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Dias Campos F, Chambel MJ, Lopes S, Dias PC. Post-Traumatic Stress Disorder in the Military Police of Rio de Janeiro: Can a Risk Profile Be Identified? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052594. [PMID: 33807636 PMCID: PMC7967303 DOI: 10.3390/ijerph18052594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Background: Significant exposure to critical incidents characteristic of military police work has a potentially traumatic effect and multiple consequences for the mental health of these professionals, such as Post Traumatic Stress Disorder (PTSD). This study aims to investigate the occurrence of PTSD in this occupational group and its correlations with socio-demographic and occupational variables. Methods: This is a cross-sectional study of Rio de Janeiro’s Military Police officers (n = 3.577). Data was collected from self-reported questionnaires applied in an institutional health program. Post-Traumatic Stress Disorder Checklist—Civilian version was used to assess PTSD. Results: Rates of 16.9% for full PTSD and 26.7% for partial PTSD were found. Based on logistic regression analysis, female officers and police officers in lower ranks of the military hierarchy and performing administrative duties were found to be at most risk of developing PTSD. Conclusions: These results suggest the need to further understand the predictive organizational and individual variables of PTSD correlated with the increased vulnerability of professionals in order to contribute to institutional policies for the prevention and rehabilitation of these cases.
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Affiliation(s)
- Fernanda Dias Campos
- Military Police of the State of Rio de Janeiro, Rio de Janeiro 20031-040, Brazil;
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
| | - Maria José Chambel
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
| | - Sílvia Lopes
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal; (M.J.C.); (S.L.)
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-302 Braga, Portugal
| | - Paulo C. Dias
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-302 Braga, Portugal
- Correspondence:
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2
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Kyron MJ, Rees CS, Lawrence D, Carleton RN, McEvoy PM. Prospective risk and protective factors for psychopathology and wellbeing in civilian emergency services personnel: a systematic review. J Affect Disord 2021; 281:517-532. [PMID: 33388463 DOI: 10.1016/j.jad.2020.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/12/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Emergency services personnel have an elevated risk of developing mental health conditions. Most research in this area is cross-sectional, which precludes inferences about temporal and potentially causal relationships between risk and protective factors and mental health outcomes. The current study systematically reviewed prospective studies of risk and protective factors for mental health outcomes in civilian emergency services personnel (firefighters, paramedics, police) assessed at pre-operational and operational stages. Out of 66 eligible prospective studies identified, several core groups of risk and protective factors emerged: (1) cognitive abilities; (2) coping tendencies; (3) personality factors; (4) peritraumatic reactions and post-trauma symptoms; (5) workplace factors; (6) interpersonal factors; (7) events away from work. Although there was insufficient evidence for many associations, social support was consistently found to protect against the development of mental health conditions, and peritraumatic dissociation, prior mental health issues, and prior trauma exposure were risk factors for future mental health conditions. Among operational studies, neuroticism was significantly associated with future PTSD symptoms, burnout, and general poor mental health, and avoidance and intrusion symptoms of PTSD were associated with future PTSD and depression symptoms. The current review results provide important targets for future research and interventions designed to improve the mental health of emergency services personnel.
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Affiliation(s)
- Michael J Kyron
- School of Psychology, Curtin University, Perth, Western Australia
| | - Clare S Rees
- School of Psychology, Curtin University, Perth, Western Australia
| | - Donna Lawrence
- Wellbeing and Support Services, St John Ambulance, Perth, Western Australia
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Western Australia; Centre for Clinical Interventions, Perth, Western Australia.
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3
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Kyron MJ, Rikkers W, Page AC, O'Brien P, Bartlett J, LaMontagne A, Lawrence D. Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees. Aust N Z J Psychiatry 2021; 55:180-195. [PMID: 32615800 DOI: 10.1177/0004867420937774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. METHOD A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. RESULTS Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. CONCLUSION Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.
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Affiliation(s)
- Michael J Kyron
- Graduate School of Education, The University of Western Australia, Crawley, WA, Australia.,School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | - Wavne Rikkers
- Graduate School of Education, The University of Western Australia, Crawley, WA, Australia
| | - Andrew C Page
- School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | | | - Jennifer Bartlett
- Graduate School of Education, The University of Western Australia, Crawley, WA, Australia
| | - Anthony LaMontagne
- Centre for Population Health Research, Deakin University, Geelong, VIC, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Crawley, WA, Australia
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Park AH, Protopopescu A, Pogue ME, Boyd JE, O'Connor C, Lanius RA, McKinnon MC. Dissociative symptoms predict severe illness presentation in Canadian public safety personnel with presumptive post-traumatic stress disorder (PTSD). Eur J Psychotraumatol 2021; 12:1953789. [PMID: 34512927 PMCID: PMC8425686 DOI: 10.1080/20008198.2021.1953789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD. Few studies have reported on the clinical characteristics of Canadian samples of PSP and even fewer have examined the dissociative subtype of PTSD, which is associated with more severe, chronic traumatic experiences, and worse outcomes. OBJECTIVE This study aimed to characterize dissociative symptoms, PTSD symptom severity, and other clinical variables among Canadian PSP with presumptive PTSD. METHODS We sampled current and past PSP in Canada from both inpatient and outpatient populations (N = 50) that were enrolled in a psychological intervention. Only baseline testing data (prior to any intervention) were analysed in this study, such as PTSD symptom severity, dissociative symptoms, emotion dysregulation, and functional impairment. RESULTS In our sample, 24.4% self-reported elevated levels of dissociation, specifically symptoms of depersonalization and derealization. Depersonalization and derealization symptoms were associated with more severe PTSD symptoms, greater emotion dysregulation, and functional impairment. CONCLUSIONS Nearly a quarter of this sample of Canadian PSP reported experiencing elevated levels of PTSD-related dissociation (depersonalization and derealization). These high levels of depersonalization and derealization were consistently positively associated with greater illness severity across clinical measures. It is imperative that dissociative symptoms be better recognized in patient populations that are exposed to chronic traumatic events such as PSP, so that treatment interventions can be designed to target a more severe illness presentation.
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Affiliation(s)
- Anna H Park
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Michelle E Pogue
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| | - Jenna E Boyd
- Homewood Research Institute, Guelph, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | | - Ruth A Lanius
- Homewood Research Institute, Guelph, Canada.,Department of Neuroscience, Robarts Research Institute, RRI 3203, Western University, London, Canada.,Department of Psychiatry, Parkwood Institute, Mental Health Care Building, F4-430, Western University, London, Canada.,Lawson Health Research Institute, London, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
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Wagner SL, White N, Fyfe T, Matthews LR, Randall C, Regehr C, White M, Alden LE, Buys N, Carey MG, Corneil W, Fraess‐Phillips A, Krutop E, Fleischmann MH. Systematic review of posttraumatic stress disorder in police officers following routine work-related critical incident exposure. Am J Ind Med 2020; 63:600-615. [PMID: 32419181 DOI: 10.1002/ajim.23120] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset. METHODS We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison. RESULTS PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk. CONCLUSIONS PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.
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Affiliation(s)
- Shannon L. Wagner
- Department of Health Sciences, College of Arts, Social, and Health SciencesUniversity of Northern British Columbia Prince George Canada
| | - Nicole White
- Department of Health Sciences, College of Arts, Social, and Health SciencesUniversity of Northern British Columbia Prince George Canada
| | - Trina Fyfe
- Northern Medical ProgramUniversity of Northern British Columbia Prince George Canada
| | | | - Christine Randall
- Menzies Health Institute of QueenslandGriffith University Gold Coast Campus Southport Australia
| | - Cheryl Regehr
- Department of Social WorkUniversity of Toronto Toronto Canada
| | - Marc White
- Department of Family PracticeUniversity of British Columbia Vancouver Canada
| | - Lynn E. Alden
- Department of PsychologyUniversity of British Columbia Vancouver Canada
| | - Nicholas Buys
- Menzies Health Institute of QueenslandGriffith University Gold Coast Campus Southport Australia
| | - Mary G. Carey
- School of NursingUniversity of Rochester New York New York
| | - Wayne Corneil
- Telfer School of ManagementUniversity of Ottawa Ottawa Canada
| | - Alex Fraess‐Phillips
- Department of Health Sciences, College of Arts, Social, and Health SciencesUniversity of Northern British Columbia Prince George Canada
| | - Elyssa Krutop
- The Centre for Response‐Based Practice Kamloops Canada
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Birmes P, Brunet A, Benoit M, Defer S, Hatton L, Sztulman H, Schmitt L. Validation of the Peritraumatic Dissociative Experiences Questionnaire self-report version in two samples of French-speaking individuals exposed to trauma. Eur Psychiatry 2020; 20:145-51. [PMID: 15797699 DOI: 10.1016/j.eurpsy.2004.06.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Accepted: 06/21/2004] [Indexed: 11/16/2022] Open
Abstract
AbstractBackgroundPeritraumatic dissociation is a risk factor for developing PTSD. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a self-report inventory used to assess dissociation that occurred at the time of a trauma. The aim of this study was the validation the PDEQ in French.MethodsNinety French speaking traumatized victims presenting to the emergency department were recruited. They were administered the PDEQ shortly after exposure and others trauma-related measures 2 weeks and 1 month posttrauma.ResultsPrincipal components factor analyses suggested a single factor solution for the PDEQ. Significant correlations between the PDEQ and acute and posttraumatic stress symptoms indicated moderate to strong convergent validity. The PDEQ also showed satisfactory test–retest reliability and internal consistency.ConclusionsThis study is the first one to investigate such detailed psychometric findings on the PDEQ. This confirms the unity of the concept of peritraumatic dissociation and the value of the PDEQ-French Version to assess it.
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Affiliation(s)
- Philippe Birmes
- Department of Psychiatry and Douglas Hospital Research Center, Psychosocial Research Division, McGill University, Montreal, Que. Canada.
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7
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Waszczuk MA, Li K, Ruggero CJ, Clouston SAP, Luft BJ, Kotov R. Maladaptive Personality Traits and 10-Year Course of Psychiatric and Medical Symptoms and Functional Impairment Following Trauma. Ann Behav Med 2019; 52:697-712. [PMID: 30010707 DOI: 10.1093/abm/kax030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Personality is a major predictor of many mental and physical disorders, but its contributions to illness course are understudied. Purpose The current study aimed to explore whether personality is associated with a course of psychiatric and medical illness over 10 years following trauma. Methods World Trade Center (WTC) responders (N = 532) completed the personality inventory for DSM-5, which measures both broad domains and narrow facets. Responders' mental and physical health was assessed in the decade following the WTC disaster during annual monitoring visits at a WTC Health Program clinic. Multilevel modeling was used in an exploratory manner to chart the course of health and functioning, and examine associations of maladaptive personality domains and facets with intercepts (initial illness) and slopes (course) of illness trajectories. Results Three maladaptive personality domains-negative affectivity, detachment and psychoticism-were uniquely associated with initial posttraumatic stress disorder (PTSD); detachment and psychoticism were also associated with initial functional impairment. Five facets-emotional lability, anhedonia, callousness, distractibility and perceptual dysregulation-were uniquely associated with initial mental and physical health and functional impairment. Anxiousness and depressivity facets were associated with worse initial levels of psychiatric outcomes only. With regard to illness trajectory, callousness and perceptual dysregulation were associated with the increase in PTSD symptoms. Anxiousness was associated with greater persistence of respiratory symptoms. Conclusions Several personality domains and facets were associated with initial levels and long-term course of illness and functional impairment in a traumatized population. Results inform the role of maladaptive personality in the development and maintenance of chronic mental-physical comorbidity. Personality might constitute a transdiagnostic prognostic and treatment target.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
| | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Health Sciences Center, Stony Brook, New York, USA
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8
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Telle E, Vicenzutto A, Buchet M, Plaisant O, Hoang TP. Dimensions de personnalité et facteurs de stress chez les policiers. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chopko BA, Palmieri PA, Adams RE. Posttraumatic Growth in Relation to the Frequency and Severity of Traumatic Experiences Among Police Officers in Small to Midsize Departments. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:1247-1260. [PMID: 27197709 DOI: 10.1177/0886260516651089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods, the severity and frequency of traumatic events experienced by law enforcement officers. We, however, found no studies utilizing the CIHQ to examine posttraumatic growth (PTG) as measured by the Posttraumatic Growth Inventory. The purpose of this brief report was to assess the strength and direction of the relationships between PTG with trauma frequency, trauma severity, and health variables, including subjective traumatic stress, relationship stress, nontraumatic work stress, posttraumatic stress disorder (PTSD) symptoms, depression, and alcohol use among law enforcement officers (N = 193) from small and midsize agencies. In addition, we sought to explore differences between cognitive and behavioral PTG. Based on results from bivariate and multivariate analyses, we found that an idiosyncratic view of trauma severity shaped by personal experience demonstrated the strongest relationship with PTG among the frequency and severity variables and that increased PTG was not associated with reduced psychological distress. Alcohol use, a variable that is assessed primarily through behaviors compared with cognitions, was not significantly associated with PTG. Overall, the findings of this study demonstrate the importance for future research to consider both the frequency and severity of trauma exposure in the development of PTG and its impact on health outcomes.
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10
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Williot A, Blanchette I. Can threat detection be enhanced using processing strategies by police trainees and officers? Acta Psychol (Amst) 2018; 187:9-18. [PMID: 29729440 DOI: 10.1016/j.actpsy.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022] Open
Abstract
The ability to detect threatening stimuli is an important skill for police officers. No research has yet examined whether implementing different information processing strategies can improve threat detection in police officers and police trainees. The first aim of our study was to compare the effect of strategies accentuating the processing of the emotional or the semantic dimension of stimuli on attention towards threatening and neutral information. The second aim was to consider the impact of PTSD symptoms on threat detection, as a function of processing strategies, in police officers and trainees. In a cueing paradigm, participants had to respond to a target that was presented following a threatening or neutral cue. Participants then answered a question, known beforehand, concerning the cue. The question was used to induce a more emotional or semantic processing strategy. Results showed that when the processing strategy was emotional, police trainees and officers were faster to detect the target when it followed a threatening cue, compared to a neutral cue, independently of its spatial location. This was not the case when the processing strategy was semantic. This study shows that induced processing strategies can influence attentional mechanisms related to threat detection in police trainees and police officers.
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11
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Relationship between the big five personality traits and PTSD among French police officers. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Street AE, Dardis CM. Using a social construction of gender lens to understand gender differences in posttraumatic stress disorder. Clin Psychol Rev 2018; 66:97-105. [PMID: 29580673 DOI: 10.1016/j.cpr.2018.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/21/2018] [Accepted: 03/07/2018] [Indexed: 01/04/2023]
Abstract
A wealth of research has established clear gender differences in exposure to potentially traumatic events and in subsequent posttraumatic stress disorder (PTSD). One perspective that is missing from most conversations about gender differences in PTSD is a systematic discussion of gender role socialization, and relatedly, the social construction of gender within our society. The purpose of the present review is to provide exposure to these theories as they relate to gender differences in PTSD, including differences in trauma exposure, risk for the development and maintenance of PTSD symptoms, and PTSD treatment outcome. In this review we focus on characteristics and behaviors that arise from a way of being in the world that is largely influenced by assigned gender. These include gender differences in patterns of trauma exposure, chronic environmental strain, behavioral responses to distress, cognitive factors, and the experience and expression of emotion. We posit that these different sets of factors reciprocally influence each other and combine synergistically to influence observed gender differences. The research reviewed here indicates that societal definitions of masculinity and femininity have psychological consequences in that they produce gender differences in major risk factors relevant to PTSD.
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Affiliation(s)
- Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States.
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13
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Schultz IZ, Law AK, Cruikshank LC. Prediction of occupational disability from psychological and neuropsychological evidence in forensic context. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:183-196. [PMID: 27810113 DOI: 10.1016/j.ijlp.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Within the fields of psychiatry, psychology, and neuropsychology, medical examiners are often tasked with providing an opinion about an injured individual's health prognosis and likelihood of returning to work. Traditionally, examiners have conducted such assessments by employing clinical intuition, expert knowledge, and judgment. More recently, however, an accumulation of research on factors predictive of disability has allowed examiners to provide prognostications using specific empirically supported evidence. This paper integrates current evidence for four common clinical issues encountered in forensic assessments-musculoskeletal pain, depression, Posttraumatic Stress Disorder, and traumatic brain injury. It discusses an evidence-informed, cross-diagnostic and multifactorial model of predicting disability that is emerging from the literature synthesis, along with recommendations for best forensic assessment practice.
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Affiliation(s)
- Izabela Z Schultz
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Ada K Law
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Leanna C Cruikshank
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Regambal MJ, Alden LE, Wagner SL, Harder HG, Koch WJ, Fung K, Parsons C. Characteristics of the traumatic stressors experienced by rural first responders. J Anxiety Disord 2015; 34:86-93. [PMID: 26188614 DOI: 10.1016/j.janxdis.2015.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms. A factor analysis revealed that distressing events were characterized by chaos and resource limitations. Consistent with contemporary models, two mediational analyses revealed that each event characteristic predicted peritraumatic dissociation and posttraumatic cognitions, which in turn predicted PTSD symptoms. Moreover, the effect of each event characteristic on PTSD symptoms was partially mediated by these cognitive processes.
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Affiliation(s)
- Marci J Regambal
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
| | - Lynn E Alden
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4.
| | - Shannon L Wagner
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, Canada V2N 4Z9
| | - Henry G Harder
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, Canada V2N 4Z9
| | - William J Koch
- Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2A1
| | - Klint Fung
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
| | - Carly Parsons
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
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15
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Lee J, Daffern M, Ogloff JRP, Martin T. Towards a model for understanding the development of post-traumatic stress and general distress in mental health nurses. Int J Ment Health Nurs 2015; 24:49-58. [PMID: 25279764 DOI: 10.1111/inm.12097] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In their daily work, mental health nurses (MHN) are often exposed to stressful events, including patient-perpetrated aggression and violence. Personal safety and health concerns, as well as concern for the physical and psychological well-being of patients, dominate; these concerns have a profound impact on nurses. This cross-sectional study explored and compared the psychological well-being of 196 hospital-based MHN (97 forensic and 99 mainstream registered psychiatric nurses or psychiatric state enrolled nurses). The aim was to examine exposure to inpatient aggression and work stress, and identify factors contributing to the development of post-traumatic stress reactions and general distress. Multiple regression analyses indicated that working in a mainstream setting is associated with increased work stress; however, mainstream and forensic nurses experienced similar psychological well-being. As a group, 14-17% of mainstream and forensic nurses met the diagnostic criteria for post-traumatic stress disorder, and 36% scored above the threshold for psychiatric caseness. A tentative model of post-traumatic stress and general distress in nurses was developed, illustrating the impact of aggression and stress on well-being. The present study affirms that mental health nursing is a challenging and stressful occupation. Implications for organizations, managers, and individual nurses are discussed.
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Affiliation(s)
- Joyce Lee
- Centre for Forensic Behavioural Science, Swinburne University, Melbourne, Victoria, Australia; Monash Health, Melbourne, Victoria, Australia
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Maia DB, Nóbrega A, Marques-Portella C, Mendlowicz MV, Volchan E, Coutinho ES, Figueira I. Peritraumatic tonic immobility is associated with PTSD symptom severity in Brazilian police officers: a prospective study. ACTA ACUST UNITED AC 2014; 37:49-54. [PMID: 25466958 DOI: 10.1590/1516-4446-2013-1267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). METHODS Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. RESULTS Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). CONCLUSIONS Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
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Affiliation(s)
- Deborah B Maia
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Augusta Nóbrega
- Polícia Militar do Estado de Goiás (PMGO), Goiânia, GO, Brazil
| | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, RJ, Brazil
| | - Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho (IBCCF), UFRJ, Rio de Janeiro, RJ, Brazil
| | - Evandro S Coutinho
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Taymur İ, Sargin AE, Özdel K, Türkçapar HM, Çalişgan L, Zamki E, Demirel B. Possible Risk Factors for Acute Stress Disorder and Post-Traumatic Stress Disorder After an Industrial Explosion. Noro Psikiyatr Ars 2014; 51:23-29. [PMID: 28360591 DOI: 10.4274/npa.y6510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 07/28/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION There have been deaths and injuries after an explosion which happened in an industrial region in Ankara in February 2011. The aim of this study was to determine the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), and to determine the variables which can be the risk factors for PTSD. METHODS In this study, we included a total of 197 subjects who were present at the factory building and at the four offices nearby when the disaster occurred. All the participants were assessed one month after the explosion and 157 of them were reassessed six months after the explosion. Socio-demographic information forms were given and the Clinician-Administered PTSD Scale (CAPS) was administered to the participants one month after the explosion. Psychiatric assessments were done using the structured clinical interview for DSM-IV axis-I disorders (SCID-I). The CAPS was re-applied six month after the disaster. RESULTS At the first-month assessments, ASD was detected in 37.1% of participants and PTSD in 13.7%, whereas PTSD was observed in 16.6% of subjects at the sixth month of the accident. According to the first month data, having any psychiatric disorder before the incident, physical injury, acquaintances among the dead and the injured people, being involved in the incident and seeing dead people were detected as the risk factors for PTSD. At the sixth month assessment, physical injury, acquaintances among the dead and the injured, being involved in the incident were seen as risk factors for PTSD. CONCLUSION ASD and PTSD can be seen after an explosion. Having a previous psychiatric disorder and being directly affected by trauma and being injured are the risk factors for PTSD. This study implies that preventive mental health care services should include the management of current psychiatric condition and employee safety issues.
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Affiliation(s)
- İbrahim Taymur
- Clinic of Psychiatry, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - A Emre Sargin
- Clinic of Psychiatry, Çankırı Public Hospital, Çankırı, Turkey
| | - Kadir Özdel
- Clinic of Psychiatry, Etlik İhtisas Training and Research Hospital, Ankara, Turkey
| | - Hakan M Türkçapar
- Clinic of Psychiatry, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Lale Çalişgan
- Clinic of Psychiatry, Etlik İhtisas Training and Research Hospital, Ankara, Turkey
| | - Erkut Zamki
- Clinic of Psychiatry, Etlik İhtisas Training and Research Hospital, Ankara, Turkey
| | - Başak Demirel
- Clinic of Psychiatry, Isparta Public Hospital, Isparta, Turkey
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DiGangi JA, Gomez D, Mendoza L, Jason LA, Keys CB, Koenen KC. Pretrauma risk factors for posttraumatic stress disorder: a systematic review of the literature. Clin Psychol Rev 2013; 33:728-44. [PMID: 23792469 DOI: 10.1016/j.cpr.2013.05.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/16/2013] [Accepted: 05/06/2013] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Julia A DiGangi
- DePaul University, Department of Psychology, Chicago, IL 60614, USA.
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Maia DB, Marmar CR, Henn-Haase C, Nóbrega A, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ESF, Figueira I. Predictors of PTSD symptoms in brazilian police officers: the synergy of negative affect and peritraumatic dissociation. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 33:362-6. [PMID: 22189925 DOI: 10.1590/s1516-44462011000400009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Exposure to traumatic events is a necessary but not a sufficient condition for the development of posttraumatic stress disorder (PTSD). Pretrauma, peritrauma and posttrauma factors interact to impact on symptom severity. The aim of the present study is to determine risk factors for PTSD symptoms in Brazilian police officers. METHOD In a cross-sectional sample of active duty officers (n = 212), participants were asked to complete a socio-demographic questionnaire and self-report scales on affective traits, cumulative critical incident exposure, peritraumatic distress and dissociation, PTSD symptoms, and social support. Hierarchical linear regression analysis was conducted to examine predictors of PTSD symptoms. RESULTS Variables related to negative affect, job duration, frequency of critical incident exposure, peritraumatic dissociation, and lack of social support remained significant in the final model and explained 55% of the variance in PTSD symptoms. When interaction terms were evaluated, a synergistic effect between negative affect and peritraumatic dissociation was found. CONCLUSIONS The risk factors found in this study provide clues on how to elaborate primary prevention strategies regarding PTSD symptoms in police officers. Such initiatives may lessen the impact of repeated exposure to traumatic events on police officers over the course of their careers.
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Affiliation(s)
- Deborah B Maia
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro, Brazil.
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Bowler RM, Harris M, Li J, Gocheva V, Stellman SD, Wilson K, Alper H, Schwarzer R, Cone JE. Longitudinal mental health impact among police responders to the 9/11 terrorist attack. Am J Ind Med 2012; 55:297-312. [PMID: 22213367 DOI: 10.1002/ajim.22000] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among police responders enrolled in the World Trade Center Health Registry (WTCHR), Post-traumatic Stress Disorder (PTSD) was almost twice as prevalent among women as men 2-3 years after the 9/11 attacks. METHODS Police participants in the WTCHR Wave 1 survey 2-3 years after 9/11/01, were reassessed for probable PTSD at Wave 2, 5-6 years after 9/11/01, using PCL DSM-IV criteria. RESULTS Police participants in the Wave 2 survey included 2,527 men, 413 women. The prevalence of "Probable PTSD" was 7.8% at Wave 1 and 16.5% at Wave 2. Mean PCL scores increased from 25.1 to 29.9 for men and 28.6 to 32.2 for women. Prevalence of PTSD was higher for women than for men at Wave 1 (χ(2) = 10.882, P = 0.002), but not Wave 2 (χ(2) = 2.416, P = 0.133). Other risk factors included losing one's job after 9/11 and being disabled. CONCLUSIONS Prevalence of probable PTSD among police doubled between 2003-2004 and 2006-2007. After the 2-year time span, the gender difference was no longer significant; prevalence of PTSD symptoms increased and there was a substantial amount of co-morbidity with other mental health problems. Further development of prevention and intervention strategies for police responders with symptoms of PTSD is needed. The observed upward trend in PCL scores over time in police officers with PCL scores less than 44, suggests that PTSD prevention and intervention strategies should be applied to all police affected by the 9/11 attacks, not limited just to those with PTSD symptoms.
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Affiliation(s)
- Rosemarie M Bowler
- Department of Psychology, San Francisco State University, California, USA.
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21
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Abstract
BACKGROUND To manage the untoward effects of exposure to personally disturbing incidents (PDIs), fire/emergency medical services (EMS) professionals use a variety of coping methods. Some detrimental coping patterns have been steeped in the tradition of emergency services. OBJECTIVE To examine the effectiveness of various coping methods utilized by fire/EMS professionals for mitigating the negative effects of exposure to PDIs. METHODS To differentiate a relationship between the demographic data, traumatic stress, exposure to personally disturbing incidents, and coping methods of fire/EMS professionals, three questionnaires were utilized: a background/demographic questionnaire (BDQ), the 28-item General Health Questionnaire (GHQ-28), and the Ways of Coping Questionnaire (WOC). Descriptive and correlational analyses were used to evaluate the level of traumatic stress symptomatology associated with personally disturbing incidents and describe the relationship between the psychological health of fire/EMS professionals and coping methods. RESULTS One hundred eighty fire/EMS professionals were surveyed. This study identified the subjective stress associated with five PDIs and pinpointed five detrimental coping methods of fire/EMS personnel that were predictors for increasing traumatic stress symptomatology. CONCLUSION A significant relationship has been established between the dangers of detrimental coping methods and traumatic stress in fire/EMS professionals. Five detrimental coping methods have been correlated with traumatic stress. Three optimal coping methods offer promise in managing the untoward effects of PDIs.
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Affiliation(s)
- Mark Holland
- Parkwood Fire Department, Durham, North Carolina 27713, USA.
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Bennett P, Williams Y, Page N, Hood K, Woollard M, Vetter N. Associations between organizational and incident factors and emotional distress in emergency ambulance personnel. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:215-26. [PMID: 16004656 DOI: 10.1348/014466505x29639] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study examined the prevalence and correlates of post-traumatic stress disorder (PTSD), anxiety and depression among emergency ambulance personnel. DESIGN AND METHOD A questionnaire and reminder were sent anonymously to 1029 emergency ambulance personnel in a large ambulance service. RESULTS Among the 617 respondents, levels of PTSD symptoms did not differ according to grade, but men had a higher prevalence rate than women. Key predictors of the severity of symptoms were organizational stress, the frequency of experiencing potentially traumatic incidents, length of service, and dissociation in response to an index incident. The degree of organizational, but not incident-related, stress discriminated between 'cases' and 'non-cases'. Nine and 23% of recorded scores indicated clinical levels of depression and anxiety respectively. Several work factors were associated with these emotions, explaining 38% of anxiety and 31% of depression scores. CONCLUSION Both organizational and individually based interventions may be necessary to minimize PTSD and other emotional disorders among ambulance personnel.
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Affiliation(s)
- Paul Bennett
- Department of Psychology, University of Wales, Swansea, UK.
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Weiss DS, Brunet A, Best SR, Metzler TJ, Liberman A, Pole N, Fagan JA, Marmar CR. Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers. J Trauma Stress 2010; 23:734-43. [PMID: 21171134 PMCID: PMC3974917 DOI: 10.1002/jts.20576] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity.
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Affiliation(s)
- Daniel S. Weiss
- Department of Psychiatry, University of California, San Francisco
| | - Alain Brunet
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute
| | | | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Affairs Medical Center
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Bui E, Brunet A, Olliac B, Very E, Allenou C, Raynaud JP, Claudet I, Bourdet-Loubère S, Grandjean H, Schmitt L, Birmes P. Validation of the Peritraumatic Dissociative Experiences Questionnaire and Peritraumatic Distress Inventory in school-aged victims of road traffic accidents. Eur Psychiatry 2010; 26:108-11. [PMID: 21071181 DOI: 10.1016/j.eurpsy.2010.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/28/2010] [Accepted: 09/20/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although the reliable and valid Peritraumatic Distress Inventory (PDI-C) and Peritraumatic Dissociative Experiences Questionnaire (PDEQ) are useful for identifying adults at risk of developing acute and chronic posttraumatic stress disorder (PTSD), they have not been validated in school-aged children and their predictive values remain unknown in this population. This study aims to assess the psychometric properties of the children versions of these two measures (PDI-C and PDEQ-C) in a sample of French-speaking school-children. METHODS One-hundred and thirty-three consecutive victims of road traffic accidents, aged 8-15 years, were recruited into this longitudinal study via the emergency room. The peritraumatic reactions were assessed at baseline and PTSD symptoms were assessed 1 month later. RESULTS Cronbach's alpha coefficients were 0.8 and 0.77 for the PDI-C and PDEQ-C, respectively. The 1-month test-retest correlation coefficient (n=33) was 0.77 for both measures. The PDI-C demonstrated a two-factor structure while the PDEQ-C displayed a one-factor structure. As with adults, the two measures were intercorrelated (r=0.52) and correlated with subsequent PTSD symptoms and diagnosis (r=0.21-0.56; P<0.05). CONCLUSIONS The children versions of the PDI and PDEQ are reliable and valid in children.
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Affiliation(s)
- E Bui
- Laboratoire du stress traumatique (LST-JE 2511), CHU de Toulouse, hôpital Casselardit, université de Toulouse, UPS, Toulouse cedex 9, France.
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Bouchard S, Baus O, Bernier F, McCreary DR. Selection of Key Stressors to Develop Virtual Environments for Practicing Stress Management Skills with Military Personnel Prior to Deployment. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2010; 13:83-94. [DOI: 10.1089/cyber.2009.0336] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stéphane Bouchard
- Université du Québec en Outaouais, Gatineau, Québec, Canada
- Laboratoire de Cyberpsychologie de l'UQO, Gatineau, Québec, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Oliver Baus
- Laboratoire de Cyberpsychologie de l'UQO, Gatineau, Québec, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - François Bernier
- Defence Research and Development Canada–ValCartier, ValCartier, Québec, Canada
| | - Donald R. McCreary
- Defence Research and Development Canada–Toronto, Toronto, Ontario, Canada
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Wald J, Taylor S. Work Impairment and Disability in Posttraumatic Stress Disorder: A Review and Recommendations for Psychological Injury Research and Practice. PSYCHOLOGICAL INJURY & LAW 2009. [DOI: 10.1007/s12207-009-9059-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trait dissociation predicts posttraumatic stress disorder symptoms in a prospective study of urban police officers. J Nerv Ment Dis 2008; 196:912-8. [PMID: 19077859 PMCID: PMC3974927 DOI: 10.1097/nmd.0b013e31818ec95d] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study prospectively examines the predictive relationship of trait dissociation, assessed during academy training, to PTSD symptoms assessed at 12 months of active police duty in relatively young and healthy police academy recruits (N = 180). The roles of pre-academy trauma exposure, exposure to life-threatening critical incidents during police duty, and peritraumatic dissociation at the time of the officer's worst critical incident were also examined. Utilizing path analytic techniques, greater trait dissociation, assessed during academy training, was predictive of both peritraumatic dissociation, and PTSD symptoms assessed at 12 months of police service. Moreover, after accounting for trait dissociation and peritraumatic dissociation, the relationship of previous trauma to later PTSD symptoms was no longer significant, demonstrating that the effect of previous trauma on later vulnerability to PTSD symptoms in this sample may be mediated by both trait and peritraumatic dissociation.
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Morgos D, Worden JW, Gupta L. Psychosocial Effects of War Experiences among Displaced Children in Southern Darfur. OMEGA-JOURNAL OF DEATH AND DYING 2008; 56:229-53. [DOI: 10.2190/om.56.3.b] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study focused on assessing the psychosocial effects of the long standing, high intensity, and guerrilla-style of warfare among displaced children in Southern Darfur. The goal was to better understand the etiology, prognosis, and treatment implications for traumatic reactions, depression, and grief symptoms in this population. Three hundred thirty-one children aged 6–17 from three IDP Camps were selected using a quota sampling approach and were administered a Demographic Questionnaire, Child Post Traumatic Stress Reaction Index, Child Depression Inventory, and the Expanded Grief Inventory. Forty-three percent were girls and 57% were boys. The mean age of the children was 12 years. Results found that children were exposed to a very large number of war experiences with no significant differences between genders for types of exposure, including rape, but with older children (13–17 years) facing a larger number of exposures than younger children (6–12 years). Out of the 16 possible war experiences, the mean number was 8.94 ( SD = 3.27). Seventy-five percent of the children met the DSM-IV criteria for PTSD, and 38% exhibited clinical symptoms of depression. The percentage of children endorsing significant levels of grief symptoms was 20%. Increased exposure to war experiences led to higher levels of: 1) traumatic reactions; 2) depression; and 3) grief symptoms. Of the 16 war experiences, abduction, hiding to protect oneself, being raped, and being forced to kill or hurt family members were most predictive of traumatic reactions. Being raped, seeing others raped, the death of a parent/s, being forced to fight, and having to hide to protect oneself were the strongest predictors of depressive symptoms. War experiences such as abduction, death of one's parent/s, being forced to fight, and having to hide to protect oneself were the most associated with the child's experience of grief. In addition to Total Grief, Traumatic Grief, Existential Grief, and Continuing Bonds were measured in these children. Although trauma, depression, and grief often exist as co-morbid disorders, the mechanisms and pathways of these is less understood. In this study we used Structural Equation Modeling to better understand the complex interaction and trajectories of these three symptoms evolving from war exposure and loss. This study is the first of its kind to assess the psychosocial effects of war experiences among children currently living in war zone areas within Sudan. It identifies some of the most prevalent war-related atrocities and their varying impact on the children's psychological well-being and overall adjustment. Implications for planning mental health interventions are discussed.
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Amrhein C, Hengmith S, Maragkos M, Hennig-Fast K. Neuropsychological characteristics of highly dissociative healthy individuals. J Trauma Dissociation 2008; 9:525-42. [PMID: 19042795 DOI: 10.1080/15299730802226332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Dissociative disorders are characterized by disturbances in several neuropsychological domains, especially attention, memory, and consciousness. As a tendency to dissociate can also be observed in healthy individuals, and may be a risk factor for the development of dissociative disorders and posttraumatic stress disorder (PTSD), we were interested in the neuropsychological characteristics of these participants. METHOD We examined attention, memory, and executive control functions in 17 high and 17 low dissociators without any psychiatric or neurological disorder and without prior experiences of trauma. RESULTS High dissociators showed relative performance deficiencies in tasks of memory for associative, context-dependent verbal material, visuospatial working memory, and executive control functions in terms of a heightened perseveration tendency and false positive errors. CONCLUSION These cognitive deficits are consistent with models of dissociative disorders and dissociation in PTSD assuming a hippocampal and prefrontal dysfunction as a core factor. Mild cognitive impairments in otherwise healthy high dissociators may constitute a risk factor for the development of later PTSD or dissociative disorders.
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Affiliation(s)
- Christine Amrhein
- Section of Clinical Psychology and Psychophysiology, University Hospital of Psychiatry, Ludwig Maximilians University of Munich, Germany
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Regehr C, LeBlanc V, Jelley RB, Barath I, Daciuk J. Previous trauma exposure and PTSD symptoms as predictors of subjective and biological response to stress. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:675-83. [PMID: 18020115 DOI: 10.1177/070674370705201008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The immediate and long-term effects of traumatic exposure and subsequent posttraumatic stress reactions in people in high-risk occupations are well-documented. What is less evident is the impact of this traumatic exposure and subsequent traumatic stress symptoms on workers' response to acute stress situations. This study aimed to examine the association between prior traumatic exposure related to policing, current posttraumatic stress symptoms and biological markers of stress, and subjective appraisal of stress before, during, and after exposure to acutely stressful stimuli. METHOD A stressful policing situation was created through the use of a video simulator room. Participants' responses to the simulated emergency were evaluated by monitoring heart rate, collecting salivatory samples for cortisol analysis, and repeated administration of a subjective measure of anxiety. RESULTS Biological indicators of stress, as measured by cortisol level and heart rate, were not associated with previous trauma exposure or trauma symptoms; however, biological response was associated with subjective anxiety. Vulnerability to psychological stress responses during an acute stress situation was also associated with lower levels of social support, previous traumatic exposures, and preexisting symptoms of traumatic stress. The importance of these factors became more pronounced as time progressed after the event. CONCLUSION Previous trauma exposure did not put individuals at increased risk of biological distress during an acute stress situation. However, previous trauma and reduced social supports were associated with continuing psychological distress, confirming previous research and raising concerns about the cumulative negative effects of traumatic exposure on psychological health in emergency responders.
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Affiliation(s)
- Cheryl Regehr
- Faculty of Social Work, University of Toronto, Ontario.
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Abstract
Research has increasingly identified alarming levels of traumatic stress symptoms in individuals working in emergency services and other high stress jobs. This study examined the effects of prior critical incident exposure and current posttraumatic symptoms on the performance of a nonpatient population, police recruits, during an acutely stressful event. A stressful policing situation was created through the use of a video simulator room that was responsive to actions of participants. The performance of participants to the simulated emergency was evaluated by 3 independent blinded raters. Prior exposure to critical incidents was measured using the Critical Incident History Questionnaire and current level of traumatic stress symptoms was measured using the Impact of Events Scale-Revised. Neither previous exposure to critical incidents nor trauma symptoms correlated with performance level. Recruits with high or severe levels of trauma symptoms did not demonstrate impairments in judgment, communication, or situation control compared with their colleagues with lesser or no trauma symptoms. On the basis of these findings, there is no reason to believe that police recruits with PTSD are prone to making errors of communication or judgment that would place them or others at increased risk.
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Violanti JM, Burchfiel CM, Miller DB, Andrew ME, Dorn J, Wactawski-Wende J, Beighley CM, Pierino K, Joseph PN, Vena JE, Sharp DS, Trevisan M. The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study: Methods and Participant Characteristics. Ann Epidemiol 2006; 16:148-56. [PMID: 16165369 DOI: 10.1016/j.annepidem.2005.07.054] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 07/12/2005] [Accepted: 07/12/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study is one of the first population-based studies to integrate psychological, physiological, and subclinical measures of stress, disease, and mental dysfunction. This pilot study was undertaken to establish a methodology and descriptive results for a larger police study. METHODS A stratified sample of 100 officers was randomly selected from the Buffalo, NY Police Department. Salivary cortisol served as a stress biomarker. Flow mediated dilation (FMD) and carotid intima-media thickness (IMT) were performed with ultrasound. Dual Energy X-Ray Absorptiometry (DEXA) and anthropometric measures assessed body composition. Self-report measures of depression and posttraumatic stress disorder (PTSD) were obtained. RESULTS Recruitment attained for the study was 100%. Seventy-five percent showed a cortisol increase upon awakening, 90% a negative diurnal slope, and 77% an increased cortisol response after a high protein lunch challenge. Dexamethasone suppression was evident. FMD showed an increase in mean brachial artery diameter of 3.2% in men and 3.9% in women, and mean IMT was lower (male=0.67 mm; female=0.62 mm) compared to populations of similar age. For males, the mean body-mass index (BMI) was 29.8 kg/m2 and total body fat 23.4%. For females, the mean BMI was 26.7 kg/m2 and total body fat 31.5%. For all officers, 16% met criteria for depression; 36% reported elevated PTSD symptoms. CONCLUSIONS Compared to populations of similar age, police officers had slightly lower FMD, lower carotid IMT, elevated BMI, and higher reported rates of depression and PTSD. Standardized physiological and psychological data collection and descriptive results confirmed that the methodology of the study is feasible in a working police population.
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Affiliation(s)
- John M Violanti
- School of Public Health and Health Professions, Department of Social and Preventive Medicine, State University of New York at Buffalo 14214-8001, USA.
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Pole N, Cumberbatch E, Taylor WM, Metzler TJ, Marmar CR, Neylan TC. Comparisons between high and low peritraumatic dissociators in cardiovascular and emotional activity while remembering trauma. J Trauma Dissociation 2005; 6:51-67. [PMID: 16537323 DOI: 10.1300/j229v06n04_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peritraumatic dissociation (PD) is one of the best predictors of posttraumatic stress disorder (PTSD). In this pilot study, we examined cardiovascular psychophysiology and negative emotions in 19 adults who, retrospectively, reported experiencing high or low levels of PD during the worst trauma of their lives. In a contiguous series of ten-minute phases, they rested, thought about, talked about, and recovered from talking about their index trauma. We hypothesized that greater PD would be associated with more negative emotion, lower cardiovascular activity, and greater discordance between negative emotions and cardiovascular activity. Our main findings were that PD was associated with lower blood pressure prior to talking about the trauma, greater negative emotion while talking about the trauma, and greater emotional and cardiovascular discordance throughout the experiment. These findings add to the very limited empirical data on physiological concomitants of peritraumatic dissociation and may aid in developing preventive interventions for PTSD.
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Affiliation(s)
- Nnamdi Pole
- Department of Psychology, University of Michigan, 525 East University, 2260 East Hall, Ann Arbor, MI 48109-1109, and San Francisco Veterans Affairs Medical Center, CA, USA.
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Sommer I, Ehlert U. Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides. J Psychosom Res 2004; 57:329-35. [PMID: 15518666 DOI: 10.1016/j.jpsychores.2004.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Accepted: 01/05/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study was designed to assess the frequency of trauma exposure, the prevalence rates of posttraumatic stress disorder, comorbid symptoms, and sense of coherence (SOC) in Swiss mountain guides. METHOD All mountain guides (n=1347) were surveyed using of the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire (GHQ-28), and the Sense of Coherence Self-Rating Scale (SOC-29). RESULTS Although Swiss mountain guides are exposed to many traumatic situations, the prevalence rate of PTSD is very low (2.7%), and their SOC total scores are high (157.9+/-18.4). Subgroups differentiated by the extent of traumatic stress symptoms differ significantly in SOC and GHQ total scores. Regression analysis showed SOC total score to be a significant predictor, although it only accounted for 1% of the variance in the number of PTSD symptoms endorsed. CONCLUSION The low prevalence rate of PTSD is not in line with findings in other high-risk populations for PTSD. SOC seems to be a marker for psychological health rather than a protective factor against PTSD.
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Affiliation(s)
- Isabelle Sommer
- Department of Clinical Psychology, University of Zurich, Zürichbergstrasse 43, CH-8044 Zurich, Switzerland
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Pulcino T, Galea S, Ahern J, Resnick H, Foley M, Vlahov D. Posttraumatic Stress in Women after the September 11 Terrorist Attacks in New York City. J Womens Health (Larchmt) 2003; 12:809-20. [PMID: 14588131 DOI: 10.1089/154099903322447774] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women have been shown to be at higher risk than men of developing posttraumatic stress disorder (PTSD) after traumatic events. Women in New York City were more likely than men to have probable PTSD 5-8 weeks after the September 11, 2001, terrorist attacks on the World Trade Center. We explored the factors that could explain the higher prevalence of probable PTSD among women in the aftermath of the attacks. METHODS Data from a telephone survey of a randomly selected group of residents of Manhattan living south of 110th street, conducted 5-8 weeks after September 11, were used in these analyses. The survey assessed demographic information, lifetime experience of traumatic events, life stressors, social support, event exposure variables, perievent panic attacks, postevent concerns, and probable PTSD related to the attacks. We determined the contribution of key covariates that could explain the gender-probable PTSD relation through stratified analyses and manual stepwise logistic regression model building. RESULTS Among 988 respondents, women were two times more likely than men to report symptoms consistent with probable PTSD after the September 11 attacks. When adjusted for potential confounders, the association between gender and probable PTSD diminished from OR = 2.2 (95% confidence interval [CI] 1.3-3.6) to OR = 1.2 (95% CI 0.7-2.2). CONCLUSIONS These results suggest that specific behavioral and biographic factors (including previous traumatic experiences and psychological disorders, social responsibilities, and perievent emotional reactions) explained most of the excess burden of probable PTSD among women after a disaster. Isolating the characteristics that place women at greater risk for probable PTSD after disasters can inform public health prevention strategies and spur further research.
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Speckhard A. Acute stress disorder in diplomats, military, and civilian Americans living abroad following the September 11 terrorist attacks on America. ACTA ACUST UNITED AC 2003. [DOI: 10.1037/0735-7028.34.2.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Halligan SL, Yehuda R. Assessing dissociation as a risk factor for posttraumatic stress disorder: a study of adult offspring of holocaust survivors. J Nerv Ment Dis 2002; 190:429-36. [PMID: 12142843 DOI: 10.1097/00005053-200207000-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dissociative symptoms are frequently present in trauma survivors with posttraumatic stress disorder (PTSD). However, the possibility that dissociative symptoms may comprise a risk factor for the development of PTSD has not been examined. The current research investigates this possibility by evaluating dissociative symptoms in a group of adult offspring of Holocaust survivors, whom we have previously shown to be at increased risk of PTSD. Eighty-seven Holocaust survivor offspring and 39 comparison participants completed the Dissociative Experiences Scale, and assessments of trauma exposure, psychopathology, and parental PTSD. Dissociative symptoms were elevated in individuals with current PTSD, but not in those with past PTSD or with the risk factor of parental PTSD. Dissociative symptoms were also associated with forms of psychopathology other than PTSD. The results suggest that dissociative symptoms are related to current psychiatric symptomatology, including PTSD, rather than representing an enduring trait or preexisting risk factor for the development of PTSD.
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Affiliation(s)
- Sarah L Halligan
- The Division of Traumatic Stress Studies, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA
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