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deMello RAF, Coimbra BM, Pedro BDM, Benvenutti IM, Yeh MSL, Mello AF, Mello MF, Poyares DR. Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4240-4266. [PMID: 35899768 DOI: 10.1177/08862605221114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.
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Affiliation(s)
- Ricardo A F deMello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bianca D M Pedro
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Isabella M Benvenutti
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mary S L Yeh
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcelo F Mello
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dalva R Poyares
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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2
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Spitzer C, Lübke L, Müller S, Conrad R, Gallinat C. State and trait dissociation in pathological skin picking. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3
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Carvalho T, Pinto-Gouveia J, Cunha M, da Motta C. Experiential avoidance, uncompassionate self-responding, and peritraumatic depersonalization/derealization: A novel mediation model for war-related PTSD symptomatology. J Clin Psychol 2022; 78:1074-1092. [PMID: 34993963 DOI: 10.1002/jclp.23303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore a novel model for war-related posttraumatic stress disorder (PTSD) symptomatology including emotion regulation processes, namely experiential avoidance (EA) and uncompassionate self-responding (USR), mediating the impact of childhood threat memories, combat exposure distress, combat and noncombat threats, and peritraumatic depersonalization/derealization (PDD) on PTSD symptomatology. METHOD A sample of 650 male Portuguese Overseas War veterans filled self-report instruments. RESULTS The model explained 59% of the variance of PTSD symptomatology. Both EA and USR mediated the effects of noncombat threats and PDD on PTSD. Additionally, EA mediated combat exposure distress and USR mediated childhood threat memories. Combat exposure distress, combat and noncombat threats, and PDD showed direct effects on PTSD symptomatology. CONCLUSION The findings help to better understand the relationship between predictive factors of war-related PTSD in clinical and research settings, providing novel insights on the effects of combat exposure distress, and the different effects of combat and noncombat-related threats on PTSD.
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Affiliation(s)
- Teresa Carvalho
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Carolina da Motta
- Cognitive-Behavioral Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,School of Psychology and Life Sciences, Lusófona University, Lisbon, Portugal.,Digital Human-Environment Interaction Lab (HEI-Lab), Lisboa, Portugal
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4
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Sommer JL, Blaney C, Mota N, Bilevicius E, Beatie B, Kilborn K, Chang U, Sareen J, El-Gabalawy R. Dissociation as a Transdiagnostic Indicator of Self-Injurious Behavior and Suicide Attempts: A Focus on Posttraumatic Stress Disorder and Borderline Personality Disorder. J Trauma Stress 2021; 34:1149-1158. [PMID: 34426995 DOI: 10.1002/jts.22726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
Dissociative symptoms and suicidality are transdiagnostic features of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The primary objective of this study was to examine associations between dissociation (i.e., depersonalization and derealization) and suicidality (i.e., self-harm and suicide attempts) among individuals with PTSD and BPD. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule for DSM-5 was used to assess lifetime PTSD and BPD. Estimated rates of self-harm among individuals who endorsed dissociation were 15.5%-26.2% for those with PTSD and 13.7%-23.5% for those with BPD, and estimates of suicide attempts among individuals who endorsed dissociation were 34.5%-38.1% for those with PTSD and 28.3%-33.1% for those with BPD. Multiple logistic regressions were conducted to examine the associations between dissociation (derealization, depersonalization, and both) and both self-harm and suicide attempts among respondents with PTSD and BPD. The results indicated that dissociation was associated with self-harm and suicide attempts, especially among individuals with BPD, aORs = 1.39-2.66; however, this association may be driven in part by a third variable, such as other symptoms of PTSD or BPD (e.g., mood disturbance, PTSD or BPD symptom severity). These results may inform risk assessments and targeted interventions for vulnerable individuals with PTSD, BPD, or both aimed at mitigating the risk of self-harm and suicide.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Caitlin Blaney
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elena Bilevicius
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brooke Beatie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kayla Kilborn
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Unice Chang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Azoulay E, Cariou A, Bruneel F, Demoule A, Kouatchet A, Reuter D, Souppart V, Combes A, Klouche K, Argaud L, Barbier F, Jourdain M, Reignier J, Papazian L, Guidet B, Géri G, Resche-Rigon M, Guisset O, Labbé V, Mégarbane B, Van Der Meersch G, Guitton C, Friedman D, Pochard F, Darmon M, Kentish-Barnes N. Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study. Am J Respir Crit Care Med 2020; 202:1388-1398. [PMID: 32866409 PMCID: PMC7667906 DOI: 10.1164/rccm.202006-2568oc] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity. Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs. Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified. Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42–0.79], 0.57 [95% confidence interval, 0.39–0.82], and 0.49 [95% confidence interval, 0.34–0.72], respectively). HCPs working in non–university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions. Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.
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Affiliation(s)
- Elie Azoulay
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Alain Cariou
- Medical ICU, Cochin University Hospital, University of Paris, Public Assistance Hospitals of Paris Center, Paris, France
| | | | - Alexandre Demoule
- Service de Pneumologie, Médecine Intensive et Réanimation (Departement R3S), Groupe Hospitalier Universitaire, site Pitié-Salpêtrière, Paris Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Unité Mixte de Recherche Sorbonne 1158, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | | | - Danielle Reuter
- Medical-Surgical ICU, South Francilien Hospital Center, Corbeil, France
| | - Virginie Souppart
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Alain Combes
- Institut de Cardiométabolisme et de Nutrition, Sorbonne Université, Unité Mixte de Recherche Sorbonne 1166-ICAN, Institut National de la Santé et de la Recherche Médicale.,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Sorbonne Université Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie Hospital, Montpellier, France
| | - Laurent Argaud
- Medical Intensive Care Department, Edouard Herriot Hospital, Lyon Civil Hospices, Lyon, France
| | - François Barbier
- Unité de Soins Intensifs Médicaux, La Source Hospital, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Mercé Jourdain
- Department of Intensive Care, Roger Salengro Hospital, Lille University Hospital Center, Lille University Unité 1190, National Institute of Health and Medical Research, Lille, France
| | - Jean Reignier
- Medical ICU, University Hospital Center, Nantes, France
| | - Laurent Papazian
- Respiratory and Infectious Diseases ICU, North Hospital, Public Assistance Hospitals of Paris, Marseille, France
| | - Bertrand Guidet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Service de Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Géri
- Medical ICU, Ambroise Paré University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | | | | | - Vincent Labbé
- Medical ICU, Tenon University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière University Hospital, University of Paris, Public Assistance Hospitals of Paris, Sorbonne Joint Research Unit 1144, National Institute of Health and Medical Research, Paris, France
| | - Guillaume Van Der Meersch
- Medical-Surgical ICU, Avicenne University Hospital, Public Assistance Hospitals of Paris, Bobigny, France
| | | | - Diane Friedman
- General ICU, Raymond Poincaré University Hospital, Public Assistance Hospitals of Paris, Garches, France
| | - Frédéric Pochard
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Michael Darmon
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Nancy Kentish-Barnes
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
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6
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Pacella-LaBarbara M, Larsen SE, Jaramillo S, Suffoletto B, Callaway C. Event centrality following treatment for physical injury in the emergency department: Associations with posttraumatic outcomes. Gen Hosp Psychiatry 2020; 67:77-82. [PMID: 33065405 PMCID: PMC7722005 DOI: 10.1016/j.genhosppsych.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between event centrality (i.e., the degree to which a stressful event is integrated into one's identity) and acute posttraumatic outcomes after relatively minor physical injury is unknown. We examined pre-injury and Emergency Department (ED) predictors of event centrality at 6-weeks post-injury, and whether event centrality is uniquely associated with 6-week posttraumatic outcomes. METHODS In the EDs of two Level I trauma centers, 149 patients completed surveys regarding demographic, psychological and injury-related factors within 24 h post-injury; 84 patients (51% male) completed 6-week surveys of event centrality, posttraumatic stress symptoms (PTSS) and trauma-specific QOL (T-QoL). Data were analyzed using linear regression modeling. RESULTS At least 20% of patients agreed or strongly agreed that the injury changed their life. Hospitalization status and peritraumatic dissociation were significant predictors of event centrality at 6-weeks. After controlling for demographics, ED-related factors and pre-injury PTSS, event centrality was uniquely associated with PTSS (p < .001) and T-QOL (p < .001) at 6 weeks. CONCLUSION Over and above the effects of the injury itself, event centrality conveyed important information for posttraumatic outcomes at 6 weeks post-injury. The centrality scale is brief and feasible to administer; future work is needed to determine the predictive utility of event centrality on post-injury outcomes.
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Affiliation(s)
- Maria Pacella-LaBarbara
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Sadie E Larsen
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America.
| | - Stephany Jaramillo
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Brian Suffoletto
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Clifton Callaway
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
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7
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Canan F, North CS. Dissociation and disasters: A systematic review. World J Psychiatry 2019; 9:83-98. [PMID: 31649861 PMCID: PMC6811731 DOI: 10.5498/wjp.v9.i6.83] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/03/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.
AIM To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.
METHODS EMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were “disaster*” and dissociation (“dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”). Reference lists of identified articles were scrutinized to identify studies for additional articles.
RESULTS The final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.
CONCLUSION The studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.
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Affiliation(s)
- Fatih Canan
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX 75390, United States
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Carol S North
- The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX 75390, United States
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
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8
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McLean MA, Cobham VE, Simcock G, Kildea S, King S. Toddler Temperament Mediates the Effect of Prenatal Maternal Stress on Childhood Anxiety Symptomatology: The QF2011 Queensland Flood Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111998. [PMID: 31195616 PMCID: PMC6603961 DOI: 10.3390/ijerph16111998] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022]
Abstract
It is not known whether alterations to temperamental characteristics associated with prenatal maternal stress (PNMS) exposure account for the development of childhood anxiety symptomatology (internalizing behaviors and anxiety symptoms). The QF2011 Queensland flood study examined whether (1) toddler temperamental characteristics explained the association between PNMS exposure and childhood anxiety symptomatology; and (2) whether effects were dependent upon child sex or the timing of gestational exposure to PNMS. We investigated the effects of various aspects of flood-related stress in pregnancy (objective hardship, cognitive appraisal, subjective distress) on maternal report of 16-month toddler temperament (attentional control, shy-inhibition, negative reactivity), 4-year maternal-reported childhood anxiety symptomatology (internalizing and anxiety symptoms; N = 104), and teacher reports of internalizing behaviors (N = 77). Severity of maternal objective hardship during pregnancy and shy-inhibited behaviors were uniquely associated with 4-year child anxiety symptoms. Mediation analyses found that higher levels of 16-month negative reactivity accounted, in part, for the relationship between increased maternal objective flood-related hardship and greater internalizing behaviors (maternal but not teacher report). Neither child sex nor gestational timing of exposure moderated the hypothesized mediations. Our findings highlight several pathways through which varying aspects of disaster-related PNMS may influence early childhood anxiety symptomatology.
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Affiliation(s)
- Mia A McLean
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Vanessa E Cobham
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Gabrielle Simcock
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia.
| | - Sue Kildea
- Mater Research Institute-University of Queensland, Brisbane, QLD 4072, Australia.
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Suzanne King
- Schizophrenia and Neurodevelopmental Disorders Research, Douglas Mental Health University Institute, Verdun, QC H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada.
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9
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Moss KM, Simcock G, Cobham VE, Kildea S, Laplante DP, King S. Continuous, emerging, and dissipating associations between prenatal maternal stress and child cognitive and motor development: The QF2011 Queensland Flood Study. Early Hum Dev 2018. [PMID: 29529544 DOI: 10.1016/j.earlhumdev.2018.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Katrina M Moss
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; Mater Research, The University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - Gabrielle Simcock
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; Mater Research, The University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; Mater Research, The University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - Sue Kildea
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia.
| | - David P Laplante
- Douglas Hospital Research Centre, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada.
| | - Suzanne King
- Douglas Hospital Research Centre, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada; McGill University, Department of Psychiatry, Montreal, Quebec, Canada.
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10
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Samson T, Iecovich E, Shvartzman P. Psychometric Characteristics of the Hebrew Version of the Professional Quality-of-Life Scale. J Pain Symptom Manage 2016; 52:575-581.e1. [PMID: 27660084 DOI: 10.1016/j.jpainsymman.2016.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
CONTEXT Exposure to human suffering may have ramifications for the professional quality of life (ProQol) of palliative care teams. The ProQol scale was designed to assess both negative and positive work-related outcomes and has been used recently for the evaluation of work-related outcomes among palliative care workers. However, the assessment of ProQol among Israeli hospice workers is scant. OBJECTIVES The aim of this study was to assess the psychometric properties and the factor structure of the Hebrew version of the 30-item ProQol questionnaire. METHODS The study population included 1100 health care providers including physicians, nurses, and social workers in primary health care and palliative care settings. RESULT A total of 380 workers participated in the study, representing a response rate of 34.5%. The confirmatory factor analysis did not show an adequate "goodness to fit." Using a factor coefficient of 0.35 or greater for inclusion, the exploratory factor analysis revealed a 23-item solution, loaded onto three factors: compassion satisfaction, secondary traumatic stress, and burnout (BU). The internal consistency subscales were 0.87, 0.82, and 0.69, respectively. The subscales showed good convergent and exploratory validity because of significant correlations with measures that examine BU, work engagement, and peritraumatic dissociative experiences. CONCLUSIONS Although the findings are consistent with those from studies in other languages, they are different from the original 30-item three-factor structure reported by Stamm. The Hebrew version of the compassion satisfaction subscale was found to be reliable and valid for studies among health care professionals, but further research is needed to improve the BU and secondary traumatic stress subscales.
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Affiliation(s)
- Tali Samson
- Department of Family Medicine, Pain and Palliative Care Unit, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clalit Health Services-South District, Beer-Sheva, Israel; Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Esther Iecovich
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Pesach Shvartzman
- Department of Family Medicine, Pain and Palliative Care Unit, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clalit Health Services-South District, Beer-Sheva, Israel
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11
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Pinto-Gouveia J, Carvalho T, Cunha M, Duarte J, Walser RD. Psychometric properties of the Portuguese version of the Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS): A study with Portuguese Colonial War Veterans. J Affect Disord 2015; 185:81-9. [PMID: 26148464 DOI: 10.1016/j.jad.2015.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS) is a self-report measure designed to assess-trauma-related psychological (in)flexibility, as conceptualized in Acceptance and Commitment Therapy. However, there are no studies to date regarding its psychometric properties. This study explores such properties in the Portuguese version of the AAQ-TS, in Portuguese Colonial War Veterans. METHOD A Principal Components Analysis (PCA) was conducted in a sample from the general population of war Veterans (N=371). Confirmatory Factor Analysis (CFA) as well as reliability and convergent validity studies were performed in a different sample from the same population (N=312). For the discriminant validity a clinical sample with a war-related PTSD (N=42) and a non-clinical sample without PTSD (N=44) were used. RESULTS The CFA suggested a re-specified 15-item model with good global adjustment and factorial validity. The AAQ-TS showed internal consistency, a good temporal reliability, convergent validity with psychopathological symptoms (related to PTSD, anxiety, depression and stress) and peritraumatic dissociation (altered awareness and depersonalization/derealization). The questionnaire also discriminates between war Veterans with and without a PTSD diagnosis. LIMITATIONS The major limitation relates to the samples' characteristics and sampling methods, which can limit the generalization of results. CONCLUSION The Portuguese version of the AAQ-TS is a reliable and valid measure to assess experiential avoidance related to trauma in Portuguese Colonial War Veterans.
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Affiliation(s)
- José Pinto-Gouveia
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal
| | - Teresa Carvalho
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal; Instituto Superior Miguel Torga, Coimbra, Portugal.
| | - Marina Cunha
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal; Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Joana Duarte
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal
| | - Robyn D Walser
- NCPTSD Dissemination and Training Division, University of Berkeley, Palo Alto, CA, United States
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12
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Miron LR, Orcutt HK, Kumpula MJ. Differential predictors of transient stress versus posttraumatic stress disorder: evaluating risk following targeted mass violence. Behav Ther 2014; 45:791-805. [PMID: 25311288 PMCID: PMC4218730 DOI: 10.1016/j.beth.2014.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 02/08/2023]
Abstract
Schools have become a common incident site for targeted mass violence, including mass shootings. Although exposure to mass violence can result in significant distress, most individuals are able to fully recover over time, while a minority develop more pervasive pathology, such as PTSD. The present study investigated how several pre- and posttrauma factors predict posttraumatic stress symptoms (PTSS) in both the acute and distal aftermath of a campus mass shooting using a sample with known levels of pretrauma functioning (N=573). Although the largest proportion of participants evidenced resilience following exposure to the event (46.1%), many reported high rates of PTSS shortly after the shooting (42.1%) and a smaller proportion (11.9%) met criteria for probable PTSD both in the acute and more distal aftermath of the event. While several preshooting factors predicted heightened PTSS after the shooting, prior trauma exposure was the only preshooting variable shown to significantly differentiate between those who experienced transient versus prolonged distress. Among postshooting predictors, individuals reporting greater emotion dysregulation and peritraumatic dissociative experiences were over four times more likely to have elevated PTSS 8months postshooting compared with those reporting less dysregulation and dissociative experiences. Individuals with less exposure to the shooting, fewer prior traumatic experiences, and greater satisfaction with social support were more likely to recover from acute distress. Overall, results suggest that, while pretrauma factors may differentiate between those who are resilient in the aftermath of a mass shooting and those who experience heightened distress, several event-level and posttrauma coping factors help distinguish between those who eventually recover and those whose PTSD symptoms persist over time.
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13
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Duncan E, Dorahy MJ, Hanna D, Bagshaw S, Blampied N. Psychological responses after a major, fatal earthquake: the effect of peritraumatic dissociation and posttraumatic stress symptoms on anxiety and depression. J Trauma Dissociation 2013; 14:501-18. [PMID: 24060033 DOI: 10.1080/15299732.2013.769479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Following trauma, most people with initial symptoms of stress recover, but it is important to identify those at risk for continuing difficulties so resources are allocated appropriately. There has been limited investigation of predictors of posttraumatic stress disorder following natural disasters. This study assessed psychological difficulties experienced in 101 adult treatment seekers following exposure to a significant earthquake. Peritraumatic dissociation, posttraumatic stress symptoms, anxiety, depression, and emotional support were assessed. Path analysis was used to determine whether the experience of some psychological difficulties predicted the experience of other difficulties. As hypothesized, peritraumatic dissociation was found to predict posttraumatic stress symptoms and anxiety. Posttraumatic stress symptoms then predicted anxiety and depression. Depression and anxiety were highly correlated. Contrary to expectations, emotional support was not significantly related to other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention.
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Affiliation(s)
- Esma Duncan
- a Department of Psychology , University of Canterbury , Christchurch , New Zealand
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14
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McDonald P, Bryant RA, Silove D, Creamer M, O'Donnell M, McFarlane AC. The expectancy of threat and peritraumatic dissociation. Eur J Psychotraumatol 2013; 4:21426. [PMID: 24363835 PMCID: PMC3864163 DOI: 10.3402/ejpt.v4i0.21426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/09/2013] [Accepted: 09/05/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peritraumatic dissociation is one of the most critical acute responses to a traumatic experience, partly because it predicts subsequent posttraumatic stress disorder. Despite this, there is little understanding about the factors that influence peritraumatic dissociation. This study investigated the extent to which peritraumatic dissociation is predicted by the amount of perceived warning that participants had of the impact of the trauma. METHOD Randomized eligible admissions to four major trauma hospitals (N=243) were assessed during hospital admission with the Peritraumatic Dissociation Experiences Questionnaire (PDEQ) and the perceived warning that participants had before the trauma impact occurred. RESULTS Whereas female gender predicted both Awareness and Derealization subscale scores on the PDEQ, perceived warning also predicted scores on the Derealization subscale. CONCLUSIONS This finding suggests that the degree of anticipated threat may contribute to peritraumatic dissociation.
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Affiliation(s)
- Pamela McDonald
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Derrick Silove
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Creamer
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Meaghan O'Donnell
- Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander C McFarlane
- Department of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
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15
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Sijbrandij M, Engelhard IM, Opmeer BC, van de Schoot R, Carlier IVE, Gersons BPR, Olff M. The structure of peritraumatic dissociation: a cross validation in clinical and nonclinical samples. J Trauma Stress 2012; 25:475-9. [PMID: 22821635 DOI: 10.1002/jts.21716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma-exposed samples: (a) trauma-exposed police officers (N = 219); (b) trauma-exposed civilians (N = 158); and (c) treatment-seeking trauma-exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2-factor structure (CFIs .96-.98; RMSEAs .07-.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow-up only in the sample of police officers (R(2) = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.
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Affiliation(s)
- Marit Sijbrandij
- Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
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16
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Abstract
This study investigated the factor-structure of retrospectively assessed peritraumatic dissociation in the moments surrounding the death of a loved one and concurrent and prospective associations of such peritraumatic dissociation with loss-related emotional distress. Data were available from 168 people, bereaved in the preceding year. They completed the Peritraumatic Dissociative Experiences Questionnaire with their loss as the index event, together with measures of prolonged grief disorder, depression, and posttraumatic stress disorder; 117 completed symptom measures again 1 year later. Confirmatory factor analysis comparing the fit of four competing models showed that the eight-item one-factor model found in the first study using the Peritraumatic Dissociative Experiences Questionnaire provided the best fit to the data. Peritraumatic dissociation predicted concurrent and prospective symptom levels even when controlling for neuroticism and demographic and loss-related variables.
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17
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Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. A review of acute stress disorder in DSM-5. Depress Anxiety 2011; 28:802-17. [PMID: 21910186 DOI: 10.1002/da.20737] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 06/24/2010] [Accepted: 06/24/2010] [Indexed: 11/07/2022] Open
Abstract
Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review presents a number of options and preliminary considerations to be considered for DSM-5. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, New South Wales, Australia.
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18
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Kumpula MJ, Orcutt HK, Bardeen JR, Varkovitzky RL. Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms. JOURNAL OF ABNORMAL PSYCHOLOGY 2011; 120:617-27. [PMID: 21604826 PMCID: PMC3170875 DOI: 10.1037/a0023927] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peritraumatic dissociation (PD) and experiential avoidance (EA) have been implicated in the etiology of posttraumatic stress symptomatology (PTSS); however, the function of these two factors in the onset and maintenance of PTSS following a potentially traumatic event is unclear. The temporal relationships between EA, PD, and the four clusters of PTSS proposed by the Simms/Watson dysphoria model (Simms, Watson, & Doebbeling, 2002) were examined in a three-wave prospective investigation of 532 undergraduate women participating in an ongoing longitudinal study at the time of a campus shooting. Path analyses indicated that preshooting EA predicted greater PD, intrusions, and dysphoria symptoms approximately one month postshooting. PD was associated with increased symptomatology across all four clusters 1-month postshooting, while 1-month postshooting EA was associated with higher dysphoria and hyperarousal symptoms eight months postshooting. PD had a significant indirect effect on all four PTSS clusters eight months postshooting via 1-month postshooting symptom reports. The results suggest that both EA and PD show unique influences as risk factors for PTSS following a potentially traumatic event.
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Affiliation(s)
- Mandy J Kumpula
- Department of Psychology, Northern Illinois University, DeKalb, IL 60115, USA
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Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder. Behav Res Ther 2011; 49:346-51. [DOI: 10.1016/j.brat.2011.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/18/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
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