To reappraise or not to reappraise? Emotion regulation strategies moderate the association of loneliness during COVID-19 with depression and anxiety

BACKGROUND

The COVID-19 pandemic resulted in heightened feelings of loneliness due to lockouts and social restrictions.

OBJECTIVE

In the present study, we examined the association of loneliness during the pandemic with anxiety and depression, while exploring the moderating role of the tendency to use two emotion-regulation strategies (expressive suppression, cognitive reappraisal).

DESIGN

We chose to examine these associations in a sample of older adults, because they faced higher risk for loneliness and health problems during the COVID-19 pandemic.

METHODS

Specifically, 174 Israeli veterans and ex-prisoners of wars from the 1973 Yom Kippur war (mean age = 69) completed self-report scales tapping loneliness, depression, anxiety, and emotion regulation strategies at the beginning of the COVID-19 outbreak (April-May 2020).

RESULTS

Findings revealed a stronger association between loneliness and depression among participants who had a greater tendency of using suppression. The tendency to use suppression did not significantly moderate the link between loneliness and anxiety. Additionally, a weaker association between loneliness and depression was found among participants who has a greater tendency of using reappraisal. However, these participants showed a stronger association between loneliness and anxiety.

CONCLUSIONS

These findings highlight the complexity of reappraisal and adds to the growing body of work on emotion regulation.

Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads

Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement.Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties.Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35).Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.

Vulnerability reawakened: Increased substance use among aging traumatized veterans during COVID-19 pandemic

OBJECTIVE

This study prospectively assesses the implication of (a) exposure to distant trauma of war captivity, (b) stressful life events across the life span, and (c) posttraumatic stress disorder (PTSD) trajectories and current PTSD, on substance use during the COVID-19 pandemic.

METHOD

One hundred and twenty Israeli ex-prisoners of war (ex-POWs) and 65 matched veterans of the 1973 Yom Kippur War filled out self-report questionnaires in 4 waves of assessment (T1-18, T2-30, T3-35, and T4-42 years after the war). A fifth wave of assessment (T5) was conducted in the midst of the COVID-19 pandemic, 47 years after the war.

RESULTS

Whereas in the earlier assessments (T1-T4) war captivity was not related to substance use, during the COVID-19 pandemic (T5) ex-POWs reported higher increase of use of alcohol, tranquilizers, cannabis, and sleep medications than comparable veterans. War-induced PTSD trajectories that were prospectively measured between T1-T4, and concurrent PTSD during the pandemic (T5) were related to increase in substance use during the pandemic (T5).

CONCLUSIONS

The findings demonstrate the long-term effects of both earlier experience of severe traumatic stress in young adulthood and the resultant PTSD trajectories, as reflected in increased substance use among the elderly, in the face of subsequent calamity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predicting Depression Among Spouses of Ex-POWs: The Contribution of Exposure to Violence, Trauma, and Stress Through the Life Cycle

The current longitudinal study focused on predicting depression among spouses of former Israeli war veterans (combat veterans or ex-prisoners of war [ex-POWs]). The research examined the direct and moderating role of secondary trauma related to their husbands' war-related experiences, stress related to being exposed to intimate partner violence in their relationship, being a second-generation Holocaust (SGH) survivor, and the effects of additional stressful life events (SLEs) since the end of the war. Wives of ex-POWs and combat veterans (N = 129) participated in two time measurements. Spouses of ex-POWs were found to be at higher risk of depression and psychological violence. Psychological violence was a risk factor for depression. The three-way interaction among psychological violence, being a SGH survivor, and experiencing SLEs was significant. In addition, experiencing earlier stressful events had a protective effect. The findings suggest that the association between early exposure and additive exposure through life is a complex iteration of factors and does not necessarily follow the vulnerability perspective.

Trajectories analysis of comorbid depression and anxiety among Israeli veterans: The implications on cognitive performance

BACKGROUND

Among war veterans, research has indicated high rates of depression, anxiety, and comorbidity of these disorders, with even higher rates among prisoners-of-war. However, little is known about the longitudinal effects of comorbidity profiles on cognitive performance, particularly in the case of aging war veterans.

METHOD

This longitudinal study focuses on Israeli veterans from the 1973 Yom Kippur War, with assessments at four time-points: 1991 (T1), 2003 (T2), 2008 (T3), and 2015 (T4). Two groups were included: veterans who were held captive (ex-POWs; n = 196), and veterans who were not (war veterans; n = 159). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).

RESULTS

Three distinct profiles of comorbidity were identified: resiliency (57.5%, n = 204); delayed-onset (29.6%, n = 105), and chronic (13.00%, n = 46). The chronic profile identified mostly among ex-POW (91.3%, n = 42), veterans with lower education at T1, and with more cognitively impaired compared to the other profiles (p < .0001). No differences were found between the profiles in age and family status at T1.

CONCLUSIONS

The findings highlight the importance of viewing aging veterans as a high-risk population for cognitive impairments, particularly those suffering from chronic comorbidity of depression and anxiety. Therefore, the appropriate diagnosis and cognitive treatment are required to preserve cognitive abilities and prevent decline.

Oral microbiota signatures in post-traumatic stress disorder (PTSD) veterans

Post-traumatic stress disorder (PTSD) represents a global public health concern, affecting about 1 in 20 individuals. The symptoms of PTSD include intrusiveness (involuntary nightmares or flashbacks), avoidance of traumatic memories, negative alterations in cognition and mood (such as negative beliefs about oneself or social detachment), increased arousal and reactivity with irritable reckless behavior, concentration problems, and sleep disturbances. PTSD is also highly comorbid with anxiety, depression, and substance abuse. To advance the field from subjective, self-reported psychological measurements to objective molecular biomarkers while considering environmental influences, we examined a unique cohort of Israeli veterans who participated in the 1982 Lebanon war. Non-invasive oral 16S RNA sequencing was correlated with psychological phenotyping. Thus, a microbiota signature (i.e., decreased levels of the bacteria sp_HMT_914, 332 and 871 and Noxia) was correlated with PTSD severity, as exemplified by intrusiveness, arousal, and reactivity, as well as additional psychopathological symptoms, including anxiety, hostility, memory difficulties, and idiopathic pain. In contrast, education duration correlated with significantly increased levels of sp_HMT_871 and decreased levels of Bacteroidetes and Firmicutes, and presented an inverted correlation with adverse psychopathological measures. Air pollution was positively correlated with PTSD symptoms, psychopathological symptoms, and microbiota composition. Arousal and reactivity symptoms were correlated with reductions in transaldolase, an enzyme controlling a major cellular energy pathway, that potentially accelerates aging. In conclusion, the newly discovered bacterial signature, whether an outcome or a consequence of PTSD, could allow for objective soldier deployment and stratification according to decreases in sp_HMT_914, 332, 871, and Noxia levels, coupled with increases in Bacteroidetes levels. These findings also raise the possibility of microbiota pathway-related non-intrusive treatments for PTSD.

The experience of aging before one's time during the coronavirus pandemic among war veterans in Israel

Subjective age, the personal sense of how old one feels, is an important concomitant of posttraumatic outcomes in the second half of life. The present study aims to disentangle the interrelationships between posttraumatic stress disorder symptoms (PTSS) and subjective age, during the COVID-19 pandemic, among a sample of Israeli older adults who are veterans of the 1973 Yom Kippur War. Participants were interviewed in 2015 (T1; N = 259; mean age = 65.23, SD = 5.32) and in 2020, during the COVID-19 outbreak in Israel (T2). We assessed subjective age, PTSS, fear of COVID-19, self-rated health, and COVID-19 related accelerated subjective aging. A cross-lagged path analysis showed that while higher PTSS at T1 were associated with an increase in subjective age from T1 to T2, subjective age at T1 was not associated with PTSS at T2. PTSS at T1, but not subjective age, were associated with higher COVID-19 related accelerated subjective aging at T2. Older adults with continued PTSS due to past traumas, might be susceptible to the stressors of COVID-19 expressed in the personal subjective experience of having aged quickly in a short period of time. Our findings also suggest that in the context of stress and trauma, subjective age is more appropriately conceived as an outcome variable rather than a predictor of PTSS.

Aging together in the aftermath of war: marital adjustment and subjective age of veterans and their spouses

OBJECTIVES

Trauma has long-term effects on those directly exposed to it, but it also impacts those closest to them, particularly one's spouse, as the marital relationship is of central importance for late-life development. Furthermore, traumatic experiences have been shown to be involved in an acceleration of aging, whether through physical health, or via psychological pathways, through an older subjective age. The present work seeks to examine the mutual connections between marital adjustment and the psychological accelerated aging of both spouses among military veterans of the Israeli 1973 Yom Kippur War.

METHOD

Data from two assessments were drawn from a larger longitudinal study. In 2008 (T1) and again in 2015 (T2), 247 veterans and their wives were interviewed on their subjective age, marital adjustment, and PTSD symptoms.

RESULTS

An actor-partner interdependence model combined with an autoregressive cross-lagged model, controlling for T1 PTSD symptoms revealed that men's subjective age at T1 was associated with women's subjective age at T2, and women's subjective age at T1 was associated with men's subjective age at T2. Women's marital adjustment at T1 was associated with men's marital adjustment at T2 but not the other way around.

CONCLUSION

Spousal relationships are an important arena in the lives of older adult veterans. The present study contributes new knowledge regarding the paths that predict subjective age by taking account of the subjective age of one's spouse, as well as levels of marital adjustment. Insights regarding secondary traumatization, as well as gender differences, for the aging process are discussed.

Secondary posttraumatic stress symptom trajectories and perceived health among spouses of war veterans: a 12-year longitudinal study

OBJECTIVE

War-related trauma may indirectly affect veterans' spouses both in terms of secondary posttraumatic stress symptoms (PTSS) and negative perceived health. The present study aimed to examine trajectories of secondary PTSS over a twelve-year period and its association with various measures of subjectively perceived health, among spouses of war veterans.

METHODS

Spouses of war veterans (n = 155) were assessed prospectively 30 (T1, 2003), 37 (T2, 2010), and 42 (T3, 2015) years after the 1973 Yom Kippur War. Participants completed self-report questionnaires of PTSS (PTSD inventory) in all three measurement waves, while perceived health measures (Short-Form Health Survey-SF-36) were assessed only at T3.

RESULTS

Most spouses were classified to the 'resilient' trajectory with low and stable secondary PTSS over time, followed by recovered, chronic, and delayed onset PTSS trajectories. Importantly, spouses in the 'chronic' and 'delayed' secondary PTSS trajectories reported a higher severity of general negative subjective health perceptions and health-related social malfunctioning.

CONCLUSION

Veterans' spouses who were grouped in the 'chronic' and 'delayed' PTSS trajectories are to be considered as at-risk populations for both PTSS and negative perceived health perceptions. Mental health professionals as well as family physicians should be aware of the ongoing nature of secondary PTSS which might negatively affect veterans' spouses medical conditions and ability to cope with the aging process.

Posttraumatic Stress Symptoms After Stroke: The Effects of Anatomy and Coping Style

BACKGROUND

Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke.

METHODS

Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients.

RESULTS

Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08-21.34]; P<0.01) compared with low-anxious and repressive coping styles, after adjusting for age, education, stroke severity, brain atrophy, and depression.

CONCLUSIONS

In our cohort, PTSD was a common sequela among stroke survivors. We suggest that risk factors for PTSD development include stroke severity, white matter damage, and premorbid coping styles. Early identification of at-risk patients is key to effective treatment.

Predicting secondary posttraumatic stress symptoms among spouses of veterans: Veteran's distress or spouse's perception of that distress?

OBJECTIVE

There is a relatively wide consensus that veterans' posttraumatic stress symptoms (PTSS) may lead to the development of secondary traumatization (ST) among their spouses. However, there is limited knowledge about the way the ST develops over time, as well as its predictors. The current longitudinal study examined ST trajectories among spouses of Israeli war veterans with PTSS, as well as the contribution of veterans' PTSS and wives' assessment of veterans' PTSS to these trajectories.

METHOD

Data were collected from both spouses at 3 time points, 30, 35-37, and 42 years after the 1973 Yom Kippur War (2003, 2008-2010, and 2015, respectively).

RESULTS

Using multiple-group Latent Class Growth Analysis (LCGA), we identified 4 distinct ST trajectories. The majority of wives (68%) were in the resilient group, 12% were in the recovery group, approximately 10% were in the chronic PTSS group and another 10% were in the delayed-onset group. Multinomial regressions revealed that veterans' PTSS predicted the 4 different trajectories among their wives. In addition, wives in the recovery and chronic groups who perceived their veteran husbands' PTSS to be higher also reported higher ST.

CONCLUSIONS

This study highlights the complexity of the development of ST trajectories over time. Findings supports the idea of PTSS contagion, and reveals the contributing role of both objective and perceived levels of veterans' PTSS in ST. Therefore, implementing interventions aimed at alleviating both individual and couple-level distress may be warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The longitudinal associations between attitudes to aging and attachment insecurities among combat veterans

For combat veterans, the trauma of war can have lasting effects, that may later extend to attitudes toward one's own aging (ATOA). The present study sought to examine whether attachment insecurities may help to predict ATOA in later life, while also exploring the moderating role of combat exposure concerning the effects of attachment insecurities on subsequent ATOA. A cohort of 171 veterans of the Israeli 1973 Yom Kippur War (mean age = 68.4, SD = 5.1) were interviewed in 1991 (Time 1; T1) and again in 2018 (Time 2; T2). The present study examined the moderating role of combat exposure, within the associations between T1 attachment insecurities and T2 ATOA. A regression analysis revealed that T1 attachment insecurities, T2 health problems, and post-traumatic stress disorder (PTSD) symptoms predicted more negative T2 ATOA. A significant interaction was found between combat exposure and attachment avoidance, suggesting that the effect of attachment avoidance on ATOA was only significant among participants with high levels of combat exposure. The present findings point to the importance of attachment insecurities for ATOA among veterans, and to the role of combat exposure in moderating these associations. Results indicate possible avenues of intervention and policy for those most vulnerable to negative ATOA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Moderating Role of Views of Aging in the Longitudinal Relationship Between Physical Health and Mental Distress

OBJECTIVES

Some degree of mental distress is commonly present in old age, and it is often exacerbated in later life following changes in physical health. This work presents in 2 studies among samples that have been exposed to stressful experiences in the past, a prospective examination of how the association between physical health and mental distress is attenuated by 2 forms of views on aging, evaluations of age, and evaluations of one's future.

METHOD

Study 1 (N = 226) was conducted in 2008 (Time 1) and 2014 (Time 2), among Israeli war veterans (mean age 64.90, SD = 5.04); Study 2 (N = 132) was conducted in 2014 (Time 1) and 2015 (Time 2) among older adults who were exposed to ongoing rocket fire in the south of Israel (mean age 66.44, SD = 9.77). Participants reported on their subjective age, subjective life expectancy (SLE [in Study 1]/distance to death [DtD; in Study 2]), health, and mental distress.

RESULTS

Both studies showed that after controlling for exposure to trauma and for Time 1 mental distress, Time 1 subjective age, but not SLE/DtD, moderated the association between Time 1 physical health and Time 2 mental distress.

DISCUSSION

Subjective age and SLE represent distinct features of views of aging. Subjective age may reflect perceptions of one's aging process, associated more directly with health-related outcomes over time. SLE reflects future, death-related perceptions, therefore perhaps less directly associated with such outcomes.

Prospective effects of PTSD and attachment on subjective age among veterans and their wives

The goal of the present study was to assess the trauma-induced experience of subjective aging for trauma survivors and their spouses in relation to the bidirectional effects of posttraumatic stress disorder (PTSD) and attachment insecurities. One hundred and seventy Israeli combat veterans from the 1973 Yom Kippur War and their wives reported their subjective age (SA), 35 and 42 years after the war (T1, T2). We conducted actor-partner interdependence cross-lagged models between spouses' SA and examined the associations between T1 PTSD, T1 attachment anxiety and avoidance, and spouses' T2 SA, while controlling for chronological age. The results indicated that the wives' T1 SA positively contributed to the veterans' T2 SA and the veterans' T1 SA positively contributed to the wives' T2 SA. Veterans' T1 attachment avoidance prospectively contributed to their higher T2 SA. Wives' PTSD severity and attachment anxiety at T1 prospectively contributed to their higher T2 SA. Wives' T1 attachment avoidance contributed to their lower T2 SA. Wives' attachment anxiety and health problems at T1 prospectively contributed to veterans' reports of higher T2 SA. This study emphasizes the dyadic processes that underly trauma-related aging. The impact of dyadic processes should not be overlooked in research and clinical interventions. Specifically, effective trauma interventions during old age should take into account the impact that spouses have on trauma survivors' mental states and aging processes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prior trauma, PTSD long-term trajectories, and risk for PTSD during the COVID-19 pandemic: A 29-year longitudinal study

This study assessed the contributions of prior war captivity trauma, the appraisal of the current COVID-19 danger and its resemblance to the prior trauma, and long-term trajectories of posttraumatic stress disorder (PTSD) to risk for PTSD during the COVID-19 pandemic. Capitalizing on a 29-year longitudinal study with four previous assessments, two groups of Israeli veterans - ex-Prisoners-of-War (ex-POWs) of the 1973 Yom Kippur War and comparable combat veterans of the same war - were reassessed during the COVID-19 pandemic. Previous data were collected on their PTSD trajectory 18, 30, 35, and 42 years after the war and exposure to stressful life events after the war. Currently, we collected data on their PTSD during the COVID-19 pandemic and their appraisal of similarities of past trauma with the current pandemic. Previously traumatized ex-POWs were found to be more vulnerable and had significantly higher rates of PTSD and more intense PTSD during the current pandemic than comparable combat veterans. Moreover, veterans in both groups who perceived the current adversity (captivity, combat) as hindering their current coping were more likely to suffer from PTSD than veterans who perceived it as a facilitating or irrelevant experience. In addition, chronic and delayed trajectories of PTSD among ex-POWs increased the risk for PTSD during the pandemic, and lifetime PTSD mediated the effects of war captivity on PTSD during the current pandemic. These findings support the stress resolution perspective indicating that the response to previous trauma - PTSD and its trajectories - increased the risk of PTSD following subsequent exposure to stress.

The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization

BACKGROUND

In the aftermath of trauma not only the primary traumatized survivors' mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses.

METHODS

Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment.

RESULTS

While veterans' primary PTSD only related to secondary PTSS of the wives, the veterans' DSO predicted the wives' secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not.

LIMITATIONS

The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection.

CONCLUSIONS

ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment.

Trajectories of PTSD and secondary traumatization: A longitudinal study

Ever since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a controversy around whether the inclusion of indirect exposure as a potential traumatic event for the diagnosis of posttraumatic stress disorder (PTSD) is justified. The aim of the current study was to examine the validity of PTSD resulting from secondary traumatization by evaluating the longitudinal trajectories and clinical picture of PTSD following both direct exposure and indirect exposure to war trauma. One-hundred-and-fifty-five war veterans of the 1973 Yom Kippur War and their spouses filled out self-report questionnaires assessing PTSD, 30 (T1), 38 (T2), and 42 years (T3) after the war. Findings revealed that although PTSD was more prevalent and intense among veterans, the relative distribution of PTSD trajectories was similar among veterans and spouses. In both groups, the most prevalent was the resilient trajectory (43% and 73%, respectively), followed by the recovered trajectory (28% and 15%, respectively), the chronic trajectory (21% and 7%, respectively), and the delayed trajectory (8% and 6%, respectively). In addition, the composition of PTSD symptoms was similar among veterans and spouses at T1 and T2, but not at T3. These findings demonstrate that although PTSD is more prevalent and intense among individuals who were exposed to traumatic events directly as compared to those who were traumatized secondarily, the similarities in the clinical picture support the inclusion of secondary traumatization in PTSD Criterion A.

Trajectories of depression in aging veterans and former prisoners-of-war: The role of social support and hardiness

OBJECTIVES

Depression is a prevalent outcome of traumatic experiences, such as combat and war captivity. This study explores the heterogeneity of changes over time and assesses the contribution of trauma exposure (combat vs. war captivity), hardiness, and social support for depression trajectories.

METHODS

Two groups of Israeli veterans were assessed in 1991, 2003, 2008, and 2015: 149 former prisoners-of-war (ex-POWs) and 107 combat veterans. Protective factors were evaluated in 1991. Group-based trajectory modeling was conducted to identify latent trajectories of change.

RESULTS

Four trajectories of "resiliency" (62.8%), "delayed onset" (25.1%), "exacerbation" (6.2%), and "chronicity" (5.9%) were found. The majority of the resilient group were combat veterans whereas the clinical groups consisted primarily of ex-POWs. Lower hardiness and social support were related to more deleterious trajectories.

CONCLUSIONS

Spirals of loss involving hardiness and social support, normative experiences, and contextual factors may present explanations for the various depression trajectories.

Overwhelmed by the news: A longitudinal study of prior trauma, posttraumatic stress disorder trajectories, and news watching during the COVID-19 pandemic

RATIONALE

It has been recognized that exposure to mass trauma tends to increase the time spent watching television (TV) news. Yet, research on the effects of this tendency on individuals' well-being yielded inconclusive findings.

OBJECTIVE

The aim of this longitudinal study is to examine the effects of prior trauma and posttraumatic stress disorder (PTSD) on changes in the amount of TV news watching and its effect on subsequent PTSD. More specifically, we examined the interrelations of prior exposure to war captivity, long-term PTSD trajectories, and amount of change TV news watching with PTSD severity during the COVID-19 pandemic, among aging Israeli combat veterans.

METHODS

One-hundred-and-twenty Israeli ex-prisoners of war (ex-POWs) from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) were followed up at five points of time: 1991 (T1), 2003 (T2), 2008 (T3), 2015 (T4), and in April-May 2020 (T5), during the outbreak of the COVID-19 pandemic.

RESULTS

Ex-POWs had higher odds of COVID-19 related increase in TV news watching, which, in turn, contributed to PTSD severity at T5. In addition, delayed PTSD trajectory was associated with COVID-19 related increase in TV news watching, which, in turn, contributed to more severe PTSD at T5.

CONCLUSIONS

These findings highlight the negative implications of TV news watching during a mass trauma for traumatized individuals. More specifically, they demonstrate its potential pathogenic role in exacerbating prior PTSD among trauma survivors.

Echoes from the past: adjustment of aging former prisoners of war to the COVID-19 pandemic

BACKGROUND

The aim of this study was to examine whether exposure to previous traumatic events is a risk factor for stress reactions during this pandemic. Capitalizing on a 29-year longitudinal study of Israeli ex-prisoners of war (ex-POWs) and combat veterans, we examined whether captivity is a risk factor for fear of coronavirus disease 2019 (COVID-19) and COVID-19-induced acute stress disorder (COVID-19 ASD) beyond the effects of combat exposure and other stressful life events. In addition, we examined the contribution of captivity experiences (severity of captivity, experience of solitary confinement, and suffering during captivity) and veterans' appraisal of the impact of their war-related experiences on adjustment to the current quarantine and isolation to fear of COVID-19 and COVID-19 ASD.

METHODS

One-hundred-and-twenty Israeli ex-POWs from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) filled out self-report questionnaires 18 (T1), 35 (T2), 42 (T3), and 47 (T4) years after the war.

RESULTS

Findings revealed that although ex-POWs and controls did not differ in their level of exposure to COVID-19, ex-POWS reported higher levels of fear of COVID-19 and COVID-19 ASD than controls. Suffering during captivity, measured at 1991, and participants' appraisal of the extent to which their war-related experiences affected adjustment to COVID-19 were significantly associated with fear of COVID-19 and COVID-19 ASD.

CONCLUSIONS

The findings of the study demonstrate the long-term effects of exposure to traumatic experiences (captivity) during young adulthood on adjustment to an unrelated collective stress, such as COVID-19, 40 years later.

Families in the Shadow of Traumatic Experiences: Negative World Assumptions and Family Relationships

World assumptions (WAs) are cognitive schemas concerning an individual's views of themselves, the world, and others. Although it is well established that WAs are negatively distorted by trauma exposure and strongly associated with posttraumatic psychopathology, the potential impact of WAs on close interpersonal relationships remains largely uninvestigated. The current study explored the implications of veterans' and their spouses' WAs on their marital and parental relationships. Male Israeli veterans (N = 213) from the 1973 Yom Kippur War and their wives were assessed for WAs, marital adjustment, and positive parenting 35-37 years postwar. Analyses included actor-partner interdependence modeling with mediators (APIMem) and were conducted separately for the three domains of WAs: world benevolence, world meaningfulness, and self-worth. The results indicated that both husbands' and wives' lower scores for all domain-specific WA scales were associated with lower scores on measures of marital adjustment and positive parenting. Lower scores for both spouses on scales measuring world benevolence and self-worth were associated with a spillover from lower marital adjustment to lower positive parenting. Finally, associations between one spouse's lower WA scores and the other spouse's spillover from lower marital adjustment to lower positive parenting (i.e., cross-spillover effects) were identified for wives' world benevolence ratings and husbands' self-worth, ds = 0.14-0.72. These results point to the detrimental ramifications of negative WAs on family relationships and the dynamics between the marital and parental family subsystems.

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.

Coping with war captivity: The role of sensation seeking

This study examines the implication of both sensation seeking and the subjective appraisal of captivity in the long‐term adjustment of ex‐prisoners of war (ex‐POWs). 164 Israeli ex‐POWs and 184 comparable controls were studied, 18 years after their participation in the Yom Kippur War. The findings indicate that high‐sensation seekers adjusted better than low‐sensation seekers to the stresses of captivity. Low‐sensation‐seeking ex‐POWs reported more PTSD symptoms, more severe psychiatric symptomatology, and more intense intrusive and avoidance tendencies. High‐ and low‐sensation‐seeking POWs differed also in feelings when taken prisoner, subjective assessment of suffering in prison, ways of coping with prison, and emotional states during captivity. The present study supports the postulation that sensation seeking is an important stress‐buffering personal resource. The role of coping styles in long‐term adjustment following war captivity is discussed.

Causal attribution, coping strategies, and combat‐related post‐traumatic stress disorder

The present study assesses the intervening role of ways of coping in mediating the effects of causal attribution for negative events on combat‐related post‐traumatic stress disorder (PTSD). The sample consisted of Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War and were followed 2 and 3 years after their participation in combat. The results showed that an attribution of negative events to stable and uncontrollable causes was associated with both a more frequent use of emotion‐focused coping and a less frequent use of problem‐focused coping. It was also found that emotion‐focused coping and problem‐focused coping were more direct antecedents of combat‐related PTSD than causal attribution. Finally, it was found that the association between causal attribution and combat‐related PTSD was mediated by variations in emotion‐focused coping. The discussion attempts to integrate theoretical notions derived from attributional models and Lazarus and Folkman's stress‐coping model.

Associations between hardiness, C-reactive protein, and telomere length among former prisoners of war

BACKGROUND

War captivity and posttraumatic stress disorder (PTSD) are known to be associated with several poor health outcomes of an accelerated aging process. However, the contribution of personality protective factors to this phenomenon are rarely studied. The present 24-year prospective study examined associations between psychological hardiness and three health outcomes: C-reactive protein (CRP) levels, metabolic syndrome (MetS), and telomere length (TL).

METHOD

Eighty-eight Israeli former prisoners of war (ex-POWs) were assessed 18 (T1) and 42 (T2) years after repatriation. Data on hardiness was collected at T1 while leukocyte TL, CRP, and MetS data was collected 42 years after the war.

RESULTS

While adjusting for age, body mass index (BMI), self-rated health, depressive and PTSD symptoms at T2, higher levels of hardiness at T1 predicted decreased CRP and longer TL at T2.

CONCLUSIONS

Long-term health vulnerabilities of traumatized ex-POWs are manifested in an accelerated aging process and cellular senescence. Raising awareness of the importance of protective factors such as veterans' hardiness might be associated with improving their longevity and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

What predicts unremitting suicidal ideation? A prospective examination of the role of subjective age in suicidal ideation among ex-prisoners of war

OBJECTIVE

Research has demonstrated that traumatic experiences have significant links to suicidal ideation (SI), particularly among older adults. The present study examined SI among older adults with a history of war trauma and the role of perceptions relating to one's age (subjective age) in predicting SI.

METHOD

Drawing from a larger longitudinal study, we analyzed data based on interviews with 125 ex-prisoners of war (ex-POWS) from Israel's 1973 Yom Kippur War and a control group of 101 veterans from the same war who did not fall captive (mean age at most recent measurement was 65.05, SD_age = 5.29). Participants were interviewed in 2008 (T1) and again in 2015 (T2).

RESULTS

Findings revealed significantly higher levels of SI among ex-POWs than evident among controls and significantly higher levels of SI and subjective age among ex-POWs with PTSD. Furthermore, a sequential mediation analysis indicated that among ex-POWs, the path from T1 PTSD symptoms to subsequent SI was mediated by subjective age at T1, and subjective age at T2, after controlling for age, self-rated health, and SI at T1.

CONCLUSION

A subset of ex-POWs are exposed to continuous suicidal risk throughout their later life, more than 40 years after the war. Furthermore, an older subjective age mediated these associations, independent of the levels of T1 SI, actual age, and self-rated health. These findings suggest debilitating long-term effects of trauma for SI in later life and their connections to advanced psychological aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis

Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.

Impostorism, subjective age, and perceived health among aging veterans

RATIONALE

Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined.

OBJECTIVE

Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans.

METHOD

The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2).

RESULTS

The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms.

CONCLUSIONS

The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.

The role of parental negative world assumptions in the intergenerational transmission of war trauma

PURPOSE

Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult-children's STS in veterans' families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult-children's STS.

METHODS

Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father-mother-offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling.

RESULTS

Mothers' STS was associated with children's STS via negative maternal WAs on world benevolence. Fathers' PTSS was related to children's STS via fathers' WAs on world benevolence and self-worth. Moreover, fathers' WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs.

CONCLUSION

Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.

How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study

Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.

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.

Dysfunctional pain perception and modulation among torture survivors: The role of pain personification

OBJECTIVE

Individuals exposed to trauma, especially those who develop posttraumatic stress disorder (PTSD), are at a higher risk of suffering from chronic pain as well as altered pain perception and modulation. However, the underlying mechanisms of these processes are yet to be established. Recent findings have indicated that trauma survivors tend to personify chronic pain that is developed after the exposure, in a way that resonates with the traumatic experience. The aim of this study was to test whether pain personification plays a significant role in explaining the long-term links between trauma, PTSD and pain.

METHODS

This study is part of a large-scale longitudinal study on ex-prisoners of war (ex-POWs) from the 1973 Yom-Kippur war, who were followed over 35 years after the war. Fifty-nine ex-POWs who were exposed to torture and 44 matched combatants were assessed for PTSD at 18, 30, and 35 post-war. Quantitative somatosensory testing of heat-pain threshold, pain tolerance, conditioned pain modulation (CPM), and temporal summation of pain (TSP), as well as torturing personification, were assessed at 35 years after the war.

RESULTS

Sequential mediation analyses revealed that the associations between torture and heat pain threshold, as well as pain tolerance were mediated by PTSD at several time-points (-1.43<indirect effect < 1.47). Torturing personification significantly mediated the associations between torture, PTSD, CPM and TSP (-0.16 < indirect effect).

CONCLUSIONS

These findings point to the effect of trauma on the subjective orientation towards bodily signals as a key factor in dysfunctional pain modulation.

The intergenerational sequelae of war captivity: the impact of a self-amplifying cycle of PTSD and attachment insecurities on offspring's attachment orientations

Background: War captivity is one of the most severe human-made traumatic events which lead to self-amplifying cycle of post-traumatic stress disorder (PTSD) symptoms and attachment insecurities. Solid evidence in the literature pointed out on the intergenerational transmission of PTSD symptoms. However, no research has been conducted on the intergenerational transmission of attachment insecurities and the effect of the self-amplifying cycle among former prisoners of war (ex-POWs) and their offspring attachment insecurities. Objective: This research aims to explore the intergenerational impact of a self-amplifying cycle of PTSD and attachment insecurities among ex-POWs on their offspring's attachment orientations. Method: We sampled dyads of Israeli ex-POWs of the Yom Kippur war and their adult offspring (ex-POW group) (n = 80) as well as dyads of Israeli veterans who fought in the Yom Kippur war, but were never held captive, and their adult offspring (control group) (n = 40). Veterans reported on PTSD severity and attachment orientations (anxiety, avoidance). Offspring reported on attachment orientations. We conducted (a) hierarchical regressions to predict offspring attachment orientations as a function of veterans' attachment orientations, and (b) moderated mediation analyses examining the role of veterans' PTSD in the intergenerational transmission of attachment orientations. Results: Ex-POWs' attachment anxiety was associated with offspring's reports of higher attachment anxiety and avoidance, and this intergenerational transmission of attachment was mediated by ex-POWs' PTSD severity. These effects were not significant in the control group. Conclusions: Decades after the war end, the intergenerational sequelae of war captivity are evident by the impact of the self-amplifying cycle of PTSD and attachment insecurities among ex-POWs and their offspring's attachment insecurities. Therefore, it is imperative for clinicians to recognize the intergenerational transmission and to focus not only on the trauma but also on the traumatized person's attachment injuries and the shattering of core beliefs about the world, self, and others, in the context of attachment-based therapies.

From the Frontline to the Homefront: The Experience of Israeli Veterans

In 1948, the state of Israel was created as a homeland for the Jewish people after 2,000 years of persecution and deportations in the diaspora. During the past 72 years, its inhabitants have experienced several wars and numerous terrorist attacks. Therefore, the issue of trauma goes beyond academic study, it is part of daily life. These circumstances have, unfortunately, turned Israel into a natural stress laboratory, which has enabled the systematic research of the biopsychosocial effects of traumatic stress on soldiers and civilians. This article reviews the findings of a series of studies that examine (a) the short- and long-term mental health effects of war on combat veterans; (b) the effects of repeated exposure to war on veterans; (c) trajectories of PTSD; and, specifically, (d) reactivation and (e) delayed-onset PTSD. We present the findings of two decades of systematic trauma research, which have followed the ongoing psychopathological effect of war on veterans. In understanding the ripple effects of trauma, it can be seen that veterans do not leave the events of the war behind once they are home; rather, it is with them wherever they go. Consequently, the trauma has a ripple effect that may carry over to veterans' spouses and offspring. The multiple manifestations and trajectories of both acute and chronic trauma will be presented. Clinical ramifications and implications will also be discussed.

The Impact of Captivity and Posttraumatic Stress Disorder on Cognitive Performance Among Former Prisoners of War: A Longitudinal Study

OBJECTIVE

War captivity is a potent pathogen for various aspects of mental health, including cognitive impairments. However, little is known about the long-term impact of war captivity and posttraumatic stress disorder (PTSD) on cognitive functioning among former prisoners of war (ex-POWs). This study assesses the effect of captivity, PTSD trajectories, and the accumulating differential effect in the prediction of cognitive performance.

METHODS

This longitudinal research includes 4 assessments (1991 [T1], 2003 [T2], 2008 [T3], 2015 [T4]) of Israeli ex-POWs and comparable combatants from the 1973 Yom Kippur War. Accordingly, 95 ex-POWs and 26 comparable combatants were included in this study. PTSD was assessed according to the DSM-IV, and cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).

RESULTS

Ex-POWs reported higher levels of PTSD symptoms compared to controls (P = 0.007). No difference was found between the groups regarding MoCA total score. Ex-POWs with chronic PTSD were found to have more difficulty in overall cognitive functioning, compared to ex-POWs with delayed, recovery, and resilient trajectories (P = 0.03). Finally, physical and psychological suffering in captivity and intrusion symptoms predicted cognitive performance (P < .001, R² = 37.9%). These findings support the potent pathogenic effects of war captivity on cognitive abilities, more than 4 decades after the end of the traumatic event.

CONCLUSIONS

Our results showed captivity to be a unique and powerful traumatic experience, leading to PTSD and long-lasting and enduring neuropsychological implications. These findings highlight the importance of viewing ex-POWs, in particular those suffering from chronic PTSD, especially as they age, as a high-risk population for cognitive disorders. This requires the appropriate diagnosis and cognitive therapy as a way to preserve cognitive abilities among this population.

Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation

Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.

Punishing the Self: Post-Traumatic Guilt Mediates the Link Between Trauma and Deficient Pain Modulation

Trauma survivors may suffer from post-traumatic stress disorder (PTSD), elevated post-traumatic guilt (PG), and alterations in the pain system. However, the association between PG and alterations in pain perception and modulation among trauma survivors has not been established, nor has the possible underlying role of PG. This longitudinal study investigated: 1) the unique contribution of PG in predicting pain perception and modulation, while controlling for PTSD symptoms; and 2) the mediating role of PG in explaining pain perception and modulation among torture survivors, above and beyond PTSD symptoms. Participants were 59 torture survivors and 44 age-matched controls. PG and PTSD symptoms were assessed in 2003 (T1). Heat-pain threshold, heat-pain tolerance, temporal summation of pain (TSP), and conditioned pain modulation (CPM) were measured 5 years later (T2). Torture survivors had elevated PG and PTSD symptoms, enhanced TSP, and reduced CPM, compared to controls. While PTSD predicted reduced pain tolerance and CPM, PG predicted increased pain tolerance. Moreover, PG mediated the associations between torture and (increased) pain threshold, pain tolerance, and TSP. It appears that PTSD and PG induce opposite effects on the pain modulation capacity of torture survivors, a dichotomy that may explain paradoxical pain responses among trauma survivors, as discussed. PERSPECTIVE: This longitudinal study sheds light on the possible mechanisms underlying variations in pain perception and modulation among trauma survivors. PTSD and PG each mediated opposing pain modulation profiles, suggesting that individual responses to trauma, rather than the trauma itself, influence pain responses.

Attachment Orientations Moderate the Self-Amplifying Cycle of Posttraumatic Stress Disorder and Negative Cognitions—A Seven-Year Longitudinal Study

Introduction: We examined whether attachment orientations moderated the self-amplifying cycle of Posttraumatic Stress Disorder (PTSD) and negative cognitions, decades after the trauma ended.

Method: We sampled Israeli veterans from the 1973 Yom Kippur War and assessed PTSD severity and cognitions about the self and the world, twice—35 (T1) and 42 (T2) years after the war. At T1, we assessed participants’ attachment orientations (anxiety, avoidance).

Results: Findings provided support for a self-amplifying cycle of PTSD severity and negative cognitions about others’ benevolence during the seven-year study period. Findings also indicated that this self-amplifying cycle was significant only among veterans who scored relatively high on attachment anxiety but not among those who had less anxious attachment. Attachment avoidance also moderated the prospective contribution of negative cognitions about the self and others to PTSD severity seven years later.

Discussion: The psychological mechanisms underlying the observed effects of attachment orientations were discussed.

Is acute stress reaction a risk factor for early mortality?

OBJECTIVE

This study aimed to examine the role of combat stress reaction (CSR) in predicting all-cause mortality over a 33-year period following the end of the war.

METHOD

Two groups of male veterans from the 1982 Lebanon War participated in this study in 1983 (T1) and 2016 (T2): the CSR group (n = 375) and a matched comparison group (n = 305) consisting of combatants who had participated in combat in the same units as the CSR group but were not identified as having CSR. Participants were assessed for posttraumatic stress disorder symptoms and depressive symptoms in T1 and mortality in T2.

RESULTS

The distribution of mortality rates was significantly different between the 2 groups and higher among the CSR group (n = 32, 8.5%) as compared to the comparison group (n = 12, 3.9%; χ2 = 5.89, p = .01). Both posttraumatic stress disorder symptoms and depressive symptoms were controlled for because they have been shown to be risk factors for all-cause mortality. The mortality curve of the CSR group increased steeply around the age of 40 years, whereas in the comparison group, the increase was less substantial.

CONCLUSIONS

CSR was found to be a significant predictor of all-cause mortality. The risk for mortality was higher and earlier among the CSR group compared with the comparison group. The findings of this study call attention to the importance of immediately identifying CSR to better care for the individual and minimize long-term negative effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels: A Longitudinal Study

OBJECTIVE

This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS.

METHODS

Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria.

RESULTS

Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P = .01, R² = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P = .05).

CONCLUSIONS

Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities.

The link between attachment orientations and cellular aging among former prisoners of war

Objective: Ex-prisoners of war (ex-POWs) experience prolonged distress that in some cases may influence their cellular aging (telomere length). The current research examines whether attachment orientations of ex-POWs and their spouses can explain individual differences in telomere length 40 years after the experience of captivity.Methods: Eighty-eight Israeli ex-POWs were assessed at four time points since captivity, whereas their spouses at three time points. Attachment orientations (anxiety, avoidance) were assessed in three time points and telomere length was measured at time four.Results: Findings indicated that ex-POWs' attachment avoidance was associated with shorter telomere length. In addition, spouses' attachment anxiety was associated with shorter telomere length among ex-POWs, whereas spouses' attachment avoidance was unexpectedly related to longer telomere length among ex-POWs.Conclusions: Results suggest that the effects of trauma on cellular aging are not uniform and that intrapersonal and interpersonal variables may moderate responses to trauma at the cellular level.

What doesn't kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

Pain perception and modulation in ex-POWs who underwent torture: The role of subjective and objective suffering

OBJECTIVE

Previous findings have demonstrated that torture survivors exhibit chronic pain and alterations in pain perception. However, not much is known regarding the characteristics of the torture experience and its contribution to these long-term ramifications. The current study examined the unique role of objective severity and subjective suffering in torture in predicting chronic pain and acute pain perception and pain modulation.

METHOD

Eighteen years after war, 59 former prisoners of war who were subjected to severe torture in captivity were assessed for subjective suffering in torture and estimated weight loss during captivity (an indication of torture severity) using self-administered questionnaires. Thirty-five years after captivity, systemic quantitative somatosensory testing was conducted, which included the measurement of pain threshold, pain tolerance, conditioned pain modulation, and perceived suprathreshold stimuli. Self-administered questionnaires were also used to evaluate chronic pain and posttraumatic stress disorder.

RESULTS

The findings indicated that subjective suffering was associated with pain threshold, conditioned pain modulation, perceived suprathreshold stimuli, and chronic pain while controlling for posttraumatic stress symptoms. Estimated weight loss was associated only with pain threshold.

CONCLUSION

The findings demonstrate that the experience of chronic and acute pain is rooted in the subjective perception of traumatic experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study

Background: The World Health Organization(WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD), separate and distinct from posttraumatic stress disorder (PTSD). However, to date, no study has examined CPTSD over time. Objectives: This prospective study aimed to examine predictors and outcomes of latent classes of PTSD and CPTSD following war captivity. Method: A sample of 183 Israeli former prisoners of the 1973 Yom Kippur War (ex-POWs) participated in a 24-year longitudinal study with three waves of measurements (T1: 1991, T2: 2008, and T3: 2015). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Results: Estimated rates of PTSD and CPTSD were high at all waves, with PTSD rates higher than CPTSD. A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small class with low probability to meet PTSD and CPTSD clusters criteria (15.26%); (2) a class high only in PTSD symptoms (42.37%) and (3) a class high only in CPTSD symptoms (42.37%). Importantly, higher levels of psychological suffering in captivity at T1 were associated with higher odds of being in the CPTSD class at T2. In addition, CPTSD at T2 was more strongly associated with low self-rated health, functional impairment, and cognitive performance at T3, compared to the PTSD only class. Conclusions: Adulthood prolonged trauma of severe interpersonal intensity such as war captivity is related to CPTSD, years after the end of the war. Exposure to psychological suffering in captivity is a risk factor for future endorsement of CPTSD symptoms. CPTSD among ex-POWs is a marker for future dire mental health and functional consequences.

One 'knows': self-rated health and telomere length among ex-prisoners of war

OBJECTIVE

Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length.

METHODS

Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3.

RESULTS

The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3.

CONCLUSIONS

These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.