction of Posttraumatic Stress Disorder: Peritraumatic Dissociation, Negative Emotions and Physical Anxiety Among French-Speaking University Students

ABSTRACT This retrospective study investigated peritraumatic predictors (peritraumatic dissociation, negative emotions and physical anxiety symptoms experienced at the time of the traumatic event) of posttraumatic stress disorder (PTSD) symptoms among 98 French-speaking university students. Participants rated their lifetime experiences of traumatic events and, in response to their “most stressful” event, completed measures of PTSD symptoms and peritraumatic reactions. Approximately 67% of respondents (N = 75) reported at least one traumatic event. Negative emotions, peritraumatic dissociation, and physical anxiety symptoms at the time of the trauma were strong predictors of PTSD symptoms. These variables explained 38% of the variance in PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.

Posttraumatic stress disorder in adult female survivors of childhood sexual abuse: a comparison study.

This study compared symptoms of posttraumatic stress disorder (PTSD) in a group of 45 adult women in outpatient treatment for childhood sexual abuse (CSA) and a group of 31 women who reported no CSA. The comparison group consisted of women in outpatient treatment for problems in their committed relationships with male living partners. This research also investigated the traumatic impact of dual abuse (both childhood sexual and physical abuse). Standardized assessment instruments were used to measure PTSD, CSA, and childhood physical abuse (CPA). Results indicated that 86.7% of the CSA group met criteria for current PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987), compared with 19.4% of the relationship distress group, providing support for CSA as an etiological agent for PTSD. In addition, 89% of the CSA survivors reported CPA. Multivariate analysis revealed that both CSA and CPA exposure variables accounted for a significant portion of the variance in PTSD symptoms in the CSA group.

The Development of Posttraumatic Stress Disorder (PTSD) in a Sample of Child Witnesses to Mother Assault

This exploratory study examined the relationship between the development of posttraumatic stress disorder (PTSD) and a number of coping variables in child witnesses to mother assault. The sample consisted of 84 children (mean age 11 years) who had been referred from shelters for battered women and child welfare agencies. Comparisons of those who met PTSD criteria (n = 47) and those who did not meet PTSD criteria (n = 37) found significant differences on variables of age, duration, and frequency of witnessing children. Child self-report instruments indicated that the PTSD group differed significantly from the non-PTSD group on the basis of assault anxiety, depression, dissociation, anger, and negative attributions. Hierarchical multiple regression analysis indicated that factors related to negative attributions and assault variables each contributed significantly to explaining 71% of the variance of PTSD symptoms, after the variables of age and sex were controlled. Discriminant function analysis correctly classified 84.3% of the respondents. The relevance of PTSD to child witnesses is considered, along with study limitations.

Posttraumatic stress disorder in a clinical sample of adult survivors of childhood Sexual Abuse

One hundred seventeen help-seeking adult survivors of childhood sexual abuse (CSA) were assessed to investigate the relationship between the level of self-reported CSA and posttraumatic stress disorder (PTSD). CSA was measured utilizing the Sexual Abuse Exposure Questionnaire, a new research instrument. Further preliminary psychometric properties of the instrument were reported. CSA was operationalized to include severity, duration, age of onset, number of perpetrators, and use of force. PTSD diagnostic status was assessed utilizing a standardized instrument, the Structured Clinical Interview for DSM-II-R. Eighty-six percent of survivors met full DSM-III-R criteria for a PTSD diagnosis at some point during their lives. Multivariate analysis indicated that CSA severity and duration accounted for significant portions of the variance in PTSD symptoms, providing support for their role as traumagenic variables.