The role of disclosure attitudes in the relationship between posttraumatic stress disorder symptom severity and perceived social support among emergency service workers

Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. A systematic review and meta-analysis

Objective

Paramedics are at particularly high risk for developing posttraumatic stress disorders (PTSD). Hitherto, evidence for higher prevalence rates in paramedics compared to the general population is vague. We aimed to determine and compare 12-month prevalence of PTSD in paramedics and general population from high-income countries.

Methods

We conducted systematic review processes to identify relevant studies for inclusion. For paramedics, we searched relevant databases, reference lists, and did citation tracking. Inclusion criteria were applied according to PICO. Quality of the studies was assessed using a validated methodological rating tool. Twelve-month prevalence data from all studies were pooled using random effects model. Subgroup analyses were performed to identify sources of heterogeneity.

Results

In total, we found 41 distinct samples with 17,045 paramedics, 55 samples with 311,547 individuals from non-exposed general population, 39 samples with 118,806 individuals from populations affected by natural disasters, and 22 samples with 99,222 individuals from populations affected by human-made disasters. Pooled 12-month prevalence estimates of PTSD were 20.0, 3.1, 15.6, and 12.0%, respectively. Prevalence estimates in paramedics varied with methodological quality and measurement instrument. Paramedics reporting distinct critical incidences had lower pooled prevalence than paramedics reporting indistinct types of exposure.

Conclusion

Paramedics have a pooled prevalence of PTSD that is considerably higher than rates of unexposed general population and populations affected by human-made disasters. Chronic exposure to low-threshold traumatic events during daily routine work is a risk factor for developing PTSD. Strategies to ensure long working lifetime are strongly needed.

Perceived COVID-19 susceptibility and preventive behaviors: moderating effects of social support in Italy and South Korea

BACKGROUND

The COVID-19 pandemic hit Italy much harder than South Korea. As a way of explaining the different impact in the two countries, this study examines the moderating role of social support on the relationship between perceived susceptibility and preventive behaviors in the two countries.

METHODS

Surveys were conducted in South Korea (n = 1396) and Italy (n = 487) of participants aged 50 to 89 years.

RESULTS

South Koreans felt higher levels of perceived social support than their Italian counterparts. As would be expected, greater perceived susceptibility was associated with increased preventive behavior. Furthermore, a significant three-way interaction effect was found for perceived susceptibility, social support, and country. For Italians, a person who feels him/herself highly susceptible will increase preventive behaviors, if there is a lot of social support. On the other hand, for South Koreans, those with a low level of susceptibility perform more preventive measures than people with a high level of susceptibility if there is a lot of social support.

CONCLUSIONS

This study provides insights into how cognitive factors, such as susceptibility and severity, as well as social and environmental factors can be taken into account, and the public be told the real risk and given behavioral guidelines when a pandemic is approaching. Given the critical role of social support as a coping mechanism in crisis situations, societies should mull over ways to increase emotional and instrumental support.

A latent profile analysis of emotional expression among patients with unintentional injuries

BACKGROUND

Emotional expression has been suggested to affect the well-being of individuals with unintentional injuries. However, few studies have investigated it as a heterogeneous phenomenon. The purpose of this study was to characterize the patterns of emotional expression among patients with unintentional injuries using latent profile analysis, and to examine the relationship among these latent profiles and cognitive processing, posttraumatic growth, and posttraumatic stress disorder.

METHODS

A cross-sectional study was carried out at two general hospitals in Wenzhou, China. In total, 352 patients with unintentional injuries completed the socio-demographic questionnaire, Berkeley Expressivity Questionnaire, Ambivalence Over Emotional Expression Questionnaire, Event-Related Rumination Inventory, the Posttraumatic Growth Inventory, and PTSD Checklist-Civilian Version.  RESULTS: Three unique profiles were identified: high emotional expressivity (n = 238, 67.6%), moderate emotional expressivity (n = 45, 12.8%), and low emotional expressivity (n = 69, 19.6%). The ANOVA and chi-square tests demonstrated significant differences among the three groups concerning deliberate rumination and posttraumatic growth. Multinomial logistic regression analysis indicated that monthly income and time since injury significantly predicted profile membership.

CONCLUSIONS

Most patients showed high emotional expressivity after an unintentional injury. Emotional expression profiles were associated with deliberate rumination and posttraumatic growth. Emotional expression interventions tailored for different profiles are warranted after an unintentional injury.

Toward trauma-informed applications of behavior analysis

Despite a growing acknowledgement of the importance of understanding the impacts of trauma on therapeutic approaches across human service disciplines, discussions of trauma have been relatively infrequent in the behavior analytic literature. In this paper, we delineate some of the barriers to discussing and investigating trauma in applied behavior analysis (ABA) and describe how the core commitments of trauma-informed care could be applied to behavior analysis. We then provide some examples of how trauma-informed care might be incorporated into ABA practice. We conclude by suggesting opportunities to approach trauma as a viable avenue for behavior analytic research and argue that omitting trauma-informed care from ABA could be detrimental not only to the public perception of ABA, but to the effectiveness of our assessment and treatment procedures.

Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender

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.

Risk factors of post-traumatic stress disorder 10 years after Wenchuan earthquake: a population-based case-control study

AIMS

To investigate the prevalence of post-traumatic stress disorder (PTSD) symptoms in the hard-hit areas 10 years after the Wenchuan earthquake, and explore the risk factors of long-term PTSD among Wenchuan earthquake survivors.

METHODS

A matched case-control study was conducted. The involving participants were from the hard-hit areas 10 years after the Wenchuan earthquake. The collected information includes demographic characteristics, socioeconomic status, behaviour habits, earthquake exposure, perceived social support, physical health and mental health. Mental health status was measured using the PTSD Checklist-Civilian Version (PCL-C). Respondents with PCL-C score ⩾38 were classified as cases, and then the cases and controls were matched based on age (±3 years) and community location according to a ratio of 1:3.

RESULTS

We obtained 86 cases and 258 controls. After controlling for confounding factors, it was found that lower income (OR 2.42; 95% CI 1.16-5.03), chronic diseases (OR 3.00; 95% CI 1.31-6.88) and death of immediate families in the earthquake (OR 7.30; 95% CI 2.36-22.57) were significantly associated with long-term PTSD symptoms.

CONCLUSION

Even 10 years after the Wenchuan earthquake, the survivors in the hard-hit areas still suffered from severe mental trauma. Low income, chronic diseases and death of immediate families in the earthquakes are significantly associated with long-term PTSD symptoms. Interventions by local governments and health institutions to address these risk factors should be undertaken to promote the health of survivors.

Emotions, Feelings, and Experiences of Social Workers While Attending to Vulnerable Groups: A Qualitative Approach

Social workers in the community setting are in constant contact with the suffering experienced by the most vulnerable individual. Social interventions are complex and affect social workers’ emotional well-being. The aim of this study was to identify the emotions, feelings, and experiences social workers have while attending to individuals in situations of vulnerability and hardship. A qualitative methodology based on hermeneutic phenomenology was used. Six interviews and two focus group sessions were conducted with social workers from the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Atlas.ti 8.0 software was used for discourse analysis. The professionals highlighted the vulnerability of certain groups, such as the elderly and minors, people with serious mental problems, and people with scarce or no economic resources. Daily contact with situations of suffering generates a variety of feelings and emotions (anger, sadness, fear, concern). Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are pointed out as relevant by all social workers. Receiving training and support (in formal settings) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.

Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis

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).

Why Family Communication Matters: the Role of Co-rumination and Topic Avoidance in Understanding Post-Disaster Mental Health

Although families can be a source of support post-disaster, depending on how they communicate about their stress, their attempts at support can be helpful or harmful. This study explored the moderating role of topic avoidance and co-rumination on post-disaster mental health (MH) in a sample of 485 parent-child dyads following severe floods affecting Texas. Parents (69.0% female) and their oldest child between the ages of 10-19 years (M = 13.75 years, SD = 2.56) completed online surveys approximately one-year post-flooding. Participants reported their flood exposure, life stressors since the disaster, topic avoidance, co-rumination, and MH symptoms (posttraumatic stress symptoms [PTSS], depression, anxiety). Structural equation models tested a moderated-mediation model of whether communication processes moderated the associations of flood exposure and life stressors on MH. They did not moderate the association of flood exposure to PTSS, but did have a moderating role for depression and anxiety. At low levels of topic avoidance, there was no association between flood exposure and child anxiety or depression. However, at mean and high levels of topic avoidance, there was a significant, positive association between flood exposure and child anxiety and depression. Co-rumination impacted both parents and children. For parents, there was no association between flood exposure and depression or anxiety when co-rumination was low or mean-level. However, flood exposure increased risk for depression and anxiety at high levels of co-rumination. A similar pattern emerged for children. Results for life stressors were nuanced. Overall, this suggests that communication can influence post-disaster MH.

Disclosure of Grief Questionnaire (DGQ): Entwicklung und Validierung eines Fragebogens zur Erfassung von Kommunikationsmustern nach Trauerfällen

Zusammenfassung. Für die Verarbeitung belastender Ereignisse ist das Offenlegen der persönlichen Erfahrungen gegenüber dem sozialen Umfeld von zentraler Bedeutung. Allerdings gibt es bislang keine geeigneten Instrumente zur Erfassung der Kommunikationsmuster nach Trauerfällen. Ziel der aktuellen Studie war daher, den Fragebogen zum Offenlegen von traumatischen Erfahrungen (FOT; Müller, Beauducel, Raschka & Maercker, 2000 ) für Trauerprozesse zu adaptieren und seine psychometrische Qualität über eine Online-Befragung von 302 Personen, die mindestens einen Trauerfall erlebt hatten, zu überprüfen. In einer Hauptkomponentenanalyse ergab sich eine 2-Faktoren-Lösung mit den beiden Faktoren „Verschwiegenheit“ und „Mitteilungsbedürfnis“. Die psychometrischen Kennwerte der Skalen sind mit Cronbachs α-Werten zwischen .82 – .88 als zufriedenstellend bis gut einzuordnen. Ebenso kann die Konstruktvalidität vor dem Hintergrund signifikanter Korrelationen mit verwandten Maßen als gegeben angesehen werden. Der „Disclosure of Grief Questionnaire“ (DGQ) ist somit ein reliables und valides Instrument zur Erfassung der individuellen Kommunikationsmuster nach einem Trauerfall.

The relative impacts of disclosure and secrecy: the role of (perceived) target response

This review examines the current trends in understanding the impact of individuals' decisions to either disclose information or continue to conceal it. As a whole, the evidence points to a relative benefit of disclosure over secret-keeping, but with clear cases, in which disclosure may be harmful. Advances in knowledge about factors that shape that impact, new research on the role verbal rumination with a partner following disclosure, and attention to the role of communal coping as an outcome of traumatic disclosures are addressed. In addition, recent re-conceptualization of secret-keeping, and investigations into the burden experienced by confidants are reviewed. Finally, a call for greater attention to the culture-specific impacts of disclosure decisions is made.

The longitudinal effect of social recognition on PTSD symptomatology and vice versa: Evidence from a population-based study

A specific type of social support after potentially traumatic events is called "social recognition". It is the acknowledgement or validation of event-related thoughts, behavior, and feelings by the individual or others. It consists of positive individual or societal reactions that recognize and acknowledge victims' traumatic experiences and difficulties. Current studies suggest that social recognition protects against the development of PTSD symptomatology, but there is a lack of population-based studies assessing the longitudinal interplay between PTSD symptomatology and social recognition. For this purpose, we conducted a longitudinal study using the Dutch LISS panel, based on a random sample of the Dutch population. Structural equation modeling showed that among recently affected adults (0-2 months ago), those with relatively higher levels of social recognition had lower levels of PTSD symptomatology 6 months later. Victims with high levels of PTSD symptomatology at baseline received less social recognition 6 months later. On the intermediate term (affected 5-12 months ago), baseline social recognition was no longer predictive of PTSD symptoms 6 months later, in contrast to PTSD symptomatology predicting lack of social recognition. In sum, PTSD symptom levels eroded social recognition on the short and intermediate term, while the protective role of social recognition was limited to the short term.

The "All of Us" study - Non-clinical staff members' experience of performing cardiopulmonary resuscitation in acute care settings

BACKGROUND

A multitude of Australian hospitals use non-clinical staff to assist with chest compressions and ancillary duties during cardiopulmonary resuscitation. Whilst few studies have focused on psychological implications for non-clinical staff, research into other groups indicates that a lack of attention to psychological support may adversely impact individual wellbeing, team functioning and clinical performance. The aim of this study was to explore how non-clinical workers were psychologically affected during cardiopulmonary resuscitation and factors that might mitigate adverse psychological effects.

METHODS

This study utilised a qualitative descriptive methodology involving semi-structured, face to face interviews to investigate the experiences of non-clinical staff involved in cardiopulmonary resuscitation. Data was collected using semi-structured interviews and a validated Post Traumatic Stress rating scale.

RESULTS

The study found that all 12 participants had experienced critical incident stress symptoms following their involvement in resuscitation attempts, though only one had ongoing evidence of Post Traumatic Stress Disorder. Participants felt that they needed more psychological preparation and that post-incident debriefs had been helpful but inconsistently provided and facilitated. Peer support was seen as the most significant factor in mitigating the psychological impact of critical incidents.

CONCLUSION

This study shows that the development and formalisation of peer support networks for non-clinical health staff warrants serious consideration. The study also indicates that non-clinical members of resuscitation teams may benefit from more psychological preparation and support with self-care.

The importance of social relationships for brain tumor patients' quality of life: A case for the inclusion of the concept of disclosure in psycho-oncological care

Purpose: Interpersonal factors are of major importance for cancer patients' physical and mental health. Brain tumor patients rank amongst those cancer patients with the highest psychosocial burden. Changes in language, cognition, and personality pose specific risk factors for impeding interpersonal functioning in this patient group. Despite this, role and relevance of social support including both supportive (e.g., emotional support) and detrimental interactions causing distress (e.g., critical remarks) are not well understood. Aims of this study were thus (1) to investigate the association of social support and patients' Health Related Quality of Life (HRQoL) and (2) to assess whether this relationship is mediated by the patients' disclosure behavior.Methods: Seventy-four ambulatory brain tumor patients (mean age 54 years; 58% women) completed the following self-report questionnaires: Illness-specific Social Support Scale (SSUK) for assessment of positive support and detrimental interactions, the Disclosure of Trauma Questionnaire (DTQ) for assessment of patients' disclosure behavior, and the Short-Form Health Survey (SF-8) for assessment of QoL.Findings: Detrimental social interactions were significantly related to patients' mental and physical well-being while positive support was not. Our results support a model in which patients perceiving detrimental social interactions show more difficulties in talking about illness-specific contents in a functional manner. This, in turn, was associated with a lower physical and mental HRQoL.Conclusions: This was the first study in which the close associations of detrimental social interactions, brain tumor patients' dysfunctional disclosure behavior and patients' mental as well as physical well-being were empiricially validated. Thus, dysfunctional disclosure behavior might pose a relevant therapeutic target when offering psycho-oncological support for brain tumor patients and their families.