On the Association Between Trauma-Related Shame and Symptoms of Psychopathology: A Meta-Analysis.

BACKGROUND: A number of studies have identified significant associations between trauma-related shame and psychopathology including posttraumatic stress disorder (PTSD), dissociation, and depression. The aim of this paper was to assess the extent to which trauma-related shame is associated with psychological distress across populations (e.g., veterans, college students, women, clinical samples) and offer via meta-analyses a preliminary conclusion about the importance of assessing trauma-related shame. METHODS: Records in Academic Search Complete, MedLine, MedLine Complete, PILOTS, PsycINFO, PsychTests, and PubMed were reviewed. Authors identified 25 studies that met the following inclusion criteria: (1) reported findings of an empirical study with quantitative results; (2) included any measurement of a trauma-related shame; and (3) included any measure of psychological distress or psychological symptoms. Data were extracted using a structured protocol, and random effects meta-analyses were calculated. FINDINGS: There were moderate weighted mean correlations between trauma-related shame and symptoms of psychopathology (r = 0.44), trauma-related distress (r = 0.49), and depression (r = 0.35). There was significant heterogeneity among studies. Neither study quality nor sample characteristics were significant moderators. CONCLUSION: This meta-analysis demonstrated robust associations between trauma-related shame and symptoms of psychopathology broadly as well as trauma-related distress and depression. The findings underscore the importance of explicitly assessing trauma-related shame as part of standard care for trauma survivors who present for treatment. Several treatments explicitly address the role of shame and have demonstrated efficacy for reducing symptoms of trauma-related distress.