Development and validation of a modified version of the Peritraumatic Dissociative Experiences Questionnaire

Mapping the factors behind ongoing war stress in Ukraine-based young civilian adults

While the literature on well-being and stress following natural disasters is well-developed, it is less so when it comes to ongoing war experiences. Between September and October of 2022, 223 Ukraine-based civilian adults (156 women and 67 men) completed a survey measuring symptoms of post-traumatic stress disorder (PTSD), peritraumatic experiences, paranoia, quality of life, death anxiety, anxiety about weapons of mass destruction and depression (i.e. assumed 'war consequence' factors), as well as perceived social support, resilience, loneliness and expected military support from the West (i.e. assumed 'buffer' factors). Our exploratory structural equation model (SEM) suggests that Perceived Social Support predicted fewer PTSD Symptoms and more Peritraumatic Experiences. The regression modelling, however, shows that Perceived Social Support was also positively correlated with Peritraumatic Experiences. Highlighting the need for a civilian war stress buffer disruption theory, we argue that when composed of one's circle of family and friends, social support could likely mean greater exposure to war stressors through the mutual sharing of ongoing war experiences with no end in sight. Such a possible war stress sharing deterioration effect would imply that Perceived Social Support may compound peritraumatic distress if the support in question is offered by those facing the same grim reality.

Dissociation and emotion regulation strategies: A meta-analytic review

OBJECTIVE

Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning.

METHODS

The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach.

RESULTS

The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (r_w = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (r_w = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (r_w = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness).

CONCLUSION

Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.

Mediators of the Relationship Between Sexual Assault and Sexual Behaviors in College Women

Some research shows that sexual assault victimization is associated with increased engagement in risky sexual behavior (e.g., intercourse without use of a condom or contraceptives), whereas other research indicates sexual assault victimization is related to sexual aversion. The purpose of the current study was to examine whether posttraumatic stress symptoms, alcohol use, and sexual assertiveness mediated the relationship between adolescent/emerging adulthood sexual assault (ASA) and risky sexual behavior, and whether posttraumatic stress symptoms mediated the relationship between ASA and sexual aversion, among college women. A sample of 462 women from a Midwestern university completed online questionnaires assessing ASA, child sexual abuse (CSA), posttraumatic stress symptoms (i.e., intrusion, avoidance, hyperarousal, and dissociation), alcohol use, sexual assertiveness, risky sexual behavior, and sexual aversion. CSA was considered as a covariate in the mediation models. Results of mediation analyses showed that the relationship between ASA and risky sexual behavior with a new partner was partially mediated by greater alcohol use and lower sexual assertiveness and that the relationship between ASA and risky sexual behavior with a regular partner was partially mediated by greater alcohol use. Results of a model examining mediators of ASA and sexual aversion detected no significant mediators. Results suggest that college women with a history of ASA would benefit from psychoeducation on the effect of alcohol on sexual decision-making, as well as from sexual assertiveness skills training, to reduce potential risks associated with risky sexual behaviors, particularly with lesser known partners, including sexually transmitted infections and sexual revictimization.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study

BACKGROUND

Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator.

METHODS

We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities.

RESULTS

Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided.

CONCLUSION

Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation.

TRIAL REGISTRATION

Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

Does State Dissociation Mediate the Relation Between Alcohol Intoxication and Deliberate Self-Harm?

Research supports the notion that alcohol intoxication is a risk factor for deliberate self-harm (DSH). However, the underlying mechanisms for this relationship are poorly understood. We aimed to determine whether alcohol-induced dissociation mediated alcohol's effects on DSH. We used data from a dose-response study of alcohol intoxication and DSH to test the proposed model. Participants were assigned to reach target blood alcohol concentrations (BAC) ranging from 0.00% through 0.10% and then completed a behavioral measure of DSH. Dissociation was assessed using the Alcohol Dissociative Experiences Scale. BAC predicted both dissociation and DSH, but dissociation did not predict DSH. Although research on clinical populations suggests dissociation is related to DSH, our findings suggest dissociation does not mediate the effects of alcohol on self-harm.

The Detachment and Compartmentalization Inventory (DCI): An assessment tool for two potentially distinct forms of dissociation

While evidence suggests a division between two qualitatively distinct forms of dissociation, no scale has been specifically designed to differentiate between them. This study describes the development and validation of the Detachment and Compartmentalization Inventory (DCI). The DCI was developed from dissociation theory, 29 existing dissociation scales and expert opinion. An initial pilot study was conducted which assessed readability, explored validity and reduced items before the DCI was administered online to 89 nonclinical and 105 clinical participants. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Mindfulness Attention Awareness Scale (MAAS) were included in the survey battery. The DCI exhibited good internal reliability, discriminant validity, convergent validity, construct validity and concurrent validity. The final version containing 22-items, is self-administered, grounded in the theoretical literature and supported by initial psychometric evaluation. It has 10 items assessing compartmentalization, 10 items assessing detachment and two items examining valid responding. The DCI could detect compartmentalization and detachment, and was designed for clinical research and for screening patients.

Theranostic pharmacology in PTSD: Neurobiology and timing

Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use-i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.

Posttraumatic stress symptoms and dissociation between childhood trauma and two different types of psychosis-like experience

This study examined the roles of posttraumatic stress (PTS) symptoms and dissociation in the relationship between childhood trauma and two different types of psychosis-like experience, including persecutory ideation and aberrant experience, in non-psychotic psychiatric patients. From August 2015 to August 2016, among psychiatric out patients seeking treatment at the Department of Psychiatry at a major teaching medical hospital in Seoul, Korea, 169 patients who had never been diagnosed with a psychotic disorder, including schizophrenia spectrum disorder, bipolar disorder, and/or depressive disorder with psychotic features, completed the Korean Childhood Trauma Questionnaire, the Korean version of the Impact of Event Scale-Revised, the modified Korean version of the Peritraumatic Dissociation Experiences Questionnaire, and the Korean Minnesota Multiphasic Personality Inventory-2 (MMPI-2). The RC 6 (Ideas of Persecution) and RC 8 (Aberrant Experiences) of the restructured scales of the MMPI-2 were used as a measure of persecutory ideation and aberrant experience. Structural equation modeling analyses confirmed a partial mediation model in which PTS symptoms partially mediated the relationship between childhood trauma and persecutory ideation, and dissociation partially mediated the relationship between childhood trauma and aberrant experience. This implies that there are distinct mechanisms depending on the type of psychosis-like experience in relation to childhood trauma.

Peritraumatic dissociation predicts posttraumatic stress disorder symptoms via dysfunctional trauma-related memory among war-affected children

Background: Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested. Objective: We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event. Method: The sample included 197 Palestinian children (10-12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children's Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events. Results: Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories. Conclusions: This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these hypotheses with larger samples and more points of measurement are called for.

Measuring Social Change Preferences in African American Adolescents

Studies addressing Black adolescents’ social change strategies are nonexistent and might be associated with the absence of social change measures for Black adolescents. In an effort to begin addressing this concern, the 30-item Measure of Social Change for Adolescents (MOSC-A) was designed to measure Black adolescents’ first- (i.e., within the system) and second- (outside of the system) order social change strategies. Factor analysis of responses that 226 Black adolescents gave to the MOSC-A revealed first- and second-order social change factors. Item response theory analyses revealed that 65% of the items on the former factor adequately discriminate across different trait levels, but those of the latter were less promising. Scaffolded on this study, future research might refine the MOSC-A’s psychometric properties and improve its utility.

Assessment of Behavioral and Emotional Strengths in Black Children: Development of the Behavioral Assessment for Children of African Heritage

Absence of culturally relevant measures of Black children's strengths inhibits psychometrically sound strength-based assessment, research, and appropriate use of strengths as scaffolds or targets for clinical intervention. Moreover, the sparse research literature on Black children is primarily deficit focused. Beginning to address these problems, considerable input was sought from the Black community in constructing behavioral and emotional strength forms for Black children. Exploratory factor analyses conducted separately on 559 parent reports, 489 teacher reports, and 417 adolescent self-reports revealed two unidimensional cross-informant factors labeled Resilience and Self-Regulation and Prosocial Behavior. Item response theory analyses revealed invariance across gender, socioeconomic status, and age, but variance across informant type and referral status, and that most items provide sufficient psychometric information to warrant retention for clinical assessment and research.

The impact of dissociation on perceptual priming and intrusions after listening to auditory narratives

This study investigates the causal role of dissociation in intrusive memory development and possible underlying aberrant memory processes (e.g., increased perceptual priming). Using an audio-only adaption of the trauma film paradigm, we divided 60 participants into 3 conditions and presented them with different visual tasks-mirror staring, dot staring, or neutral images. The former 2 conditions were hypothesized to induce dissociation. Postaudio, a number of factors were assessed, including state dissociation, perceptual priming and conceptual priming, as well as intrusions over 3 days. Participants in the dissociation conditions displayed an increase in perceptual priming compared to those in the control condition and reported more distressing intrusions. No differences were found in conceptual priming and the overall number of intrusions between conditions. Findings contribute to the growing knowledge on the impact of dissociation and cognitive processing in the etiology of posttraumatic stress disorder intrusions.

Evaluating the Cultural Validity of the Stressful Life Events Screening Questionnaire

Measures of psychological trauma are rarely evaluated for validity with disadvantaged populations. The authors used three qualitative methods to assess the cultural validity of the Stressful Life Events Screening Questionnaire (SLESQ) with low-income African American women. Focus groups ( n = 17), cognitive interviews ( n = 20), and videotape reviews of SLESQ interviews were conducted ( n = 16). Focus group participants spontaneously used similar language to the SLESQ items and tended to identify SLESQ events as traumatic. Most items were well understood in the interviews, with some criticism of wording. Tape reviews indicated little wording modification by interviewers. One item showed consistent problems. The interview was revised accordingly.

State and Trait Dissociation: Evaluating Convergent and Discriminant Validity

In an undergraduate sample ( N = 214), we examined the construct validity of the Clinician Administered Dissociative States Scales (CADSS; Bremner, Krystal, Putnam, Southwick, Marmar, Charney, et al., 1998) in the context of measures of state and trait dissociation, administered in conjunction with measures of depression, state anxiety, and affect. We found evidence for the convergent and discriminant validity of the dissociation measures in terms of correlations among dissociation measures that exceeded the correlations of the dissociation measures with measures of other constructs. Internal consistencies of the dissociation measures exceeded .80. Multiple regression analyses provided further evidence of construct validity in that variance in dissociation scores was largely accounted for by scores on other dissociation measures. Nevertheless, measures of anxiety, affect, and depression accounted for incremental variance in the prediction of dissociation measures and therefore should be included in a comprehensive model of dissociation. Our results strongly support the construct validity of the measures of dissociation.

Remembering the initial realization of one's own mortality

Research shows many effects of reminding people of their mortality; however, little is known about whether people recall the moment they first realized they will die, or what factors are associated with whether they do. Data from 1,552 undergraduates and a community sample of 149 adults found that about one third of participants reported remembering the moment. Individuals who recall the moment have slightly lower self-esteem, are more likely to believe in a soul, and are more prone to dissociation than those who do not. Further research into how recollection of the moment relates to psychological well-being is recommended.

The relationship between sexual trauma, peritraumatic dissociation, posttraumatic stress disorder, and HIV-related health in HIV-positive men

This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.

Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor

Understanding which factors predict individual dissociative response during stressful situations is important to clarify the nature of dissociation and the mechanisms associated to its use as a coping strategy. The present study examined (1) whether experiential avoidance (EA), anxiety sensitivity (AS), depressive symptoms, and state anxiety concurrently predicted trait dissociation (TD)-absorption, amnesia, depersonalization, and total TD scores-and laboratory induced dissociation (LID); and (2) whether TD and catastrophizing predicted LID. We also examined whether catastrophizing mediated the relationships between both AS and depressive symptoms and LID. A total of 101 female undergraduate students participated in a cold pressor task, which significantly induced dissociation. Results of hierarchical regression analyses showed that AS at Time 1 (9 months before the experimental session), as well as depressive symptoms and catastrophizing at the time of the experiment (Time 2), predicted LID at Time 2. Depressive symptoms at Time 2 predicted total TD, absorption, and amnesia scores. AS at Time 1 and depressive symptoms at Time 2 predicted depersonalization. AS, depressive symptoms, and catastrophizing seem to facilitate the use of dissociative strategies by healthy individuals, even in response to non-traumatic but discomforting stress.

Association of trauma, posttraumatic stress disorder, and experimental pain response in healthy young women

BACKGROUND

Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response.

OBJECTIVES

To examine differences in pain response and in certain psychological variables between trauma-exposed women (TEW) with PTSD, TEW without PTSD, and non-trauma-exposed women (NTEW) and to explore the role of these psychological variables in the differences in pain response between the groups.

METHODS

A total of 122 female students completed a cold pressor task (42 TEW with PTSD, 40 TEW without PTSD, and 40 NTEW). Anxiety sensitivity, experiential avoidance, trait and state dissociation, depressive symptoms, state anxiety, catastrophizing, and arousal were assessed.

RESULTS

TEW with PTSD reported significantly higher pain unpleasantness than NTEW, but not more than that of TEW without PTSD. They also presented higher trait dissociation, state anxiety, depressive symptoms, and skin conductance than the other 2 groups and higher anxiety sensitivity than TEW without PTSD. TEW without PTSD reported more pain unpleasantness than NTEW, but they recovered faster from pain. However, these differences were not explained by any psychological variable.

CONCLUSIONS

The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.

Behavioral and Emotional Problem Scales of the Behavioral Assessment for Children of African Heritage (BACAH)

Using extensive African American community input, Black researchers developed the Behavioral Assessment for Children of African Heritage (BACAH). Information regarding its strength dimensions is published but not its behavioral and emotional problem scales. Rational (i.e., expert opinion and mathematical) procedures grouped BACAH problem item responses from 1,465 youth, parent, and teacher informants into eight cross-informant scales labeled Anxiety-, Attention/Hyperactive-, Conduct-, Depression-, Hypomania/Mania-, Oppositional-Defiance-, Self-Destructive-, and Reality-Contact-Problems. Data analyses showed no response bias across child gender, socioeconomic status, or age groupings, but bias emerged across informant type, referral status, and rating scale type (i.e., presence and magnitude vs. concern levels regarding problems). Item linking reduced this bias. Items on each BACAH scale discriminate well for problem levels they assess and capably measure children’s problem levels, ranging from moderately below to above the mean. This study’s foundation and findings provide professionals and their test respondents with culturally valid, user friendly, economical, and highly flexible, clinical/research tools to assess Black children’s functioning.

Guilt by dissociation: guilt primes augment the relationship between dissociative tendencies and state dissociation

We examined the influence of guilt on the relationship between dissociative tendencies and state dissociation during mirror-gazing in a non-clinical sample. Dissociative tendencies correlated with state dissociation following guilt primes, but not after negative or neutral primes. This suggests that guilt augments the relationship between dissociative tendencies and state dissociation.

The structure of peritraumatic dissociation: a cross validation in clinical and nonclinical samples

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.

Peritraumatic dissociation after loss: latent structure and associations with psychopathology

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.

The brief family relationship scale: a brief measure of the relationship dimension in family functioning

The Relationship dimension of the Family Environment Scale, which consists of the Cohesion, Expressiveness, and Conflict subscales, measures a person's perception of the quality of his or her family relationship functioning. This study investigates an adaptation of the Relationship dimension of the Family Environment Scale for Alaska Native youth. The authors tested the adapted measure, the Brief Family Relationship Scale, for psychometric properties and internal structure with 284 12- to 18-year-old predominately Yup'ik Eskimo Alaska Native adolescents from rural, remote communities. This non-Western cultural group is hypothesized to display higher levels of collectivism traditionally organized around an extended kinship family structure. Results demonstrate a subset of the adapted items function satisfactorily, a three-response alternative format provided meaningful information, and the subscale's underlying structure is best described through three distinct first-order factors, organized under one higher order factor. Convergent and discriminant validity of the Brief Family Relationship Scale was assessed through correlational analysis.

Multicultural Mastery Scale for youth: multidimensional assessment of culturally mediated coping strategies

Self-mastery refers to problem-focused coping facilitated through personal agency. Communal mastery describes problem solving through an interwoven social network. This study investigates an adaptation of self- and communal mastery measures for youth. Given the important distinction between family and peers in the lives of youth, these adaptation efforts produced Mastery-Family and Mastery-Friends subscales, along with a Mastery-Self subscale. We tested these measures for psychometric properties and internal structure with 284 predominately Yup'ik Eskimo Alaska Native adolescents (12- to 18-year-olds) from rural, remote communities-a non-Western culturally distinct group hypothesized to display higher levels of collectivism and communal mastery. Results demonstrate a subset of items adapted for youth function satisfactorily, a 3-response alternative format provided meaningful information, and the subscale's underlying structure is best described through 3 distinct first-order factors organized under 1 higher order mastery factor.

Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study

OBJECTIVE

To determine the prevalence and risk factors of symptoms of anxiety, depression, and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay.

DESIGN

Prospective multicenter study.

SETTING

Nineteen French intensive care units.

SUBJECTS

One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale (IES). At intensive care unit discharge, 90% of patients recollected traumatic psychological events in the intensive care unit. At day 90, we were able to conduct telephone interviews with 53 patients and 47 relatives. Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52% and 45.5% of patients at intensive care unit discharge and in 28.3% and 18.9% on day 90, respectively. Corresponding prevalence in relatives were 72.2% and 25.7% at intensive care unit discharge and 40.4% and 14.9% on day 90, respectively. The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7% of patients and 29.8% of relatives on day 90. Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Questionnaire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives. Previous intensive care unit experience and recollection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients.

CONCLUSIONS

Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care unit discharge and 90 days later. Peritraumatic dissociation at intensive care unit discharge was found to independently predict posttraumatic stress disorder-related symptoms in this sample of patients and relatives.

The value of item response theory in clinical assessment: a review

Item response theory (IRT) and related latent variable models represent modern psychometric theory, the successor to classical test theory in psychological assessment. Although IRT has become prevalent in the measurement of ability and achievement, its contributions to clinical domains have been less extensive. Applications of IRT to clinical assessment are reviewed to appraise its current and potential value. Benefits of IRT include comprehensive analyses and reduction of measurement error, creation of computer adaptive tests, meaningful scaling of latent variables, objective calibration and equating, evaluation of test and item bias, greater accuracy in the assessment of change due to therapeutic intervention, and evaluation of model and person fit. The theory may soon reinvent the manner in which tests are selected, developed, and scored. Although challenges remain to the widespread implementation of IRT, its application to clinical assessment holds great promise. Recommendations for research, test development, and clinical practice are provided.

Skin conductance and memory fragmentation after exposure to an emotional film clip in depersonalization disorder

It is often assumed that when confronted with an emotional event, patients with DPD inhibit information processing. It is also thought that this fosters memory fragmentation. This hypothesis has not been tested in chronic depersonalization. The aim of this study was to investigate the temporal pattern of autonomic responding to emotional material in depersonalization disorder, along with concomitant deficits in subjective and objective memory formation (i.e., difficulties to form a coherent narrative consisting of an ordered sequence of events). Participants with depersonalization disorder (n=14) and healthy control participants (n=14) viewed an emotional video clip while their skin conductance (SC) levels were measured. Peritraumatic dissociation was measured before and after the clip, and memory performance was measured 35 min after viewing. Compared to controls, depersonalized participants exhibited a distinctly different temporal pattern of autonomic responding, characterized by an earlier peak and subsequent flattening of SCLs. Maximum SCLs did not differ between the two groups. Moreover, unlike the control group, depersonalized participants showed no SC recovery after clip offset. In terms of memory performance, patients exhibited objective memory fragmentation, which they also reported subjectively. However, they did not differ from controls in free recall performance. Apparently, emotional responding in DPD is characterized by a shortened latency to peak with subsequent flattening and is accompanied by memory fragmentation in the light of otherwise unremarkable memory functioning.

Prevalence of and sex disparities in posttraumatic stress disorder in an internally displaced Sri Lankan population 6 months after the 2004 Tsunami

BACKGROUND

When the 2004 Indian Ocean tsunami suddenly hit unsuspecting coastal populations in Sri Lanka, it inflicted unprecedented devastation including 35,000 deaths and 500,000 people displaced. Evaluating the psychological impact of this natural disaster provides valuable insights into planning interventions and disaster preparedness.

METHODS

A cross-sectional survey was conducted among 264 adult males and females > or =16 years old living in temporary shelters housing tsunami survivors at 6 months. Interviewer-administered structured interviews were conducted to measure posttraumatic stress disorder (PTSD) and its risk factors.

RESULTS

The participation rate was 97%. Of the subjects, 56% met criteria for symptoms of PTSD, with females at 64% and males at 42%. Females had at least twice the risk of experiencing PTSD (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.37-3.76). This sex difference persisted after adjusting for age, marital status, being a parent, loss of family members, amount of social support, education level, and level of depression (OR 2.14, 95% CI 1.21-3.80). Depression was significantly associated with PTSD (OR 7.19, 95% CI 3.83-13.52).

CONCLUSIONS

In this directly affected population, a majority met criteria for PTSD, indicating a significant long-term public health burden. The findings also confirm that females are at much higher risk for PTSD than males, suggesting that special mental health efforts should be targeted at women exposed to trauma.

Acute dissociation predicts rapid habituation of skin conductance responses to aversive auditory probes

The present study examined how acute dissociation, trait-like dissociative symptoms, and physiological reactivity relate to each other. Sixty-nine undergraduate students were exposed to 14 aversive auditory probes, while their skin conductance responses were measured. A combination of self-reported anxiety and trait-like dissociation was found to predict variability in peritraumatic dissociation levels induced by the aversive probes. Furthermore, high levels of acute dissociation were associated with faster habituation of skin conductance responding, while trait-like dissociation was unrelated to habituation. Interestingly, individuals who reported childhood trauma displayed elevated skin conductance responses. Our findings contribute to the growing body of evidence indicating that subjective feelings of acute dissociation have their objective concomitants, notably fast habituation of physiologic responses.

Dissociative experiences on ice--peritraumatic and trait dissociation during the cold pressor test

The present study investigated the relationship between trait dissociation and peritraumatic dissociation during acute painful stimulation. In a sample of 70 undergraduate students, peritraumatic dissociation was induced by means of a cold pressor test, which basically consists of participants holding an arm in ice water for as long as possible. Results indicate that heightened trait dissociation scores were related to shorter durations that participants could sustain the task. However, trait dissociation was not associated with increases in acute dissociative symptoms (i.e., peritraumatic dissociation). These findings are in sharp contrast to the defensive function ascribed to both types of dissociation and also the commonly held assumption that peritraumatic and trait dissociation are intimately linked.

Dimensionality and psychometric invariance of the Youth Self-Report Form of the Child Behavior Checklist in cross-national settings

The Youth Self-Report Form's (YSR's) factor model was derived from traditional exploratory factor analytical procedures. Assuming appropriate model specification, psychometrically invariant items, and that its items provide useful psychometric information across nations omitted from its normative samples, the YSR is widely used in cross-national studies of nonreferred children. Item response theory analytical procedures reveal (a) 2 dimensions partly overlapping with the YSR's Internalizing and Externalizing second-order factors; (b) variance (i.e., differential item functioning) in how well a few items discriminate for nonreferred children across two nations; and (c) variance in estimating severity levels in children with identical psychopathological severity cross-nationally. Addressing psychometric variance, limiting redundancy, and matching children's psychopathological severity levels with items measuring this severity might promote more accurate and economical assessment.

Examining the correlates of engagement and disengagement coping among help-seeking battered women

This study examined several potential correlates of engagement and disengagement coping, including abuse-related factors, socioeconomic and social coping resources, and childhood trauma variables among a sample of battered women (N = 388). Relationship abuse frequency, particularly psychological aggression, and peritraumatic dissociation were the strongest positive predictors of the use of disengagement coping. Social coping resources, including tangible support and appraisals of social support and belonging, were associated with higher engagement coping and lower disengagement coping. A positive association was also found between interparental domestic violence and disengagement coping, and negative associations were found between both childhood physical and sexual abuse and engagement coping. Results suggest that coping strategies used by battered women are multidetermined and deserve further exploration.

Dissociative experiences in children with abuse histories: a replication in Puerto Rico

This study examined the use of a Spanish version of the Child Dissociative Checklist (CDC) in Puerto Rico. The CDC was administered to the primary caretakers of three groups of children: 31 with documented abuse histories, 30 with Attention Deficit Hyperactivity Disorder (ADHD), 33 with no abuse or psychiatric record. Results confirmed the reliability and validity of the CDC and revealed that Puerto Rican children with abuse histories showed significantly higher levels of dissociation than the children in the other two groups. Moreover, more than half of the abused children had a score above the usual cut-off point of 12 in the CDC, while only a handful of the ADHD children and none in the control group evidenced such a pattern. The results also showed that there were significant correlations between the CDC and the duration of the abusive experiences. Implications of our findings and subsequent clinical recommendations are offered.

Predictors of acute distress among young adults injured by community violence

Acute reactions to trauma are examined in 267 individuals severely injured via community violence. Respondents were interviewed about pretrauma, peritraumatic, and acute posttraumatic factors. A series of bivariate and multivariate analyses were conducted. We found few factors related to peritraumatic dissociation (PD): only injury severity and neuroticism emerged as multivariate predictors and the effects were small. PD was strongly related to acute PTSD symptoms, and partially mediated the relationship between other factors and acute PTSD and general distress symptoms. Different patterns of predictors emerged for acute PTSD symptoms vis-à-vis general distress symptoms. Future research on predictors of PD is indicated to develop prevention and early intervention programs.

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.