Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents

Criterion A and Non-Criterion A Racial Discrimination Experiences, Posttraumatic Stress Symptoms, and Posttraumatic Cognitions Among Black or African Americans

Racial discrimination is an unfortunately common experience for Black Americans with detrimental physical and mental health consequences. Prior research has established an association between discrimination and posttraumatic stress symptoms (PTSS); yet, trauma-related cognitions have not been studied. The majority of the existing empirical work in this area has not examined specific forms of discrimination experiences, despite potential key differences in these adversities. Relatedly, some forms of discrimination constitute "traumatic" events as defined by Criterion A for PTSD in the DSM-5 while others do not, and these distinctions have also been overlooked. Thus, the present study aimed to (a) examine discrimination, including specific types, in relation to PTSS and posttraumatic cognitions and (b) investigate whether Criterion A and non-Criterion A discrimination experiences were tied to PTSS and trauma-related thoughts. Participants were 172 undergraduate students who identified as Black or African American (Mage = 25.11, SD = 8.25, range = 18-56; 84.9% female). Results indicated that while cumulative trauma was unrelated to PTSS, discrimination experiences were linked with higher PTSS and negative posttraumatic cognitions. Specifically, avoidance discrimination experiences were associated with both outcomes. Criterion A discrimination events were not tied to PTSS. These findings support previous research showing a link between racial discrimination and trauma-related outcomes. In addition, the results suggest that avoidance discrimination, while not classified as "traumatic," may have an important contribution to PTSS and posttraumatic cognitions among Black individuals. The study underscores the need to address racial discrimination experiences, including microaggressions, within a traumatic stress context.

Event centrality in social anxiety disorder and major depressive disorder

Event centrality is defined by the extent to which a memory of an event has become central to an individual's identity and life story. Previous research predominantly focused on the link between event centrality and trauma-related symptomatology. Nevertheless, it can be argued that the perception of (adverse) events as central to one's self is not exclusive to Posttraumatic Stress Disorder (PTSD). Other disorders where adverse events are linked to the onset of symptoms might also be related to event centrality. This study examined the relevance of event centrality for Social Anxiety Disorder (SAD) and for Major Depressive Disorder (MDD) separately. Moreover, we examined which cognitive and emotion regulation variables (i.e., trait anxiety, rumination, worry, intrusions and avoidance, and posttraumatic cognitions) mediated these relationships. No significant correlation was found between event centrality and social anxiety. However, a significant positive correlation was found between event centrality and depression. In a combined group, this relation was mediated by all cognitive and emotion regulation variables except for worry.

What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review

ABSTRACT

Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.

Acceptability, feasibility, and utility of a safety aid reduction treatment in underserved veterans: a pilot investigation

Access to mental health services, particularly for veterans residing in underserved communities, remain scarce. One approach to addressing availability barriers is through the use of group-based transdiagnostic or unified treatment protocols. One such protocol, Safety Aid Reduction Treatment (START), previously termed False Safety Behavior Elimination Treatment (FSET), has received increasing empirical support. However, prior research has only examined this treatment among civilians with a primary anxiety diagnosis. Thus, the purpose of the current study was to replicate and extend prior research by examining the acceptability, feasibility, and utility of START among veterans, particularly those living in underserved communities, and across a wider array of diagnoses. Veterans (n = 22) were assessed prior to, immediately after, and one month following the 8-week treatment. The majority of veterans found START useful and acceptable. Additionally, recruitment and retention rates suggest that the treatment was feasible. Notably, results revealed reductions in overall anxiety, depression, and safety aid usage, which were maintained throughout the brief follow-up period. These findings add to a growing body of literature highlighting the utility of transdiagnostic approaches in the amelioration of various anxiety and related disorders. Limitations include the small sample size and uncontrolled design.

Negative Attributions as a Source of Vulnerability for trauma-related Shame and PTSD Symptoms

Shame is a common trauma response that is associated with the development and maintenance of PTSD. Phenomenological descriptions of shame indicate that shame arises from internal, stable and global causal attributions (negative attributions) for the precipitating event. The current study investigated whether negative attributions would be associated with higher levels of shame and PTSD, and whether shame would mediate the relationship between causal attributions and PTSD. As negative attributions may reflect a common transdiagnostic process in both depression and PTSD, it also examined whether depression would moderate this relationship. Eighty-seven participants meeting criteria for a Criterion A stressor were administered a structured PTSD diagnostic interview and a series of self-report measures. Findings indicate that shame mediated the relationship between internal, stable and global trauma-related causal attributions and PTSD symptoms. Further, depression did not moderate this relationship, indicating that negative causal attributions are associated with shame and PTSD independent of depression. Results provide empirical support for the cognitive concomitants of trauma-related shame, which raise the possibility that addressing negative attributions through cognitive therapeutic methods may be pertinent in reducing trauma-related shame. Future prospective data is needed to establish cognitive antecedents to shame.

Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination

OBJECTIVE

Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination.

METHOD

As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models.

RESULTS

Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor.

CONCLUSIONS

The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.

Measuring Driving Fear

Abstract. Presently, there is no instrument to support the diagnosis of driving fear and its severity. To enable a reliable and valid diagnosis, the 5-item German-language Instrument for Fear of Driving (IFD) was developed. The items, by DSM-5 criteria for a specific phobia, measure the emotional, cognitive, and physiological components of driving fear as well as the degree of avoidance and impairment. The present paper comprises two studies that describe the development of the IFD and its psychometric properties. In Study 1, the IFD was administered to 810 non-clinical participants in an online survey and demonstrated good reliability and construct validity. In Study 2, fifty-four people with a clinical diagnosis, including clinically relevant driving fear, completed the IFD and a clinical interview. The IFD demonstrated good sensitivity and specificity, and a cut-off score resulted in 95% sensitivity and 97% specificity. While the findings are preliminary and further studies with larger samples are needed, the IFD is a promising screening instrument for driving fear and its severity.

Prevalence and predictors of psychological distress following injury: findings from a prospective cohort study

BACKGROUND

Research examining psychological distress in people who have experienced an injury has focused on those with serious injuries or specific injury types, and has not involved long-term follow up. The aims of this investigation were to describe the prevalence of, and factors contributing to, psychological distress in a cohort of people with a broad range of injuries.

METHODS

The Prospective Outcomes of Injury Study (POIS) is a longitudinal cohort study of 2856 injured New Zealanders recruited from a national insurance entitlement claims register between 2007 and 2009. Participants were interviewed approximately 3, 12, and 24 months after their injury. The Kessler Psychological Distress Scale (K6) was used to measure psychological distress at each interview.

RESULTS

25% of participants reported clinically relevant distress (K6 ≥ 8) 3 months post-injury, 15% reported distress at 12 months, and 16% reported distress at 24 months. Being 45 years or older, Māori or Pacific ethnicity, experiencing pre-injury mental health conditions, having inadequate pre-injury income, reporting poor pre-injury health or trouble accessing healthcare, having a severe injury or an injury resulting from assault, and reporting clinically relevant distress 3 months post-injury were independently associated with an increased risk of distress 12 months post-injury. The majority of these associations were also evident with respect to distress 24 months post-injury.

CONCLUSIONS

Distress is common after injury among people with a broad range of injury types and severities. Screening for distress early after injury is important to identify individuals in need of targeted support.

Longitudinal Associations Among Negative Cognitions and Depressive and Posttraumatic Stress Symptoms in Women Recently Exposed to Stalking

Being stalked is a potentially traumatic experience associated with a threat to personal safety. Although major depression and posttraumatic stress (PTS) disorder are highly prevalent among stalking victims, little is known about factors associated with risk for the onset and maintenance of depressive and PTS symptoms in individuals with recent stalking exposure. The aim of this study was to determine the role of cognitive appraisals (negative views about the self, negative views about the world, self-blame) in the development of depressive and PTS symptoms in young adult women who had experienced stalking within 1 month of their baseline assessment. Participants (n = 82) completed self-report online surveys of posttraumatic cognitions and symptoms four times over the course of 3 months. Levels of posttraumatic cognitions among female stalking victims were comparable to those in other studies of trauma-exposed individuals. Multilevel models (MLMs) revealed that within-person changes in cognitions were differentially associated with concurrent changes in depressive and PTS symptoms over time, controlling for the influence of time, age, race, ethnicity, lifetime stalking victimization, childhood trauma exposure, and symptoms of the other disorder. Whereas more negative cognitions about the world were associated with higher levels of concurrent depressive and PTS symptoms, negative cognitions about the self were uniquely associated with higher concurrent depressive symptoms. Contrary to expectation, self-blame was not significantly associated with depressive or PTS symptoms. Results provided support for the potential utility of negative cognitions as risk markers for depressive and PTS symptoms in young adult female stalking victims. The present findings suggest that interventions targeting symptom-specific thinking patterns could help reduce risk for negative mental health outcomes associated with stalking victimization.

Cognitive and body manifestations of driving anxiety according to different onsets

BACKGROUND

Driving anxiety can have deleterious effects not only on driving behavior, but also on life quality. The interaction between motor vehicle collision (MVC) experiences and driving anxiety has been studied from different standpoints. However, the comparison with other events triggering it has been scarcely considered. Objectives: To analyze the body manifestations and the driving cognitions related to the accident, social and panic concerns in people suffering from different levels of driving anxiety. Method: A total of 260 participants suffering from driving anxiety were included in a survey, including Driving Cognition Questionnaire and Body Sensation Questionnaire. Results: Panic attacks and criticisms are the most relevant onsets of driving anxiety, more than MVC. Only 11.4% of MVC victims considered it as the onset. People with MVC history showed lower scores in social concerns than people without MVC experience and neither the responsibility of the MVC nor the role (driver/passenger) seemed to have an impact on the anxiety level. Conclusions: Although the most relevant body sensations, heart palpitations and sweating, were the same in people with panic attack experiences and MVC victims, a discrimination of the emotions behind the concept of "driving anxiety" is desirable to clarify the psychological effects of different onsets.

The indirect effect from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal

BACKGROUND

Emotion regulation strategies may help explain the risk of experiencing posttraumatic stress disorder (PTSD) symptoms among adults with a history of child maltreatment. However, no study to date has examined the roles of both thought suppression and cognitive reappraisal in the association between childhood maltreatment and PTSD symptoms.

OBJECTIVE

The current study sought to understand the associations between childhood maltreatment, thought suppression, cognitive reappraisal, and PTSD symptoms while controlling for negative affect and gender.

PARTICIPANTS AND SETTING

Data were collected on 660 university students (71 % female) ages 18-25 between 2013 and 2014. Participants completed self-report measures of childhood maltreatment, PTSD symptoms, and emotion regulation strategies.

METHOD

A structural equation model was tested to examine the direct and indirect effects from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal, over and above gender and negative affect.

RESULTS

Childhood maltreatment was directly associated with PTSD symptoms (β = 0.28, SE = 0.04, p < .001). Childhood maltreatment also had a significant indirect effect on PTSD via cognitive reappraisal (β = 0.01, CI 95 % [0.00, 0.03]), but not through thought suppression, although (β = 0.01, CI 95 % [-0.00, 0.04]) thought suppression was significantly positively associated with PTSD symptoms (β = 0.21, SE = 0.04, p < .001).

CONCLUSION

The present study sheds light on the effect of childhood maltreatment and two commonly used emotion regulation strategies on PTSD symptoms.

Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation

Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.

Kognitive Verhaltenstherapie bei Autofahrangst

Die Exposition im Straßenverkehr bei der kognitiv-verhaltenstherapeutischen Behandlung der Autofahrangst ist oftmals mit Fragen der praktischen Umsetzung sowie mit Haftungsfragen verbunden. Die folgende Handlungsempfehlung gibt einen Überblick über die Diagnostik, Ätiologie und psychometrische Erfassung der Autofahrangst und stellt versicherungsrechtliche Aspekte, die bei der Exposition im Straßenverkehr zu beachten sind, dar. Es wird ein Therapiemodul zur Behandlung der Autofahrangst vorgestellt, das konkrete Hinweise zur praktischen Umsetzung der Behandlung von Autofahrangst gibt.

Psychiatric disorders after an accident: Predictors and the influence of the psychiatric condition prior to an accident

Background

The goal of this study is to assess prevalence and incidence of psychiatric sequelae in a sample of inpatient accident survivors. Such an attempt to assess psychiatric conditions that originate due to an accident seems to be important; this does not include psychiatric conditions already present prior to the accident.

Method

208 accident victims were consecutively examined over a period of 12 months using DSM-IV diagnostic assessment, CAPS, and self-evaluating questionnaires as well as ISS for injury severity. A predictor model for psychiatric disorders was set up.

Results

Incidence of newly developed Axis I disorders in our sample was 14.2% (6 months) and 12.3% (12 months). Incidence of PTSD was 5.9% (6 months) and 2.5% (12 months). Comorbidity was a general phenomenon. The psychiatric condition prior to the accident could be identified as a predictor for the development of Axis I disorders. The subjectively evaluated intensity of experienced threat to life and female gender were the main predictors for the development of PTSD.

Conclusions

Accidents can lead to different psychiatric disorders. PTSD as a single diagnosis is rare. Without taking into account pre-existing disorders, the incidence may be overestimated. Two predictor models for the development of PTSD and other mental disorders are presented.

Measuring Anxiety-Related Avoidance With the Driving and Riding Avoidance Scale (DRAS)

Abstract. Driving anxiety is a common experience that, for those with high levels of driving anxiety, can markedly interfere with functioning, particularly because of avoidance behavior. The Driving and Riding Avoidance Scale (DRAS; Stewart & St. Peter, 2004 ) is a promising measure of self-reported avoidance, but its psychometric properties have been questioned as the instructions do not specifically ask respondents to report avoidance that is due to driving anxiety. The present study investigated the psychometric properties of the DRAS using revised instructions in 437 participants from the general population of New Zealand. Internal consistency for the DRAS was 0.94 and ranged from 0.79 to 0.90 for the four subscales. A two-factor solution was supported, in line with previous research using the revised instructions, supporting the distinction between general and traffic avoidance compared with weather and riding avoidance. Further work on the psychometric properties of this measure with clinical samples is needed to clarify the subscale structure.

Cognitive Reappraisal and the Association Between Perceived Stress and Anxiety Symptoms in COVID-19 Isolated People

The purpose of this study is to examine how the emotion regulation strategy, cognitive reappraisal, affects the association between perceived stress and anxiety symptoms in COVID-19 isolated people. Data for this cross-sectional study come from a community-based online survey of COVID-19 isolated people (N = 328), who are not infected with the 2019-nCoV virus. We applied correlation and moderating effect for data analysis and found that cognitive reappraisal negatively moderated the relationship between perceived stress and anxiety symptoms. These results give us a new perspective on understanding the relationship between anxiety symptoms and perceived stress by clarifying the protective function of cognitive reappraisal. It buffers the induced negative emotion when COVID-19 isolated people perceive overpressure, and thus instigates future research into targeted clinical interventions, which aim to cultivate cognitive reappraisal skills for those isolated people in the face of stressful events or crisis events.

Post-traumatic stress and psychological health following infidelity in unmarried young adults

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity-related post-traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity-related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post-traumatic cognitions mediated the associations between infidelity-related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity-related PTSD. Whether used as continuous or categorical predictor, infidelity-related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post-traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post-traumatic cognitions.

Associations Between Trauma-Related Rumination and Symptoms of Posttraumatic Stress and Depression in Treatment-Seeking Female Veterans

Trauma-related rumination is a cognitive style characterized by repetitive negative thinking about the causes, consequences, and implications of a traumatic experience. Frequent trauma-related rumination has been linked to posttraumatic stress disorder (PTSD) and depression in civilian samples but has yet to be examined among military veterans. This study extended previous research by examining trauma-related rumination in female veterans who presented to a Veterans Affairs women's trauma recovery clinic (N = 91). The study had two main aims: (a) to examine associations between trauma-related rumination and specific PTSD symptoms, adjusting for the overlap between trauma-related rumination and other relevant cognitive factors, such as intrusive trauma memories and self-blame cognitions; and (b) to assess associations between trauma-related rumination, PTSD, and depression, adjusting for symptom comorbidity. At intake, patients completed a semistructured interview and self-report questionnaires. Primary diagnoses were confirmed via medical record review. Trauma-related rumination was common, with more than 80% of patients reporting at least sometimes engaging in this cognitive style in the past week. After adjusting for other relevant cognitive factors, trauma-related rumination was significantly associated with several specific PTSD symptoms, r_p s = .33-.48. Additionally, the severity of trauma-related rumination was associated with overall PTSD symptom severity, even after adjusting for comorbid depression symptoms, r_p ² = .35. In contrast, the association between trauma-related rumination and depressive symptom severity was not significant after adjusting for comorbid PTSD symptoms, r_p ² = .008. These results highlight trauma-related rumination as a unique contributing factor to the complex clinical presentation for a subset of trauma-exposed veterans.

Do dysfunctional posttraumatic cognitions play a mediating role in trauma adjustment? Findings from interpersonal and accidental trauma samples of children and adolescents

Background: Trauma adjustment varies in children and adolescents. Studies on objective risk factors of posttraumatic stress symptoms (PTSS) yielded inconsistent results. Dysfunctional posttraumatic cognitions (PTCs) might play a mediating role between risk factors and posttraumatic symptomatology. Objective: To investigate the interplay of the characteristics of the trauma (e.g. trauma type), the characteristics of the individual (e.g. age, sex), and the characteristics of the social environment (e.g. parental distress, marital status) on PTSS and depression, taking the child's dysfunctional PTCs into account as a possible mediator. Method: Structural equation modelling was used to better understand trauma adjustment in two heterogeneous samples of children and adolescents: a sample of 114 participants aged 7-16 after accidental trauma and a sample of 113 participants aged 6-17 after interpersonal trauma. Results: In the accidental trauma sample, dysfunctional PTCs mediated the positive associations of younger age and lower parental educational level on child PTSS, but not on depression. In the interpersonal trauma sample, being female positively predicted child depression. Furthermore, parental dysfunctional PTCs positively predicted both child PTSS and depression. No mediation effect of child dysfunctional PTCs was found in the interpersonal trauma sample. Child dysfunctional PTCs moderately to strongly predicted child PTSS and depression in both trauma samples. Conclusions: The impact of the characteristics of the individual and the characteristics of the social environment on child PTSS and depression might depend on the type of trauma experienced. Dysfunctional PTCs mediated between the characteristics of the individual and the characteristics of the social environment and the severity of PTSS in the aftermath of accidental trauma, but not of interpersonal trauma.

Trigger warning: Empirical evidence ahead

BACKGROUND AND OBJECTIVES

Trigger warnings notify people of the distress that written, audiovisual, or other material may evoke, and were initially used to provide for the needs of those with posttraumatic stress disorder (PTSD). Since their inception, trigger warnings have become more widely applied throughout contemporary culture, sparking intense controversy in academia and beyond. Some argue that they empower vulnerable individuals by allowing them to psychologically prepare for or avoid disturbing content, whereas others argue that such warnings undermine resilience to stress and increase vulnerability to psychopathology while constraining academic freedom. The objective of our experiment was to investigate the psychological effects of issuing trigger warnings.

METHODS

We randomly assigned online participants to receive (n = 133) or not receive (n = 137) trigger warnings prior to reading literary passages that varied in potentially disturbing content.

RESULTS

Participants in the trigger warning group believed themselves and people in general to be more emotionally vulnerable if they were to experience trauma. Participants receiving warnings reported greater anxiety in response to reading potentially distressing passages, but only if they believed that words can cause harm. Warnings did not affect participants' implicit self-identification as vulnerable, or subsequent anxiety response to less distressing content.

LIMITATIONS

The sample included only non-traumatized participants; the observed effects may differ for a traumatized population.

CONCLUSIONS

Trigger warnings may inadvertently undermine some aspects of emotional resilience. Further research is needed on the generalizability of our findings, especially to collegiate populations and to those with trauma histories.

A Short-Term Population Model of the Suicide Risk: The Case of Spain

A relevant proportion of deaths by suicide have been attributed to other causes that produce the number of suicides remains hidden. The existence of a hidden number of cases is explained by the nature of the problem. Problems like this involve violence, and produce fear and social shame in victims' families. The existence of violence, fear and social shame experienced by victims favours a considerable number of suicides, identified as accidents or natural deaths. This paper proposes a short time discrete compartmental mathematical model to measure the suicidal risk for the case of Spain. The compartment model classifies and quantifies the amount of the Spanish population within the age intervals (16, 78) by their degree of suicide risk and their changes over time. Intercompartmental transits are due to the combination of quantitative and qualitative factors. Results are computed and simulations are performed to analyze the sensitivity of the model under uncertain coefficients.

Driving cognitions, rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic-related cognitions, accident-related cognitions, and social-related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social-related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.

The mediation effect of PTSD, perceived job stress and resilience on the relationship between trauma exposure and the development of depression and alcohol use problems in Korean firefighters: A cross-sectional study

BACKGROUND

Firefighters constitute a high-risk group for depression and alcohol use disorders (AUDs) due to frequent exposure to trauma. Perceived job stress and resilience are powerful factors affecting the occurrence of depression and AUDs; however, research on this subject is scarce.

METHODS

We investigated the relationship of perceived job stress and resilience with depression or AUDs in firefighters. A total of 7151 Korean firefighters were included for analysis. Participants completed self-report scales, including a self-reported number of exposure to incident stressors, the Korean Occupational Stress Scale - Short Form, the Post-traumatic Stress Disorder (PTSD) Symptoms Checklist - Civilian version, the Patient Health Questionnaire 9, the Brief Resilience Scale, and the Alcohol Use Disorders Identification Test. Hierarchical multivariable linear regression analyses were performed to identify the relationship of perceived job stress and resilience with depression or AUDs. Path analyses were applied to investigate the mediation effects of PTSD, perceived job stress and resilience between trauma exposure and depression or AUDs.

RESULTS

There were significant associations of perceived job stress and resilience with depression and AUDs, respectively, even after adjusting for demographic factors, number of traumatic events, and PTSD symptoms. The relationship between trauma exposure and depression/AUDs was mediated by PTSD symptoms, which had both direct and indirect effects on depression and AUDs; indirect effect was mediated by job stress and resilience.

CONCLUSIONS

The findings in this study demonstrated that PTSD, perceived job stress and resilience can mediate the development of depression or AUDs following trauma exposure in firefighters. Efforts to prevent PTSD, reduce job stress and increase individual resilience could help prevent depression and AUDs.

LIMITATIONS

The cross-sectional study design and self-report nature of the assessment tools limit the current findings.

Survivors' experiences of consequences and recovery five years after a major bus crash

RATIONALE

There is a lack of long-term follow-up studies focused on injured and uninjured survivors' experiences of the recovery process after major traffic crashes.

AIM

To explore all survivors' experiences of long-term physical and psychological consequences and recovery 5 years after a major bus crash.

METHODOLOGICAL DESIGN AND JUSTIFICATION

A qualitative design was used to explore experiences in a 5-year follow-up study.

RESEARCH METHODS

Participants were 54 survivors of a bus crash with 56 survivors and six fatalities. Telephone interviews were analysed with qualitative content analysis.

RESULTS

The first category, 'Being resilient or suffering in daily life', has four subcategories covering quick recovery, suffering in daily life, distress in traffic situations and long-term pain. Reasons for quick recovery among survivors were previous crisis experiences, travelling alone, being uninjured and not being exposed to traumatic impressions. For the other survivors, being reminded of the crash caused disturbing reactions, such as sweating, anxiety and flashbacks. Survivors avoided going by bus if they could. A group of the injured survivors was still suffering from limiting and painful injuries. The second category, 'Reassessing oneself and social connections', has three subcategories covering self-awareness, impact on relationships and connectedness. Survivors either developed a stronger bond to their significant other or separated from their partner within the first couple of years. Friendships and a sense of connectedness among survivors were sources of long-lasting comfort and support. The theme overarching the categories is 'Visible and existential marks in everyday life', representing the various ways in which the crash influence the survivors' lives.

CONCLUSION

There is a need for more information about disruptive long-lasting consequences, such as travel anxiety, and available treatments. Initially, health-promoting connectedness can be facilitated by treating survivors as a group of people who belong together, from the day of the crash and throughout the recovery process.

Perceived control and avoidance in posttraumatic stress

Despite much evidence concerning the importance of control over stressors in animal models of adaptation to stress, there is a dearth of experimental evidence for the role of controllability in posttraumatic stress disorder (PTSD). This study investigated whether perceived control over aversive stimuli influenced subsequent avoidance in a female community sample with and without PTSD symptomatology. Female participants (N = 145) with high or low PTSD symptoms were randomized to receive instructions indicating either controllable or uncontrollable offset of aversive, positive, and neutral images; despite this perception, the actual duration of presentations was standardized in both conditions. Participants subsequently completed an emotional avoidance task. There was a significant group × condition interaction effect, such that those with PTSD symptoms who were told they lacked control displayed greater avoidance of the subsequent stressor relative to those told they had control. This pattern was not observed in those without PTSD symptoms. This finding suggests that ongoing experiences of uncontrollability may heighten psychological vulnerabilities implicated in PTSD.

Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents

The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

Social support, posttraumatic cognitions, and PTSD: The influence of family, friends, and a close other in an interpersonal and non-interpersonal trauma group

Research has suggested that social support can shape posttraumatic cognitions and PTSD. However, research has yet to compare the influence of separate domains of support on posttraumatic cognitions. Multiple-group path analysis was used to examine a model in a sample of 170 victims of intimate partner violence and 208 motor vehicle accident victims in which support from friends, family, and a close other were each predicted to influence posttraumatic cognitions, which were in turn predicted to influence PTSD. Analyses revealed that support from family and friends were each negatively correlated with posttraumatic cognitions, which in turn were positively associated with PTSD. Social support from a close other was not associated with posttraumatic cognitions. No significant differences in the model were found between trauma groups. Findings identify which relationships are likely to influence posttraumatic cognitions and are discussed with regard to interpersonal processes in the development and maintenance of PTSD.

Psychometric properties of the Posttraumatic Cognition Inventory within a Northern Ireland adolescent sample

OBJECTIVES

This study sought to investigate the psychometric properties of the Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999, Psychol. Assess., 11, 303) among a cohort of older adolescents and to determine the relationship between post-traumatic cognitions and a variety of psychological outcomes including depression, anxiety, stress, and loneliness.

METHODS

The PTCI was investigated among a large sample (N = 785) of Northern Irish adolescents. Confirmatory factor analysis and composite reliability analysis were conducted to assess the psychometric properties of the scale.

RESULTS

The familiar three-factor solution of negative cognitions of self, negative cognitions of the world and others, and self-blame was supported; however, it was necessary to remove eight items from the original 33-item scale. The three-factor structure was subsequently demonstrated to be factorially invariant across gender and to possess satisfactory internal reliability. The three PTCI factors were found to correlate with depression, anxiety, stress, and three dimensions of loneliness.

CONCLUSION

These results provide the first piece of evidence that older adolescents cognitively respond to trauma in a similar manner to adults, that the PTCI is factorially invariant between genders, and that trauma cognitions are correlated with feelings of loneliness. The contextual dependent nature of the structure of the PTCI factors is discussed in relation to future research efforts.

PRACTITIONER POINTS

The PTCI is a valid and reliable measure of trauma-related cognitions among adolescents and works equally well for male adolescents and female adolescents. Trauma cognitions are associated with a range of mental health problems beyond post-traumatic stress disorder including depression, anxiety, stress, and various aspects of loneliness. Reductions in trauma cognitions in survivors of trauma will have wide-scale clinical benefits to patient well-being. The exact structure and make-up of items in the PTCI may well be dependent on culture, context, and the nature of the trauma. The study is limited due to the fact that the authors could not assess the severity of the trauma experienced by the adolescent sample.

The effects of the Omagh bomb on adolescent mental health: a school-based study

BACKGROUND

The main objective of this study was to assess psychiatric morbidity among adolescents following the Omagh car bombing in Northern Ireland in 1998.

METHODS

Data was collected within schools from adolescents aged between 14 and 18 years via a self-completion booklet comprised of established predictors of PTSD; type of exposure, initial emotional response, long-term adverse physical problems, predictors derived from Ehlers and Clark's (2000) cognitive model, a PTSD symptoms measure (PDS) and the General Health Questionnaire (GHQ).

RESULTS

Those with more direct physical exposure were significantly more likely to meet caseness on the GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previous meta-analyses accounted for 20% of the variance in PDS scores but the amount of variance accounted for increased to 56% when the variables highlighted in Ehlers and Clark's cognitive model for PTSD were added.

CONCLUSIONS

High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilst increased exposure was associated with increased psychiatric morbidity, the best predictors of PTSD were specific aspects of the trauma ('seeing someone you think is dying'), what you are thinking during the event ('think you are going to die') and the cognitive mechanisms employed after the trauma. As these variables are in principle amenable to treatment the results have implications for teams planning treatment interventions after future traumas.

Predictors of posttraumatic stress symptoms following childbirth

BACKGROUND

Posttraumatic stress disorder (PTSD) following childbirth has gained growing attention in the recent years. Although a number of predictors for PTSD following childbirth have been identified (e.g., history of sexual trauma, emergency caesarean section, low social support), only very few studies have tested predictors derived from current theoretical models of the disorder. This study first aimed to replicate the association of PTSD symptoms after childbirth with predictors identified in earlier research. Second, cognitive predictors derived from Ehlers and Clark's (2000) model of PTSD were examined.

METHODS

N = 224 women who had recently given birth completed an online survey. In addition to computing single correlations between PTSD symptom severities and variables of interest, in a hierarchical multiple regression analyses posttraumatic stress symptoms were predicted by (1) prenatal variables, (2) birth-related variables, (3) postnatal social support, and (4) cognitive variables.

RESULTS

Wellbeing during pregnancy and age were the only prenatal variables contributing significantly to the explanation of PTSD symptoms in the first step of the regression analysis. In the second step, the birth-related variables peritraumatic emotions and wellbeing during childbed significantly increased the explanation of variance. Despite showing significant bivariate correlations, social support entered in the third step did not predict PTSD symptom severities over and above the variables included in the first two steps. However, with the exception of peritraumatic dissociation all cognitive variables emerged as powerful predictors and increased the amount of variance explained from 43% to a total amount of 68%.

CONCLUSIONS

The findings suggest that the prediction of PTSD following childbirth can be improved by focusing on variables derived from a current theoretical model of the disorder.

Trauma-Focused Cognitive Behavioral Therapy Applied to Childhood Traumatic Grief in the Aftermath of a Motor-Vehicle Accident

Symptoms of posttraumatic stress, depression, and unresolved grief can appear in children and adolescents following the witnessing or experiencing of a traumatic event and respond with intense fear, helplessness, or horror. Those who lose a loved one in a traumatic manner can develop childhood traumatic grief (CTG), where typical grieving is hindered by trauma symptoms, causing significant impairment in daily functioning, relationships, and academic pursuits. The following is a case study describing a trauma-focused cognitive behavioral approach to treat posttraumatic stress disorder and CTG in a 16-year-old driver of a motor vehicle accident in which his peer was killed. A graduate student clinician provided treatment under supervision within the context of a school mental health program. The results of the intervention were associated with significant reductions in symptoms and impairments in daily living. The implications of these data and recommendations for clinicians treating CTG are provided.

Translation and cross-cultural adaptation of the Brazilian Portuguese version of the Driving Behavior Survey (DBS)

BACKGROUND

Fear of driving has been recognized as a complex diagnostic entity. For this reason, the use of psychometric instruments is fundamental to advancing research in this area. Psychometric instruments are also necessary for clinical care, as they can help conceptualize the disorder and plan adequate treatment.

OBJECTIVE

To describe the cross-cultural adaptation of a Brazilian version of the Driving Behavior Survey (DBS).

METHODS

The process consisted of: 1) two translations and back-translations carried out by independent evaluators; 2) development of a brief version by four bilingual experts in mental health; 3) experimental application; and 4) investigation of operational equivalence.

RESULTS

The adaptation process is described and a final Brazilian version of the DBS is presented.

CONCLUSION

A new instrument is now available to assess the driving behaviors of the Brazilian population, facilitating research in this field.

A community study of the psychological effects of the Omagh car bomb on adults

BACKGROUND

The main aims of the study were to assess psychological morbidity among adults nine months after a car bomb explosion in the town of Omagh, Northern Ireland and to identify predictors of chronic posttraumatic stress disorder symptoms.

METHOD

A questionnaire was sent to all adults in households in The Omagh District Council area. The questionnaire comprised established predictors of PTSD (such as pre-trauma personal characteristics, type of exposure, initial emotional response and long-term adverse physical or financial problems), predictors derived from the Ehlers and Clark (2000) cognitive model, a measure of PTSD symptoms and the General Health Questionnaire.

RESULTS

Among respondents (n = 3131) the highest rates of PTSD symptoms and probable casesness (58.5%) were observed among people who were present in the street when the bomb exploded but elevated rates were also observed in people who subsequently attended the scene (21.8% probable caseness) and among people for whom someone close died (11.9%). People with a near miss (left the scene before the explosion) did not show elevated rates. Exposure to the bombing increased PTSD symptoms to a greater extent than general psychiatric symptoms. Previously established predictors accounted for 42% of the variance in PTSD symptoms among people directly exposed to the bombing. Predictors derived from the cognitive model accounted for 63%.

CONCLUSIONS

High rates of chronic PTSD were observed in individuals exposed to the bombing. Psychological variables that are in principle amenable to treatment were the best predictors of PTSD symptoms. Teams planning treatment interventions for victims of future bombings and other traumas may wish to take these results into account.

Contributions of physical and cognitive impairments to self-reported driving difficulty in chronic whiplash-associated disorders

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To conduct a preliminary analysis of the physical, cognitive, and psychological domains contributing to self-reported driving difficulty after adjusting for neck pain, dizziness, and relevant demographics in chronic whiplash-associated disorders (WAD) using hierarchical regression modeling.

SUMMARY OF BACKGROUND DATA

Pain is a risk factor for car crashes, and dizziness may affect fitness to drive. Both symptoms are common in chronic WAD and difficulty driving is a common complaint in this group. Chronic WAD is often accompanied by physical, cognitive, and psychological impairments. These impairments may contribute to self-reported driving difficulty beyond neck pain, dizziness, and relevant demographics.

METHODS

Forty individuals with chronic WAD participated. Dependent variables were the magnitude of self-reported driving difficulty assessed in the strategic, tactical, and operational levels of the Neck Pain Driving Index. Three models were developed to assess the contributions of independent variables (physical, cognitive, and psychological domains) to each of the 3 dependent variables after adjusting for neck pain intensity, dizziness, and driving demographics. The measures included were: physical domain-range and maximum speed of head rotation, performances during gaze stability, eye-head coordination, and visual dependency tests; cognitive domain-self-reported cognitive symptoms including fatigue and the trail making tests; and psychological domain-general stress, traumatic stress, depression, and fear of neck movements and driving.

RESULTS

Symptom duration was relevant to driving difficulty in the strategic and tactical levels. The cognitive domain increased statistical power to estimate the strategic and operational levels (P < 0.1) beyond other contributors. The physical domain increased statistical power to estimate the tactical level (P < 0.1) beyond other contributors.

CONCLUSION

Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD beyond neck pain, dizziness, and symptom duration.

LEVEL OF EVIDENCE

3.

Psychological consequences of terrorist attacks: prevalence and predictors of mental health problems in Pakistani emergency responders

Earlier research showing moderate to high prevalence rates of post-traumatic stress disorder (PTSD) and other mental health problems in emergency personnel has mostly been carried out in Western countries. Data from non-Western countries are largely lacking. The current study aimed to gather evidence on the prevalence of PTSD, anxiety, and depression in N=125 Pakistani emergency workers, most of whom (n=100; 80%) had been exposed to terrorist attacks. Fifteen percent of participants showed clinically relevant levels of PTSD, and 11-16% of participants reported heightened levels of anxiety or depression. Neither the experience of terrorist attacks per se nor the severity of the attack experienced was related to symptom severities. However, symptom levels of PTSD were related to a number of predictor variables, including subjective threat, peritraumatic dissociation, past traumas, rumination, and avoidant coping. Only a few variables were predictive of levels of anxiety and depression. In sum, a substantial subgroup of emergency workers experienced mental health problems, and prevalences were in the high range of those reported in earlier studies focusing on emergency personnel in Western countries.

Cognitive and non-cognitive factors associated with posttraumatic stress symptoms in mothers of children with type 1 diabetes

BACKGROUND

The experience of having a child diagnosed with type 1 diabetes mellitus (T1DM) can negatively impact on the mother's well-being and trigger posttraumatic stress symptoms. To date, only one study has examined the role of non-cognitive factors in predicting the occurrence of PTSD in parents of children diagnosed with diabetes. However, in the broader PTSD literature is has been shown that both non-cognitive variables and cognitive variables predict PTSD in traumatized populations.

AIMS

The current study aimed to investigate the relationship of both non-cognitive (trauma severity, psychiatric history and social support) and cognitive variables (negative cognitive appraisals and dysfunctional cognitive appraisals) with PTSD in mothers of children recently diagnosed with diabetes.

METHOD

A single group survey design and self-report questionnaires were used to investigate the relationship between both non-cognitive (trauma severity, psychiatric history and history of trauma, and social support) and cognitive factors (negative cognitive appraisals and dysfunctional strategies) and PTSD symptoms in mothers of children who had been diagnosed with type 1 diabetes in the last 5 years.

RESULTS

All cognitive variables were positively associated with PTSD symptoms. In contrast, of the non-cognitive variables, only social support was significantly (negatively) associated with PTSD symptoms. Moreover, regression analysis found that cognitive variables explained variance in PTSD symptoms over and above that contributed by the non-cognitive variables.

CONCLUSIONS

This supports the cognitive model of PTSD. The implications of the study with regards to early detection of and therapies for PTSD in this population are discussed.

Investigating Cognitive Pathways to Psychopathology: Predicting Depression and Posttraumatic Stress Disorder From Early Responses After Assault

Depression and posttraumatic stress disorder (PTSD) are common after trauma, but it remains unclear what factors determine which disorder a trauma survivor will develop. A prospective longitudinal study of 222 assault survivors assessed candidate predictors derived from cognitive models of depression and PTSD at 2 weeks posttrauma (N = 222), and depression and PTSD symptom severities (N = 183, 82%) and diagnoses at 6 months (N = 205, 92%). Structural equation modeling showed that the depression and PTSD models predicted both depression and PTSD symptom severity, but that the disorder-specific models predicted the respective outcome best (43% for depression, 59% for PTSD symptom severity). Maintaining cognitive variables (hopelessness and self-devaluative thoughts in depression; cognitive responses to intrusive memories and persistent dissociation in PTSD) showed the clearest specific relationships with outcome. Model-derived variables predicted depression and PTSD diagnoses at 6 months over and above what could be predicted from initial diagnoses. Results support the role of cognitive factors in the development of depression and PTSD after trauma, and provide preliminary evidence for some specificity in maintaining cognitive mechanisms.

Effects of rumination on intrusive memories: does processing mode matter?

BACKGROUND AND OBJECTIVES

Excessive rumination following traumatic or highly distressing experiences has been proposed to be an important maintaining factor of posttraumatic stress symptoms. However, not all forms of repetitive thinking about a negative event appear to be dysfunctional. It has been suggested that the abstractness of thinking is critical for its symptom-maintaining effects. The present study tested this hypothesis using an experimental analogue design with participants who had experienced a recent negative life event.

METHODS

After a short symptom provocation task, participants (N=57) wrote about their negative experience in either an abstract-evaluative or a concrete-experiential way. Intrusive memories were assessed during the session and in the first 36 h after the session.

RESULTS

In line with the expectations, participants in the abstract-evaluative condition showed less reduction of intrusive memories during the experimental session than those in the concrete-experiential condition, and showed a slower recovery in the 36 h following the session.

LIMITATIONS

An analogue design was used. Therefore, results need to be replicated with survivors of traumatic events following DSM-IV.

CONCLUSIONS

Taken together, the results support the idea that abstractness of thinking is responsible for the dysfunctional effects of rumination about a highly distressing or traumatic event.

Predictors of chronic trauma-related symptoms in a community sample of New Zealand motor vehicle accident survivors

This study examined 1,500 New Zealand community-residing adults for involvement in serious motor vehicle accident (MVA) and the development of trauma-related symptomatology. The incidence of MVA was 11 %. More than 50 % of the accident victim sub-sample reported hyperarousal, with exaggerated startle, intrusive recollections, situational avoidance, emotional reactivity, and cognitive avoidance. The high incidence of trauma-related symptoms is noteworthy given 59 % of victims reported sustaining no or mild accident injury, and only 27 % were admitted to hospital for severe injury. Trauma-related symptoms were related to measures of injury severity, psychological and social functioning, and persistent medical problems. Pre- and post-accident factors, that is, experience of additional trauma, experience of stressful life events and post-accident social contact were the most important predictors of trauma-related symptoms severity. This study discusses the importance of examining trauma-related symptoms rather than using categorical diagnostic criteria (i.e., post-traumatic stress disorder, PTSD) as a sole means of characterizing the psychological impact of MVA.