Understanding the association between material hardship and posttraumatic stress disorder: a test of the social selection and social causation hypotheses and an exploration of gender differences

Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas

Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals-invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.

The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea

Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (β = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (β = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (β = .26, p = .005) were associated with poverty, and both CPTSD symptoms (β = -.52, p < .001) and poverty (β = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.

Social causation, social selection, and economic selection in the health outcomes of Chinese older adults and their gender disparities

Background

The economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities.

Methods

Data was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method.

Results

The presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group.

Conclusions

Social causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.

Development of the oppression-based traumatic stress inventory: a novel and intersectional approach to measuring traumatic stress

There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based traumatic stress broadly, and in an intersectional manner, we have developed the oppression-based traumatic stress inventory (OBTSI). The OBTSI includes two parts. Part A comprises open-ended questions asking participants to describe experiences of oppression as well as a set of questions to determine whether Criterion A for PTSD is met. Part B assesses specific posttraumatic stress symptoms anchored to the previously described experiences of oppression and also asks participants to identify the various types of discrimination they have experienced (e.g., based on racial group, sex/gender, sexual orientation, etc.). Clients from a mental health clinic and an undergraduate sample responded to the OBTSI and other self-report measures of depression, anxiety, and traditional posttraumatic stress (N = 90). Preliminary analyses demonstrate strong internal consistency reliability for the overall symptom inventory (α = 0.97) as well as for the four symptom clusters of posttraumatic stress symptoms in the DSM-5 (α ranging from 0.86 to 0.94). In addition to providing descriptive information, we also assess the convergent validity between the OBTSI and measures of anxiety, depression, and traditional posttraumatic stress and examine the factor structure. This study provides preliminary evidence that the OBTSI is a reliable and valid method of assessing oppression-based traumatic stress symptoms.

Decent Work, Posttraumatic Stress Disorder, and Posttraumatic Growth From the Psychology of Working Perspective: A Three-Wave Study of Military Personnel

Scholarly interest in the relationship between decent work and mental health based on the Psychology of Working Theory has recently increased. This study evaluated the indirect effects of survival, social contribution, and self-determination needs satisfaction on the relationship between decent work and trauma-related mental health among military personnel. We conducted a three-wave survey over 1 year. Results showed that decent work predicted satisfaction of the three basic needs. Additionally, survival needs directly predicted posttraumatic stress disorder symptoms, while social contribution and self-determination needs directly predicted posttraumatic growth. Finally, decent work had a significant indirect effect on posttraumatic stress disorder symptoms via survival needs, whereas decent work had significant indirect effects on posttraumatic growth via social contribution and self-determination needs. Our findings suggest that the more military personnel perceive their work as decent and feel that their three basic needs are fulfilled, the more posttraumatic stress disorder symptoms diminish, and posttraumatic growth increases. We discuss the implications and need for follow-up studies.