Posttraumatic stress symptoms, posttraumatic growth, and personality factors: A network analysis.

BACKGROUND: After experiencing a traumatic event, two possible outcomes are experiencing positive changes, such as posttraumatic growth (PTG), and/or experiencing distress in the form of posttraumatic stress symptoms (PTSS). These constructs are not mutually exclusive; those who experience PTSS may concurrently or at a later date likewise undergo PTG. Pretrauma factors, such as personality as measured by the Big Five Inventory (BFI), can interact with both PTSS and PTG. METHODS: The present study utilized Network theory to examine the interactions between PTSS, PTG, and personality in 1310 participants. Three networks were computed (PTSS, PTSS/BFI, PTSS/PTG/BFI). RESULTS: Within the PTSS network, strong negative emotions emerged as the strongest influence on the network. Again, in the PTSS and BFI network, strong negative emotions exerted the strongest overall influence in addition to bridging the PTSS and personality domains. In the network with all variables of interest, the PTG domain of new possibilities was the strongest overall influence on the network. Specific relationships between constructs were identified. LIMITATIONS: Limitations of this study include the cross-sectional design and utilization of a sub-threshold PTSD, non-treatment seeking sample. CONCLUSIONS: Overall, nuanced relationships between variables of interest were identified, informing personalized treatment and furthers our understanding of both positive and negative responses to trauma. As the primary influence across two networks, the experience of strong negative emotions appears to be central to the subjective experience of PTSD. This may indicate a need to modify present treatments for PTSD, which conceptualize PTSD as a primarily fear-based disorder.

Perceived sleep quality mediates the relationship between posttraumatic stress and somatic symptoms.

OBJECTIVE: Posttraumatic stress symptoms (PTSS) have been associated with increased somatic symptom expression. Sleep concerns have been associated with PTSS and somatic symptoms. Previous research suggests that sleep affects multiple domains of functioning including comorbid psychological and physical health concerns. The current study examines whether perceived sleep quality or sleep efficiency/duration may be mediating the relationship between PTSS and somatic symptoms in a trauma-exposed sample. METHOD: The sample consisted of 864 students, recruited from a large Midwestern university and compensated with research participation credit. Data were collected online over approximately 39 months (October 2015 through January 2019), and the pertinent scales examined in this study included Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and Screening for Somatoform Symptoms-7. RESULTS: Of the 864 students, 668 participants identified as female (77.3%) and 540 identified as non-Hispanic White (62.5%), with an overall average age of 23.14 years (SD = 6.64). Mediation analyses indicated that the overall model examining global sleep quality complaints as a mechanism of the relationship between PTSS and somatic symptoms was significant, F(3, 860) = 193.97, R² = .40, p < .001, and that perceived sleep quality was found to be the only significant specific mediator (indirect effect = .21). Although females reported greater somatic severity, PTSS, and sleep concerns, models were significant, even after examining the influence of gender. CONCLUSIONS: Global sleep complaints are associated with both PTSS and somatic symptoms. Perceived sleep quality specifically mediated the relationship between PTSS and somatic symptoms, highlighting a potential intervention for improving physical health consequences in trauma-exposed individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do older veterans experience change in posttraumatic cognitions following treatment for posttraumatic stress disorder?

OBJECTIVE: It is unclear whether PTSD treatments improve negative posttraumatic cognitions (NPCs) and if changes in NPCs mediate treatment outcomes in older veterans. The current study examined if prolonged exposure therapy (PE) and relaxation therapy (RT) reduce NPCs over time in older adult veterans with PTSD. METHOD: This study analyzed data from a randomized controlled trial of 86 older male veterans with PTSD randomized to PE or RT. The Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999), which includes a total score and three subscales, Negative Cognitions of the Self (Self), Negative Cognitions of the World (World), and Self-Blame (Blame), was used to assess NPCs at pretreatment, posttreatment, and 6-month follow-up. RESULTS: Changes in NPCs differed by treatment condition. Veterans who received PE had significantly reduced overall NPCs and NPCs about the self at posttreatment, but these NPCs were no longer significantly different from baseline at the follow-up assessment. In contrast, NPCs about the world and self-blame did not significantly change following PE. NPCs did not change following RT. Effects of PE on decreased 6-month follow-up clinician-rated PTSD symptoms were conveyed through intervening effects of decreased posttreatment PTCI total scores, suggesting the utility of targeting posttraumatic cognitions as a mechanism of long-term PTSD symptom reduction. CONCLUSIONS: Given that reductions in overall negative cognitions are associated with lower clinician-administered PTSD scores 6 months after PE, clinicians could consider monitoring changes in these cognitions over the course of treatment. RT is not a recommended treatment approach to target NPCs in older adults with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

End of Life Outside of "Business Hours": A Retrospective Review Evaluating Time of Death and Provider Time at End of Life.

Introduction: Pediatric palliative care (PPC) benefits patients and families, while potentially creating emotional and resource-management burdens for providers. This study's purpose was to characterize the occurrence of deaths attended by PPC providers outside of "business hours." Methods:N = 786 PPC patients at a single center died between 2008 and 2015. Descriptive statistics were prepared for all variables (Wilcoxon rank-sum test for continuous; chi-square or Fisher's exact test for categorical). Results:N = 434 (55%) of deaths occurred outside of business hours; n = 332 (70%) were attended by PPC. Time spent attending a death was not significantly longer when other PPC providers were present but was when certain tasks were performed (coordination with medical examiner and memory making). Conclusion: The occurrence of the majority of deaths outside of business hours has significant implications for service delivery models, provider emotional health, and health care value.

Neuroticism and Its Associated Brain Activation in Women With PTSD.

Previous research suggests a diathesis-stress model of posttraumatic stress disorder (PTSD), wherein individuals with high levels of neuroticism who are exposed to traumatic events subsequently develop PTSD. Although studies have established relationships between neuroticism and neurological functioning in various brain regions for healthy and depressed individuals, the specific neural correlates of neuroticism for individuals with PTSD are yet unknown. This relationship is particularly relevant for women, given that their increased risk for PTSD is partially accounted for by their higher baseline levels of neuroticism. The current study examined previously established neural correlates of neuroticism in 61 women (48 women with interpersonal violence [IPV]/PTSD and 13 healthy controls). A specific region of interest map, including the amygdala, hippocampus, parahippocampus, anterior cingulate cortex (ACC), and dorsal medial prefrontal cortex (dmPFC), was examined while participants completed an emotional conflict task. Results showed that the PTSD group had significantly higher neuroticism scores than the healthy control group (t = 6.90, p < .001). Higher neuroticism scores were associated with increased neural activity in the right dmPFC when participants were instructed to directly attend to faces with negative emotional valences. Significant trends between higher neuroticism scores and greater right amygdala and right ACC activation also emerged for this condition. Finally, neuroticism was found to be associated with right amygdala and right parahippocampal activity when participants were instructed to ignore faces with negative emotional valences. The results of this study lend further evidence to the proposed diathesis-stress model of neuroticism and PTSD. Moreover, findings suggest a significant association between neuroticism and neural activity in brain regions associated with fear and emotion regulation for women with IPV and subsequent PTSD.

Investigating the relationship between posttraumatic stress symptoms and posttraumatic growth following community violence: The role of anger.

OBJECTIVE: Past research has revealed that posttraumatic stress disorder (PTSD) is characterized by disturbances in emotional reactivity, including anger reactions. In turn, posttraumatic stress symptoms (PTSS) and anger reactions have been shown to be independently associated with posttraumatic growth (PTG). As such, anger reactions may serve as a pathway of influence through which PTSS lead to PTG in trauma-exposed adults. METHOD: The current study examined cross-sectional relationships among PTSS, anger reactions, and PTG in 318 participants who were exposed to the violent political protests in Ferguson, Missouri after the officer-involved shooting of Michael Brown. Specifically, anger reactions were examined as a pathway of influence through which PTSS contribute to PTG. RESULTS: PTSS positively predicted anger reactions and PTG. Further anger reactions were associated with PTG. Anger reactions were found to partially account for the relationship between PTSS and PTG; thus, PTSS affect PTG, in part, through anger reactions to traumatic events. CONCLUSION: These results indicate a more direct role of anger reactions in facilitating growth after the associated distress of community violence. On the basis of these findings, anger may be useful in galvanizing individuals to make positive change after traumatic events. (PsycINFO Database Record

Exposure to Violence During Ferguson Protests: Mental Health Effects for Law Enforcement and Community Members.

There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence-connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption-as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ(2) (d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (ηp (2) = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (ηp (2) = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events.