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Chambliss T, Hsu JL, Chen ML. Post-traumatic Stress Disorder in Veterans: A Concept Analysis. Behav Sci (Basel) 2024; 14:485. [PMID: 38920817 PMCID: PMC11200391 DOI: 10.3390/bs14060485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) occurs when an individual experiences a traumatic event that exceeds the limits of psychological endurance. Many veterans experience PTSD. PTSD can negatively impact veterans' quality of life, functioning, life satisfaction, and overall well-being. It is important to analyze the concept of PTSD in the veteran population. This concept analysis aimed to investigate the defining attributes, a model case, antecedents, consequences, and empirical referents related to the concept of PTSD among veterans. Walker and Avant's method was used to guide this concept analysis of PTSD. The results showed that three attributes were determined from the analysis: intrusive memories of traumatic events, feelings of isolation and estrangement, and negative cognitions. PTSD is conceptualized as a collection of symptoms that arise from highly traumatic experiences. The military environment predisposes veterans to traumatic events that should be identified or acknowledged. A better understanding of the concept of PTSD can facilitate the development of effective interventions for the veteran population and enhance their mental health.
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Affiliation(s)
- Tormechi Chambliss
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, USA;
| | - Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan;
| | - Mei-Lan Chen
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, USA;
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Grover LE, Williamson C, Burdett H, Palmer L, Fear NT. Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02685-3. [PMID: 38771350 DOI: 10.1007/s00127-024-02685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts. METHODS Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed. RESULTS In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors. CONCLUSION Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.
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Affiliation(s)
- Laura E Grover
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK.
| | - Charlotte Williamson
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Howard Burdett
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Laura Palmer
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
- Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
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3
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Sippel LM, Liebman RE, Schäfer SK, Ennis N, Mattern AC, Rozek DC, Monson CM. Sources of Social Support and Trauma Recovery: Evidence for Bidirectional Associations from a Recently Trauma-Exposed Community Sample. Behav Sci (Basel) 2024; 14:284. [PMID: 38667080 PMCID: PMC11047467 DOI: 10.3390/bs14040284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Although the association between post-traumatic stress disorder (PTSD) and social support is well documented, few studies have tested the causal pathways explaining this association at several points in the acute post-trauma recovery period or examined whether the association varies for different sources of social support. To address these gaps, 151 community individuals (mean age = 37.20 years, 69.5% women) exposed to trauma within the previous 6 months were recruited to complete measures of PTSD and social support from intimate partners, friends, and relatives four times in 1 year. In line with recent recommendations for research on social support and PTSD symptoms, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine dynamic changes between PTSD severity and social support over time. The pattern of RI-CLPM cross-lagged coefficients indicated that positive deviations from one's expected stable level of total social support (across all sources) sped up the recovery of PTSD symptoms at the end of the post-trauma year, and more severe PTSD symptoms than expected based on one's expected stable level of PTSD started eroding social support midway through the assessment year. When specific sources of social support were analyzed separately, the association between within-person increases in social support from friends at any given time point accelerated the recovery from PTSD across the entire year. Among participants with intimate partners (n = 53), intimate partner support did not predict PTSD symptoms, but more severe PTSD symptoms at any given time point predicted less support at the following time point. Results from this longitudinal study provide additional support for the bidirectional relationship between PTSD and social support over time and suggest that perceived social support from friends may be especially helpful during trauma recovery.
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Affiliation(s)
- Lauren M. Sippel
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, CT 06516, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- National Center for PTSD, West Haven, CT 06516, USA
| | - Rachel E. Liebman
- Centre for Mental Health, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Sarah K. Schäfer
- Leibniz Institute for Resilience Research, 55122 Mainz, Germany
- Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Naomi Ennis
- Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Alexandra C. Mattern
- VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA
| | - David C. Rozek
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Candice M. Monson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
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4
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Monson CM, Shnaider P, Wagner AC, Liebman RE, Pukay-Martin ND, Landy MSH, Wanklyn SG, Suvak M, Hart TL, Koerner N. Longitudinal associations between interpersonal relationship functioning and posttraumatic stress disorder (PTSD) in recently traumatized individuals: differential findings by assessment method. Psychol Med 2023; 53:2205-2215. [PMID: 34620265 DOI: 10.1017/s0033291721003913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment. METHODS The current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year. RESULTS Approximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time. CONCLUSIONS These results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed.
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Affiliation(s)
| | - Philippe Shnaider
- Ryerson University, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Anne C Wagner
- Ryerson University, Toronto, ON, Canada
- Remedy, Toronto, ON, Canada
| | - Rachel E Liebman
- Ryerson University, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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5
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Perrotte JK, Weston R, Meyer EC, DeBeer BB, Kimbrel NA, Gulliver SB, Morissette SB. A brief report on the temporal relations between social functioning and behavioral health among veterans. Soc Psychiatry Psychiatr Epidemiol 2023; 58:177-181. [PMID: 36114856 PMCID: PMC9852037 DOI: 10.1007/s00127-022-02364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/02/2022] [Indexed: 01/22/2023]
Abstract
Using a four-wave longitudinal design, three competing hypotheses (i.e., social selection, social causation, and reciprocal causation) were tested pertaining to the relation between social functioning and several indices of behavioral health [i.e., post-traumatic stress symptoms (PTSS), distress, and alcohol-related problems] among military veterans exposed to trauma. Across two latent growth curve analyses, data largely supported longitudinal links between improved social functioning and positive behavioral health, often indicating that the improvements in social functioning frequently precede improvements in behavioral health. Overall, findings underscore the merit of directly targeting social functioning as part of mental health treatment among trauma-exposed individuals.
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Affiliation(s)
| | - Rebecca Weston
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Eric C Meyer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Health Science Center, Texas A&M University, Texas Veterans Healthcare System, Waco, TX, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Bryann B DeBeer
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Health Science Center, Texas A&M University, Texas Veterans Healthcare System, Waco, TX, USA
| | - Nathan A Kimbrel
- Department of Veterans Affairs, Mid-Atlantic Mental Illness Research Education and Clinical Center, and Duke University Medical Center, Durham, NC, USA
| | - Suzy B Gulliver
- Warriors Research Institute at Baylor Scott & White Health and Texas, A&M University Health Science Center, Waco, TX, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA.
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Yoshiko K, Nagano K, Hu C, Furuyashiki T. Relationship between dairy product intake and sense of coherence among middle and high school students in Japan. PLoS One 2022; 17:e0279232. [PMID: 36538538 PMCID: PMC9767322 DOI: 10.1371/journal.pone.0279232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Despite the growing attention toward the effects of dairy intake on stress and mental health, its relationship to psychological constructs that affect mental health remains poorly understood. We conducted a cross-sectional study (Study 1) and a longitudinal study (Study 2) to examine the association between food intake and stress resilience in Japanese middle and high school students. In Study 1, 865 participants (412 males and 453 females) completed the questionnaires. In Study 2, 109 students (51 males and 58 females) participated each year from 2016 to 2018. Dietary intake was assessed using a brief self-administered diet history questionnaire. Stress resilience was evaluated using a 13-item sense of coherence (SOC) questionnaire. Correlation coefficients were calculated in Study 1 to investigate the relationship between food group intake and SOC. In Study 2, a cross-lagged panel model was tested using structural equation modeling to investigate the effect of dairy product consumption on SOC. Study 1 revealed that only dairy product intake positively correlated with SOC and other food intake indicated no significant relationship. Study 2 indicated that augmented dairy product intake was positively associated with SOC. Among all foods, only dairy products were associated with SOC in adolescents. Although the association was weak, the longitudinal study confirmed that dairy consumption was associated with SOC. Randomized controlled trials are necessary to examine the causal relationship.
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Affiliation(s)
- Kato Yoshiko
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
- * E-mail:
| | - Kazumi Nagano
- Kobe University Secondary School, Kobe, Hyogo, Japan
| | - Chenghong Hu
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
| | - Tomoyuki Furuyashiki
- Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
- Japan Agency for Medical Research and Development, Chiyoda, Tokyo, Japan
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Li Z, Zhang X, Zheng J, Zhang Z, Wan P. Challenge or Hindrance? The Dual Path Effect of Perceived Task Demand on In-Role Performance and Work Fatigue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15561. [PMID: 36497636 PMCID: PMC9737550 DOI: 10.3390/ijerph192315561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
The evidence for the existence of perceived task demand is paradoxical. The purpose of the present study is to explore whether perceived task demand is a challenge or a hindrance stressor. To achieve this research purpose, based on conservation of resources theory, a conceptual model is developed that utilizes both a resource acquisition path and a resource depletion path. Using the experience-sampling method, over five consecutive days, 370 matched data were collected via mobile phone from 74 full-time employees in mainland China. The results show that perceived task demand has the characteristics of both challenge and hindrance stressors. On the one hand, perceived task demand enhances employees' cognitive engagement, thereby facilitating task performance (resource acquisition path). On the other hand, perceived task demand boosts employees' cognitive strain, thereby increasing work fatigue and decreasing in-role performance (resource depletion path). This research offers a comprehensive understanding of perceived task demand and provides strategies for task demand management.
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Affiliation(s)
- Zhigang Li
- School of Economics and Management, Beijing Polytechnic, Beijing 100176, China
| | - Xin Zhang
- Graduate School of Education, Dalian University of Technology, Dalian 116024, China
| | - Junwei Zheng
- Faculty of Civil Engineering and Mechanics, Kunming University of Science and Technology, Kunming 650500, China
| | - Zhenduo Zhang
- School of Economics and Management, Dalian University of Technology, Dalian 116024, China
| | - Pengyu Wan
- School of Economics and Management, Chongqing Normal University, Chongqing 401331, China
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8
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Johansen VA, Milde AM, Nilsen RM, Breivik K, Nordanger DØ, Stormark KM, Weisæth L. The Relationship Between Perceived Social Support and PTSD Symptoms After Exposure to Physical Assault: An 8 Years Longitudinal Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP7679-NP7706. [PMID: 33140665 PMCID: PMC9092899 DOI: 10.1177/0886260520970314] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p < .001); PSS were significantly correlated only between T1 and T2 (p < .001), T1 and T3 (p < .05), and between T2 and T3 (p < .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points (ps < .05); not proved between prior PTSD symptoms and later PSS (ps > .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions.
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Affiliation(s)
- Venke A Johansen
- Haukeland University Hospital, Bergen, Norway
- Western Norway University of Applied Sciences (HVL), Bergen, Norway
| | - Anne Marita Milde
- NORCE Norwegian Research Centre AS, Bergen, Norway
- University of Bergen, Norway
| | | | | | - Dag Øystein Nordanger
- Haukeland University Hospital, Bergen, Norway
- Oslo Metropolitan University, Oslo, Norway
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9
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Yuan G, Shi W, Lowe S, Chang K, Jackson T, Hall BJ. Associations between posttraumatic stress symptoms, perceived social support and psychological distress among disaster-exposed Chinese young adults: A three-wave longitudinal mediation model. J Psychiatr Res 2021; 137:491-497. [PMID: 33798977 DOI: 10.1016/j.jpsychires.2021.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 01/06/2023]
Abstract
Research has documented a strong association between perceived social support, posttraumatic stress symptoms (PTSS), and psychological distress (PD) among people exposed to natural disasters. However, the direction of associations between these factors remains unclear. This study examined possible mediational relationships among perceived social support, PTSS, and PD. A three-wave longitudinal design (6 months intervals) was employed in a sample of 341 Chinese university students (Mage = 21.24, SD = 2.72; 75.7% female) aged 18 to 34 who were directly exposed to a typhoon that occurred in Macao, China, during August 2017. Results indicated that perceived social support at T2 mediated the linkage between PTSS at T1 and PD at T3, and that PTSS at T2 significantly mediated the relationship between PD at T1 and perceived social support at T3. This three-wave longitudinal study highlights the key role of perceived social support on the aggravating effect of acute PTSS on long-term psychological problems, and demonstrates that adverse psychological health outcomes negatively affect the perception of supportive social resources in the context of a natural disaster.
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Affiliation(s)
- Guangzhe Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China
| | - Sarah Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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10
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Ferretti F, Gualtieri G, Bossini L, Olivola M, Del Matto L, Desantis S, Fagiolini A, Pozza A, Coluccia A. Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender. Perspect Psychiatr Care 2021; 57:761-769. [PMID: 32853435 DOI: 10.1111/ppc.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/02/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Posttraumatic stress disorder (PTSD) includes different symptoms: re-experiencing, avoidance of reminders and numbing, and hyperarousal. Although questionnaires are widely used, clinician-administered interviews provide a more comprehensive exploration of symptoms. Few studies examined the convergence between clinician-rated and patient-reported general severity and symptoms, with mixed findings. We explored the association between clinician-rated and patient-reported general severity and symptoms and the moderator role of gender in PTSD patients referred to a specialized outpatient service. DESIGN AND METHODS The Clinician-Administered PTSD Scale and Davidson Trauma Scale were administered to 56 patients. FINDINGS Patients classified by clinicians as with higher avoidance/numbing symptoms and women classified with higher hyperarousal symptoms reported higher general severity. PRACTICE IMPLICATIONS The assessment of the patients reporting high severity should focus on hyperarousal, particularly for women.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Letizia Bossini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Miriam Olivola
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, School of Medicine, University of Siena, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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11
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Zalta AK, Tirone V, Orlowska D, Blais RK, Lofgreen A, Klassen B, Held P, Stevens NR, Adkins E, Dent AL. Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis. Psychol Bull 2021; 147:33-54. [PMID: 33271023 PMCID: PMC8101258 DOI: 10.1037/bul0000316] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Vanessa Tirone
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Daria Orlowska
- University Libraries, Western Michigan University, Kalamazoo, MI
| | | | - Ashton Lofgreen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Brian Klassen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Philip Held
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Natalie R. Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Elizabeth Adkins
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Amy L. Dent
- Department of Psychological Science, University of California, Irvine, Irvine, CA
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12
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Blais RK, Tirone V, Orlowska D, Lofgreen A, Klassen B, Held P, Stevens N, Zalta AK. Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis. Eur J Psychotraumatol 2021; 12:1851078. [PMID: 34992740 PMCID: PMC8725779 DOI: 10.1080/20008198.2020.1851078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. Results: The overall random effects estimate was -.33 (95% CI: -.38, -.27, Z = -10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Vanessa Tirone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daria Orlowska
- University Libraries, Western Michigan University, Kalamazoo, MI, USA
| | - Ashton Lofgreen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Brian Klassen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Natalie Stevens
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alyson K Zalta
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
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Beck JG, Dodson TS, Pickover AM, Woodward MJ, Lipinski AJ, Tran HN. The effects of shame on subsequent reactions to a trauma analog. J Anxiety Disord 2019; 66:102108. [PMID: 31387013 DOI: 10.1016/j.janxdis.2019.102108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/07/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022]
Abstract
The current study examined the effects of experimentally-induced shame on subsequent reactions to a trauma analog. Participants were 88 college-aged women randomly assigned to a shame prime condition or to a control (neutral) condition. Participants then were presented with an analog trauma audiotape depicting dating violence. Participants reported intrusive thoughts relating to the trauma analog in the two days following the procedure. Negative (shame, guilt) and positive (pride, positive affect) emotions were monitored throughout the procedure. Results indicated that the shame prime successfully increased shame in the Shame condition alone. After the trauma analog, increases in shame were noted in both conditions. In contrast, guilt reduced in the Shame condition, while this emotion increased in the Control condition, contrary to hypothesis. Shame and guilt were somewhat volatile for participants in the Shame condition in the two days following the lab procedure, while individuals in the Control condition reported steadily decreasing levels of these emotions. No between-condition differences were noted in the frequency of intrusions in the two days following the laboratory procedure, contrary to hypothesis. Results are discussed in light of our current understanding of shame and its role in PTSD, with suggestions to guide future research.
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Affiliation(s)
- J Gayle Beck
- Department of Psychology, The University of Memphis, United States.
| | - Thomas S Dodson
- Department of Psychology, The University of Memphis, United States
| | | | - Matthew J Woodward
- Department of Psychological Sciences, Western Kentucky University, United States
| | | | - Han N Tran
- Department of Psychology, The University of Memphis, United States
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14
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Sippel LM, Watkins LE, Pietrzak RH, Hoff R, Harpaz-Rotem I. Heterogeneity of posttraumatic stress symptomatology and social connectedness in treatment-seeking military veterans: a longitudinal examination. Eur J Psychotraumatol 2019; 10:1646091. [PMID: 31489133 PMCID: PMC6713134 DOI: 10.1080/20008198.2019.1646091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022] Open
Abstract
Elucidating whether PTSD symptoms predict poorer social connectedness over time (i.e. social erosion) and/or that poor social connectedness contributes to maintenance of PTSD (i.e. social causation) has implications for PTSD treatment and relapse prevention. Most extant research has been cross-sectional and examined overall PTSD symptoms. Evidence of longitudinal associations among heterogeneous PTSD symptom clusters and social connectedness could provide insight into more nuanced targets for intervention. Using data from 1,491 U.S. military veterans in residential treatment for PTSD at 35 Department of Veterans Affairs facilities, we evaluated a two-wave cross-lagged panel model including a five-factor model of PTSD and two aspects of social connectedness. PTSD, quality of connectedness (i.e. degree of distress related to interpersonal conflict), and structural social support (i.e. number of days of contact with supportive loved ones) in the past 30 days were assessed at baseline and 4 months after discharge. The largest effect was greater severity of PTSD dysphoric arousal symptoms (i.e. irritability/anger, poor concentration, and sleep problems) at baseline predicting more conflict-related distress at follow-up (β = 0.43). Post-hoc symptom-level analyses indicated that irritability/anger drove this association. In addition, conflict-related distress predicted greater PTSD symptom severity across all five clusters (β's = 0.10 to 0.14, p's < 0.01). More days of contact predicted lower severity of avoidance and numbing symptoms (β's = -.05 and -.07, p's < 0.01), along with individual symptoms within these clusters, plus flashbacks. Results support both social erosion and social causation models. Engaging loved ones in veterans' treatment and targeting dysphoric arousal symptoms, particularly anger and irritability, may improve long-term PTSD and relationship outcomes, respectively.
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Affiliation(s)
- Lauren M Sippel
- National Center for PTSD Executive Division, White River Junction, VT, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Laura E Watkins
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert H Pietrzak
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- National Center for PTSD Clinical Neurosciences Division, West Haven, CT, USA.,National Center for PTSD Evaluation Division, West Haven, CT, USA
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