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Shiri S, Wexler ID, Schwartz I, Kadari M, Kreitler S. The association between reality-based beliefs and indirectly experienced traumatization. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2010; 45:469-76. [PMID: 22044087 DOI: 10.1080/00207594.2010.503759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.
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Affiliation(s)
- Shimon Shiri
- Department of Psychology, Tel Aviv University, Tel Aviv, Israel.
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52
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Bui E, Brunet A, Olliac B, Very E, Allenou C, Raynaud JP, Claudet I, Bourdet-Loubère S, Grandjean H, Schmitt L, Birmes P. Validation of the Peritraumatic Dissociative Experiences Questionnaire and Peritraumatic Distress Inventory in school-aged victims of road traffic accidents. Eur Psychiatry 2010; 26:108-11. [PMID: 21071181 DOI: 10.1016/j.eurpsy.2010.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/28/2010] [Accepted: 09/20/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although the reliable and valid Peritraumatic Distress Inventory (PDI-C) and Peritraumatic Dissociative Experiences Questionnaire (PDEQ) are useful for identifying adults at risk of developing acute and chronic posttraumatic stress disorder (PTSD), they have not been validated in school-aged children and their predictive values remain unknown in this population. This study aims to assess the psychometric properties of the children versions of these two measures (PDI-C and PDEQ-C) in a sample of French-speaking school-children. METHODS One-hundred and thirty-three consecutive victims of road traffic accidents, aged 8-15 years, were recruited into this longitudinal study via the emergency room. The peritraumatic reactions were assessed at baseline and PTSD symptoms were assessed 1 month later. RESULTS Cronbach's alpha coefficients were 0.8 and 0.77 for the PDI-C and PDEQ-C, respectively. The 1-month test-retest correlation coefficient (n=33) was 0.77 for both measures. The PDI-C demonstrated a two-factor structure while the PDEQ-C displayed a one-factor structure. As with adults, the two measures were intercorrelated (r=0.52) and correlated with subsequent PTSD symptoms and diagnosis (r=0.21-0.56; P<0.05). CONCLUSIONS The children versions of the PDI and PDEQ are reliable and valid in children.
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Affiliation(s)
- E Bui
- Laboratoire du stress traumatique (LST-JE 2511), CHU de Toulouse, hôpital Casselardit, université de Toulouse, UPS, Toulouse cedex 9, France.
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Bremner JD. Cognitive processes in dissociation: comment on Giesbrecht et al. (2008). Psychol Bull 2010; 136:1-6; discussion 7-11. [PMID: 20063920 DOI: 10.1037/a0018021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In their recent review "Cognitive Processes in Dissociation: An Analysis of Core Theoretical Assumptions," published in Psychological Bulletin, Giesbrecht, Lynn, Lilienfeld, and Merckelbach have challenged the widely accepted trauma theory of dissociation, which holds that dissociative symptoms are caused by traumatic stress. In doing so, the authors have outlined a series of links between various constructs--such as fantasy proneness, cognitive failures, absorption, suggestibility, altered information-processing, dissociation, and amnesia--claiming that these linkages lead to the false conclusion that trauma causes dissociation. A review of the literature, however, shows that these are not necessarily related constructs. Careful examination of their arguments reveals no basis for the conclusion that there is no association between trauma and dissociation. The current comment offers a critical review and rebuttal of Giesbrecht et al.'s argument that there is no relationship between trauma and dissociation.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine and Veterans Affairs Medical Center, Atlanta, Georgia 30306, USA.
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55
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Meffert SM, Metzler TJ, Henn-Haase C, McCaslin S, Inslicht S, Chemtob C, Neylan T, Marmar CR. A prospective study of trait anger and PTSD symptoms in police. J Trauma Stress 2008; 21:410-6. [PMID: 18720397 PMCID: PMC3974928 DOI: 10.1002/jts.20350] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.
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Affiliation(s)
- Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA.
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Hagenaars MA, van Minnen A, Holmes EA, Brewin CR, Hoogduin KAL. The effect of hypnotically induced somatoform dissociation on the development of intrusions after an aversive film. Cogn Emot 2008. [DOI: 10.1080/02699930701575151] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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57
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True and false recall and dissociation among maltreated children: the role of self-schema. Dev Psychopathol 2008; 20:213-32. [PMID: 18211735 DOI: 10.1017/s0954579408000102] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The current investigation addresses the manner through which trauma affects basic memory and self-system processes. True and false recall for self-referent stimuli were assessed in conjunction with dissociative symptomatology among abused (N=76), neglected (N=92), and nonmaltreated (N=116) school-aged children. Abused, neglected, and nonmaltreated children did not differ in the level of processing self-schema effect or in the occurrence and frequency of false recall. Rather, differences in the affective valence of false recall emerged as a function of maltreatment subtype and age. Regarding dissociation, the abused children displayed higher levels of dissociative symptomatology than did the nonmaltreated children. Although abused, neglected, and nonmaltreated children did not exhibit differences in the valence of their self-schemas, positive and negative self-schemas were related to self-integration differently among the subgroups of maltreatment. Negative self-schemas were associated with increased dissociation among the abused children, whereas positive self-schemas were related to increased dissociation for the neglected children. Thus, positive self-schemas displayed by the younger neglected children were related to higher dissociation, suggestive of defensive self-processing. Implications for clinical intervention are underscored.
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58
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Huang G, Zhang Y, Momartin S, Huang X, Zhao L. Child sexual abuse, coping strategies and lifetime posttraumatic stress disorder among female inmates. Int J Prison Health 2008; 4:54-63. [PMID: 18382850 DOI: 10.1080/17449200701875840] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of the study was to assess the relationship between child sexual abuse (CSA) and posttraumatic stress disorder (PTSD) in female inmates in China. A total of 471 participants were assessed for CSA, personality traits, coping strategies, and frequency of lifetime PTSD. Results demonstrated that CSA and negative coping were predictive factors for lifetime PTSD among female inmates after personality traits were controlled. The findings suggest that CSA is one potential factor contributing to lifetime PTSD among female inmates. The importance of screening for CSA among female inmates was highly emphasized. Early intervention and prevention programmes based on coping skills may be useful to forestall the development of chronic PTSD in female inmates.
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Affiliation(s)
- Guoping Huang
- The Mental Health Center of Sichuan Province, China.
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59
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Chang CM, Lee LC, Connor KM, Davidson JRT, Lai TJ. Modification effects of coping on post-traumatic morbidity among earthquake rescuers. Psychiatry Res 2008; 158:164-71. [PMID: 18258306 DOI: 10.1016/j.psychres.2006.07.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 05/17/2006] [Accepted: 07/29/2006] [Indexed: 11/17/2022]
Abstract
This study aims to investigate the modification effects of coping strategies on the relationships between rescue effort and psychiatric morbidity (i.e. general psychiatric morbidity and post-traumatic morbidity) in earthquake rescue workers. Firefighters (n=193) who were involved in the rescue effort after the Taiwan Chi-Chi earthquake were invited to complete a questionnaire which contained questions on demographics, exposure to rescue work, general psychiatric morbidity, post-traumatic morbidity, and coping strategies. Multivariate regression models with interaction terms were carried out to investigate the modification effect of coping strategies on the relationships between rescue effort and psychiatric morbidities. Older age and longer job experiences (>3 years) were associated with both general psychiatric and post-traumatic morbidities. Coping strategies such as confrontive coping, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem solving, and positive appraisal significantly modified the effect of exposure to dead bodies on general psychiatric morbidity. Furthermore, confrontive coping, distancing, and planned problem solving significantly modified the effect of exposure to direct rescue involvement on general psychiatric morbidity. However, coping strategies were not observed to buffer the effect of rescue involvement or contact with dead bodies on post-traumatic morbidity. More frequent use of coping strategies could reduce the effect that exposure to rescue efforts has on the incidence of general psychiatric morbidity in rescue workers. However, coping strategies do not seem to reduce the influence of such exposure on trauma-related morbidities. This suggests that coping strategies can be used to prevent general psychiatric morbidity but not trauma-related morbidities.
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Affiliation(s)
- Chia-Ming Chang
- Department of Psychiatry and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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60
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Gates DM, Gillespie GL. Secondary Traumatic Stress in Nurses Who Care for Traumatized Women. J Obstet Gynecol Neonatal Nurs 2008; 37:243-9. [DOI: 10.1111/j.1552-6909.2008.00228.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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61
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PDM volume 23 issue 1 Cover and Back matter. Prehosp Disaster Med 2008. [DOI: 10.1017/s1049023x00005458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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62
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Coping with posttraumatic stress disorder and comorbidity after myocardial infarction. Compr Psychiatry 2008; 49:55-64. [PMID: 18063042 DOI: 10.1016/j.comppsych.2007.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/27/2007] [Accepted: 08/07/2007] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Literature on the relationship between coping strategies, posttraumatic stress after myocardial infarction (post-MI PTSD), and comorbidity is limited. This study aimed to fill this gap in literature by investigating this relationship. METHOD One hundred twenty patients with MI were recruited from 2 general practices and interviewed using the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire, and the COPE Scale. RESULTS Thirty-one percent had PTSD. Patients used acceptance-focused coping in that most of them accepted that the MI had happened and that it could not be changed. At the same time, some patients used avoidance-focused coping in that they disengaged themselves mentally and behaviorally from the traumatic effects of MI. When the variables of age, bypass surgery, mental health problems before MI, and angioplasty were held constant, the results showed that patients who used maladaptive coping strategies of emotion-focused and avoidance-focused copings tended to report more comorbid symptoms. Patients who underwent medical procedures or interventions such as bypass surgery and angioplasty tended to report more PTSD symptoms. CONCLUSIONS The way in which MI patients' coping strategies relate to health outcomes has been shown to be symptom-specific. Using maladaptive coping strategies does not necessarily have a significant impact on PTSD symptoms. On the other hand, medical procedures or interventions for treating MI can play a major role in maintaining PTSD symptoms for patients with MI.
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63
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Yoshizumi T, Murase S. The effect of avoidant tendencies on the intensity of intrusive memories in a community sample of college students. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Henry M, Fishman JR, Youngner SJ. Propranolol and the prevention of post-traumatic stress disorder: is it wrong to erase the "sting" of bad memories? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2007; 7:12-20. [PMID: 17849331 DOI: 10.1080/15265160701518474] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry.
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Affiliation(s)
- Michael Henry
- Case Western Reserve University, Cleveland, OH 44106-4976, USA
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65
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Abstract
Dissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. The authors tested whether experimentally induced increases in state dissociation would cause an analgesic response. Participants (N = 120) were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on pre- and postchanges in subjective pain and immersion time in response to a standard cold pressor test. Unexpectedly, the dissociation induction led to small, but significant increases in subjective pain and did not lead to greater immersion time. An exploratory analysis revealed that increases in absorption and derealization significantly predicted increased subjective pain and increased immersion time, respectively.
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Affiliation(s)
- Jonathan D Horowitz
- Laboratory for Study of Anxiety Disorders, University of Texas at Austin, Austin, TX 78712-0187, USA
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66
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Hoge EA, Austin ED, Pollack MH. Resilience: research evidence and conceptual considerations for posttraumatic stress disorder. Depress Anxiety 2007; 24:139-52. [PMID: 16892420 DOI: 10.1002/da.20175] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The growing recognition and occurrence of traumatic exposure in the general population has given increased salience to the need to understand the concept of resilience. More than just the "flip side" of a risk factor, the notion of resilience encompasses psychological and biological characteristics, intrinsic to an individual, that might be modifiable and that confer protection against the development of psychopathology in the face of stress. In this review, we provide some perspective on the concept of "resilience" by examining early use of the term in research on "children at risk" and discuss the relationship between risk and resilience factors. We then review psychological and biological factors that may confer resilience to the development of posttraumatic stress disorder (PTSD) following trauma, examine how resilience has been assessed and measured, and discuss issues to be addressed in furthering our understanding of this critical concept going forward.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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67
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Fikretoglu D, Brunet A, Best SR, Metzler TJ, Delucchi K, Weiss DS, Fagan J, Liberman A, Marmar CR. Peritraumatic fear, helplessness and horror and peritraumatic dissociation: Do physical and cognitive symptoms of panic mediate the relationship between the two? Behav Res Ther 2007; 45:39-47. [PMID: 16516845 DOI: 10.1016/j.brat.2006.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 12/30/2005] [Accepted: 01/19/2006] [Indexed: 11/22/2022]
Abstract
The goal of this study was to examine whether panic mediates the relationship between fear, helplessness, and horror (PTSD criterion A2) and dissociation at the time of trauma. The study sample included 709 police officers and 317 peer-nominated civilians who had been exposed to a variety of critical incidents. Participants filled out measures of critical incident exposure, PTSD criterion A2, panic, and dissociation. Results indicate that together, physical and cognitive symptoms of panic completely mediate the relationship between criterion A2 and dissociation in civilians, and partially mediate that relationship in police. These results provide support for the idea that panic mediates the relationship between fear, helplessness, and horror (criterion A2) and dissociation at the time of trauma. The results also raise the possibility, however, that the mediational role of panic may be further moderated by additional variables.
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Affiliation(s)
- Deniz Fikretoglu
- Douglas Hospital Research Center, McGill University, Montreal, Canada.
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Taft CT, Resick PA, Panuzio J, Vogt DS, Mechanic MB. Examining the correlates of engagement and disengagement coping among help-seeking battered women. VIOLENCE AND VICTIMS 2007; 22:3-17. [PMID: 17390560 PMCID: PMC2977516 DOI: 10.1891/vv-v22i1a001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study examined several potential correlates of engagement and disengagement coping, including abuse-related factors, socioeconomic and social coping resources, and childhood trauma variables among a sample of battered women (N = 388). Relationship abuse frequency, particularly psychological aggression, and peritraumatic dissociation were the strongest positive predictors of the use of disengagement coping. Social coping resources, including tangible support and appraisals of social support and belonging, were associated with higher engagement coping and lower disengagement coping. A positive association was also found between interparental domestic violence and disengagement coping, and negative associations were found between both childhood physical and sexual abuse and engagement coping. Results suggest that coping strategies used by battered women are multidetermined and deserve further exploration.
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Affiliation(s)
- Casey T Taft
- National Center for PTSD, VA Boston Healthcare System, MA 02130, USA.
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69
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Dalenberg C. Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community. TRAUMA, VIOLENCE & ABUSE 2006; 7:274-310. [PMID: 17065548 DOI: 10.1177/1524838006294572] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.
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McCaslin SE, Rogers CE, Metzler TJ, Best SR, Weiss DS, Fagan JA, Liberman A, Marmar CR. The impact of personal threat on police officers' responses to critical incident stressors. J Nerv Ment Dis 2006; 194:591-7. [PMID: 16909067 DOI: 10.1097/01.nmd.0000230641.43013.68] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The relationship of type of critical incident (CI) stressor with peritraumatic responses and posttraumatic stress disorder symptoms was examined in police. Officers (N = 662) provided narratives of their most distressing CI experienced during police service and completed measures of related peritraumatic responses and posttraumatic stress disorder symptoms. Narratives were reliably rated (kappa = .80-1.0) on seven categories emerging from a series of factor analyses of a measure of critical incident stressors. Additional analysis revealed that the classification of primary narrative features required only five categories (personal life threat, duty-related violence, encountering physical or sexual assault victims, exposure to civilian death, other). When analyzed by further collapsing these five categories into high versus low personal threat, officers whose narratives contained high personal threat reported more peritraumatic dissociation, peritraumatic emotional distress, and current hyperarousal symptoms. Results suggest that greater personal threat during a CI may place an officer at greater risk for subsequent distress.
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Affiliation(s)
- Shannon E McCaslin
- Department of Psychiatry, University of California, San Francisco, California, USA.
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71
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Sterud T, Ekeberg Ø, Hem E. Health status in the ambulance services: a systematic review. BMC Health Serv Res 2006; 6:82. [PMID: 16817949 PMCID: PMC1559607 DOI: 10.1186/1472-6963-6-82] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 07/03/2006] [Indexed: 11/17/2022] Open
Abstract
Background Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services. Methods We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group. Results Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population. Conclusion Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research.
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Affiliation(s)
- Tom Sterud
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway
| | - Øivind Ekeberg
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway
| | - Erlend Hem
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, NO-0317 Oslo, Norway
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Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R, Mohr D, Neylan T. Predictors of Posttraumatic Stress in Police and Other First Responders. Ann N Y Acad Sci 2006; 1071:1-18. [PMID: 16891557 DOI: 10.1196/annals.1364.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We provide an overview of previous research conducted by our group on risk and resilience factors for PTSD symptoms in police and other first responders. Based on our work, the findings of other investigators on individual differences in risk for PTSD, and drawing on preclinical studies fear conditioning and extinction, we propose a conceptual model for the development of PTSD symptoms emphasizing the role of vulnerability and resilience to peritraumatic panic reactions. We tested this conceptual model in a cross-sectional sample of police officers (n = 715). Utilizing an hierarchical linear regression model we were able to explain 39.7% of the variance in PTSD symptoms. Five variables remained significant in the final model; greater peritraumatic distress (beta = 0.240, P < .001), greater peritraumatic dissociation (beta = 0.174, P < .001), greater problem-solving coping (beta = 0.103, P < .01), greater routine work environment stress (beta = 0.182, P < .001), and lower levels of social support (beta = -0.246, P < .001). These results were largely consistent with the proposed conceptual model. Next steps in this line of research will be to test this model prospectively in a sample of 400 police academy recruits assessed during training and currently being followed for the first 2 years of police service.
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Affiliation(s)
- Charles R Marmar
- San Francisco Veterans Affairs Medical Center, 4150 Clement St. (116 P), San Francisco, CA 94121, USA.
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Psychische Verarbeitung nach einem terroristischen Anschlag. Notf Rett Med 2006. [DOI: 10.1007/s10049-006-0810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cohen P, Kasen S, Chen H, Gordon K, Berenson K, Brook J, White T. Current affairs and the public psyche: American anxiety in the post 9/11 world. Soc Psychiatry Psychiatr Epidemiol 2006; 41:251-60. [PMID: 16501884 DOI: 10.1007/s00127-006-0033-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The most recent wave of interviews in a longitudinal study spanned the terrorist attacks of September 11, 2001. This unintended "natural experiment" allows examination of effects of traumatic events in ways impossible in studies conducted solely after the event and in populations not previously studied. METHODS Participants were 610 members of the randomly selected Children in the Community cohort studied longitudinally for over 25 years and between ages 27 and 38 at the time of the current in-home interviews. Symptoms of generalized anxiety, post-traumatic stress disorder, panic disorder, agoraphobia, dissociation, and depression were assessed with an adaptation of the Structured Clinical Interview for Diagnosis. Changes in self-reported symptoms from an assessment 10 years earlier were related to the date of interview between 7/2001 and 12/2003 by polynomial regression methods, including demographic and design controls. Diagnoses based on clinical follow-up were also examined. RESULTS In contrast to other data on this cohort where timing effects were absent, levels of symptoms were related to time of interview. The months following 9/11/2001 and the two anniversary periods in 2002 and 2003 showed significant elevation in anxiety symptoms (t = 2.50, df = 608, P = 0.013) with some evidence of elevated anxiety disorder as well (Fisher's exact test P = 0.096). Similar patterns were seen for specific anxiety and depressive symptom groups. Effects of religious participation, patriotism, having offspring, and media exposure on anxiety symptoms tended to differ by season, but the effect of community involvement did not. Proximity to New York City was not significantly related to symptoms. CONCLUSIONS Study findings suggest that young Americans showed symptomatic and, possibly, diagnostic anxiety reactions to the events of 9/11 that persisted in response to heightened awareness of ongoing threat during anniversary periods.
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Affiliation(s)
- Patricia Cohen
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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75
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Morren M, Yzermans CJ, van Nispen RMA, Wevers SJM. The health of volunteer firefighters three years after a technological disaster. J Occup Health 2006; 47:523-32. [PMID: 16369116 DOI: 10.1539/joh.47.523] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
On May 13, 2000, a firework depot exploded in a residential area of the city of Enschede, The Netherlands. Many disaster workers responded, including volunteer firefighters, a group that has received little attention in disaster research. This study examined the presence of health problems in volunteer firefighters who were involved in disaster work, three years after the disaster. Furthermore, it was investigated whether demographic characteristics and disaster exposure predicted health problems. The study population consisted of 246 volunteer firefighters who were deployed in disaster work and 71 non-deployed controls. These firefighters completed a questionnaire which inquired about their perceived health and health change, physical symptoms, post-traumatic stress, mental health problems, and health care utilization. Three years after the disaster, no health differences emerged between deployed and non-deployed firefighters. Good health and health improvement over the previous year were reported. Respondents who encountered more distressing experiences during disaster work or carried out more direct disaster-related recovery tasks reported more mental health problems and health care utilization. However, the most reliable predictors of health problems were distressing experiences unrelated to the disaster in personal life or during work. Three years after the disaster, the health of volunteer firefighters involved in the disaster work was not much impaired, possibly because aftercare was available and utilized. Nevertheless, disaster exposure was associated with elevated post-traumatic stress symptoms and mental health care utilization. Health care workers should direct specific attention to the treatment and prevention of post-traumatic stress symptoms in cases of major accidents or disasters.
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Affiliation(s)
- Mattijn Morren
- NIVEL, Netherlands Institute for Health Services Research, Utrecht.
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76
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Fraidlin N, Rabin B. Social workers confront terrorist victims: The interventions and the difficulties. SOCIAL WORK IN HEALTH CARE 2006; 43:115-30. [PMID: 16956856 DOI: 10.1300/j010v43n02_08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The article deals with unremitting stress experienced by social workers dealing with terror victims. The article will describe the activity of social workers responsible for setting up a hospital information center. It will describe how they assist families searching for their loved ones and the process of identifying victims. The process in which the uncertainty is treated, the anxiety is contained, bad news are conveyed and concrete solutions are provided, will be elaborated on. Special emphasis will be placed on the multifaceted complimentary relationship between team members and between the provision of support, role exchange and the opportunity to share difficult experiences. The team is expert in identifying both personal and collective signs of distress. This is of particular significance and importance in connection with compassion fatigue, survival guilt, anxiety, depression and on- going burnout, regarding themselves and their colleagues. The article will propose organizational and clinical solutions, which could also be of service to other frameworks within the health system.
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Affiliation(s)
- Nelly Fraidlin
- Social Services Department, Sapir Medical Center, Meir Hospital, Kfar Saba, Israel.
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77
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Wong M, Looney E, Michaels J, Palesh O, Koopman C. A preliminary study of peritraumatic dissociation, social support, and coping in relation to posttraumatic stress symptoms for a parent's cancer. Psychooncology 2006; 15:1093-8. [PMID: 16548023 DOI: 10.1002/pon.1041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examined predictors of posttraumatic stress disorder (PTSD) symptoms in adults who, as children, had a parent diagnosed with cancer. Possible predictors of adulthood PTSD examined were peritraumatic dissociation, satisfaction with social support, coping through denial, behavioral disengagement and self-distraction, and whether or not the parent died. Thirty research participants (20 women and 10 men, ages 18-38) were recruited who were 8-17-years old at the time of a parent's cancer diagnosis. Each participant completed measures of their current PTSD symptoms in response to their parent's cancer, peritraumatic dissociative experiences, demographic characteristics, and satisfaction with social support and use of coping strategies at the time of their parent's cancer diagnosis. Seventeen percent met screening criteria for likely PTSD. As hypothesized, PTSD symptoms were strongly and positively correlated with peritraumatic dissociation. Furthermore, PTSD symptoms were greater among females and were related to greater use of denial and behavioral disengagement and to less satisfaction with social support. These results suggest that health care providers need to recognize symptoms of peritraumatic dissociation in the children of parents who are diagnosed with cancer so that steps can be taken to minimize the children's development of PTSD that may extend into their adult lives.
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Affiliation(s)
- Melisa Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, CA 94305-5718, USA.
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78
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Olff M, Langeland W, Gersons BPR. The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology 2005; 30:974-82. [PMID: 15964146 DOI: 10.1016/j.psyneuen.2005.04.009] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Revised: 04/18/2005] [Accepted: 04/21/2005] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions where a specific psychosocial stressor is explicitly tied to etiology. Although a majority of people experience a traumatic event in their life, most of them will not develop PTSD or other mental health problems such as depressive or anxiety disorders. Emotional and neurobiological responses to psychosocial stressors show striking individual variation. In this paper cognitive appraisal and coping factors are explored as potential sources of individual differences in the neuroendocrinological stress response, and subsequently in mental health outcome. Continued study of the psychobiology of trauma and PTSD will enhance our understanding of adaptation to psychosocial stressors and support efforts to treat associated psychological and biological sequelae.
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Affiliation(s)
- Miranda Olff
- Center for Psychological Trauma, Academic Medical Center/De Meren, Department of Psychiatry, University of Amsterdam, 1105 BC Amsterdam, The Netherlands.
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79
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Shapinsky AC, Rapport LJ, Henderson MJ, Axelrod BN. Civilian PTSD scales: relationships with trait characteristics and everyday distress. Assessment 2005; 12:220-30. [PMID: 15914723 DOI: 10.1177/1073191104273130] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Strong associations between civilian posttraumatic stress disorder (PTSD) scales and measures of general psychological distress suggest that the scales are nonspecific to PTSD. Three common PTSD scales were administered to 122 undergraduates who had experienced an emotionally salient, nontraumatic event: a college examination. Results indicated that normal levels of anxiety associated with the examination were positively correlated with scores on the Impact of Event Scale-Revised, Revised Civilian Mississippi Scale, and PTSD Checklist-Civilian Version. Multiple regression analyses indicated that substantial variance in the PTSD scales was accounted for by trait characteristics such as negative and positive affectivity and affect intensity (R2 .29 to .53). Negative affectivity correlated as highly with PTSD measures (r = .46 to .71) as those measures correlated with each other (r = .48 to .65). A high proportion of participants exceeded clinical cutoffs on these measures. The findings suggest that these PTSD scales may be overly sensitive to nontraumatic stressors such as everyday distress and trait characteristics.
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80
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Marx BP, Sloan DM. Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behav Res Ther 2005; 43:569-83. [PMID: 15865913 DOI: 10.1016/j.brat.2004.04.004] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 03/30/2004] [Accepted: 04/07/2004] [Indexed: 10/26/2022]
Abstract
This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.
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Affiliation(s)
- Brian P Marx
- Department of Psychology, Temple University, Weiss Hall, Philadelphia, PA 19122, USA.
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81
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Abstract
Research has suggested that rescue workers are at increased risk for psychological distress. To determine whether 9/11 deployment was a significant risk factor for canine search and rescue handlers, 82 deployed handlers were compared to 32 nondeployed handlers on measures of posttraumatic stress disorder (PTSD), depression, anxiety, acute stress, and clinical diagnoses. Deployed handlers reported more PTSD and general psychological distress 6 months after 9/11. Among deployed handlers, prior diagnoses and peritraumatic reactions were associated with psychological distress whereas social support and training were protective. Results suggest that more extensive screening and prophylactic interventions for individuals with a history of mental illness could be beneficial. Future research should examine identified risk/resilience factors prospectively, and training and intervention should be designed accordingly.
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Affiliation(s)
- Jennifer Alvarez
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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82
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Fiszman A, Marques C, Berger W, Volchan E, Oliveira LAS, Coutinho ESF, Mendlowicz M, Figueira I. Adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Versão Auto-Aplicativa. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s0101-81082005000200005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUÇÃO: Este artigo apresenta a adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Self-Report Version (PDEQ-SRV), para rastrear e quantificar os fenômenos dissociativos peritraumáticos. MÉTODOS: Fizeram-se duas traduções e suas respectivas retrotraduções, avaliação da equivalência semântica, elaboração da versão-síntese, pré-teste na população-alvo e realização da versão final. RESULTADOS: Observou-se um grau elevado de equivalência semântica entre o instrumento original e os dois pares de traduções/retrotraduções da perspectiva dos significados referencial e geral. O pré-teste na população-alvo conduziu a poucas modificações, que confirmaram a realização dos critérios de equivalência semântica. DISCUSSÃO: Este trabalho disponibiliza a primeira adaptação para o contexto brasileiro de um instrumento específico para a detecção e a quantificação de sintomas dissociativos peritraumáticos.
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83
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Pole N, Best SR, Metzler T, Marmar CR. Why are hispanics at greater risk for PTSD? CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2005; 11:144-61. [PMID: 15884985 DOI: 10.1037/1099-9809.11.2.144] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several studies have found that Hispanic Americans have higher rates of posttraumatic stress disorder (PTSD) than non-Hispanic Caucasian and Black Americans. The authors identified predictors of PTSD symptom severity that distinguished Hispanic police officers (n=189) from their non-Hispanic Caucasian (n=317) and Black (n=162) counterparts and modeled them to explain the elevated Hispanic risk for PTSD. The authors found that greater peritraumatic dissociation, greater wishful thinking and self-blame coping, lower social support, and greater perceived racism were important variables in explaining the elevated PTSD symptoms among Hispanics. Results are discussed in the context of Hispanic culture and may be important for prevention of mental illness in the fastest growing ethnic group in the United States.
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Affiliation(s)
- Nnamdi Pole
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1109, USA.
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84
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Lane P, O'Brien U, Gooney MA, Reid T. The Progression of Holism Into Postgraduate Curricula in Critical Care Nursing. Dimens Crit Care Nurs 2005; 24:131-8. [PMID: 15912063 DOI: 10.1097/00003465-200505000-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Critical care education is an important part of the professional development of a competent critical care nurse. Interdependence between physiological and psychosocial theories and concepts is a key consideration in the development of critical care educational programs. This multidisciplinary educational framework fosters a deeper understanding of factors contributing to ill health. Establishing a strategic framework where research, education, clinical excellence, and quality assurance are interlinked is central to enhancing the efficacy of patient care outcomes.
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MESH Headings
- Adaptation, Psychological
- Attitude of Health Personnel
- Critical Care/organization & administration
- Critical Care/psychology
- Critical Illness/nursing
- Critical Illness/psychology
- Curriculum/trends
- Education, Nursing, Graduate/organization & administration
- Holistic Health
- Holistic Nursing/education
- Holistic Nursing/trends
- Humans
- Ireland
- Knowledge
- Models, Educational
- Models, Nursing
- Nurse's Role
- Nursing Education Research
- Nursing Research/education
- Nursing Research/organization & administration
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/organization & administration
- Patient Care Team/organization & administration
- Philosophy, Nursing
- Program Development
- Program Evaluation
- Quality Assurance, Health Care/organization & administration
- Spirituality
- Students, Nursing/psychology
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Affiliation(s)
- Paula Lane
- Waterford Regional Hospital, Dunmore Rd, Waterford, Republic of Ireland.
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85
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Kindt M, Van den Hout M, Buck N. Dissociation related to subjective memory fragmentation and intrusions but not to objective memory disturbances. J Behav Ther Exp Psychiatry 2005; 36:43-59. [PMID: 15687009 DOI: 10.1016/j.jbtep.2004.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The present study was a replication of Kindt and Van den Hout (Behaviour Research and Therapy 41 (2003) 167) with several methodological adaptations. Two experiments were designed to test whether state dissociation is related to objective memory disturbances, or whether dissociation is confined to the realm of subjective experience. High trait dissociative participants (N(exp.1)=25; N(exp.2)=25) and low trait dissociative participants (N(exp.1)=25; N(exp.2)=25) were selected from normal samples (N(exp.1)=372; N(exp.2)=341) on basis of scores on the Dissociative Experience Scale (DES). Participants watched an extremely aversive film, after which state dissociation was measured by the Peri-traumatic Dissociative Experience Questionnaire (PDEQ). Memory disturbances were assessed 4h later (Exp. 1) or 1 week later (Exp. 2). Objective memory disturbances were assessed by a sequential memory task, items tapping perceptual representations (Exp. 1), or an open question with respect to the remembrance of the film (Exp. 2). Subjective memory disturbances were measured by means of visual analogue scales assessing fragmentation and intrusions. The two experiments provided a fairly exact replication of an earlier experiment (Behaviour Research and Therapy 41 (2003) 167-178), indicating a relation between dissociation and memory disturbances that appeared to be confined to the subjective experience of memory.
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Affiliation(s)
- Merel Kindt
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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86
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Cardeña E, Dennis JM, Winkel M, Skitka LJ. A snapshot of terror: acute posttraumatic responses to the September 11 attack. J Trauma Dissociation 2005; 6:69-84. [PMID: 16150670 DOI: 10.1300/j229v06n02_07] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper reports on acute posttraumatic reactions and forms of coping to the September 11 attack. We conducted a survey within three weeks of the attack on a nationwide, representative sample of individuals 13 years or older (N = 3,134). Measures included the Stanford Acute Stress Reaction Questionnaire (SASRQ), the brief version of the COPE, and questions about demographics and attitudes toward the attackers. Results show that residents of New York City--women, young adults (but not teens), and people recently immigrated into the country--experienced more distress about the attack. There was a positive linear association between hours of watching TV news related to the attack and distress, and a small positive association between hostility toward the perpetrators, TV watching, and distress. Income, religion, education, and ethnicity did not have an effect on distress. Maladaptive coping strategies and TV watching explained considerably more variance than did demographics. Reactions to acute trauma seem to depend on the lack of appropriate coping strategies. The curvilinear relationship between age and posttraumatic distress suggests caution when interpreting previous findings about age and posttraumatic reactions. The association between media exposure, coping styles, and acute distress among teens extends previous findings and deserves further investigation.
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Affiliation(s)
- Etzel Cardeña
- Department fo Psychology, University of Lund, Sweden.
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87
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Pole N, Cumberbatch E, Taylor WM, Metzler TJ, Marmar CR, Neylan TC. Comparisons between high and low peritraumatic dissociators in cardiovascular and emotional activity while remembering trauma. J Trauma Dissociation 2005; 6:51-67. [PMID: 16537323 DOI: 10.1300/j229v06n04_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peritraumatic dissociation (PD) is one of the best predictors of posttraumatic stress disorder (PTSD). In this pilot study, we examined cardiovascular psychophysiology and negative emotions in 19 adults who, retrospectively, reported experiencing high or low levels of PD during the worst trauma of their lives. In a contiguous series of ten-minute phases, they rested, thought about, talked about, and recovered from talking about their index trauma. We hypothesized that greater PD would be associated with more negative emotion, lower cardiovascular activity, and greater discordance between negative emotions and cardiovascular activity. Our main findings were that PD was associated with lower blood pressure prior to talking about the trauma, greater negative emotion while talking about the trauma, and greater emotional and cardiovascular discordance throughout the experiment. These findings add to the very limited empirical data on physiological concomitants of peritraumatic dissociation and may aid in developing preventive interventions for PTSD.
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Affiliation(s)
- Nnamdi Pole
- Department of Psychology, University of Michigan, 525 East University, 2260 East Hall, Ann Arbor, MI 48109-1109, and San Francisco Veterans Affairs Medical Center, CA, USA.
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88
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van Son M, Verkerk G, van der Hart O, Komproe I, Pop V. Prenatal depression, mode of delivery and perinatal dissociation as predictors of postpartum posttraumatic stress: an empirical study. Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.446] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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89
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Olde E, van der Hart O, Kleber RJ, van Son MJM, Wijnen HAA, Pop VJM. Peritraumatic dissociation and emotions as predictors of PTSD symptoms following childbirth. J Trauma Dissociation 2005; 6:125-42. [PMID: 16172085 DOI: 10.1300/j229v06n03_06] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED The current study investigated the contributive role of perinatal dissociative and perinatal emotional responses to the development of PTSD symptoms following childbirth. METHOD Using a prospective, longitudinal design, 140 women were studied who were followed from the first week after delivery to three months postpartum. RESULTS Three women (2.1%) met criteria for PTSD and 21.4% reported a traumatic childbirth experience. Both perinatal negative emotional reactions and perinatal dissociative reactions were the predictors of PTSD symptoms at three months postpartum. The effect of perinatal dissociation, however, was partially mediated by perinatal emotional reactions. CONCLUSION Posttraumatic stress disorder can be a consequence of the experience of childbirth. Women who reported high levels of negative emotions during and shortly after childbirth were more likely to develop PTSD symptoms than women who did not. Women who experienced an instrumental delivery and also reported higher levels of psychoform perinatal dissociation, were at higher risk than women who reported higher levels of perinatal dissociation during a spontaneous delivery. These findings add to the growing body of literature regarding traumatic childbirth and indicate that perinatal dissociative and emotional phenomena are associated with posttraumatic stress.
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Affiliation(s)
- Eelco Olde
- Department of Psychiatry, Research School of Psychology & Health, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands
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90
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Abstract
INTRODUCTION This study investigated the prevalence of post-traumatic stress symptoms among professional ambulance personnel in Sweden and investigated the question: "Does self-knowledge have influence on how well one copes with the effects of daily work exposure from such events?" Little is known about the variables that might be associated with post-traumatic stress symptoms in high-risk occupational groups such as ambulance service groups. METHODS Data were gathered from ambulance personnel by means of an anonymous questionnaire. Survey responses of 362 ambulance personnel from the county of Västra Götaland were analyzed. A correlation was established between post-traumatic symptoms using the impact of event scale (IES-15) and the Professional Self-Description Form (PSDF). RESULTS Of those who reported a traumatic situation, 21.5% scored > or =26 on the IES-15 subscale. Scores >26 indicate "PTSD caseness". There were significant differences on PSDF subscales between those presenting with or without post-traumatic symptoms. CONCLUSIONS The mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work. The high prevalence of PTSD symptoms in ambulance personnel indicates an inability to cope with post-traumatic stress caused by daily work experiences.
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Affiliation(s)
- Anders Jonsson
- Hogskolan I Boras School of Health Sciences, Goteborg University Faculty of Medicine, Department of Primary Health Care, Boras, Sweden.
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91
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Abstract
OBJECTIVE Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. METHOD Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. RESULTS Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena--rigid alterations in the level and field of consciousness--prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. CONCLUSIONS Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.
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Affiliation(s)
- Onno van der Hart
- Department of Clinical Psychology, Utrecht University, Heidelberglaan, The Netherlands.
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92
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Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients' problems with new medication for chronic conditions. Qual Saf Health Care 2004; 13:172-5. [PMID: 15175485 PMCID: PMC1743839 DOI: 10.1136/qhc.13.3.172] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess patients' adherence to new medication for a chronic condition (and whether non-adherence was intentional), patients' problems with their medication, and their further information needs. METHODS A longitudinal survey with data collection at 10 days and 4 weeks was performed on 258 patients recruited from 23 community pharmacies in south east England. Patients were eligible to participate if they were starting a new chronic medication and were either 75 years or older or had one of the following chronic conditions: stroke, coronary heart disease, asthma, diabetes, and rheumatoid arthritis. At each time point a semi-structured telephone interview was conducted and a postal questionnaire was sent. MAIN OUTCOME MEASURES Self-reported adherence, causes of non-adherence, problems with medication, information needs. RESULTS Sixty seven (30%) of 226 patients still taking their medication at 10 days and 43 of 171 (25%) still taking their medication at 4 weeks were non-adherent. At 10 days 55% of the non-adherence was unintentional and the remainder was intentional; these proportions were similar at 4 weeks. 138 of 208 (66%) participants still taking their new medication at 10 days reported at least one problem with it. 137 of 226 patients (61%) expressed a substantial and sustained need for further information at 10 days and 88 of 171 (51%) at 4 weeks. Several patients who were adherent or reported no problems at 10 days were non-adherent or had problems at 4 weeks. CONCLUSIONS A significant proportion of patients newly started on a chronic medication quickly become non-adherent, often intentionally so. Many have problems with their medication and information needs. Patients need more support when starting on new medication for a chronic condition and new services may be required to provide this.
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Affiliation(s)
- N Barber
- Department of Practice and Policy, The School of Pharmacy, 29/39 Brunswick Square, London WC1N 1AX.
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93
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Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients' problems with new medication for chronic conditions. Qual Saf Health Care 2004. [PMID: 15175485 DOI: 10.1136/qshc.2003.005926] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess patients' adherence to new medication for a chronic condition (and whether non-adherence was intentional), patients' problems with their medication, and their further information needs. METHODS A longitudinal survey with data collection at 10 days and 4 weeks was performed on 258 patients recruited from 23 community pharmacies in south east England. Patients were eligible to participate if they were starting a new chronic medication and were either 75 years or older or had one of the following chronic conditions: stroke, coronary heart disease, asthma, diabetes, and rheumatoid arthritis. At each time point a semi-structured telephone interview was conducted and a postal questionnaire was sent. MAIN OUTCOME MEASURES Self-reported adherence, causes of non-adherence, problems with medication, information needs. RESULTS Sixty seven (30%) of 226 patients still taking their medication at 10 days and 43 of 171 (25%) still taking their medication at 4 weeks were non-adherent. At 10 days 55% of the non-adherence was unintentional and the remainder was intentional; these proportions were similar at 4 weeks. 138 of 208 (66%) participants still taking their new medication at 10 days reported at least one problem with it. 137 of 226 patients (61%) expressed a substantial and sustained need for further information at 10 days and 88 of 171 (51%) at 4 weeks. Several patients who were adherent or reported no problems at 10 days were non-adherent or had problems at 4 weeks. CONCLUSIONS A significant proportion of patients newly started on a chronic medication quickly become non-adherent, often intentionally so. Many have problems with their medication and information needs. Patients need more support when starting on new medication for a chronic condition and new services may be required to provide this.
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Affiliation(s)
- N Barber
- Department of Practice and Policy, The School of Pharmacy, 29/39 Brunswick Square, London WC1N 1AX.
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94
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Dalenberg CJ, Palesh OG. Relationship between child abuse history, trauma, and dissociation in Russian college students. CHILD ABUSE & NEGLECT 2004; 28:461-474. [PMID: 15120926 DOI: 10.1016/j.chiabu.2003.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2002] [Revised: 10/20/2003] [Accepted: 11/13/2003] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The research was conducted to determine the relationship between violent trauma, child abuse history, and dissociative symptoms in a Russian population. METHOD Three hundred and one undergraduate students from Moscow State Linguistics University participated in the study and completed the Dissociation Continuum Scale, the Violence History Questionnaire, the Traumatic Events Survey (TES), and a demographic measure. RESULTS Scores on dissociation and its subfactors were significantly higher in the Russian sample compared to the normative US group. The best predictors for dissociation were experiencing a violent trauma, child abuse history, and/or the experience of a fearful event. Those participants with a prior child abuse history were more symptomatic after adult trauma than those with no such history. CONCLUSIONS The relationship between trauma/abuse and dissociation is unlikely to be a result of suggestion by therapists or media exposure, since the correlation appears in a Russian population who are relatively unexposed to these suggestive sources. The validity, reliability, and structure of the dissociation measure were relatively similar in American and Russian samples.
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Affiliation(s)
- Constance J Dalenberg
- Psychology Department, Trauma Research Institute, Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
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95
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96
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Biebrich R, Kuhl J. Innere Kapitulation beim komplexen Problemlösen: Dissoziative versus integrative Verarbeitungsstrategien. ACTA ACUST UNITED AC 2003. [DOI: 10.1024/0170-1789.24.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Überforderung durch komplexe Problemsituationen kann einen multimodalen Zustand innerer Kapitulation auslösen. Dieser Zustand beschränkt sich nicht nur auf den Verlust an Situationskontrolle, er umfasst auch Merkmale wie Reduzierung des Selbstsicherheitsgefühls, der positiven Stimmung und Erfolgszuversicht sowie die Steigerung der negativen Stimmung u. a. m. Es werden ein Entstehungsmodell der “Inneren Kapitulation”, das auf der Grundlage der Theorie der Persönlichkeits-System-Interaktionen ( Kuhl, 1998 , 2000 , 2001 ) entwickelt wurde, sowie individuelle Unterschiede bei der Verarbeitung negativer Erlebnisse diskutiert. Erste Ergebnisse einer Untersuchung auf der Basis der von Dörner und Mitarbeitern entwickelten Computersimulation “Feuer” werden zusammengefasst und in Bezug auf Prädiktoren der “Inneren Kapitulation” diskutiert.
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97
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Jaycox LH, Marshall GN, Orlando M. Predictors of acute distress among young adults injured by community violence. J Trauma Stress 2003; 16:237-45. [PMID: 12816335 DOI: 10.1023/a:1023739922809] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Acute reactions to trauma are examined in 267 individuals severely injured via community violence. Respondents were interviewed about pretrauma, peritraumatic, and acute posttraumatic factors. A series of bivariate and multivariate analyses were conducted. We found few factors related to peritraumatic dissociation (PD): only injury severity and neuroticism emerged as multivariate predictors and the effects were small. PD was strongly related to acute PTSD symptoms, and partially mediated the relationship between other factors and acute PTSD and general distress symptoms. Different patterns of predictors emerged for acute PTSD symptoms vis-à-vis general distress symptoms. Future research on predictors of PD is indicated to develop prevention and early intervention programs.
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98
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Chang CM, Lee LC, Connor KM, Davidson JRT, Jeffries K, Lai TJ. Posttraumatic distress and coping strategies among rescue workers after an earthquake. J Nerv Ment Dis 2003; 191:391-8. [PMID: 12826921 DOI: 10.1097/01.nmd.0000071588.73571.3d] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disaster workers are at high risk for developing psychiatric morbidity. This study examined the prevalence rates of psychiatric and posttraumatic distress and the relationship between psychiatric and posttraumatic morbidity and coping strategies among rescue workers following an earthquake in Taiwan on September 21, 1999. Eighty-four male firefighters who had been exposed to earthquake rescue work were assessed 5 months after the event. The Chinese Health Questionnaire (CHQ), the Impact of Event Scale (IES), and the Ways of Coping Questionnaire (WCQ) were used to assess psychiatric morbidity, posttraumatic morbidity, and coping strategies. The observed prevalence rates were 16.7% and 21.4% for general psychiatric morbidity and posttraumatic morbidity, respectively. Results from multivariate logistic regression indicated that job experience and confrontive coping were significant predictors of psychiatric morbidity, while job experience, distancing, escape-avoidance, and positive reappraisal were significant predictors of posttraumatic morbidity. Rescue workers with longer job experience were at the highest risk for developing psychiatric and posttraumatic distress.
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Affiliation(s)
- Chia-Ming Chang
- Department of Psychiatry and Graduate Institute of Medicine, Chung Shan Medical University, No. 110, Sec 1, Chien Kuo N. Road, Taichung, Taiwan
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99
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Abstract
This paper focuses on the consequences for providers of working with survivors of traumatic events, particularly criminal victimization. The paper reviews the relevant research and treatment literature associated with secondary traumatic stress (STS) and related variables (burnout, compassion fatigue, vicarious trauma, and countertransference). The latter part of the paper identifies the most important mitigating factors in the development of STS. These include good training specific to trauma work, a personal history of trauma, and the interpersonal resources of the worker. Implications for treatment, prevention, and research are discussed.
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100
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Gershuny BS, Cloitre M, Otto MW. Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation? Behav Res Ther 2003; 41:157-66. [PMID: 12547377 DOI: 10.1016/s0005-7967(01)00134-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Relations among peritraumatic dissociation, PTSD severity, event-related fear (i.e. fear experienced during traumatic event) about death, and event-related fear about losing control were examined in the current study. Particular emphasis was placed on testing whether or not fears about death and losing control mediate the relation between peritraumatic dissociation and PTSD severity in a sample of 146 nontreatment-seeking university women. Results indicated that event-related fears about death and losing control accounted for the relation between peritraumatic dissociation and PTSD severity; that is, the effect of peritraumatic dissociation on PTSD severity was eliminated after controlling for these fears. Speculations about findings are discussed.
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Affiliation(s)
- Beth S Gershuny
- Harvard Medical School, Massachusetts General Hospital, OCD Clinic and Research Unit, Charlestown 02129, USA.
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