Battlefield functioning and chronic PTSD: associations with perceived self efficacy and causal attribution

The mediating role of self-efficacy between workplace violence and PTSD among nurses in Liaoning Province, China: A cross-sectional study

Purpose

Nurses are at high risk for workplace violence, which can lead to psychological problems. The purpose of this study was to determine the relationship between workplace violence, self-efficacy, and PTSD, and to further explore whether self-efficacy mediates the relationship between workplace violence and PTSD among Chinese nurses.

Materials and methods

This cross-sectional study was conducted in Liaoning Province, China in 2020. A total of 1,017 valid questionnaires were returned. Each questionnaire included the Workplace Violence Scale, the General Self-Efficacy Scale, the Post-traumatic Stress Disorder Scale (PTSS-10), and demographics information. A hierarchical multiple regression approach was used to explore the mediating role of self-efficacy in the relationship between workplace violence and PTSD. The mediation model was then tested by the PROCESS macro in SPSS.

Results

A total of 1,017 nurses were included in this study, and the average score of PTSD among Chinese nurses was 26.85 ± 13.13 (mean ± SD). After further adjustment for control variables, workplace violence was positively associated with PTSD, explaining 13% of the variance. High self-efficacy was associated with low PTSD, explaining 18% of the variance. Self-efficacy partially mediated the role of workplace violence and PTSD.

Conclusion

The high scores of PTSD among Chinese nurses demand widespread attention. Workplace violence is an important predictor of PTSD in nurses. Self-efficacy is a significant factor in improving PTSD in nurses and mediates the relationship between workplace violence and PTSD. Measures and strategies to improve self-efficacy may mitigate the effects of workplace violence on PTSD in nurses.

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.

An exploratory study of embitterment in traumatized refugees

BACKGROUND

Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties.

METHODS

A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment.

RESULTS

Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment.

CONCLUSION

The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.

Self-efficacy and coping style in Iraq and Afghanistan-era veterans with and without mild traumatic brain injury and posttraumatic stress disorder

OBJECTIVE

To examine self-efficacy and coping style in combat-exposed Veterans with and without mild traumatic brain injury (mTBI) history and posttraumatic stress disorder (PTSD).

METHODS

Veterans (N = 81) were categorized into four groups: comorbid mTBI and PTSD (n = 23), PTSD-only (n = 16), mTBI-only (n = 25), and combat-exposed controls (n = 17). Outcomes included the Self-Efficacy for Symptom Management Scale and the Brief Coping Orientation to Problems Experienced.

RESULTS

Significant group effects were found on self-efficacy and coping style, even when adjusting for total mTBIs and psychiatric comorbidities. Post-hoc analyses revealed that the comorbid and PTSD-only groups generally had lower self-efficacy than the mTBI-only and control groups and that the PTSD-only group used less action-focused coping than the mTBI-only and control groups.

CONCLUSION

Our results suggest that self-efficacy and coping style vary as a function of mTBI history and PTSD status and that it may be important to integrate these malleable factors into interventions for this population.

Perceived organizational support and PTSD symptoms of frontline healthcare workers in the outbreak of COVID-19 in Wuhan: The mediating effects of self-efficacy and coping strategies

The present study aimed to examine the effect of perceived organizational support on the PTSD symptoms of frontline healthcare workers, and to examine the mediating effects of coping self-efficacy and coping strategies in this relationship. A short-term longitudinal study design was used to conduct two waves of online surveys in March and April 2020. Participants comprised 107 medical staff in both waves of investigation. Self-efficacy, coping strategies, and perceived organizational support were reported at Wave 1, and PTSD symptoms were reported at Wave 2. Results indicated that (1) The prevalence of probable PTSD was 9.3% and 4.7% on the Chinese version of the Impact of Events Scale-Revised of 33 and 35, respectively. Local healthcare workers had greater risks of PTSD than the members of medical rescue teams. Doctors reported higher PTSD symptoms than nurses. (2) Perceived organizational support had a significant indirect effect on PTSD symptoms through the mediation of problem-focused coping strategies and the sequential mediating effect of coping self-efficacy and problem-focused coping strategies. The findings highlight the importance of providing adequate organizational support to reduce PTSD symptoms in frontline medical staff during the COVID-19 pandemic.

Impact of Divergent Thinking Training on Teenagers' Emotion and Self-Efficacy During the COVID-19 Pandemic

Currently due to the COVID-19 pandemic, young people are experiencing a decrease in self-efficacy and an increase in mental illness. Though previous studies have shown that self-efficacy and divergent thinking training are positively related, little is known about the impact of divergent thinking training on self-efficacy and emotions. Therefore, our study seeks this answer to support teenagers injured psychologically during disastrous periods. We randomly assigned 70 students to a 2 (time: pretest, post-test) × 2 (groups: divergent thinking training, controlled) mixed design. Participants in the experimental group were given a 9-day divergent thinking training with the theme of "writing down 10 novel functions of the mask," while those in the control group spent 10 min each day recording what they ate. The self-efficacy, anxiety, depression, and stress of two groups were measured before and after training. Results showed that, compared to the control group, self-efficacy ceased decreasing while anxiety decreased for the experimental group. These findings confirm the positive effect of divergent thinking on teenagers. Implications and limitations are discussed.

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

The role of mPFC and MTL neurons in human choice under goal-conflict

Resolving approach-avoidance conflicts relies on encoding motivation outcomes and learning from past experiences. Accumulating evidence points to the role of the Medial Temporal Lobe (MTL) and Medial Prefrontal Cortex (mPFC) in these processes, but their differential contributions have not been convincingly deciphered in humans. We detect 310 neurons from mPFC and MTL from patients with epilepsy undergoing intracranial recordings and participating in a goal-conflict task where rewards and punishments could be controlled or not. mPFC neurons are more selective to punishments than rewards when controlled. However, only MTL firing following punishment is linked to a lower probability for subsequent approach behavior. mPFC response to punishment precedes a similar MTL response and affects subsequent behavior via an interaction with MTL firing. We thus propose a model where approach-avoidance conflict resolution in humans depends on outcome value tagging in mPFC neurons influencing encoding of such value in MTL to affect subsequent choice.

Psychiatric distress among aging decorated and non-decorated veterans: The role of impostorism and loneliness

Objectives: The aging process may be affected by negative life events as well as social factors. Though psychological aspects of the aging process in veterans have been the focus of considerable research, decorated veterans have been scarcely investigated in this domain. The current study sought to assess psychiatric distress (PD) levels among aging decorated and non-decorated veterans' (DVs and n-DVs, respectively) and examine its association with the maladaptive perception that others will identify a high-achieving person as an impostor (i.e. impostorism) and perceived social isolation (i.e. loneliness).Methods: Two groups of Israeli veterans of the 1973 Yom Kippur War, DVs (n = 75) and n-DVs (n = 73), were assessed for PD and combat exposure in middle adulthood (1991; T1); in later life (2018; T2) they were assessed for negative life events, impostorism, loneliness and PD.Results: Impostorism, loneliness and PD were all inter-correlated. DVs evinced less PD at T1 and T2 than n-DVs but similar levels of impostorism and loneliness at T2. Nevertheless, negative life events, impostorism and loneliness explained PD at T2, with loneliness being more significant, especially among the n-DVs. Combat exposure did not explain variances in late-life PD.Conclusion: Aging DVs seem to be less vulnerable to late-life PD than n-DVs, and impostorism and loneliness may be important factors in this respect. Being the first study to investigate aging DVs' mental health and impostorism among aging veterans, the findings further underscore the clinical imperative of psychosocial factors in understanding aging veterans' mental health.

Self-Efficacy as an Agentic Protective Factor against Death Anxiety in PTSD and Psychiatric Co-Morbidity

PTSD has profound personal, social and economic impact. Understanding factors that influence strong recovery is a priority for informing the use of limited treatment resources. This study follows up a preliminary finding from Hoelterhoff and Cheung Chung, Psychiatr Q, 88, 635-651, [30] which found that death anxiety is related to PTSD and suggested that self-efficacy may mediate this relationship. Specifically, this study examined self-efficacy as a protective factor in the context of people who have experienced a life-threatening event. 109 undergraduate university students completed self-report questionnaires on, self-efficacy, death anxiety, trauma and well-being as well as a number of demographic factors. Self-efficacy was found that to be significantly and inversely related to death anxiety and psychiatric co-morbidity, but not PTSD. Results were discussed in light of literature regarding death anxiety. It seems that self-efficacy is related to death anxiety and well-being; however, it interacts with these processes independently and not as a mediating factor. More research is needed to understand coping mechanisms that help develop resilience against the negative effects of death anxiety against PTSD and minimize its detrimental impact on mental health.

PTSD and the influence of context: The self as a social mirror

The principal accepted models of posttraumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well-being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experience and experiences that occur distant from the threatening event. These findings suggest posttraumatic responding is best conceptualized through the lens of the self-in-context, as opposed to imprinting that results from a given event at a given time. Moreover, studies of non-Western populations often do not express trauma as PTSD, or at least not primarily as PTSD, which argues against specific neural or memory encoding processes, but rather for a more plastic neural process that is shaped by experience and how the self develops in its cultural context, as a product of a broad array of experiences. We posit that fear and emotional conditioning as well as the ways traumas are encoded in memory are only partial explanatory mechanisms for trauma responding, and that issues of safety and harm, which are long term and developmental, are the common and principal underpinnings of the occurrence of posttraumatic distress, including PTSD.

'Everything just seems much more right in nature': How veterans with post-traumatic stress disorder experience nature-based activities in a forest therapy garden

Available evidence shows that an increasing number of soldiers are seeking help for post-traumatic stress disorder. The post-traumatic stress disorder condition has big emotional and psychological consequences for the individual, his/her family and the society. Little research has been done to explore the impact of nature-based therapy for veterans with post-traumatic stress disorder although there is a growing amount of evidence pointing towards positive outcome. This qualitative study aims to achieve a deeper understanding of this relationship from the veteran’s perspective. Eight Danish veterans participated in a 10-week nature-based therapy. Qualitative interviews were conducted and analysed using the interpretative phenomenological method. The results indicated that the veterans have achieved tools to use in stressful situations and experienced an improvement in their post-traumatic stress disorder symptoms.

The prevalence and psychosocial correlates of suicide attempts among inpatient adolescent offspring of Croatian PTSD male war veterans

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12-18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5% (65.2% for girls and 58.0% for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

How Disorder-Specific are Depressive Attributions? A Comparison of Individuals with Depression, Post-Traumatic Stress Disorder and Healthy Controls

Depressed individuals tend to assign internal, stable, and global causes to negative events. The present study investigated the specificity of this effect to depression and compared depressive attributional styles of individuals with major depression (MD), post-traumatic stress disorder (PTSD), and healthy controls. We indexed attributional style using the depressive attributions questionnaire in 164 participants. Additionally, we assessed appraisals characteristic of PTSD using the post-traumatic cognitions inventory (PTCI), depressive rumination, trauma history, and depression and PTSD symptom severity. Individuals with MD endorsed a depressive attributional style to a greater extent than both individuals with PTSD, who were not depressed, and healthy controls. Depressive attributional style was associated with the severity of depressive and PTSD symptoms, number and distress of traumatic experiences, frequency of rumination, and post-traumatic cognitions. Depressive attributions and PTCI appraisals independently predicted MD and PTSD symptom severity. They may thus be useful in predicting MD and PTSD, and should be targeted in psychological treatments of these conditions.

A consideration of select pre-trauma factors as key vulnerabilities in PTSD

Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.

Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom

BACKGROUND

A number of studies have examined the prevalence and correlates of posttraumatic stress disorder (PTSD), depression, and related psychiatric conditions in soldiers returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but none have examined whether factors such as psychological resilience and social support may protect against these conditions in this population.

METHODS

A total of 272 predominantly older reserve/National Guard OEF/OIF veterans completed a mail survey assessing traumatic stress and depressive symptoms, resilience, and social support.

RESULTS

Resilience scores in the full sample were comparable to those observed in civilian outpatient primary-care patients. Respondents with PTSD, however, scored significantly lower on this measure and on measures of unit support and postdeployment social support. A hierarchical regression analysis in the full sample suggested that resilience (specifically, increased personal control and positive acceptance of change) and postdeployment social support were negatively associated with traumatic stress and depressive symptoms, even after adjusting for demographic characteristics and combat exposure.

CONCLUSIONS

These results suggest that interventions to bolster psychological resilience and postdeployment social support may help reduce the severity of traumatic stress and depressive symptoms in OEF/OIF veterans.

Self-Efficacy and Health-Related Outcomes of Collective Trauma

The objective of our study was to systematically review research evidence for relationships between self-efficacy beliefs and psychological as well as somatic outcomes of collective traumatic events. Twenty-seven studies enrolling adult and adolescent survivors of acute, escalating, and chronic collective trauma with a total of N = 8011 participants were reviewed. Cross-sectional studies suggest medium to large effects of self-efficacy on general distress, severity and frequency of PTSD (posttraumatic stress disorder) symptoms (weighted r values range from –.36 to –.77), whereas longitudinal studies indicate large effects on general distress and PTSD symptom severity (weighted r values range: –.55 to –.62). Self-efficacy was also related to better somatic health (self-reported symptoms, i.e., less pain, fatigue, or disability). Studies addressing the relationship between self-efficacy and substance abuse after collective trauma revealed a more complex picture. Some types of pretreatment self-efficacy (e.g., self-efficacy for coping with urges) or changes in efficacy beliefs may predict less substance use or relapses. Studies testing the mediating role of cognitive or social variables in the relationship among efficacy beliefs and health outcomes indicated rather direct, unmediated effects of beliefs about ability to deal with adversities on posttraumatic adaptation. Men may benefit more from stronger efficacy beliefs. In terms of reciprocity between self-efficacy and health, evidence from longitudinal studies suggested that self-efficacy determines health-related outcomes, but changes in diagnosis do not predict changes in self-efficacy. Although a lack of experimental studies limits the conclusions, the results indicated that self-efficacy is a powerful predictor of posttraumatic recovery among collective trauma survivors.

Cognitive-behavioral theory and preparation for professionals at risk for trauma exposure

Military personnel, emergency first responders, and others whose work environments include exposure to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). To help prevent negative sequelae, there is a strong need to identify well-operationalized, empirically supported, theoretically framed models of healthy adaptation to potentially traumatic events. Cognitive-behavioral theories (CBTs) describe etiological factors in trauma, guide research that has identified risk for PTSD, and help develop interventions that can effectively reduce posttrauma symptomatology. In this article, the authors draw on CBT and empirical research on post-traumatic stress to propose possible cognitive-behavioral mechanisms in trauma adaptation. They then suggest directions for future research, including areas for prevention interventions for at-risk professionals.

Psychiatric and emotional sequelae of surgical amputation

The prevalence of posttraumatic stress symptoms after the experience of amputation is not well established. The current study gathered data on the prevalence of posttraumatic stress disorder (PTSD) and other psychiatric disorders after amputation. Participants were recruited from a large Northeastern rehabilitation hospital and were assessed with structured clinical interviews. The data suggest that planned surgical amputations resulting from chronic illness do not frequently lead to PTSD symptoms. In contrast, data suggest that amputation resulting from accidental injury may lead to a higher prevalence of PTSD, in part because of the emotional stress surrounding the accident.

THE INFLUENCE OF PESSIMISTIC EXPLANATORY STYLE ON THE RELATION BETWEEN STRESSFUL LIFE EVENTS AND HOSPITAL DOCTORS' PSYCHOLOGICAL DISTRESS

This study examined the influence of pessimistic explanatory style (PES) on the relation between stressful events and psychological distress, first as a moderator with an interaction term, and secondly as a mediator between stressful events and psychological distress. A demographic questionnaire, the General Health Questionnaire (GHQ-12; Goldberg & Williams, 1991), the Social Readjustment Rating Scale (SRRS; Holmes & Masuda, 1974), and the Attributional Style Questionnaire (ASQ; Peterson, 1995) were completed by 121 hospital doctors, 70 men and 51 women, aged 23–65 years (M = 37.2, SD = 1.2). There were no significant differences in mean GHQ psychological distress scores between groups for sex, domestic status, employment status or grade. Stressful events were positively associated with PES, and both were positively associated with psychological distress. In the absence of a significant interaction component, multiple regression analyses did not support explanatory style as a moderator, but did support it as a mediator in the relationship between stressful events and psychological distress. Findings were discussed in terms of helping doctors to alter their explanatory styles and possibly attenuate the influence of stressful events on their psychological distress.

Hopelessness as a risk factor for post-traumatic stress disorder symptoms among interpersonal violence survivors

Post-traumatic stress disorder often co-occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post-traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self-reported and interviewer-rated measures of hopelessness gathered at 2 weeks post-trauma and self-reported and interviewer-rated symptoms of post-traumatic stress disorder gathered at 2 weeks and 3 months post-trauma were examined. Hierarchical, simultaneous regression analyses that co-varied trauma type revealed that hopelessness was related to self-reported symptoms of post-traumatic stress disorder, both concurrently and prospectively. Follow-up analyses revealed that relationships between hopelessness and symptoms of post-traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer-rated symptoms of post-traumatic stress disorder.

PTSD and world assumptions following myocardial infarction: a longitudinal study

The study aims to examine the association between exposure to trauma, posttraumatic stress disorder (PTSD), and world assumptions. The study included 3 groups of subjects: PTSD myocardial infarction (MI) patients, non-PTSD MI patients, and matched controls. World assumptions were examined twice: within a week of the patient's MI (Time 1) and 7 months later (Time 2). The findings indicate that world assumptions are not related to exposure to trauma but are associated with PTSD.