Article

Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study

July 2002
Behaviour Research and Therapy 40(6):665-75

July 2002
40(6):665-75

DOI:10.1016/S0005-7967(01)00069-9

Source
PubMed

Authors:

Anke Ehlers

University of Oxford

The paper presents a 3-year follow-up of a prospective longitudinal study of posttraumatic stress disorder (PTSD) after motor vehicle accidents (J. Abnormal Psychol., 107 (1998) 508). Participants were 546 patients who had been assessed when attending an emergency clinic shortly after a motor vehicle accident, and at 3 months and 1 year afterwards. The prevalence of posttraumatic stress disorder PTSD at 3 years was 11%. Maintaining psychological factors, i.e. negative interpretation of intrusions, rumination, thought suppression and anger cognitions, were important in predicting the persistence of PTSD at 3 years, as were persistent health and financial problems after the accident. Other predictors were female sex, hospital admission for injuries, perceived threat and dissociation during the accident, and litigation.

Posttraumatic Stress Disorder After a Car Accident in the Czech Population: Prevalence and Risk Factors For Its Development

Article

Full-text available

Oct 2023

Empathy and self-compassion in Posttraumatic Stress Disorder

Thesis

Jan 2008

Victoria Rose

p>The area of posttraumatic stress disorder (PTSD) has attracted a large amount of research interest. Research has attempted to explore both what may contribute towards an individual developing symptoms following exposure to traumatic stressor, and what may protect against severe symptoms. This thesis considers models of PTSD, together with research exploring potential risk or protective factors associated with the onset and maintenance of symptoms of PTSD. The relationship between empathy and PTSD has attracted little research, however, studies exploring vicarious or secondary traumatisation, suggest that empathy may be a risk factor for developing symptoms. An exploration of empathy and its consistent parts, including the skills of emotion recognition required in order to interact successfully and respond appropriately to others, is considered. The empirical study examined the role of empathy and self-compassion within primary PTSD. Measures of empathy were provided in the form of a self-report scale and ratings of pleasantness and arousal when viewing emotional facial expressions. An emotion recognition task (following the paradigm of Joormann & Gotlib, 2006) was also completed to explore the association between levels of empathy and the skills of emotion recognition. It was predicted that participants with PTSD would have higher levels of empathy and lower self-compassion than accident exposed individuals with no PTSD and a non-accident exposed group. These predicted differences were not found, however, correlations revealed a positive relationship between symptom severity and some empathy subscales. Results are discussed and suggestions for future research made.</p

The use of professional help and predictors of unmet needs for dealing with mental health to legal problems among victims of violence, accidents, theft and threat, and nonvictims in the general population

Article

Full-text available

Nov 2021
PLOS ONE

Aims Victims of violence, accidents, theft, and serious threat (hereafter abbreviated as victims) are more than nonvictims at risk for problems in different domains, varying from mental health to legal problems. However, the extent to which victims with these problems compared to nonvictims with similar problems receive problem-related professional or formal help is unclear. It is unknown if predictors of unmet needs differ between victims and nonvictims. Aim of the present study is to fill this gap of knowledge. Methods Data was extracted from surveys of the VICTIMS-study (2018, 2019 and 2020), conducted with the Dutch population-based longitudinal LISS panel. Each survey assessed 1.) experiences with physical violence, accidents, theft, and serious threat and other traumatic or stressful events in the past 12 months and 2.) various problems and use of professional help, e.g. do receive help, do not need help, could use help but do not use it, cannot find or afford help for these problems. Multivariate logistic regression analyses were performed to assess differences in problems, in the use of problem-related professional help, and in predictors of unmet needs between victims (N = 1,756) and nonvictims (N = 5,000). Results Victims more often had assessed problems than nonvictims. Victims compared to nonvictims with similar problems had 1.5 to 2 times more often unmet needs: they could not find or afford professional help for their mental, physical, partner/family, financial and legal problems. In addition, victims less often received help for legal and administrative problems. Most predictors of unmet needs, e.g. could use help but do not use it, cannot find or afford help, were not significant and hardly differed between both groups. Conclusions The findings that victims compared to nonvictims more often have various problems and more often cannot find or afford problem-related professional help, suggest that there is room for improvement for victims services.

The Role of Specific Sources of Social Support on Postinjury Psychological Symptoms

Article

Full-text available

Aug 2021

Purpose/objective: The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury. Results: Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family. Conclusions/implications: MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding the Relation Between Self-Compassion and Suicide Risk Among Adolescents in a Post-disaster Context: Mediating Roles of Gratitude and Posttraumatic Stress Disorder

Article

Full-text available

Jul 2020

Background The suicide risk among adolescents post-earthquake remains an important issue in trauma psychology. While existing studies and theories suggest that factors such as self-compassion, gratitude, and posttraumatic stress disorder (PTSD) play roles in the risk of suicide, few studies have combined these factors to explore the relationship between them. Objective This study examined the mediating roles of gratitude and PTSD in the relationship between self-compassion and suicide risk among Chinese adolescents after the Ya’an earthquake. Methods Four and a half years after the Ya’an earthquake, 499 middle school students in Lushan County were assessed using the following systems: Measures of Self-Compassion Scale, Gratitude Questionnaire, PTSD Checklist for DSM-5, and Child Behavior Problems Questionnaire. Results When we controlled for gender, age, and traumatic exposure, in the direct effect model, positive self-compassion had a negative effect on suicide risk, and negative self-compassion had a positive effect on suicide risk. In the indirect effects model, both positive self-compassion and negative self-compassion had no significant direct effect on suicide risk. Moreover, we found an indirect and negative effect of positive self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD. On the other hand, we also found an indirect and positive effect of negative self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD. Conclusion Positive self-compassion reduces the risk of suicide, while negative self-compassion increases the risk of suicide. Gratitude and PTSD play significant mediating role between self-compassion and suicide risk.

Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach

Article

Full-text available

May 2024

Background In Australia, motor vehicle crashes (MVC)-related health data are available from insurance claims and hospitals but not from primary care settings. This study aimed to identify the frequency of MVC-related consultations in Australian general practices, explore the pharmacological management of health conditions related to those crashes, and investigate general practitioners’ (GPs) perceived barriers and enablers in managing these patients. Methods Mixed-methods study. The quantitative component explored annual MVC-related consultation rates over seven years, the frequency of chronic pain, depression, anxiety or sleep issues after MVC, and management with opioids, antidepressants, anxiolytics or sedatives in a sample of 1,438,864 patients aged 16 + years attending 402 Australian general practices (MedicineInsight). Subsequently, we used content analysis of 81 GPs’ qualitative responses to an online survey that included some of our quantitative findings to explore their experiences and attitudes to managing patients after MVC. Results MVC-related consultation rates remained stable between 2012 and 2018 at around 9.0 per 10,000 consultations. In 2017/2018 compared to their peers, those experiencing a MVC had a higher frequency of chronic pain (48% vs. 26%), depression/anxiety (20% vs. 13%) and sleep issues (7% vs. 4%). In general, medications were prescribed more after MVC. Opioid prescribing was much higher among patients after MVC than their peers, whether they consulted for chronic pain (23.8% 95%CI 21.6;26.0 vs. 15.2%, 95%CI 14.5;15.8 in 2017/2018, respectively) or not (15.8%, 95%CI 13.9;17.6 vs. 6.7%, 95% CI 6.4;7.0 in 2017/2018). Qualitative analyses identified a lack of guidelines, local referral pathways and decision frameworks as critical barriers for GPs to manage patients after MVC. GPs also expressed interest in having better access to management tools for specific MVC-related consequences (e.g., whiplash/seatbelt injuries, acute/chronic pain management, mental health issues). Conclusion Chronic pain, mental health issues and the prescription of opioids were more frequent among patients experiencing MVC. This reinforces the relevance of appropriate management to limit the physical and psychological impact of MVC. GPs identified a lack of available resources (e.g. education, checklists and management support tools) for managing MVC-related consequences, and the need for local referral pathways and specific guidelines to escalate treatments.

Differential predictors of early- and delayed-onset post-traumatic stress disorder following physical injury: a two-year longitudinal study

Article

Full-text available

May 2024

Objectives This study aimed to investigate the predictors of both early- and delayed-onset PTSD over a 2-year period following physical injuries. Methods Patients were recruited from a trauma center at a university hospital in South Korea (June 2015 ~ January 2021). At baseline, 1142 patients underwent comprehensive assessments including socio-demographic, pre-trauma, trauma-related, and peri-trauma evaluations. Diagnoses of acute stress disorder (ASD) and subthreshold ASD were also determined using the Clinician-administered PTSD Scale (CAPS). Follow-up assessments at three months included diagnoses of PTSD and subthreshold PTSD using CAPS, and stressful life events (SLEs), with additional evaluations at 6, 12, and 24 months. The analyzed sample comprised 1014 patients followed up at least once after the baseline and 3-month evaluations. PTSD diagnoses were categorized into early-onset (within the first six months after trauma) and delayed-onset (more than six months after trauma). Logistic regression models identified predictors for each group. Results Early-onset and delayed-onset PTSD were diagnosed in 79 and 35 patients, respectively. Early-onset PTSD was predicted by previous psychiatric disorders, previous traumatic events, ASD and subthreshold ASD diagnoses, and higher anxiety levels. In contrast, delayed-onset PTSD was linked to higher education, higher injury severity, and subthreshold PTSD and SLEs at 3-month follow-up. Conclusion Distinct predictors were found for early-onset and delayed-onset PTSD. The findings underscore the heterogeneous factors influencing the temporal development of PTSD post-trauma, and may provide valuable guidance for more targeted interventions and improved patient outcomes.

European Journal of Psychotraumatology ISSN: (Print) ( Psychosocial resources underlying disaster survivors' posttraumatic stress symptom trajectories: insight from in-depth interviews with mothers who survived Hurricane Katrina Psychosocial resources underlying disaster survivors' posttraumatic stress symptom trajectories: insight from in-depth interviews with mothers who survived Hurricane Katrina

Article

Full-text available

Jun 2023

Background: Weather-related disasters, including hurricanes, are becoming more frequent and severe due to climate change. Vulnerable populations, such as people with low income and racial and ethnic minorities, are particularly prone to increased levels of physical harm and psychiatric adversity from weather-related events. Objectives: We aimed to explore psychosocial resources and coping of survivors with three different posttraumatic stress symptom (PTSS) trajectories (High-Decreasing, Moderate-Decreasing, and High-Stable), after Hurricane Katrina across two different time points: F1 (1-year post-disaster) and F3 (12 years post-disaster). Method: Participants in this multi-method study were part of a larger cohort of the Resilience in Survivors of Katrina (RISK) project. Transcripts of interviews completed at the two time points were analysed using two qualitative methods, combining thematic analysis and narrative analysis, and providing both breadth of perspectives with the depth of specific case studies. Results: Sixteen survivors completed interviews at both F1 and F3. From our in-depth analysis of the data, we derived five inductive themes: ‘Hope,’ ‘Adaptive vs maladaptive avoidance,’ ‘Emotional delay,’ ‘Acceptance, Finding Meaning and Being in the Moment,’ and ‘Coping strategies.’ Survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories experienced hope for future, accepted the hurricane and its results, and found efficient ways to cope with their situation. Survivors with High-Stable PTSS trajectories tended to express a lack of hope for future and struggled to be mindful and accept the hurricane and its harm. Unlike survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories, survivors with High-Stable PTSS trajectories also reported less social and family support and faced more discrimination and racism. Conclusion: There are factors beyond individual-level psychosocial resources that may shape post-disaster resilience. When supporting survivors after a weather-related disaster, it is essential to provide ongoing psychological, financial, and physical assistance to bolster these resources.

Cognitive distortions, anxiety, and depression in individuals suffering from PTSD

Article

Jun 2023

Cognitive distortions are an essential factor in the develop- ment and maintenance of post-traumatic stress disorder (PTSD). The aim of the study is to investigate the link between the production of cognitive distortions and PTSD by measur- ing levels of anxiety and depression. Our sample comprised 183 participants divided into three groups: 59 trauma-exposed with PTSD, 61 trauma-exposed without PTSD, and 63 non- trauma-exposed non-PTSD (controls). All participants were assessed on the following dimensions: PTSD (PCL-5), cognitive distortions (EDC-A), anxiety and depression (HADS). The main results highlight a production of cognitive distortions in peo- ple with PTSD, who had significantly more positive than nega- tive cognitive distortions compared to the group exposed to trauma without PTSD. In addition, the PTSD group had higher anxiety and depression scores than the other two groups. Findings indicate that people with PTSD show more positive cognitive distortions than those without PTSD, and that this is not related to levels of anxiety and depression.

The impact of pre- and post-trauma financial problems on posttraumatic stress symptoms, anxiety and depression symptoms, and emotional support: A prospective population-based comparative study

Article

Full-text available

Apr 2023
J ANXIETY DISORD

Potentially traumatic events (PTEs) are associated with a higher risk of mental health problems and a lack of emotional support. The extent to which pre- and/or post-trauma financial problems further increase this risk, while controlling for pre-trauma mental health problems and lack of support and compared to nonvictims, is largely unknown. To better understand this risk, data was extracted from four surveys of VICTIMS study using the Dutch population-based longitudinal LISS-panel. Multivariate logistic regression analyses (MLRA) showed that nonvictims (nnonvictims total=5003) with persistent financial problems (present at T1 and present at T2 one year later) more often suffered from severe anxiety and depression symptoms (ADS; Adjusted OR (aOR)= 1.72) and lack of emotional support (aOR=1.96) than nonvictims without these problems, and that victims of PTEs (nvictims total=872) with persistent financial problems more often suffered moderate ADS (aOR=2.10) than nonvictims with persistent financial problems. MLRA showed that victims with pre- and/or post-trauma financial problems were more at risk of probable PTSD than victims without financial problems (aORs ≥ 2.02). Victim services and (mental) health care professionals should screen for pre- and post-trauma financial problems and, when found, refer the victims to relevant professionals since these problems can significantly hinder recovery.

Psychometric Properties of the PTSD Checklist for DSM-5 (PCL-5) Anchored to One's Own Suicide Attempt

Article

Full-text available

Mar 2023

Objective: Emerging evidence indicates that a nontrivial proportion of suicide attempt (SA) survivors develop clinically significant posttraumatic stress disorder (PTSD) symptoms related to their suicide attempt (SA-PTSD). However, SA-PTSD is rarely assessed in either clinical practice or research studies, due at least in part to a lack of research examining approaches to assessing SA-PTSD. This study examined the factor structure, internal consistency, and concurrent validity of scores on a version of the PTSD Checklist for DSM-5 (PCL-5) specifically anchored to one's own SA (PCL-5-SA). Method: We recruited a sample of 386 SA survivors who completed the PCL-5-SA and related self-report measures. Results: A confirmatory factor analysis (CFA) that specified a 4-factor model consistent with the DSM-5 conceptualization of PTSD indicated that the PCL-5-SA had acceptable fit in our sample, χ²(161) = 758.03, RMSEA = 0.10, 90% CI =[0.09–0.11], CFI = 0.90, and SRMR = 0.06. The PCL-5-SA total and subfactor scores demonstrated good internal consistency (ωs = 0.88–0.95). Significant positive correlations of PCL-5-SA scores with anxiety sensitivity cognitive concerns, expressive suppression, depression symptoms, and negative affect provided evidence for concurrent validity (rs = .25–.62). Conclusion: Results suggest that SA-PTSD, when measured with a specific version of the PCL-5, is a conceptually coherent construct that operates consistent with the DSM-5 conceptualization of PTSD stemming from other traumatic events.

Maladaptive cognitions and emotion regulation in posttraumatic stress disorderMaladaptive Kognitionen und Emotionsregulation bei posttraumatischer Belastungsstörung

Article

Jan 2023

Purpose: The present study investigated the interactions between emotion regulation strategies and cognitive distortions in posttraumatic stress disorder (PTSD). We also examined differences in emotion regulation and cognitive distortions across the trauma spectrum. Methods: The study was conducted in France between December 2019 and August 2020 and was approved by the university ethics committee. We recruited 180 participants aged over 18, with 3 groups of 60 each: (1) patients diagnosed with PTSD, (2) trauma-exposed without PTSD, (3) no history of trauma. Exclusion criteria were a history of neurological or mental disorders, psychoactive substance abuse, and a history of physical injury that could affect outcomes. All participants completed the Life Events Checklist‑5 (LEC-5), Post-traumatic Check List‑5 (PCL-5), Dissociative Experiences Scale (DES), Cognitive Emotion Regulation Questionnaire (CERQ), and Cognitive Distortions scale for Adults (EDC-A). Correlation analysis was performed to observe the relationship between PTSD severity and cognitive functioning. Correlations between cognitive distortions and maladaptive emotion regulation strategies were calculated for the PTSD group. A moderation analysis of the whole sample was conducted to examine the relationship between cognitive distortions, emotion regulation strategies, and PTSD. Results: Participants with PTSD scored significantly higher on the PCL‑5 and for dissociation than the other groups. PCL‑5 scores were positively correlated with maladaptive emotion regulation strategies and acceptance. They were also correlated with positive and negative dichotomous reasoning and negative minimization. Analysis of the PTSD group revealed correlations between maladaptive emotion regulation strategies and negative cognitive distortions. The moderation analysis revealed the cognitive distortions explaining the relationship between emotion regulation strategies and trauma exposure overall, and how they exacerbate emotional problems in PTSD. Conclusion: The study provides indications for management of PTSD patients. Inclusion of an intermediate group of individuals exposed to trauma without PTSD revealed differences in the observed alterations. It would be interesting to extend the cross-sectional observation design to study traumatic events that may cause a specific type of disorder.

Posttraumatic Stress Disorder

Chapter

Jan 2023

The chapter begins by describing how PTSD is diagnosed, contrasting the ‘broad’, inclusive DSM formulations with the ‘narrow’ formulation focusing on core symptoms introduced in ICD-11. The ICD-11 distinction between PTSD and Complex PTSD is also described. We go on to consider why PTSD has been regarded as a disorder of memory, and the two signature changes consisting of vivid re-experiencing of the traumatic event in the present coupled with impaired voluntary recall of the event. Other aspects of memory affected in PTSD that are unrelated to the traumatic event include a general bias toward recalling negative rather than positive stimuli, verbal memory deficits, and difficulties in retrieving specific memories and suppressing unwanted memories. We discuss three prominent controversies, whether traumatic memories are ‘special’, whether traumatic events can be forgotten, and whether there is evidence for delayed onset PTSD. Contemporary theories of PTSD are then described including fear conditioning, neo-conditioning theories, the Ehlers and Clark cognitive model, and dual representation theory, all of which identify deficits in memory for context as central to the disorder. In the final section we discuss how traumatic memory changes with successful treatment and the likely mechanisms involved in psychological therapy for PTSD: Habituation/extinction, updating/reconsolidation, and metacognitive change.

To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study

Article

Full-text available

Dec 2022
INT J SOC PSYCHIATR

Background Findings from prospective studies question the assumption that mental health problems observed in traumatized adults mainly reflect the effects of potentially traumatic events. Aims Aim of the present comparative prospective study is to clarify the extent to which victims of potentially traumatic events with mental health, social, financial, and/or legal problems, already suffered from such problems before these events. Method Data was extracted from three surveys of the prospective VICTIMS-study (T1 = 2018, T2 = 2019, T3 = 2020), conducted with the population-based longitudinal LISS-panel. Differences between victims ( n = 340, victimized by violence, accidents, and serious threats in the 12 months before T3) and nonvictims ( n = 3,872, not victimized by such events in this period), were examined using multivariate logistic regression analyses. Results The large majority of victims with current (at T3) anxiety and depression symptomatology (74%), general mental health problems (71%), partner/family (67%), financial (76%), and legal problems (58%), and lack of support (79%), already had these problems (at T1 and/or at T2). A similar pattern was observed among nonvictims. Of the victims with current probable PTSD (at T3), 87% already had any mental health problem. At T3, among both groups, the incidence of problems was substantially lower than their prevalence. The large majority of victims with post-event mental health, social, financial, and legal problems already suffered from these problems in the past. Conclusions When victims seek help for their problems, professional care providers should be aware that in most cases, as among nonvictims, these problems are chronic/re-current rather than new problems.

The Helplessness Dimension of Pain Catastrophizing Mediates the Relation between PTSD Symptoms and Pain Rehabilitation Measures

Article

Full-text available

Nov 2022
Pain Res Manag

Background: Comorbid chronic pain and post-traumatic stress disorder (PTSD) complicate the treatment of both conditions. Previous research has identified pain catastrophizing as a potentially important variable contributing to the relationship between chronic pain and PTSD. However, little is known regarding how the different dimensions of pain catastrophizing-rumination, magnification, and helplessness-uniquely contribute to the relationship between PTSD symptomatology and measures of pain outcome. Methods: 491 treatment seeking participants were admitted to a three-week interdisciplinary pain rehabilitation program between July 2016 and March 2020. The patients completed measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, quality of life (QOL), and PTSD symptoms at pretreatment. Results: Parallel mediation analyses were conducted to evaluate the mediating effect of the Pain Catastrophizing Scale subscales on the relationship between PTSD symptomatology and pain-relevant variables. The helplessness subscale accounted for significant unique variance in the relationship between PTSD symptomatology and pain severity (b = 0.010, SE = 0.002, 95% CI: 0.006, 0.014), pain interference (b = 0.004, SE = 0.002, 95% CI: 0.001, 0.008), and mental health QOL (b = -0.117, SE = 0.031, 95% CI: -0.179, -0.059), while the rumination and magnification subscales had no significant influence. Conclusions: Pain catastrophizing is a multifaceted construct. These results suggest that the helplessness dimension of pain catastrophizing may be the primary target when treating patients with comorbid chronic pain and PTSD symptoms. This study represents the first to evaluate the influence of the individual dimensions of pain catastrophizing on the relationship between PTSD symptomatology and chronic pain outcome.

Machine learning classification of maladaptive rumination and cognitive distraction in terms of frequency specific complexity

Article

Aug 2022
BIOMED SIGNAL PROCES

In this study, cognitive and behavioral emotion regulation strategies (ERS) are classified by using machine learning models driven by a new local EEG complexity approach so called Frequency Specific Complexity (FSC) in resting-states (eyes-opened (EO), eyes-closed (EC)). According to international 10–20 electrode placement system, FSC is defined as entropy estimations in Alpha (8-12Hz) and Beta (12.5-30Hz) frequency band intervals of non-overlapped short EEG segments to observe local EEG complexity variations at 62 points on scalp surface. The healthy adults who use both rumination and cognitive distraction frequently are included in the 1st groups, while the others who use these strategies rarely are included in the 2nd group with respect to Cognitive Emotion Regulation Questionnaire (CERQ) scores of them. EEG data and CERQ scores are downloaded from publicly available data-base LEMON. In order to test the reliability of the proposed method, five different supervised machine learning methods in addition to two Extreme Learning Machine models are examined with 5-fold cross-validation for discrimination of the contrasting groups. The highest classification accuracy (CA) of 99.47% is provided by Class-specific Cost Regulation Extreme Learning Machines in EC state. Regarding cortical regions (anterio-frontal, central, temporal, parieto-occipital), the regional FSC estimations did not provide the higher performance, however, corresponding statistical distribution shows the decrease in EEG complexity at mostly anterior cortex in the 1st group characterized by maladaptive rumination. In conclusion, FSC can be proposed to investigate cognitive dysfunctions often caused by the use of rumination. https://www.sciencedirect.com/science/article/abs/pii/S1746809422002622?CMX_ID=&SIS_ID=&dgcid=STMJ_AUTH_SERV_PUBLISHED&utm_acid=29263482&utm_campaign=STMJ_AUTH_SERV_PUBLISHED&utm_in=DM258621&utm_medium=email&utm_source=AC_

For there is nothing either good or bad: a study of the mediating effect of interpretation bias on the association between mindfulness and reduced post-traumatic stress vulnerability

Article

Full-text available

May 2022
BMC PSYCHIATRY

Background Despite increasing interest in the association between mindfulness and reduced trauma vulnerability, and the use of mindfulness in the latest interventions for Post-Traumatic Stress Disorder (PTSD), few studies have examined the mechanisms through which mindfulness may influence post-trauma psychopathology. The present study aimed to determine whether negative interpretation bias, the tendency to interpret ambiguous information as negative or threatening rather than positive or safe, mediates the association between higher levels of trait mindfulness and lower levels of PTSD symptoms. Negative interpretation bias was examined due to prior evidence indicating it is associated with being less mindful and post trauma psychopathology. Methods The study examined 133 undergraduate students who reported exposure to one or more potentially traumatic events in their lifetime. Participants completed self-report measures of trait mindfulness (Five Facet Mindfulness Questionnaire – Short Form; FFMQ-SF) and PTSD symptoms (Post-Traumatic Stress Disorder Checklist – Civilian version; PCL-C) as well an interpretation bias task that assessed the degree to which participants interpreted a range of everyday hypothetical scenarios to be threatening to their physical and/or psychological wellbeing. Results Results of a mediation analysis indicated a significant negative direct effect of trait mindfulness on PTSD symptomatology ( p < .001). There was no evidence that negative interpretation bias mediated this relationship [BCa CI [-0.04, 0.03)], nor was it associated with trait mindfulness ( p = .90) and PTSD symptomatology ( p = .37). Conclusions The results of the current study provide further evidence of the link between trait mindfulness and reduced post-trauma psychopathology while providing no support for the role of negative interpretation bias in this relationship.

Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination

Article

Nov 2021
BEHAV RES THER

Objective Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination. Method As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models. Results Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor. Conclusions The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.

El malestar emocional como síntoma de estrés postraumático

Article

Full-text available

Oct 2019

Effects of a tailored multidisciplinary counselling intervention to support the adjustment process after a traumatic injury: a randomized controlled trial

Article

Aug 2021

Purpose To investigate the efficacy of a tailored counselling intervention for injured workers regarding different aspects of subjective well-being. Materials and Methods Prospective randomized controlled trial with 192 mildly-to-moderately injured workers who were on sick leave for at least 18 weeks and showed a high-risk profile for a complicated rehabilitation process in a screening. Patients were assessed at baseline, 12 and 18 months post-injury. The outcome variables concerned five aspects of subjective well-being (negative feelings, life and job satisfaction, satisfaction related to family and health). Both the control and the experimental group received conventional case management. Participants in the intervention group additionally received tailored workplace interventions and/or mental health counselling sessions. Results Participants in the intervention group received an average of 2.23 (SD = 6.94) counselling sessions. Both groups showed a significant reduction (mean (95% CI) of negative feelings control group 2.6 (2.3–3.4), intervention group 2.4 (1.6–3.4)), with a significant difference in negative feelings between the groups (p = 0.01). Conclusions Our results suggest that a tailored counselling intervention has a modest long-term effect (d = 0.74) on negative feelings for mildly-to-moderately injured workers. However, future studies should evaluate the feasibility of this study’s treatment approach. • Implications for rehabilitation • Accidents and the resulting injuries often cause a wide range of burdens including psychosocial and emotional distress as well as long-time sick leaves. • Tailored counselling led to significant reductions of negative feelings in mildly-to-moderately injured workers over time. • By showing that even conventional case management can have a beneficial effect on subjective wellbeing, the results of this study reaffirm the holistic biopsychosocial nature of injury rehabilitation.

The Modulating Effect of Geographical Proximity of Permanent Residence to Tsunami-Affected Regions on Posttraumatic Symptoms

Article

Full-text available

Jan 2007

Analysis of posttraumatic stress symptoms (hyperarousal, intrusion and avoidance) was undertaken in adult people-helpers exposed to the immediate aftermath of the 2004 Asian tsunami. At three weeks and six months post-tsunami people-helpers living in one of two geographically distinct locations, one affected by the tsunami and one relatively protected from the tsunami, completed a Sri Lankan version of The Impact of Events Scale Revised (IES-R-SL). Results revealed that there was a main effect of geographical location of permanent residence on posttraumatic stress symptoms at both three weeks and six months post-tsunami. IES-R-SL subscales identified that subjects who permanently reside in the tsunami-affected location had significantly higher hyperarousal and avoidance scores at both time points. Intrusion scores were significantly higher in subjects living in the tsunami-affected location at six months only. The modulating role of the environment in the development and maintenance of posttraumatic symptoms is discussed within an ecological framework of trauma.

The mediating role of rumination in the relation between self-compassion, posttraumatic stress disorder, and posttraumatic growth among adolescents after the Jiuzhaigou earthquake

Article

Full-text available

Apr 2021
CURR PSYCHOL

Previous studies indicated that self-compassion can alleviate posttraumatic stress disorder (PTSD) and promote posttraumatic growth (PTG). Rumination is a cognitive process in which individuals repeatedly think about traumatic events and their consequences, which includes invasive rumination (IR) and deliberate rumination (DR). IR is a process of thoughts over traumatic event that invades the cognitive world in an undesired state, whereas DR is an individual’s conscious and repeated thinking on events. IR and DR have also been shown to have effects on PTSD and PTG. Studies have examined the relationship between self-compassion, IR, deliberate rumination DR, PTSD, and PTG, respectively, but only a few studies have examined their combined roles in PTSD and PTG among adolescents who have experienced an earthquake. In addition, recent studies have shown that the positive and negative components of self-compassion have different effects on post-traumatic stress responses, but few studies have explored the mechanisms of positive and negative self-compassion on PTSD and PTG in adolescents who experience earthquakes. This study examines the mediating roles of rumination in the relationship between self-compassion, PTSD and PTG among Chinese adolescents after the Jiuzhaigou earthquake. Ten months after the Jiuzhaigou earthquake, a questionnaire survey was conducted among 621 middle school students in Jiuzhaigou county. The participants were assessed by using the following systems: Trauma Exposure Questionnaire, Self-Compassion Scale, Event-Related Rumination Inventory, PTSD Checklist for DSM-5, and Posttraumatic Growth Inventory. When we controlled for the gender, age, and trauma exposure in the direct effect model, positive self-compassion (PSC) had a negative effect on PTSD and a positive effect on PTG. Moreover, negative self-compassion (NSC) had a positive effect on PTSD, but the effect on PTG was nonsignificant. In the indirect model, PSC had an indirect and positive effect on PTSD and PTG via deliberate rumination (DR). NSC had an indirect and positive effect on PTSD and PTG via invasive rumination (IR), whereas NSC also had an indirect and negative effect on PTSD and PTG, as well as via an indirect path from IR to DR on PTSD and PTG. Findings indicated that increased PSC may reduce PTSD and be beneficial for PTG. NSC may exacerbate PTSD. Rumination plays a significant mediating role between self-compassion, PTSD, and PTG.

Psychometric properties and factor structure of Repetitive Thinking Questionnaire: A Persian version of the RTQ-31 and RTQ-10

Article

Full-text available

Apr 2022

Objective: Repetitive thinking as a transdiagnostic factor has an essential role in the development and maintenance of emotional disorders. Two versions of the Repetitive Thinking Questionnaire (31-item and 10-item) are the most known measures used for assessing repetitive thinking in clinical and non-clinical samples, and the present study developed to evaluate psychometric properties and factor structure of the Persian version of them. Methods: Participants are 592 students assessed by 31-item Repetitive Thinking Questionnaire, 10-item Repetitive Thinking Questionnaire, Ruminative Response Scale, Perseverative Thinking Questionnaire, Beck Depression Inventory- second edition, the Beck Anxiety Inventory, and the Depression, Anxiety, Stress Scale-21. Exploratory and confirmatory factor analysis were used to determine construct validity. Results: The findings showed that the RTQ-31 and RTQ-10 demonstrated excellent internal consistency and good test-retest reliability (α=0.946: r=0.844) and (α= 0.903: r=0.776) respectively. Also, five items were omitted from the original version due to insufficient factor loadings; this study showed that the 26-item version has a two-factor structure, and the short version has a unidimensional structure. respectively. Finally, it is found that repetitive thinking has a positive and powerful relationship with other measures of rumination and symptoms of depression, anxiety, and stress. Conclusions: Persian versions of the Repetitive Thinking Questionnaire have a good factor structure and psychometric properties, and can be used in clinical papulation and related studies.

A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder

Article

Full-text available

Jan 2021
CLIN PSYCHOL REV

Richard Bryant

Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.

Emotional working memory training reduces rumination and alters the EEG microstate in anxious individuals

Article

Full-text available

Jan 2020

Rumination is an important etiological factor of anxiety pathology, with its mechanism related to the deficit of working memory. The current study examined whether working memory training (WM-T) and emotional working memory training (EWM-T) could reduce rumination in anxious individuals. The participants with high trait anxiety underwent 21 days of mobile applications-based WM-T (n = 34), EWM-T (n = 36) or placebo control (n = 36), with questionnaires, cognitive tasks, and resting electroencephalogram (EEG) as the pre-post-test indicators. The results revealed that two training groups obtained comparable operation span increases (WM-T: d = 0.53; EWM-T: d = 0.65), updating improvement (WM-T: d = 0.43; EWM-T: d = 0.60) and shifting improvement (WM-T: d = 0.49; EWM-T: d = 0.72). Furthermore, compared to the control group, the EWM-T showed significant self-reported rumination reduction (d = 0.69), increased inhibition ability (d = 0.72), as well as modification of resting EEG microstate C parameters (Duration C: d = 0.42, Coverage C: d = 0.39), which were closely related to rumination level (r ~ 0.4). The WM-T group also showed the potential to reduced self-reported rumination (d = 0.45), but with the absence of the observable inhibition improvement and resting EEG changes. The correlation analysis suggested that the emotional benefits of WM-T depending more on improved updating and shifting, and that of EWM-T depending more on improved inhibition ability. The advantage to add emotional distractions into general working memory training for targeting rumination related anxiety has been discussed.

The indirect effect from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal

Article

Apr 2021
CHILD ABUSE NEGLECT

Emotion regulation strategies may help explain the risk of experiencing posttraumatic stress disorder (PTSD) symptoms among adults with a history of child maltreatment. However, no study to date has examined the roles of both thought suppression and cognitive reappraisal in the association between childhood maltreatment and PTSD symptoms. Objective. The current study sought to understand the associations between childhood maltreatment, thought suppression, cognitive reappraisal, and PTSD symptoms while controlling for negative affect and gender. Participants and Setting. Data were collected on 660 university students (71% female) ages 18 - 25 between 2013 and 2014. Participants completed self-report measures of childhood maltreatment, PTSD symptoms, and emotion regulation strategies. Method. A structural equation model was tested to examine the direct and indirect effects from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal, over and above gender and negative affect. Results. Childhood maltreatment was directly associated with PTSD symptoms (β = 0.28, SE = 0.04, p < .001). Childhood maltreatment also had a significant indirect effect on PTSD via cognitive reappraisal (β = 0.01, CI 95% [0.00, 0.03]), but not through thought suppression, although (β = 0.01, CI 95% [-0.00, 0.04]) thought suppression was significantly positively associated with PTSD symptoms (β = 0.21, SE = 0.04, p < .001). Conclusion. The present study sheds light on the effect of childhood maltreatment and two commonly used emotion regulation strategies on PTSD symptoms.

Prevalence of post-traumatic stress disorder during the COVID-19 pandemic in Saudi Arabia

Article

Full-text available

Oct 2020

Background The coronavirus diseases of 2019 (COVID-19) pandemic was classified as one of the worst pandemics in the 21st century. Its rapid transmission, unpredicted mortality rate, and the uncertainty surrounding its transmission method have evoked additional fear and anxiety. Nonetheless, to the best of our knowledge, no prior study has explored PTSD prevalence three months after the start of the quarantine procedures in Saudi Arabia nor has examined PTSD prevalence by three different methods. Objective This observational cross-sectional study aimed to identify the prevalence, severity, and influencing factors of PTSD in different regions of Saudi Arabia three months after the onset of the quarantine procedures related to the COVID-19 pandemic. Methods Through the month of June 2020, 1374 people (49.05% men and 50.95% women) completed a 35-item, 10-minute online. The prevalence of PTSD was measured using PCL-S (specific for COVID-19) that assesses the 17 symptoms of PTSD. Resilience was measured using 2-items Arabic version of the Connor-Davidson Resilience Scale 2 (CD-RISC 2). Results We calculated the prevalence by three methods, namely, PTSD cut-off score, criteria, and combined, and the prevalence was 22.63%, 24.8%, and 19.6%, respectively. Female participants showed higher prevalence than male. As well, participants who were either tested positive or suspected of having been infected with COVID-19 showed higher PTSD prevalence. Higher resilience was associated with lower PTSD prevalence. Conclusions This was the first study to report PTSD prevalence by three differential methods three months after the onset of the quarantine procedures related to the COVID-19 pandemic in Saudi Arabia. We observed a significant impact of the COVID-19 pandemic in the Saudi population; therefore, great attention should be performed in implementing new procedures that deal with the highlighted risk factors, especially in vulnerable groups, to overcome the psychological impact of the COVID-19 pandemic.

Rumination in posttraumatic stress disorder: A systematic review

Article

Sep 2020

Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we conducted a systematic review of the empirical literature on rumination in posttraumatic stress disorder (PTSD). Six sub-groups of studies on this topic were identified; these addressed: (i) the frequency and nature of rumination, (ii) cross-sectional relationships between rumination and PTSD symptoms, (iii) the capacity of rumination to predict PTSD longitudinally, (iv) other processes associated with rumination, (v) neurobiological correlates of rumination, and (vi) whether treating PTSD reduces rumination. This review synthesizes these domains of research and identifies key methodological limitations which limit causal inferences, and points to important areas of future research to advance knowledge on rumination in PTSD.

Does pre-event lack of emotional support increase the risk of post-event PTSD, anxiety, depression symptoms and lack of support? A comparative population-based study among victims of threat and violence

Article

Full-text available

Jul 2020
J ANXIETY DISORD

Our knowledge about the effects of perceived emotional support on PTSD, anxiety and depressive symptoms after serious threat and violence is primarily based on post-event studies. Very little is known about the extent to which (1) victims lacking pre-event emotional support are more at risk of post-event symptoms and lack of post-event support than victims with pre-event emotional support, and (2) victims with pre-event emotional support and victims lacking emotional support are more at risk of post-event anxiety and depressive symptoms than nonvictims with similar pre-event support levels. For this purpose, we conducted a 2-wave prospective study (VICTIMS) using the Dutch population-based longitudinal LISS panel. Multivariate logistic regression analyses were conducted, controlling for pre-event demographics, symptoms, and physical, work-related and financial problems. As hypothesized, victims (Nvictims total = 187) lacking pre-event support more often had high post-event PTSD, anxiety and depressive symptoms than victims with pre-event support. No significant differences were found between victims and nonvictims with pre-event emotional support (Nnonvictims total = 2,828, not exposed to any event). Since victims and nonvictims with pre-event support did not differ in post-event symptoms and support, the findings offer strong evidence for the buffering hypothesis of emotional support.

Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures

Research

Jan 2017

Brief State Rumination Inventory (BSRI): A Standardization Study for Turkish Speaking Populations

Article

Full-text available

Jun 2020
J PSYCHOPATHOL BEHAV

Rumination, which is a form of repetitive negative thinking, has been suggested as a variable associated with elevated risks for depression. Current research conceptualizes rumination as a dispositional entity but has neglected its more state-based forms, which may also be equally related to emotional disorders. Brief State Rumination Inventory (BSRI) is a psychometrically sound measure of state rumination, demonstrated to be sensitive to situational changes in rumination. The current study aims to examine the psychometric characteristics of the Turkish form of BSRI. Results of the first study replicated the single factor structure of the original version of BSRI in a group of 192 Turkish speaking adults between ages 18 and 65. Moreover, the Turkish version of BSRI yielded satisfactory levels of internal consistency and construct validity indicated by significant associations with measures of repetitive negative thinking, avoidant coping, and psychological distress. Study 2 examined the sensitivity of BSRI to momentary changes in rumination to assess the criterion validity of the Turkish form of BSRI, by examining its sensitivity to a rumination induction procedure in 66 university students (39 women). Together, these results suggest that the Turkish version of BSRI is a psychometrically reliable tool which is appropriate for the assessment of state rumination in Turkish speaking populations.

Post-Traumatic Stress Disorder in Road Traffic Accident Survivors - Can We Do More?

Article

Jun 2019
ANN ACAD MED SINGAP

What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review

Article

Feb 2024
J NERV MENT DIS

Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.

The Longitudinal Association Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Postmigration Stressors Among Refugees

Article

Apr 2023

Although emotion dysregulation has been robustly associated with posttraumatic stress disorder (PTSD), there is relatively little understanding of this process in refugees. Specifically, longitudinal methodology has not been used to examine the relationship between emotion dysregulation and PTSD among refugees. In this study, we investigated the temporal relationship between emotion dysregulation, postmigration stressors, and PTSD clusters (reexperiencing, avoidance, negative alterations in mood and cognition [NAMC], and hyperarousal) from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders among a community sample of refugees ( N = 1,081) over a 2-year period. Random intercept cross-lagged panel analysis found that emotion dysregulation was antecedent to within-persons increases in reexperiencing and NAMC symptoms over time and bidirectionally associated with hyperarousal and postmigration stressors. In addition, postmigration stressors were antecedent to within-persons increases in reexperiencing, avoidance, and NAMC and bidirectionally associated with hyperarousal symptoms. Findings provide novel evidence in support of postmigration stressors and emotion dysregulation as mechanisms maintaining PTSD and highlight the potential utility of tailoring interventions to address these factors.

Posttraumatic Stress Symptoms and its Association with Rumination, Thought Suppression and Experiential Avoidance: a Systematic Review and Meta-Analysis

Article

Full-text available

Feb 2023
J PSYCHOPATHOL BEHAV

Posttraumatic stress disorder (PTSD) is a severe mental disorder causing high individual and societal costs. The use of maladaptive emotion regulation (ER) strategies has been identified as a potential contributing factor. This meta-analysis aimed to quantify the associations between PTSD symptoms and rumination, thought suppression and experiential avoidance. The systematic literature search resulted in 5574 studies, 75 of which were included in the analysis. From those eligible studies 189 effect sizes were obtained. For symptoms of posttraumatic stress, large effects were found for associations with rumination (r = .52) and experiential avoidance (r = .48), whereas a medium effect size was found for thought suppression (r = .29). With respect to different PTSD symptom clusters, associations ranged between r = .35 and r = .41 for associations with intrusive re-experiencing, between r = .39 and r = .41 for associations with avoidance, between r = .50 and r = .53 for associations with alterations in cognitions and mood and between r = .41 and r = .45 for associations with alterations in arousal and activity. Few available studies provide some evidence that associations might be somewhat reduced but still substantial in longitudinal compared to cross-sectional studies. These findings provide valuable targets for future investigations with the long-term goal of improving targeted interventions for the prevention and treatment of PTSD symptoms.

"No Man's Land": the experiences of persons injured in a road traffic crash wanting to return to work in Queensland, Australia

Article

Dec 2022
DISABIL REHABIL

Purpose: This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI. Methods: The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data. Results: Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support. Conclusions: Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.

Posttraumatic stress symptoms and its association with rumination, thought suppression and experiential avoidance: A systematic review and meta-analysis

Preprint

Full-text available

Sep 2022

Posttraumatic stress disorder (PTSD) is a severe mental disorder causing high individual and societal costs. The use of maladaptive emotion regulation (ER) strategies has been identified as a potential contributing factor. This meta-analysis aimed to quantify the associations between PTSD symptoms and rumination, thought suppression and experiential avoidance. The systematic literature search resulted in 4486 studies, 44 of which were included in the analysis. From those eligible studies 135 effect sizes were obtained. For symptoms of posttraumatic stress, large effects were found for associations with rumination (r = .53) and experiential avoidance (r = .47), whereas a medium effect size was found for thought suppression (r = .27). With respect to different PTSD symptom clusters, associations ranged between r = .35 and r = .38 for associations with intrusive re-experiencing, between r = .39 and r = .40 for associations with avoidance, between r = .48 and r = .56 for associations with alterations in cognitions and mood and between r = .42 and r = .43 for associations with alterations in arousal and activity. Few available studies provide some evidence that associations might be somewhat reduced but still substantial in longitudinal compared to cross-sectional studies. These findings provide valuable targets for future investigations with the long-term goal of improving targeted interventions for the prevention and treatment of PTSD symptoms.

Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study

Article

Full-text available

Jun 2022
J OCCUP REHABIL

Purpose This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders’ perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI. Methods The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data. Results Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders’ recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers’ support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders’ insufficient communication and knowledge on RTW process following RTI. Conclusions Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.

Post-traumatic Stress Disorder

Chapter

Apr 2022

The observation that extreme events cause extreme reactions is old. But it was not until 1980 that the diagnosis of post-traumatic stress disorder (PTSD) was officially defined and recognised as a clinical presentation. Since this initial description, the description of the clinical presentation has changed, most recently with the drafting of the currently valid international classification systems DSM-5 of the American Psychiatric Association (APA) and ICD-11 of the World Health Organization (WHO). Despite striking differences in the operationalisation in the two systems, the following characteristics are similarly defined.

A model of Early Psychological Intervention for Direct and Indirect Road Victims

Article

Full-text available

Dec 2021

Road accidents are a major emergency in Europe, and several studies investigating road trauma victims have demonstrated their serious psychological consequences and their incidence related to several serious psychological disorders (e.g., anxiety disorders, depression, psychoactive substance abuse, Acute Stress Disorder and Post-Traumatic Stress Disorder). The quality of assistance provided to the victims immediately after the event is crucial for both short- and long-term psychological consequences and can often explain the causes of post-traumatic morbidity. Based on these considerations, the paper presents a scientifically grounded early psychological intervention program that is specifically designed for road accident victims: ANIACARES. ANIACARES provides psychosocial support to road trauma victims who suffered serious injuries and/or to their relatives. This model is inspired by the most-investigated protocols related to first-aid psychology, crisis intervention, and trauma-focused psychological interventions. ANIACARES aims to reduce the possible post-traumatic psychological effects, as well as to limit the decline in the life quality of family members, and of the seriously traumatized, by providing psychological counselling and support. The program aims to support the victims during the different phases of the traumatic event to foster better emotion regulation strategies, to facilitate communication between victims and rescue personnel, to promote adherence to medical care, to promote the mourning process, to prevent the onset of post-traumatic psychopathologies, and to promote the resolution of conflicts. The validity of the model was evaluated by presenting the pre-and post-intervention results, focusing on several aspects of the individual’s well-being investigated on 125 road trauma victims categorized as Direct Victims, Indirect Victims with seriously Injured family members, and Indirect Victims with a Deceased family member. Results allow to support the validity of ANIACARES; in fact, an improvement in the general conditions of psychological health and well-being of the victims has been shown and on dimensions which mood and affectivity, memory, and speech. The relevance of ANIACARES does not lie solely in developing “new” clinical techniques or procedures, but rather in structuring a specific model of psychological support and supportive intervention for a population that is too often overlooked and on which the possible outcomes are well known.

References

Chapter

Jul 2006

Scott Allen Johnson

Catenin Alpha 2 May Be a Biomarker or Potential Drug Target in Psychiatric Disorders with Perseverative Negative Thinking

Article

Full-text available

Aug 2021

AlphaN-catenin gene CTNNA2 has been implicated in intrauterine brain development, as well as in several psychiatric disorders and cardiovascular diseases. Our present aim was to investigate CTNNA2 gene-wide associations of single-nucleotide polymorphisms (SNPs) with psychiatric and cardiovascular risk factors to test the potential mediating role of rumination, a perseverative negative thinking phenotype in these associations. Linear mixed regression models were run by FaST-LMM within a sample of 795 individuals from the Budakalasz Health Examination Survey. The psychiatric outcome variables were rumination and its subtypes, and ten Brief Symptom Inventory (BSI) scores including, e.g., obsessive-compulsive, depression, anxiety, hostility, phobic anxiety, and paranoid ideation. Cardiovascular outcome variables were BMI and the Framingham risk scores for cardiovascular disease, coronary heart disease, myocardial infarction, and stroke. We found nominally significant CTNNA2 associations for every phenotype. Rumination totally mediated the associations of CTNNA2 rs17019243 with eight out of ten BSI scores, but none with Framingham scores or BMI. Our results suggest that CTNNA2 genetics may serve as biomarkers, and increasing the expression or function of CTNNA2 protein may be a potential new therapeutic approach in psychiatric disorders with perseverative negative thinking including, e.g., depression. Generally, an antiruminative agent could be a transdiagnostic and preventive psychopharmacon.

Distinguishing Transdiagnostic versus Disorder-Specific Pathways between Ruminative Brooding and Internalizing Psychopathology in Adolescents: A Latent Variable Modeling Approach

Article

Apr 2021

Rumination is correlated with diverse types of internalizing problems, but the extent to which it relates to a higher-order internalizing spectrum versus disorder-specific pathology is unclear. Using a quantitative model of the internalizing dimension, we compared the strength of transdiagnostic versus diagnosis-specific pathways from brooding—the most depressogenic component of rumination—to major depressive disorder (MDD) in adolescents. Community-recruited mid-adolescents (N = 241, Mage = 15.90 years, 53% female) completed semi-structured interviews of anxiety and depressive conditions and a self-report brooding measure. Confirmatory factor analysis revealed good fit for a one-factor model of internalizing conditions. Results revealed a large, significant factor correlation between brooding and the internalizing factor (r = 0.55), with some evidence for a more modest specific link between brooding and the unique component of the MDD diagnosis (r = 0.17; approximately one-third as large as the transdiagnostic pathway). These cross-sectional associations were generally consistent across two assessment waves separated by 19 months. We concluded that brooding is better conceptualized as a common characteristic of all internalizing problems in adolescence, rather than a specific feature of MDD. Preregistered hypotheses, data analysis code, and correlation matrices for this study are posted at https://osf.io/dax7u/.

THE EFFECTS OF EDUCATION ON THE MAJOR LIFE ACTIVITIES OF ROAD TRAFFIC INJURY VICTIMS CONCERNING HEALTH SATISFACTION STATUS

Article

Full-text available

Apr 2021

Purpose of the study: To examine the satisfaction of the health status of RTI victims and to measure the association between the satisfaction of health status with the prevailing level of participation of RTI victims in various major life activities. Methodology: This study follows a cross-sectional research design. A comprehensive interview schedule was designed and pre-tested before the actual process of data collection. For data analysis, SPSS v.20 was run for obtaining univariate, bivariate, and multivariate analysis. Main Findings: At a bivariate level, it was found that RTI victims were having difficulty in walking, standing, sitting, and dysfunctional memory status had significantly associated with low health satisfaction. Furthermore, at the multivariate level, the victims with low educational status were more likely to report limitations in Major Life Activities (MLA), ultimately affecting their health satisfaction status. Applications of this study: This research's findings can apply to such studies that emphasize the sociological perspectives for minimizing traffic crashes. Moreover, it also provides the role of education in controlling traffic injuries in the south Asian region. Novelty/Originality of this study: This study is the first-ever attempt to determine the effects of MLA limitations on the health satisfaction status. Apart from describing the phenomenon from a sociological perspective, the article also enlightens the role of education in minimizing RTI injuries.

14. Accidents de la route

Chapter

Apr 2013

Aurore Séguin-Sabouraud

A concise measure of anger in combat‐related posttraumatic stress disorder

Article

Jun 2004
J TRAUMA STRESS

There is a need for a brief specific measure of anger for use in assessment of posttraumatic mental health problems. One unpublished short scale is the Dimensions of Anger Reactions (DAR; R. Novaco, 1975). This study examined the psychometric properties of the DAR using intake and 12‐month data for 192 Australian Vietnam veterans with combat‐related PTSD. Results showed the DAR to be unidimensional, reliable, and sensitive to change over time, and removal of two items improved the scale's properties. The DAR measures anger disposition directed towards others. Assessment of convergent validity indicated that the DAR primarily measures Trait Anger. Results suggest that the DAR is a psychometrically strong measure, potentially useful for the evaluation of anger in PTSD.

A longitudinal investigation of the association between rumination, hostility, and PTSD symptoms among trauma-exposed individuals

Article

Aug 2020
J AFFECT DISORDERS

Background Rumination, defined as perseverative thinking regarding the causes and consequences of psychological symptoms, is a risk and maintaining factor for PTSD. Existing work has largely focused on the extent to which rumination functions as a coping strategy used to avoid traumatic memories and associated emotions. However, rumination may also maintain negative thinking patterns, such as hostility, which has been positively associated with both rumination and PTSD symptoms. The current study therefore investigated the extent to which hostility was a significant mediator of the prospective association between rumination and PTSD symptoms. Methods The sample consisted of 119 trauma-exposed individuals (48.7% female), who completed self-report questionnaires at three time points during a clinical trial. Results When controlling for treatment condition and baseline depressive disorder diagnosis, hostility temporally mediated the effects of rumination on PTSD symptoms. Specificity analyses provided further support for the direction and specific variables examined in this model, such that rumination was positively and uniquely associated with later hostility. Limitations Our findings are limited by the use of a sample in which only 30% of participants met diagnostic criteria for a trauma-related disorder, as well as the administration of the rumination measure at only one time point. Conclusions Results suggest that rumination and hostility may be promising treatment and prevention targets for PTSD symptoms.

The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy

Article

Jun 2020

While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees’ belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.

Experiential Avoidance as a Mediator in the Relationship Between Shame and Posttraumatic Stress Disorder: The Effect of Gender

Article

Full-text available

Jun 2020

Objective: The current study sought to investigate whether experiential avoidance (EA) mediates the effect of shame on posttraumatic symptoms (PTS) in a population of trauma-exposed individuals. Given demonstrated gender differences in posttraumatic stress disorder (PTSD), the current cross-sectional study also sought to examine whether gender moderates this mediational proposed effect. EA has been shown to mediate shame and depression symptoms, suggesting that the unwillingness to feel and/or the attempt to control shame may be an important factor in later psychopathological symptoms. Furthermore, EA appears to influence PTS over time. Method: Trauma-exposed undergraduates (n = 326, 68.8% male, Mage = 19.35, SD = 2.30) at a large Midwestern university completed measures of shame, EA, and PTS. Results: EA was found to fully mediate the relationship between shame and PTS. The role of gender was mixed as it moderated the relationship between EA and PTS such that the effect of EA is stronger for men than women; however, when analyzed with more robust methods, the effect of gender was no longer significant. A competing, flipped mediational model was run to further assess the direction of hypothesized relationships, but shame was not a significant mediator of EA and PTSD symptoms. Conclusions: Results provide further evidence for the centrality of EA in maintaining PTS and suggest targeting EA rather than shame in treatment as an avenue for intervention. Future research is needed to investigate gender differences in engagement in EA. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A systematic review of the association between fault or blame-related attributions and procedures after transport injury and health and work-related outcomes

Article

Dec 2019

Attributions of fault are often associated with worse injury outcomes; however, the consistency and magnitude of these impacts is not known. This review examined the prognostic role of fault on health, mental health, pain and work outcomes after transport injury. A systematic search of five electronic databases (Medline, Embase, CINAHL, PsycINFO, Cochrane Library) yielded 16,324 records published between 2000 and January 2018. Eligibility criteria were: adult transport injury survivors; prospective design; multivariable analysis; fault-related factor analysed; pain, mental health, general health or work-related outcome. Citations (n = 10,558, excluding duplicates) and full text articles (n = 555) were screened manually (Reviewer 1), and using concurrent machine learning and text mining (Reviewer 2; using Abstrackr, WordStat and QDA miner). Data from 55 papers that met all inclusion criteria were extracted, papers were evaluated for risk of bias using the QUIPS tool, and overall level of evidence was assessed using the GRADE tool. There were six main fault-related factors classified as: fault or responsibility, fault-based compensation, lawyer involvement or litigation, blame or guilt, road user or position in vehicle, and impact direction. Overall there were inconsistent associations between fault and transport injury outcomes, and 60% of papers had high risk of bias. There was moderate evidence that fault-based compensation claims were associated with poorer health-related outcomes, and that lawyer involvement was associated with poorer work outcomes beyond 12 months post-injury. However, the evidence of negative associations between fault-based compensation claims and work-related outcomes was limited. Lawyer involvement and fault-based compensation claims were associated with adverse mental health outcomes six months post-injury, but not beyond 12 months. The most consistent associations between fault and negative outcomes were not for fault attributions, per se, but were related to fault-related procedures (e.g., lawyer engagement, fault-based compensation claims).

A cognitive model of posttraumatic stress disorder

Article

Full-text available

Apr 2000
BEHAV RES THER

Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or ist sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualisation, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies provided preliminary support for several aspects of the model.

Dissociation and post-traumatic stress disorder: Two prospective studies of road traffic accident survivors

Article

Full-text available

May 2002

Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient. It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms. To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD. Two samples of 27 and 176 road traffic accident survivors were recruited. Patients were assessed shortly after the accident and followed at intervals over the next 6 months. Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms. All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months. Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters. Memory fragmentation and data-driven processing also predicted PTSD. Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms. Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions.

A Dual Representation Theory of Posttraumatic Stress Disorder

Article

Full-text available

Oct 1996

A cognitive theory of posttraumatic stress disorder (PTSD) is proposed that assumes traumas experienced after early childhood give rise to 2 sorts of memory, 1 verbally accessible and 1 automatically accessible through appropriate situational cues. These different types of memory are used to explain the complex phenomenology of PTSD, including the experiences of reliving the traumatic event and of emotionally processing the trauma. The theory considers 3 possible outcomes of the emotional processing of trauma, successful completion, chronic processing, and premature inhibition of processing We discuss the implications of the theory for research design, clinical practice, and resolving contradictions in the empirical data.

The validation of a self-report measures of PTSD: the PTSD diagnostic scale (PDS)

Article

Full-text available

Dec 1997

The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994 DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Maintenance of Intrusive Memories in Posttraumatic Stress Disorder: A Cognitive Approach

Article

Full-text available

Jul 1995

Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.

Posttraumatic Stress Disorder in the National Comorbidity Survey

Article

Full-text available

Jan 1996
ARCH GEN PSYCHIAT

Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.

Predictors of PTSD in injured trauma survivors: A prospective study

Article

Full-text available

Mar 1996

The aim of this study was to prospectively examine the relationship between immediate and short-term responses to a trauma and the subsequent development of posttraumatic stress disorder (PTSD). All patients consecutively admitted to a general hospital were screened for the presence of physical injury due to a traumatic event. Fifty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, peritraumatic dissociation, and symptoms of intrusion, avoidance, depression, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R--Non-Patient Version and the civilian trauma version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depression, anxiety, and intrusive symptoms at the 1-week assessment. Peritraumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of the variance of PTSD symptom intensity. Initial scores on the Impact of Event Scale predicted PTSD status with 92.3% sensitivity and 34.2% specificity. Symptoms of avoidance that were initially very mild intensified in the subjects who developed PTSD. Peritraumatic dissociation is strongly associated with the later development of PTSD. Early dissociation and PTSD symptoms can help the clinician identify subjects at higher risk for developing PTSD.

A dual representation theory of posttraumatic stress disorder

Article

Full-text available

Nov 1996

Psychological Predictors of Chronic Posttraumatic Stress Disorder After Motor Vehicle Accidents

Article

Full-text available

Aug 1998

A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.

Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD

Article

Jan 1999

Elizabeth M. Ellis

What constitutes a stressor? The 'A' criterion issue

Article

Jan 1993

J.S. March

Dissociation and the fragmentary nature of traumatic memories

Article

Jan 1996

One year prospective follow up of motor vehicle accident victims

Article

Oct 1996
BEHAV RES THER

One-hundred and thirty-two victims of motor vehicle accidents (MVAs), who sought medical attention as a result of the MVA, were assessed at three points in time: 1-4 months post-MVA, 6 months later, and 12 months later. Of the 48 who met the full criteria for Post-Traumatic Stress Disorder (PTSD) initially, half had remitted at least in part by the 6-month follow-up point and two-thirds had remitted by the 1-yr follow-up. Using logistic regression, 3 variables combined to correctly identify 79% of remitters and non-remitters at the 12-month follow-up point: initial scores on the irritability and foreshortened future symptoms of PTSD and the initial degree of vulnerability the subject felt in a motor vehicle after the MVA. Four variables combined to predict 64% of the variance in the degree of post-traumatic stress symptoms at 12 months: presence of alcohol abuse and/or an Axis-II disorder at the time of the initial assessment as well as the total scores on the hyperarousal and on avoidance symptoms of PTSD present at the initial post-MVA assessment.

Posttraumatic Stress Disorder in the National Comorbidity Survey

Article

Dec 1995
ARCH GEN PSYCHIAT

Ronald C. Kessler

Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.

Structured Clinical Interview of DSM-III-R-Patient Edition

Article

Jan 1990

Anger and post-traumatic stress disorder in rape victims

Article

Oct 1992
J TRAUMA STRESS

This study examined feelings of anger among female victims of crime and the relation of anger to the development of post-traumatic stress disorder (PTSD). One hundred and sixteen women who had been victims of sexual or nonsexual criminal assaults were compared to a matched comparison group of 50 nonvictimized women on measures of anger and anger expression. Results indicate that victims were angrier than nonvictims. The level of anger was related to various aspects of the assault, such as the use of a weapon and the victim's response to the attack. In addition, the results indicate that elevated anger is positively related to the development of PTSD. Results are discussed in relation to a cognitive/behavioral conceptualization of PTSD.

Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims

Article

Apr 1997
J TRAUMA STRESS

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.

Reliability and Validity of A Brief Instrument for Assessing Posttraumatic Stress Disorder

Article

Oct 1993

This study examines the psychometric properties of two versions of the PTSD Sympton Scale (PSS). The scale contains 17 items that diagnose PTSD according to DSM-III-R criteria and assess the severity of PTSD symptoms. An interview and self-report version of the PSS were administered to a sample of 118 recent rape and non-sexual assault victims. The results indicate that both versions of the PSS have satisfactory internal consistency, high test-retest reliability, and good concurrent validity. The interview version yielded high interrater agreement when administred separately by two interviewers and excellent convergent validity with the SCID. When used to diagnose PTSD, the self-report version of the PSS was somewhat more conservative than the interview version.

After the Crash: Assessment and Treatment of Motor Vehicle Accident Survivors

Article

Jan 1998
J HEAD TRAUMA REHAB

Sumario: Introduction and overview -- The magnitude of the problem -- What percentage of MVA survivors develop PTSD? -- Tha Albany MVA project -- What are the psychosocial effects of MVAs on accident survivors? -- Who develops PTSD from MVAs? -- What is the short-term history of MVA-related PTSD and what predicts remission? -- Delayed-onset PTSD from MVAs -- The role of physical injury in the development and maintenance of PTSD among MVA survivors -- The role of litigation in the remission of MVA-related PTSD -- Acute stress disorder among MVA survivors -- Psychophysiological assessment with MVA survivors -- The psychological treatment of PTSD -- The treatment of MVA-related PTSD -- The Albany MVA treatment project -- A closer look at psychological treatment -- Summary and conclusions -- Appendixes Bibliografía: P. 303-313

Psychiatric Disorders Following Road Traffic and Industrial Injuries

Article

Apr 1973

The nature and prognosis of psychoneurotic disorders following accidental injury have long been a source of argument. The present authors have endeavoured to follow up and classify 82 subjects referred by solicitors for psychiatric evaluation following injury. The subsequent progress of 71 (87%) of the original consecutive sample was successfully obtained. Approximately one-third of the group were disabled by neurotic symptoms which appeared to result from the emotional stress of the accident itself and were thus classified as suffering from true “traumatic neurosis”. These patients improved with the passage of time. About one-half of the group were thought to be unconsciously motivated by the possibility of financial compensation and these patients failed to improve or became worse up until the time of settlement of their claims. The sample also included 5 (6%) frank malingerers; the subjects with “compensation neurosis” invariably denied concern over the outcome of their lawsuits. Only two of the group received psychiatric treatment following termination of their litigation and only one able-bodied worker was known not to have returned to work by the end of the study. The need for early recognition of the fact that a neurotic disorder is being perpetuated by secondary gain factors is stressed.

Avoidant coping style and post-traumatic stress following motor vehicle accidents

Article

Aug 1995
BEHAV RES THER

Predictors of post-traumatic intrusive symptomatology were studied in 56 motor vehicle accident (MVA) survivors 12 months after their MVA. Measures were obtained on Ss' subjective response to the trauma, objective indices of injury severity, coping response (Coping Style Questionnaire), and post-traumatic stress (Impact of Event Scale; IES). Significant levels of intrusive and avoidance symptomatology were reported by 20% of MVA survivors. An avoidant coping style and compensation accounted for 41% of variance of IES-Intrusion scores. Findings are discussed in terms of the role of avoidance behaviour in post-traumatic adjustment.

Psychiatric Consequences of Road Traffic Accidents

Article

Oct 1993

To determine the psychiatric consequences of being a road traffic accident victim. Follow up study of road accident victims for up to one year. Emergency department of the John Radcliffe Hospital, Oxford. 188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."

Who develops PTSD from motor vehicle accidents?

Article

Jan 1996
BEHAV RES THER

Within 1 to 4 months of their motor vehicle accident (MVA), we assessed 158 MVA victims who sought medical attention as a result of the MVA. Using the Clinician-Administered PTSD Scale (CAPS: Blake, Weathers, Nagy, Kaloupek, Klauminzer, Charney & Keane, 1990. National Center for Post-Traumatic Stress Disorder, Boston, MA)., we found that 62 (39%) met DSM-III-R (American Psychiatric Association, 1987. Washington, DC: American Psychiatric Press) criteria for Post-Traumatic Stress Disorder. Using variables from the victim's account of the accident and its sequelae, pre-MVA psychosocial functioning, demographic variables, pre-MVA psychopathology and degree of physical injury, we found that 70% of the subjects could be classified as PTSD or not with 4 variables: prior major depression, fear of dying in the MVA, extent of physical injury and whether litigation had been initiated. Using multiple regression to predict the continuous variable of total CAPS score, as a measure of post-traumatic stress symptoms, we found that 8 variables combined to predict 38.1% of variance (Multiple R = 0.617).

Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study

Article

Nov 1995

Since trauma arises from an inescapable stressful event that overwhelms people's coping mechanisms, it is uncertain to what degree the results of laboratory studies of ordinary events are relevant to the understanding of traumatic memories. This paper reviews the literature on differences between recollections of stressful and of traumatic events. It then reviews the evidence implicating dissociation as the central pathogenic mechanism that gives rise to posttraumatic stress disorder (PTSD). A systematic exploratory study of 46 subjects with PTSD indicated that traumatic memories were retrieved, at least initially, in the form of dissociated mental imprints of sensory and affective elements of the traumatic experience: as visual, olfactory, affective, auditory, and kinesthetic experiences. Over time, subjects reported the gradual emergence of a personal narrative that can be properly referred to as "explicit memory." The implications of these findings for understanding the nature of traumatic memories are discussed.

Blanchard EB, Hickling EJ, Barton KA, Taylor AE. One-year prospective follow-up of motor vehicle accident victims. Behav Res Ther 34: 775-786

Article

Nov 1996
BEHAV RES THER

Prediction of Remission of Acute Posttraumatic Stress Disorder in Motor Vehicle Accident Victims

Article

May 1997

Long-Term Outcome of Motor Vehicle Accident Injury

Article

Nov 1997

To define the psychological outcome at 5 years of a sample of non-head-injured motor vehicle accident victims and identify baseline predictors. Self-report questionnaires were completed by 111 consecutive subjects who had been injured in a motor vehicle accident 5 years earlier and who had been assessed previously in a prospective 1-year study. Although most subjects reported a good outcome, a substantial minority described continuing social, physical, and psychological difficulties and a quarter of those studied suffered phobic anxiety about travel as a driver or passenger. There was little change in quality of life outcome and effects on travel between assessments at 3 months, 1 year, and 5 years. The prevalence of posttraumatic stress disorder remained approximately 10% throughout the follow-up; most early cases had remitted by 5 years, and a similar number of delayed new onsets had occurred between 1 year and 5 years. PTSD at 5 years was predicted by physical outcome and by postaccident intrusive memories and emotional distress. Compensation proceedings were initiated by 66 subjects and were often prolonged and a cause of distress. There were no significant associations with outcome. Trends for a poor outcome in claimants, especially those not settled at 5 years, may be due to their having more serious physical problems. Psychological complications are important and persistent after injury in a motor vehicle accident, are associated with adverse effects on everyday activities, and pose a challenge for consultation-liaison psychiatry.

Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault

Article

Oct 1999
BEHAV RES THER

Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.

Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 38: 319-345

Article

May 2000
BEHAV RES THER

Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.

A prospective investigation of the role of cognitive factors in persistent Posttraumatic Stress Disorder (PTSD) after physical or sexual assault

Article

Oct 2001
BEHAV RES THER

The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.

Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. Submitted for publication Standard occupational classification

Jan 1991

J Murray
A Ehlers
R A Mayou

Murray, J., Ehlers, A., & Mayou, R. A. (2001). Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. Submitted for publication. Office of Population Censuses and Surveys. (1991). Standard occupational classification. London: HMSO.

Post-traumatic stress disorder in rape victims Annual review of psychiatry

Jan 1993
273-303

E B Foa
D S Riggs

Foa, E. B., & Riggs, D. S. (1993). Post-traumatic stress disorder in rape victims. In J. Oldham, M. B. Riba, & A. Tasman (Eds), Annual review of psychiatry, (Vol. 12) (pp. 273–303). Washington, DC: American Psychiatric Association.

Cognitive factors involved in the onset and maintenance of PTSD

Jan 1999
809-829

E Dunmore
D M Clark
A Ehlers

Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of PTSD. Behaviour Research and Therapy, 37, 809–829.

The practical statistician

Jan 1975

M Linton
P S Gallo

Linton, M., & Gallo, P. S. (1975). The practical statistician. Monterey, CA: Brooks/Cole Publishing.

Emotional dissociation in response to trauma: An information-processing approach

Jan 1996

Foa, E. B., & Hearst-Ikeda, D. (1996). Emotional dissociation in response to trauma: An information-processing approach. In L. K. Michelson, & W. J. Ray (Eds), Handbook of dissociation: Theoretical, empirical, and clinical perspectives. New York: Plenum Press.

The abbreviated injury scale

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American Association for Automotive Medicine (1985). The abbreviated injury scale. Des Plaines, IL: American Association for Automotive Medicine.

Treating the trauma of rape

Jan 1998

Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape. In Cognitive-behavior therapy for PTSD. New York: Guilford.

What constitutes a stressor? The "A" criterion issue

Mar 1975
37-56

M Linton
P S Gallo

Linton, M., & Gallo, P. S. (1975). The practical statistician. Monterey, CA: Brooks/Cole Publishing. March, J. S. (1993). What constitutes a stressor? The "A" criterion issue. In R. T. Davidson, & E. B. Foa (Eds), Posttraumatic stress disorder and beyond (pp. 37-56). Washington, DC: American Psychiatric Press.

Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. Submitted for publication. Office of Population Censuses and Surveys

Jan 1991

J Murray
A Ehlers
R A Mayou

Cognitive factors involved in the onset and maintenance of PTSD

Jan 1999
809

Dunmore

The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale

Jan 1997
445

Reliability and validity of a brief instrument for assessing post-traumatic stress disorder

Jan 1993
459

Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study

Abstract

No full-text available

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