Posttraumatic stress disorder and retrospectively reported stressor exposure: a longitudinal prediction model

Inconsistent Reporting of Adverse Life Events Is Predicted by Current Internalizing Distress Among Military Service Members

INTRODUCTION

Accurate measurement of adverse life events is critical for understanding the effects of stressors on health outcomes. However, much of this research uses cross-sectional designs and self-report years after the events take place. The reliability of this retrospective reporting and the individual difference factors associated with inconsistent recall over time are not frequently addressed, especially among military service members.

MATERIALS AND METHODS

A longitudinal cohort of National Guard service members (n = 801) completed the Deployment Risk and Resilience Inventory-2 Prior Stressors scale and several measures of general well-being, including anxious depressive symptomatology, personal functioning, perceived social support, and overall health at two time points (before and after completion of basic combat training; median 11-month interval).

RESULTS

Consistency in reporting the life event items ranged from 69.5% to 99.7%, with an overall Cohen's kappa coefficient of 0.215 for the scale, indicating minimal agreement. Lower well-being scores at Time 1 independently predicted yes-to-no changes in responding, whereas lower well-being scores at Time 2 independently predicted no-to-yes changes in responding. Follow-up mediations were conducted using study measures available only at Time 2. For all study measures, Time 2 well-being independently predicted changes from no-to-yes responding by way of indirect effects through self-reported non-specific internalizing distress and arousal.

CONCLUSIONS

These findings highlight the confounding effects of fluctuations in current emotional distress on past stressor recall. There is a need for additional caution regarding the use of retrospective self-report of adverse life events in research and clinical practice and greater consideration of current psychological distress at the time of measurement completion.

Examining Risk Absorption Capacity as a Mediating Factor in the Relationship between Cognition and Neuroplasticity in Investors in Investment Decision Making

The encouragement of potential investors who are emotionally broken by past losses and market experiences is crucial to the sustainable flow of funds to the stock market. This can be established by building a knowledge-creating mechanism among investors in their cognitive dimensions, which, in turn, can develop their risk-bearing potential to reach the optimum level so that emotionally broken investors can use their cognitive abilities with their developed risk-absorption potential to further invest in the market in the near future. This study investigates the mediating effect of risk-absorption attitudes in the relationship between cognition and neuroplasticity in investors. Data for the study collected from 506 individual retail investors’ samples using a stratified random sampling technique were analyzed through covariance-based structural equation modeling. The findings of the study indicate that the constructs, viz., the investors’ cognition, risk absorption, and neuroplasticity, are valid and reliable. The structural model also supports the notion that risk absorption mediates the relationship between the investors’ cognition and neuroplasticity. The outcomes of the study are expected to aid in the policy formulation for equity-related financial product marketers, such as depository participants, brokers, mutual funds and SIP institutions, and to help in healing psychological trauma that potential investors suffered from due to losses in the past and overcoming reluctances to further invest in stock markets. The investors’ terrible psychological health developed because of past loss experience can be restored through the concept of neuroplasticity, in which different cognitive dimensions are used, while also enhancing risk absorption in potential investors.

The role of belief in memory amplification for trauma events

BACKGROUND AND OBJECTIVES

Trauma survivors often report trauma events inconsistently over time. Many studies, for example, have found that people report having experienced trauma events that they initially failed to report or remember, a phenomenon called "memory amplification." Other studies have found the opposite: people report experiencing fewer events over time. Nahleen, Nixon, and Takarangi (2019) asked participants at two time-points, with a six-month delay, whether they had experienced 19 sexual assault events on a yes/no scale. Participants reported fewer events over time, that is, memory for sexual assault did not amplify overall. In the current study, we assessed whether inconsistency in reports of trauma exposure over time may be attributed to changes in participants' belief that certain events were experienced.

METHODS

We replicated Nahleen et al. (2019), but rather than respond to a yes/no trauma exposure scale, participants were required to rate the likelihood that each trauma event occurred on an 8-point scale (1 = definitely did not happen; 8 = definitely did happen).

RESULTS

We found that participants believed that they were less likely to have experienced the sexual assault events at follow-up compared to initial assessment.

LIMITATIONS

We could not corroborate trauma experiences or determine causality with our design. Further, not all of our findings were consistent with Nahleen et al. (2019).

CONCLUSIONS

Sexual assault memories did not amplify over time, perhaps because, compared to other types of trauma, the idea of experiencing additional sexual assault events that were not actually experienced is less believable.

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study

BACKGROUND

The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned.

AIMS

We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster.

METHOD

Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events.

RESULTS

When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events.

CONCLUSIONS

Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.

Imagining trauma: Memory amplification and the role of elaborative cognitions

BACKGROUND AND OBJECTIVES

Trauma victims, such as war veterans, often remember additional traumatic events over time: the "memory amplification effect". This effect is associated with the re-experiencing symptoms of post-traumatic stress disorder (PTSD), including frequent and intrusive images of the trauma. One explanation for memory amplification is that people gradually incorporate new, imagined information about the trauma with what they actually experienced, leading to an amplified memory for what actually happened. We investigated this proposal here.

METHODS

Participants viewed highly negative and graphic photographs and recorded their intrusions. Critically, we instructed some participants to elaborate on their intrusions-that is, we asked them to imagine details about the trauma beyond what they actually witnessed. We assessed memory for the traumatic photos twice, 24-h apart.

RESULTS

The elaboration condition experienced fewer intrusions about the photos compared to the control condition. Furthermore, the elaboration condition were less susceptible to memory amplification compared to controls.

LIMITATIONS

The use of negative photos allowed experimental control, however does not permit generalization of our findings to real-world traumatic experiences.

CONCLUSIONS

Our findings suggest that effortful imagination of new trauma-related details leads to a reduction in intrusions and an increased tendency to not endorse trauma exposure over time. One explanation for this finding is that elaboration enhanced conceptual processing of the trauma analogue, therefore reducing intrusions. Critically, this reduction in intrusions affected participants' tendency to endorse trauma exposure, which is consistent with the reality-monitoring explanation for memory amplification.

Consistency of Recall for Deployment-Related Traumatic Brain Injury

OBJECTIVE

To examine the temporal consistency of self-reported deployment-related traumatic brain injury (TBI) and its association with posttraumatic stress disorder (PTSD) symptom severity.

SETTING

In-person interviews at US Army installations (postdeployment); phone interviews (long-term follow-up).

PARTICIPANTS

A total of 378 US Army soldiers and veterans deployed to Iraq; 14.3% (n = 54) reported TBI with loss of consciousness during an index deployment.

DESIGN

Participants were evaluated after returning from deployment and again 5 to 9 years later.

MAIN MEASURES

Temporal consistency of TBI endorsement based on TBI screening interviews; PTSD Checklist, Civilian Version.

RESULTS

The concordance of deployment-related TBI endorsement from the postdeployment to long-term follow-up assessment was moderate (κ = 0.53). Of the 54 participants reporting (predominantly mild) TBI occurring during an index deployment, 32 endorsed TBI inconsistently over time. More severe PTSD symptoms at postdeployment assessment were independently associated with discordant reporting (P = .0004); each 10-point increase in PCL scores increasing odds of discordance by 69% (odds ratio = 1.69; 95% confidence interval, 1.26-2.26).

CONCLUSIONS

Deployment-related TBI may not be reported reliably over time, particularly among war-zone veterans with greater PTSD symptoms. Results of screening evaluations for TBI history should be viewed with caution in the context of PTSD symptom history.

Emotional distress and positive and negative memories from military deployment: the influence of PTSD symptoms and time

During military deployment, soldiers are confronted with both negative and positive events. What is remembered and how it affects an individual is influenced by not only the perceived emotion of the event, but also the emotional state of the individual. Here we examined the most negative and most positive deployment memories from a company of 337 soldiers who were deployed together to Afghanistan. We examined how the level of emotional distress of the soldiers and the valence of the memory were related to the emotional intensity, experience of reliving, rehearsal and coherence of the memories, and how the perceived impact of these memories changed over time. We found that soldiers with higher levels of post-traumatic stress disorder (PTSD) symptoms were more affected by both their negative and positive memories, compared with soldiers with lower levels of PTSD symptoms. Emotional intensity of the most negative memory increased over time in the group with highest levels of PTSD symptoms, but dropped in the other groups. The present study adds to the literature on emotion and autobiographical memory and how this relationship interacts with an individual's present level of emotional distress and the passage of time.

Consistency of Self-Reported Neurocognitive Symptoms, Post-Traumatic Stress Disorder Symptoms, and Concussive Events From End of First Deployment to Veteran Health Administration Comprehensive Traumatic Brain Injury Evaluation by Operations Enduring Freedom/Iraqi Freedom/New Dawn Veterans

Objective

This study examined the consistency of self-reported symptoms and concussive events in combat veterans who reported experiencing concussive events.

Method

One hundred and forty, single deployed, Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn combat veterans with Veteran Health Administration (VHA) Comprehensive Traumatic Brain Injury Evaluations (CTBIE) and no post-deployment head injury were examined to assess consistency of self-reported (a) traumatic brain injury (TBI)-related symptoms, (b) post-traumatic stress disorder (PTSD)-related symptoms, and (c) TBI-related concussive events from soon after deployment to time of VHA CTBIE.

Results

Compared to their self-report of symptoms and traumatic events at the time of their Post-Deployment Health Assessment, at the time of their comprehensive VHA evaluation, subjects reported significantly greater impairment in concentration, decision making, memory, headache, and sleep. In addition, although half the subjects denied any PTSD symptoms post-deployment, approximately three quarters reported experiencing all four PTSD screening symptoms near the time of the VHA CTBIEs. At the latter time, subjects also reported significantly more TBI-related concussive events, as well as more post-concussive sequelae such as loss of consciousness immediately following these concussive events. Finally, although 84% reported a level of impairment so severe as to render all but the simplest activity doable, the vast majority simultaneously reported working and/or attending college.

Conclusions

These findings raise questions regarding the accuracy of veteran self-report of both near and distant traumatic events, and argue for the inclusion of contemporaneous Department of Defense (DOD) records in veteran assessment and treatment planning.

“The wound is still open”: the Nakba experience among internally displaced Palestinians in Israel

Purpose

While the 1948 Nakba represents the most significant crisis in the history of the Palestinian people, its psychological effects on its survivors in Israel have yet to be explored. The purpose of this paper is to examine the subjective experience and the psychological implications of the Nakba ordeals and the ensuing uprooting among the internally displaced Palestinians living in Israel.

Design/methodology/approach

Qualitative semi-structured in-depth interviews were conducted with ten internally displaced Palestinians who experienced the Nakba as youngsters. The interview transcripts were analyzed thematically in line with accepted practice in phenomenological research in psychology.

Findings

Participants had experienced a wide range of traumatic events intertwined with protracted daily struggles and accumulated losses. These experiences resulted in pronounced psychological distress and immense inner pain that was perpetuated throughout their lives, rendering the Nakba an unresolved traumatic experience.

Research limitations/implications

This paper describes the psychological outcome of the Nakba among a small sample of elderly survivors. Further urgent research is needed to collect valuable untapped information from this aging and dwindling community.

Originality/value

Although more than six decades have elapsed since the tragic events, the current research paper constitutes a pioneering effort to document the subjective experience of the Nakba. The current research findings counterbalance 60 years of public and academic disregard of this tragic period.

Memory amplification for trauma: Investigating the role of analogue PTSD symptoms in the laboratory

Victims of trauma often remember their experience as being more traumatic later, compared to immediately after, the event took place. This finding-the "memory amplification effect"-is associated with increased re-experiencing symptoms. However, the effect has been found almost exclusively in field-based studies. We examined whether the effect could be replicated in the laboratory. In two studies, we exposed participants to negative photographs and assessed their memory for the photographs and analogue PTSD symptoms on two occasions. In Study 1, analogue symptoms at follow-up were positively associated with remembering more negative photos over time. In Study 2, we focused on "memory amplifiers": people whose memory of the photos amplified over time. Consistent with field research, analogue re-experiencing symptoms were associated with memory amplification. Overall, our findings confirm that analogue PTSD symptoms are also associated with an amplified memory for a trauma analogue.

Consistency of Reporting for Stressful Life Events Among Nondeployed Soldiers

OBJECTIVES

Measurement of stress exposure is central to understanding military mental health outcomes. Although temporal stability of combat event reporting has been examined, less is known about the stability of reporting for noncombat events in military samples. Objectives are to examine consistency in reporting stressful life events in nondeployed U.S. Army soldiers and its association with posttraumatic stress disorder (PTSD) symptomatology.

METHOD

Examined reporting consistency over approximately 8 months among 466 soldiers. Regression models examined factors associated with decreased, increased, and stable reporting.

RESULTS

Stability of the number of events endorsed over time was high. However, item-level agreement was slight to moderate (kappas: .13-.54), with inconsistencies due primarily to decreased reporting. After adjusting for covariates and initial PTSD, second assessment PTSD was associated with increased and stable reporting.

CONCLUSIONS

Inconsistent reporting extends beyond combat events to other stressful life events in military personnel and is associated with PTSD.

Differential predictors of transient stress versus posttraumatic stress disorder: evaluating risk following targeted mass violence

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.

Metacognitive appraisal of memory inconsistency for traumatic events in Dutch veterans

Although memories of traumatic events are often remembered vividly, these memories are subject to change over time. In our previous study, we found that Dutch infantry veterans who had served in Iraq often reported stressful events at a second assessment point that they had not reported during a prior assessment point and vice versa. In the present exploratory study, we recontacted subjects from this previous study and asked how they explained the discrepancy in their memory reports between post-deployment assessment points 1 and 2. Common explanations were: interpreting the item differently, having forgotten the incident initially, repression and having accidentally incorporated someone else's experience into their own memory. Although such reports are not necessarily revelatory of the mechanisms driving discrepancies in memory reports over time, our study illuminates the metacognitive variables involved.

The Influences of Linguistic Demand and Cultural Loading on Cognitive Test Scores

The increasing diversity of the U.S. population has resulted in increased concerns about the psychological assessment of students from culturally and linguistically diverse backgrounds. To date, little empirical research supports recommendations in test selection and interpretation, such as those presented in the Culture–Language Interpretative Matrix (C-LIM). The current investigation was conducted to empirically evaluate the validity of the C-LIM classifications for the Woodcock–Johnson Tests of Cognitive Abilities, Third Edition (WJ III COG). The WJ III Normative Update standardization sample was used to determine the extent to which the two dimensions of the C-LIM (i.e., cultural loading and linguistic demand) influence performance on 20 of the WJ III tests. Results provide support for a re-classification of the C-LIM. Implications for research and school psychology practices are discussed.

Risk factors for post-deployment posttraumatic stress disorder in national guard/reserve service members

Identification of factors that increase risk for PTSD in military personnel following deployments is critical to early intervention and prevention. The study tested hypothesized main and moderating risk factors for PTSD in National Guard/Reserve members deployed to Iraq or Afghanistan. Members of the National Guard/Reserves (n=238) completed diagnostic interviews and measures of risk factors at a post-deployment assessment conducted an average of four and a half months following return from deployment. Hierarchical multivariate logistic regression analyses were used to test hypotheses. Higher levels of combat exposure, life and family concerns during deployment, and post-deployment social support independently predicted PTSD. Life/family concerns during deployment and perceived adequacy of training and preparation were significant moderators of the association between combat exposure and PTSD. Among those with higher levels of both combat exposure and life and family stress, 27% had PTSD in contrast to 3% of those with high exposure but lower levels of such stress during deployment. In addition to combat exposure, life and family stress during deployment is a particularly important predictor of PTSD. The findings highlight the importance of identifying and addressing such stress.

A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia

The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context.

Pretrauma risk factors for posttraumatic stress disorder: a systematic review of the literature

As it has become clear that most individuals exposed to trauma do not develop PTSD, it has become increasingly important to examine pretrauma risk factors. However, PTSD research has overwhelmingly relied on retrospective accounts of trauma, which is beleaguered by problems of recall bias. To further our understanding of PTSD's etiology, a systematic review of 54 prospective, longitudinal studies of PTSD published between 1991 and 2013 were examined. Inclusion criteria required that all individuals were assessed both before and after an index trauma. Results revealed six categories of pretrauma predictor variables: 1) cognitive abilities; 2) coping and response styles; 3) personality factors; 4) psychopathology; 5) psychophysiological factors; and 6) social ecological factors. The results indicated that many variables, previously considered outcomes of trauma, are pretrauma risk factors. The review considered these findings in the context of the extant retrospective PTSD literature in order to identify points of overlap and discrepancy. Pretrauma predictor categories were also used to conceptualize variable risk for PTSD. Limitations and directions for future research are discussed.

Susceptibility to long-term misinformation effect outside of the laboratory

OBJECTIVE

To test the effect of misinformation outside of the laboratory and to explore correlates of the effect, including arousal, cognitive ability, and neuroticism.

METHOD

About 2 months before deployment to Afghanistan, 249 soldiers enrolled in this study, which was embedded in a larger project. Two months after deployment, participants were interviewed about stressors on deployment and they received subtle misinformation about a fictional event on deployment. Seven months later, they were retested, and completed a questionnaire about events on deployment.

RESULTS

At 9 months, a total of 26% of participants reported that they had experienced the fictional event, although 7 months earlier they said they had not experienced it. Logistic regression analyses revealed that lower cognitive ability and a combination of high arousal and more stressors on deployment were related to higher susceptibility to the misinformation effect.

CONCLUSIONS

Results suggest that information provided by another source may be incorporated into related autobiographical memory, particularly for individuals with lower cognitive ability, high arousal at the time of encoding the information and more related experiences.

Courts' misplaced confidence in psychiatric diagnoses

In considering psychiatric evidence, criminal justice systems make considerable use of labels from official psychiatric classificatory systems. There are legislated requirements for psychological and/or behavioural phenomena to be addressed in legal tests, however medico-legal use of the current categorical diagnostic frameworks which are increasingly complex is difficult to justify. The lack of validity in large domains of the present classificatory systems is now more openly acknowledged, prompting a critical rethink. Illustrative examples include post-traumatic stress disorder, various personality disorders, and dissociative identity disorder. It follows that the Courts' faith in the present categorical classifications (e.g., DSMIV and ICD10) is misplaced and may be ultimately unhelpful to the administration of justice.

Emerging adulthood and leaving foster care: settings associated with mental health

The present study examined the role of contextual support on mental health during the transition to adulthood within a vulnerable group, adolescents leaving foster care because of their age. Participants were 265 19- to 23-year-olds who retrospectively reported on 3 main contexts of emerging adulthood: housing security, educational achievement, and employment attainment in the first 2 years after leaving foster care. Mental health measured self-reported emotional distress, substance abuse, and deviancy at the time of interview. Growth Mixture Modeling empirically identified 3 latent trajectory classes. Stable-Engaged (41%) experienced secure housing and increasing connections to education and employment over time. Stable-Disengaged (30%) maintained housing but reported decreasing rates of education and small increases in employment. Instable-Disengaged (29%) experienced chronic housing instability, declined connection to education, and failed to attain employment. Stable-Engaged and Stable-Disengaged classes reported better mental health compared to the Instable-Disengaged class, indicating the importance of housing in transitioning to adulthood.

What is the cause of post-traumatic stress disorder following subarachnoid haemorrhage? Post-ictal events are key

BACKGROUND

Post-traumatic stress disorder (PTSD) is common after subarachnoid haemorrhage (SAH) and causes poor outcome. Knowing which SAH events cause the stress leading to PTSD development could allow for their severity, and so the chances of PTSD, to be reduced. The dramatic nature of SAH onset has meant ictal events have been the presumed cause. Frequent loss of consciousness (LOC) at ictus, and presumed resultant amnesia, however, means this might not be correct. We examined two hypotheses for how SAH patients develop PTSD despite frequent LOC. Firstly, has the frequency of amnesia for ictal events subsequent to LOC been overestimated? Secondly, is it the stress of post-ictal events, rather than ictal events, which causes PTSD?

METHOD

Sixty SAH patients, 18 months post-ictus, were assessed for PTSD, LOC at ictus, memory for ictal events, as well as which aspects of their SAH, ictal and post-ictal, were psychologically stressful. Patients also underwent neuropsychological examination.

FINDINGS

Of patients, 36.7% had PTSD. Memory overall for ictal events was more common than expected: 50% reported LOC, and only 18% reported no memory. However, memory was not associated with PTSD development. Rather, the key predictor of PTSD was the stress of post-ictal events. The stress of ictal events, cognitive impairment and clinical characteristics were unrelated to PTSD development. Post-ictal events included realizing that their life could have/had changed, that they may have been left with long-term problems, that they could have died and that they had little memory for some SAH events and regaining consciousness.

CONCLUSIONS

The traumatic quality of an SAH lies in post-ictal events, rather than ictal events. These events are related to the patients' adjustment to the experience of having had an SAH. Reducing the traumatic severity of these events could potentially reduce the likelihood of PTSD in SAH patients and so improve their outcome.

Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq

BACKGROUND

National Guard troops are at increased risk for post-traumatic stress disorder (PTSD); however, little is known about risk and resilience in this population.

METHOD

The Readiness and Resilience in National Guard Soldiers Study is a prospective, longitudinal investigation of 522 Army National Guard troops deployed to Iraq from March 2006 to July 2007. Participants completed measures of PTSD symptoms and potential risk/protective factors 1 month before deployment. Of these, 81% (n=424) completed measures of PTSD, deployment stressor exposure and post-deployment outcomes 2-3 months after returning from Iraq. New onset of probable PTSD 'diagnosis' was measured by the PTSD Checklist - Military (PCL-M). Independent predictors of new-onset probable PTSD were identified using hierarchical logistic regression analyses.

RESULTS

At baseline prior to deployment, 3.7% had probable PTSD. Among soldiers without PTSD symptoms at baseline, 13.8% reported post-deployment new-onset probable PTSD. Hierarchical logistic regression adjusted for gender, age, race/ethnicity and military rank showed that reporting more stressors prior to deployment predicted new-onset probable PTSD [odds ratio (OR) 2.20] as did feeling less prepared for deployment (OR 0.58). After accounting for pre-deployment factors, new-onset probable PTSD was predicted by exposure to combat (OR 2.19) and to combat's aftermath (OR 1.62). Reporting more stressful life events after deployment (OR 1.96) was associated with increased odds of new-onset probable PTSD, while post-deployment social support (OR 0.31) was a significant protective factor in the etiology of PTSD.

CONCLUSIONS

Combat exposure may be unavoidable in military service members, but other vulnerability and protective factors also predict PTSD and could be targets for prevention strategies.

Consistency of retrospective reports of peritraumatic responses and their relation to PTSD diagnostic status

Few studies have examined whether trauma-exposed individuals are consistent in their retrospective reports of how they reacted at the time of trauma exposure, and whether this phenomenon has any implications at the diagnostic level. In a series of three longitudinal studies (N = 113) with different timeframes, the authors prospectively investigated the consistency of peritraumatic response scores as a function of posttraumatic stress disorder (PTSD) diagnostic status. Across the three studies, consistency of scores was better among individuals who either did not develop PTSD or who remitted from it than among those whose PTSD did not remit. These results are consistent with the literature suggesting that compromised memory processes are related to sustained PTSD.

Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology

Unconditional and conditional trajectories of posttraumatic stress disorder (PTSD) symptomatology were examined using a sample of U.S. soldiers deployed on a NATO-led peacekeeping mission to Kosovo. Data were collected at 4 time points, ranging from the weeks leading up to deployment to 9-months post deployment. Latent class growth analysis revealed 4 unique symptom trajectories: resilience, recovery, delayed, and unrealized anxiety. Variables identified as significant predictors of trajectory class included previous traumatic events, combat exposure, peacekeeping daily hassles, depression, alcohol use, aggressive behavior, stress reactivity, and military rank. Results from this study add to the literature detailing the variability in PTSD course, as well as to the literature pertaining to predictors of PTSD onset and course.

Longitudinal changes in recalled perceived life threat after a natural disaster

BACKGROUND

Post-traumatic stress disorder (PTSD) diagnosis often depends on a retrospective, self-report of exposure to a life-threatening event.

AIMS

To examine the stability of recalled perceived life threat in a community sample exposed to a distinct stressful event.

METHOD

Five hundred and thirty-two Norwegian citizens who experienced the 2004 South-East Asia tsunami completed a self-report questionnaire 6 and 24 months post-disaster. The questionnaire measured perceived life-threat intensity, exposure, immediate stress response, psychopathology, personality dimensions, self-efficacy and social support.

RESULTS

Recalled threat intensity increased from 6 to 24 months (P<0.001). Recall amplification was associated with lack of PTSD symptom improvement (P<0.05), but not with degree of exposure, immediate stress response, mood or stress symptoms, personality, self-efficacy or social support.

CONCLUSIONS

Recall amplification of perceived life threat from a single stressful event occurs in the general population, it may hinder PTSD symptom improvement and it questions the diagnostic validity of PTSD.

Traditional versus modern values, self-perceived interpersonal factors, and posttraumatic stress in Chinese and German crime victims

OBJECTIVES

The influence of cultural factors on mental health is not disputed in general - but elaborated research approaches are still lacking. We investigate cultural influences not only by nationality but also by value orientation (modern vs. traditional). A cross-cultural comparison with Chinese and German crime victims included an assessment of value orientation according to Schwartz's theory (Schwartz, 1994) of personal values.

DESIGN

Chinese and German adult crime victims were assessed. By means of structural equation multi-sample analysis, data of the two groups were compared.

METHOD

Traditional (conformity, benevolence, customs orientation) and modern values (achievement, hedonism, stimulation), traumatic exposure, posttraumatic stress (PTS), and two self-perceived interpersonal mediator processes (disclosure intentions, social acknowledgement as a victim) were assessed by self-report measures in 130 Chinese and 151 German crime victims.

RESULTS

The two patterns of prediction for PTS differed between the countries: In the German sample both value types but in the Chinese sample only traditional values were directly or indirectly predictive of PTS. Traditional values inhibited social acknowledgement as a victim in China and Germany. In Germany, traditional values were related to increased PTS severity. Modern values predicted social acknowledgement as well as lower symptoms in Germany, but not in China.

CONCLUSIONS

The study shows cultural and interpersonal factors that may contribute to the development of PTSD that are under-researched in contemporary psychology and psychotherapy.

PTSD prevalence, associated exposures, and functional health outcomes in a large, population-based military cohort

OBJECTIVES

Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life-threatening events including combat-related experiences. The purpose of this study was to investigate the prevalence of PTSD symptoms and diagnosis, self-reported exposures, and functional health in a large cross-section of the U.S. military.

METHODS

This study used baseline Millennium Cohort data (July 2001 to June 2003) of 75,156 U.S. military members to assess the population-based prevalence of PTSD symptoms, self-reported exposures, and functional health as measured by the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans (SF-36V).

RESULTS

PTSD diagnosis without current symptoms was reported by 953 respondents (1.2%, weighted), 1,490 respondents (2.1%, weighted) reported no diagnosis but reported PTSD symptoms, and 287 respondents (0.4%, weighted) reported diagnosis and current symptoms. Self-reported exposure to chemical or biological warfare agents, protective countermeasures, or hearing alarms were associated with PTSD symptoms independent of other combat-like exposures. Physical health was similar among those with PTSD diagnosis and current PTSD symptoms. However, compared with the overall cohort, lower mental health summary means for those reporting current PTSD symptoms (mean = 27.8), current symptoms and diagnosis (mean = 24.6), and diagnosis without current symptoms (mean = 47.5) were found.

CONCLUSIONS

Results suggest a 2.0% prevalence of PTSD symptoms without diagnosis and that self-reported threatening exposures were significantly associated with PTSD symptoms. Mental and physical health scores of those with current PTSD symptoms appear diminished, but suggest a return to cohort levels with resolution of PTSD symptoms.

Relationships between memory inconsistency for traumatic events following 9/11 and PTSD in disaster restoration workers

The present study examined the relationships between memories for a single incident traumatic event - the 9/11 attack on the World Trade Center (WTC)--and posttraumatic stress disorder (PTSD). 2641 disaster restoration workers deployed at the WTC site in the aftermath of the attack were evaluated longitudinally, one year apart, for PTSD, using clinical interviews. Their recollection of the traumatic events was also assessed at these times. The results showed that recall of traumatic events amplified over time and that increased endorsement of traumas at Time 2 was associated with more severe PTSD symptoms. It was also shown that, of all the exposure variables targeted, memory of the perception of life threat and of seeing human remains were differentially associated with PTSD symptoms. Implications of the results are also discussed.

Prevalence and correlates of posttraumatic stress disorder among Kuwaiti military men according to level of involvement in the first Gulf War

First, to compare the prevalence and intensity of posttraumatic stress disorder (PTSD) among Kuwaiti military men, divided into four groups (50 subjects each) according to degree of exposure to war trauma: (1) the retired (retired before the invasion); (2) an active-in-the-army group (AIA) (involved in duties at the rear only); (3) an in-battle (IB) group (involved in combat); and (4) prisoners of war (POWs-captured during combat). Second, to compare the severity of impact of event, comorbid depression, and anxiety among the groups. Third, to evaluate the contribution of self-esteem and locus of control (LOC). Subjects were interviewed once, 6 years after the war, using: the Clinician Administered PTSD Scale; the Impact of Event Scale (IES); the Hopkins Symptom Checklist-25; the Internal-External LOC; and The Self-Esteem Scale. Subjects were aged 24-71 years (mean 37.9). Sixty-three subjects (31.5%) fulfilled criteria for PTSD, with the rate significantly higher among the POWs (48%) than the retired (24%) and IB (22%), reflecting the severity of IES. Avoidance symptoms were the most pronounced. Self-esteem was significantly lowest among the POWs and those with PTSD. External LOC was associated with PTSD, anxiety, and depression. Self-esteem was the only covariate of PTSD scores. LOC was a significant covariate for anxiety. The characteristics of PTSD in these veterans showed similarity with those from elsewhere. The prominence of self-esteem and avoidance symptoms implies that they should be part of focus for interventions. Focus on LOC should be from the perspective of anxiety.

The symmetry rule: a seven-year study of symptoms and explanatory labels among Gulf War veterans

Noticing medical symptoms can cause one to search for explanatory labels such as "ate bad food" or even "exposed to anthrax," and perhaps these labels may cause new symptom reports. The present study examined whether there is empirical support for this symptom-label "symmetry rule." We interviewed veterans (N= 362) from the Gulf War Registry in 1995 and 2002 about their medical symptoms and about their exposure to war-related hazards and stressors. Health symptom reports were strongly correlated between the two time periods and showed relatively stable mean levels, whereas recall of war-related exposures was notably unstable. Veterans starting with fewer medical symptoms recalled fewer war-related exposures seven years later. Initial recollection of chemical and biological warfare exposure (but not other exposures) longitudinally predicted novel medical symptoms. The findings generally support the symmetry rule hypotheses, although the evidence for the label to symptom link was less strong. The findings account for some variability in symptoms and exposure recall over time, but they do not, on their own, account for the Gulf War veterans' elevated number of unexplained medical symptoms.

Does prior psychological health influence recall of military experiences? a prospective study

In a prospective study, we evaluated pre- and postdeployment psychological health on recall of risk factors to assess recall bias. Measures of the General Health Questionnaire (GHQ), PTSD Checklist (PCL), and symptom clusters from the PCL were obtained from 681 UK military personnel along with information on traumatic and protective risk factors. Postdeployment psychological health was more important in explaining recall of traumatic experiences than predeployment psychological health. Predeployment intrusive cluster scores were highly associated with traumatic exposures. Postdeployment, but not predeployment GHQ showed small effects for most risk factors. With the exception of intrusive thoughts, there is insufficient evidence to suggest predeployment psychological status would be useful in correcting for recall bias in subsequent cross-sectional studies.

Post-traumatic stress disorder among wives of Kuwaiti veterans of the first Gulf War

OBJECTIVES

To assess post-traumatic stress disorder (PTSD) among wives of Gulf War Kuwaiti military men, divided into four groups according to degree of combat exposure: the retired, an active-in-the-army group (AIA) (involved in duties at the rear); an in-battle group (IB) (involved in combat); and a prisoners-of-war (POWs) group. To assess the relationship between wives' PTSD and indices of family adjustment, husbands' level of combat exposure, and PTSD status.

METHOD

One hundred and seventy-six wives were assessed with the PTSD Checklist for DSM-IV, the family adjustment device, and for anxiety/depression.

RESULTS

Fifty (28.4%) fulfilled criteria for probable PTSD. The prevalence was significantly associated with husbands' combat exposure, her presence in Kuwait, but not with husbands' PTSD status. Wives' PTSD was mostly predicted by their depression/anxiety scores.

CONCLUSION

The findings support the salience of effective social support, and the need for women empowerment issues in psychosocial intervention for this group.

Memory consistency for traumatic events in Dutch soldiers deployed to Iraq

Retrospective accounts of traumatic events are consistently associated with symptoms of post-traumatic stress disorder (PTSD). This has often been interpreted as causal impact of such events on psychological functioning, but recent studies suggest that the causal direction is (partly) reversed: high levels of PTSD symptoms may be associated with amplified recollections of precipitating traumatic events. The aim of this prospective study was to index the consistency with which Dutch Army soldiers reported traumatic stressors and nontraumatic stressors on their deployment to Iraq, and to examine to what extent PTSD symptoms and pre-existing reporting biases, such as that arising from neuroticism, affect memory inconsistency. Retrospective accounts of stressors were highly variable over time. Individuals with higher levels of PTSD symptoms and neuroticism, lower levels of extraversion, and fewer prior missions, were more prone to increased reporting over time.

Autobiographical memory for trauma: update on four controversies

Empirical research since the year 2000 on trauma and autobiographical memory in adults is reviewed and related to four enduring controversies in the field: Whether traumatic memories are inherently different from other types of autobiographical memory; whether memory for trauma is better or worse than memory for non-traumatic events; whether traumas can be forgotten and then recalled later in life; and whether special mechanisms such as repression or dissociation are required to account for any such forgetting. The review concludes that trauma and non-trauma memories differ substantially, but only in clinical and not in healthy populations. Whereas involuntary memory is enhanced in clinical populations, voluntary memory is likely to be fragmented, disorganised, and incomplete. Progress in experimental and neuroimaging research will depend on analysing how task performance is affected by the interaction of voluntary and involuntary memory and by individual tendencies to respond to trauma with increased arousal versus dissociation.

Gulf War Illness: lessons from medically unexplained symptoms

Service in the Persian Gulf in 1991 is associated with increased reporting of symptoms and distress in a proportion of those who served there. Yet despite clear evidence of an increase in symptom burden and a decrease in well being, exhaustive clinical and laboratory based scientific research has failed to document many reproducible biomedical abnormalities in this group. Likewise, there has been no evidence of an increase in disease related mortality. Formal psychiatric disorders are twice as common in Gulf War veterans, as might be expected in the aftermath of any conflict, but this too is insufficient to explain the ill-health observed. Many service personnel who returned unwell believe that they have Gulf War Syndrome, and that their ill-health is due to exposures that they encountered in theatre. Research on multiple exposures to date has not generated a plausible aetiological mechanism for veterans' ill-health. Even if medical research has failed to provide a satisfactory explanation, it remains the case that many of those affected continue to be unwell and disabled some 15 years after returning from combat. For this reason, it is time that more attention is given to developing effective interventions to relieve their ill-health and distress. In this review we discuss the importance of the wider social context, individual illness beliefs and attributions and go on to outline a model of continuing ill-health in Gulf veterans. The review concludes with some suggestions for future research priorities, in particular the need for further qualitative studies to further our understanding of the illness, in order that better treatments may be developed.

Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees

This longitudinal study examined traumatic memory consistency over a 3-year period among a sample of highly traumatized Bosnian refugees, focusing on demographic factors, types of trauma, and posttraumatic stress disorder (PTSD) and depression. In 1996 and 1999, 376 Bosnian refugees were interviewed about 54 wartime trauma and torture events, and symptoms of PTSD and depression. Reports were compared for both time periods, and changed responses were analyzed for significance. Overall, there was consistency in reporting over time; when change occurred it was in the direction of decreased reports at follow-up. This downward trend was not associated with any particular diagnosis. However, PTSD alone, without comorbid symptoms of depression, was uniquely associated with the group that exhibited an upward trend. This implies that increased reporting is related specifically to the presence of PTSD symptoms, and that PTSD may be distinctly associated with the failed extinction of traumatic memories.

Reliability of self-reported trauma exposure among people with heroin dependence: a longitudinal investigation

Estimates of trauma exposure rely almost exclusively on retrospective self-reports; however, the reliability of these reports has received little attention. The present study examined the reliability of self-reported lifetime trauma exposure among 309 dependent heroin users over 2 years, and the factors associated with inconsistent recall. The correlation between the number of events reported at baseline and follow-up was .72; however, 87% of the sample reported at least one event inconsistently. Variability in reporting was associated with trauma type, a lifetime posttraumatic stress disorder, and antisocial personality disorder. These findings suggest that dependent heroin users are moderately reliable in their reports of trauma exposure, and their reports of trauma exposure are as reliable as those of nonsubstance use disordered samples.

Detection and management of malingering in people presenting for treatment of posttraumatic stress disorder: methods, obstacles, and recommendations

Malingering of symptoms of posttraumatic stress disorder (PTSD) has become a growing concern, particularly in healthcare and other settings in which the diagnosis is associated with financial incentives such as disability benefits. Although there is a steadily increasing body of research on methods for detecting PTSD malingering, little has been written on the assessment and practical management of malingering in treatment settings. The present article addresses this important issue, including a review of the methods, obstacles, and possible solutions for assessing PTSD malingering, along with suggestions for managing cases in which malingering is strongly suspected.

The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma

The Criterion A problem in the field of traumatic stress refers to the stressor criterion for posttraumatic stress disorder (PTSD) and involves a number of fundamental issues regarding the definition and measurement of psychological trauma. These issues first emerged with the introduction of PTSD as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980) and continue to generate considerable controversy. In this article, the authors provide an update on the Criterion A problem, with particular emphasis on the evolution of the DSM definition of the stressor criterion and the ongoing debate regarding broad versus narrow conceptualizations of traumatic events.