Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder

The Impact of Social Support and Social Network Characteristics on Trauma Symptoms Among Violence-Exposed Women with Substance Use Disorders

Background: Women with substance use disorder (SUD) experience higher rates of violence exposure, post-traumatic stress disorder (PTSD), and post-traumatic stress symptoms (PTSS) than their non-substance-using peers. Exposure to violence in women with SUD is associated with PTSS symptom severity and leads to lower rates of treatment adherence, poorer treatment outcomes, and a higher risk for relapse. Little is known about the buffers to PTSS among violence-exposed women with SUD. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Using ordinary least squares regression models, we sought to identify the direct effects of violence, general social support, recovery-specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support, recovery social support, and greater duration of network relationships were associated with lower trauma symptom scores. General social network composition variables were directly associated with lower trauma symptom severity. Recovery-specific social network variables moderated the association between violence exposure and PTSS for Black participants only. Conclusions: These data suggest that providers should target the quality of the client's interpersonal relationships to reduce PTSS among violence-exposed women with SUD. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence.

Comparing Transdiagnostic Risk Factors: Predicting Emergence of Significant Depressive, Anxiety, and Substance Abuse Symptoms Among Juvenile Delinquents

In a 7-year 11-wave study of low-SES adolescents (N = 856, age = 15.98), we compared multiple well-established transdiagnostic risk factors as predictors of first incidence of significant depressive, anxiety, and substance abuse symptoms across the transition from adolescence to adulthood. Risk factors included negative emotionality, emotion regulation ability, social support, gender, history of trauma, parental histories of substance abuse, parental mental health, and socioeconomic status. Machine learning models revealed that negative emotionality was the most important predictor of both depression and anxiety, and emotion regulation ability was the most important predictor of future significant substance abuse. These findings highlight the critical role that dysregulated emotion may play in the development of some of the most prevalent forms of mental illness.

Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness

BACKGROUND

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.

METHODS

PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.

RESULTS

Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.

CONCLUSION

Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

Psychological impacts of the COVID-19 pandemic in a Hispanic sample: Testing the buffering role of resilience and perceived social support

The current study examined the effects of specific COVID-19 stressors (i.e., family member's death due to COVID-19, COVID-19 infection, and school/financial stressors) on stress, anxiety, and depression and the potential buffering roles of resilience and perceived social support in the association between COVID-19 stressors and psychological symptoms in a Hispanic university student sample (n = 664). Participants were classified in three stressor groups: those reporting a family member's death due to COVID-19 (15.7%), those reporting their own or a family member's COVID-19 infection but no COVID-19 death (35.5%), and those reporting only school and/or financial stressors due to the pandemic (48.8%). Participants completed self-report measures online. Over 50% of participants with a COVID-19 death or infection in the family reported clinical levels of depression symptoms and over 40% endorsed clinically elevated anxiety symptoms. A series of moderation analyses with multi-categorical predictors found that among relatively highly resilient people, the magnitudes of the impact of COVID-19 infection or death on stress, anxiety, and depression were similar to the effect of a financial/school stressor alone, suggesting the buffering role of resilience. Perceived social support did not play a buffering role in the associations. Family member death due to COVID-19 and COVID-19 infection had significant negative psychological impacts on Hispanic young adults. Internal personal resources such as resilience, rather than external personal resources such as perceived social support, appear to be a critical factor that may help protect Hispanic individuals' mental health from the worst stressors of the COVID-19 pandemic.

Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review

Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.

The relationship of COVID-19 traumatic stress, cumulative trauma, and race to posttraumatic stress disorder symptoms

The purpose of this study was to test if coronavirus disease 2019 (COVID-19) traumatic stress predicts posttraumatic stress disorder (PTSD) symptoms after cumulative trauma and whether there is a three-way interaction between COVID-19 traumatic stress, cumulative trauma, and race in the prediction of PTSD. Using a cross-sectional design, a diverse sample of 745 participants completed measures of cumulative trauma, COVID-19 traumatic stress, and PTSD. COVID-19 traumatic stress accounted for a significant amount of the variance in PTSD above and beyond cumulative trauma. A significant interaction effect was found, indicating that the effect of COVID-19 traumatic stress in predicting PTSD varied as a function of cumulative trauma and that the effects of that interaction were different for Asians and Whites. There were generally comparable associations between COVID-19 traumatic stress and PTSD at low and high levels of cumulative trauma across most racial groups. However, for Asians, higher levels of cumulative trauma did not worsen the PTSD outcome as a function of COVID Traumatic Stress but did at low levels of cumulative trauma.

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18-34, 35-49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18-34 (prevalence=14.0%/6.3%) and 35-49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35-49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age.

Long-Term Post-traumatic Stress Disorder After Orthopaedic Injury: Prevalence and Risk Factors

OBJECTIVES

To evaluate the prevalence of post-traumatic stress disorder (PTSD) symptoms in individuals who are further removed from injury (up to 3 years) and to identify injury-specific characteristics that are associated with an increased risk for persistent PTSD symptoms.

DESIGN

Cross-sectional, retrospective cohort.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

Two hundred forty-three patients operatively treated for orthopaedic trauma between March 2017 through June 2018.

INTERVENTION

Orthopaedic trauma requiring operative intervention.

MAIN OUTCOME MEASUREMENTS

The primary outcome was score on the PTSD Checklist for the DSM-5 (PCL-5) survey. A score of 31 or higher was considered concerning for PTSD.

RESULTS

Forty-nine of 239 respondents (20.5%) scored positive for PTSD. Multivariate analysis demonstrated an increased risk of PTSD for patients with a history of smoking and those who required delayed reoperation (greater than 90 days postoperative). White race and low-energy mechanisms of injury were associated with decreased risk of PTSD. Fracture locations were not associated with a higher likelihood of PTSD.

CONCLUSIONS

The prevalence of PTSD symptoms in patients up to 3 years after surgery remains higher than the estimated prevalence of PTSD in the general US population. It is similar to previously documented rates of PTSD for patients less than 1 year after injury. Long-term complication requiring reoperation was associated with an increased risk of persistent PTSD symptoms. Orthopaedic providers should be mindful of PTSD symptoms not only in the immediate postoperative period but throughout the treatment course particularly for those with identified PTSD risk factors.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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).