No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life
Abstract
Few studies have been conducted on psychological disorders other than post-traumatic stress disorder (PTSD) in war survivors. The aim of this study was to examine PTSD, social anxiety disorder (SAD), and major depressive disorder (MDD) and their associations with distress and quality of life in 174 Albanian civilian survivors of the Kosovo War. This included testing of conceptual models suggesting that experiential avoidance might influence associations between anxiety and mood disorders with psychological functioning. Each of the three psychiatric disorders was associated with greater experiential avoidance and psychological distress, and lower quality of life. Being a refugee was associated with a higher likelihood of having SAD and MDD. We found evidence for experiential avoidance as a partial mediator of the respective effects of SAD and PTSD on quality of life; experiential avoidance did not mediate the effects of disorders on global distress. We also found support for a moderation model showing that only war survivors without SAD and low experiential avoidance reported elevated quality of life; people with either SAD or excessive reliance on experiential avoidance reported compromised, low quality of life. This is the third independent study, each using a different methodology, to find empirical support for this moderation model [Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: a prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12; Kashdan, T. B., & Steger, M. F. (2006). Expanding the topography of social anxiety: an experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128]. Overall, we provided initial evidence for the importance of addressing PTSD, SAD, MDD, and experiential avoidance in primarily civilian war survivors.
... Recent literature has linked EA to a range of psychological disorders, most frequently focusing on anxiety disorders in adults and adolescents [1,2]. More specifically, studies have shown significant relationships between EA and generalized anxiety disorder and social anxiety disorder [3,4]. In addition to its associations with anxiety disorders in adults, levels of EA have also been shown to predict anxiety and depressive symptoms in adolescents [5]. ...
... In addition to its associations with anxiety disorders in adults, levels of EA have also been shown to predict anxiety and depressive symptoms in adolescents [5]. EA has also been found to be a partial mediator between behavioral inhibition and social anxiety as well as between the respective effects of social anxiety disorder on quality of life [3,6]. While there has been extensive research examining EA and anxiety disorders, only five studies have been conducted on the relationship between EA and borderline personality disorder (BPD) or BPD features. ...
... Briefly, all individuals were inpatients at McLean Hospital when they began the study. To participate, participants needed to be: (1) between the ages of 18-35; (2) have a known or estimated IQ of 71 or higher; (3) have no history or current symptoms of schizophrenia, schizoaffective disorder, bipolar I disorder, or an organic condition that could cause psychiatric symptoms. Participants with these disorders did not participate in the study because of the difficulty in determining enduring personality patterns in people suffering from psychosis, mania, or a physical illness with serious psychological sequelae. ...
Background
The present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament.
Methods
The Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure).
Results
Participants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD.
Conclusions
Taken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.
... In particular, the most common conditions include posttraumatic stress disorder (PTSD), depression, and anxiety (1)(2)(3)(4). At the same time, the deterioration of pre-existing mental disorders is observed both among people living directly on the territory of the military conflict and among internally displaced persons (IDPs) and refugees (2,(5)(6)(7)(8)(9). Most of the existing studies focus on examining the psycho-emotional state and mental health of the affected communities in the post-war periods (1,2,4,(10)(11)(12). ...
... Researchers pay special attention to the issue of the mental health of refugees who are forced to leave their usual residence due to a military conflict in a country or region. In particular, Kashdan et al. (6) confirm that refugees are a vulnerable group and are more prone to psychological distress and anxiety disorders. In turn, Jain et al. (5) have reached similar conclusions, demonstrating an association between refugee status and anxiety disorders, including PTSD and depression. ...
... Hinz and Schwarz (27) suggest that the prevalence of depression is linked to age and should not exceed 15% for the normal population, indicating that Ukrainians exhibit significantly elevated levels of anxiety and depression due to the war. Although the increased levels of stress among Ukrainians seem self-evident, the results of this study differ from earlier post-war studies (1)(2)(3)(4)(5)(6)9) and are even at odds with recent studies conducted within the first month of the Russian invasion (13)(14)(15)(16), which found a significant decline in the mental health of Ukrainians. However, it is important to note that the mental health of individuals who have experienced the stresses of war may deteriorate over time (28). ...
Objective
This study examines the prevalence and predictors of mental health issues, specifically anxiety, depression, and stress, among Ukrainians during the military conflict with Russia.
Method
A cross-sectional correlational study was conducted six months after the beginning of the conflict. Sociodemographic factors, traumatic experiences, anxiety, depression, and stress were assessed. The study included 706 participants, both men and women, from different age groups and living in various regions of Ukraine. The data were collected from August till October 2022.
Results
The study found that a large portion of the Ukrainian population shows increased levels of anxiety, depression, and stress due to the war. Women were found to be more vulnerable to mental health issues than men, and younger people were found to be more resilient. Worsened financial and employment statuses predicted increased anxiety. Ukrainians who fled the conflict to other countries exhibited higher levels of anxiety, depression, and stress. Direct exposure to trauma predicted increased anxiety and depression, while war-related exposure to “other stressful events” predicted increased acute stress levels.
Conclusion
The findings of this study highlight the importance of addressing the mental health needs of Ukrainians affected by the ongoing conflict. Interventions and support should be tailored to address the specific needs of different groups, particularly women, younger individuals, and those with worsened financial and employment statuses.
... Post-traumatic stress disorder (PTSD) and social anxiety disorder, which share experiential avoidance as a common feature with AvPD, have been studied in various populations. Research has shown that experiential avoidance significantly contributes to distress and impairs quality of life (Kashdan et al., 2009). Addressing experiential avoidance in individuals with AvPD may therefore be crucial in reducing their psychosomatic symptoms. ...
... For instance, Condén et al. (2013) noted that individuals with Type D personality, similar to those with AvPD, frequently experience musculoskeletal pain and other physical symptoms as a result of stress (Condén et al., 2013). The catastrophic thinking and self-blame observed in participants' stress appraisal are also supported by studies on cognitive processes in anxiety disorders, where individuals tend to magnify negative outcomes and internalize blame (Kashdan et al., 2009). ...
This study aims to explore the psychosomatic responses to stress in individuals with Avoidant Personality Disorder (AvPD). The research utilized a qualitative design, employing semi-structured interviews with 16 individuals diagnosed with AvPD. Participants were recruited from mental health clinics and support groups specializing in personality disorders. Data collection continued until theoretical saturation was achieved. The interviews were transcribed verbatim and analyzed using NVivo software. Thematic analysis was conducted to identify patterns and themes in the data, focusing on participants' perceptions of stress, psychosomatic symptoms, and coping mechanisms. Ethical considerations included obtaining informed consent and ensuring confidentiality. The study identified three main themes: perceptions of stress, psychosomatic symptoms, and coping mechanisms. Participants described stress as overwhelming pressure and emotional burden, with key triggers being social interactions, performance expectations, criticism, and uncertainty. Psychosomatic symptoms included physical manifestations like headaches and muscle tension, emotional reactions such as anxiety and depression, cognitive impairments, behavioral symptoms, and heightened sensory responses. Coping mechanisms varied, with adaptive strategies including seeking support and problem-solving, and maladaptive strategies such as substance use and isolation. Barriers to effective coping included stigma and lack of resources. The findings highlight the significant impact of stress on both psychological and physical health in individuals with AvPD. The study underscores the need for comprehensive assessment and treatment strategies that address psychosomatic symptoms. Future research should focus on larger and more diverse samples, longitudinal studies, and objective measures of stress. Clinical practice should integrate cognitive-behavioral therapy and promote adaptive coping strategies to enhance the well-being of individuals with AvPD.
... War anxiety has two dimensions: one affecting the populations suffering from the ravages of wars, and the other involving the transmission of anxiety about war spreading to the global environment. In the first dimension, individuals enduring war, oppression, displacement, and detention in conflict zones experience psychological disorders and post-traumatic stress disorder (PTSD), the effects of which can persist for years after the end of the war (Kashdan et al., 2009). Additionally, they may suffer from acute depression, social phobia, and separation anxiety (Karam et al., 2014). ...
... The resulting structure confirms the complex nature of the war anxiety model, encompassing symptoms of depression, social phobia, and separation anxiety disorder. This mix of emotions causing psychological distress is supported by visual media and reported in studies by Forrest et al. (2018), Kashdan et al. (2009), andKaram et al. (2014). ...
The study aims to verify the factorial structure of war anxiety in a sample of adolescent students in Jordanian society and to estimate the relationship between war anxiety and emotional empathy. The study adopted the symptoms of general anxiety stipulated in the Diagnostic and Statistical Manual and transformed them into statements using the GAD-7 list. Additionally, an emotional empathy scale was developed. A random sample was selected from Northeastern Badia schools (from the third grade to the ninth grade). The study tools were applied in a paper format for students to respond to. Confirmatory factor analysis was conducted, and the war anxiety scale achieved an acceptable fit in light of the sample data. The study also reached, using exploratory factor analysis, a three-member structure for the emotional empathy scale. The results of the Pearson correlation matrix were moderate and positive for the relationship between war anxiety and the dimensions of emotional empathy among adolescents, which means that cases of war anxiety are acceptable and moderate among adolescents and can be expressed in positive channels through behavioral manifestations of emotional empathy, such as rejecting foreign products and other common behaviors mentioned in the study.
... Furthermore, armed conflicts are linked to poverty, unemployment, communal violence, unstable living conditions, and changes in the social dynamic. This makes the post-war scenario strongly linked to a lower quality of life, which leads to different mental health issues [13]. ...
... The Oslo 3-item Social Support Scale (OSSS-3) was utilized to gather information about the degree of social support. It was categorized into three broad categories of social support; poor social support [3][4][5][6][7][8], moderate social support [9][10][11], and strong social support [12][13][14]34]. Substances were measured using the WHO student drug-use questionnaire [35]. ...
Background
Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia.
Method
A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.
Result
The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76–4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47–17.49), low social support (AOR = 1.90, 95% CI 1.23–2.96) were variables significantly associated with depression.
Conclusion
This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.
... body of work has identified a link between trauma and depression across genders, ages, cultures, and nations (e.g., Heim et al., 2008;Lincoln et al., 2016). Among survivors of war-related trauma, rates of clinical depressive symptoms are often 40% or higher than the general population (Ai et al., 2002;Kandemir et al., 2018;Kashdan et al., 2009). Anxiety disorders are also common among survivors of genocide. ...
... Bosnian refugees exposed to war-related trauma as children demonstrated high rates of adult separation anxiety disorder (Silove et al., 2010), as did American students directly exposed to the September 11th attacks on the World Trade Center (Hoven et al., 2004). Survivors of the Kosovo war, too, showed high rates of social anxiety disorder (Kashdan et al., 2009). Although this research is foundational, less is known about these associations among non-Western (often systematically understudied) cultural, racial, and ethnic groups. ...
The 1994 Genocide Against the Tutsi in Rwanda resulted in the murder of nearly one million Rwandan Tutsis and moderate Hutus. Given its large scale and devastating impact, it is critical to understand how survivors of this genocide have fared. The present study investigates the protective roles of social support and distress disclosure against posttraumatic stress disorder, depressive, and anxiety symptoms among survivors of this genocide who were recruited via a survivor organization (N = 289). Path analysis investigated five models testing the indirect effects of social support on the relations between distress disclosure and five mental health outcomes (i.e., avoidance, hyperarousal, intrusion, anxiety, and depressive symptoms). Social support mediated the relationship between distress disclosure and hyperarousal, intrusion, anxiety symptoms, and depressive symptoms. Results suggest that social support is a key facilitator of the relationship between distress disclosure and negative mental health outcomes, and therefore, social support may be an important intervention vehicle for genocide survivors.
... EA refers to the detestation or unwillingness of a patient to remain in contact with unpleasant private experiences (e.g., unwanted thoughts, emotions, and bodily sensation) associated with a chronic illness, and then takes steps to alter or suppress the form or frequency of those experiences, including the conditions that trigger them (Aliche et al., 2021a;Bond et al., 2011). Individuals with high EA may likely engage in psychological denial of their illness, poor medication adherence, and may lack interest in overall treatment regimens (Kashdan et al., 2009). Empirically, EA has been associated with a wide range of psychological problems, including posttraumatic stress disorder (PTSD) (Aliche et al., 2021a) and poor QoL (Eustis et al., 2016;Karekla & Panayiotou, 2011;Kashdan et al., 2009). ...
... Individuals with high EA may likely engage in psychological denial of their illness, poor medication adherence, and may lack interest in overall treatment regimens (Kashdan et al., 2009). Empirically, EA has been associated with a wide range of psychological problems, including posttraumatic stress disorder (PTSD) (Aliche et al., 2021a) and poor QoL (Eustis et al., 2016;Karekla & Panayiotou, 2011;Kashdan et al., 2009). Conversely, a very recent study has found a non-significant association between EA and HRQoL among T2DM patients (Ezaka et al., 2022). ...
Individuals diagnosed with type 2 diabetes mellitus may experience death anxiety and experiential avoidance, which may impact negatively on health-related quality of life. Meaning in life is a positive psychological resource that protects against negative psychosocial outcomes. Although a direct relationship between these variables exists, to our knowledge, previous research has not explored their interaction effect. The present study examined whether meaning in life moderates the relationship between (1) the multidimensional death anxiety and health-related quality of life, and (2) experiential avoidance and health-related quality of life among type 2 diabetes mellitus patients. The pool of participants consisted of 311 type 2 diabetes outpatients drawn from a tertiary health care institution in South-East Nigeria. The participants completed several self-report measures, such as the short form of the Diabetes Quality of Life Questionnaire, Death Anxiety Inventory–Revised, Acceptance and Action Questionnaire, and the Presence of Meaning in life subscale of Meaning in Life Questionnaire. The results of a regression analysis showed that death anxiety in terms of death acceptance, death finality, and thoughts about death were independently associated with poor health-related quality of life at low, but not at average and high levels of meaning in life. Externally generated death anxiety was associated with poor health-related quality of life at low and average, but not at high levels of meaning in life. Finally, experiential avoidance was associated with poor health-related quality of life at low and average, but not at high levels of meaning in life. We concluded that psychological interventions geared towards promoting health-related quality of life of type 2 diabetes mellitus patients should consider integrating meaning in life for its protective nature in improving positive health outcomes and recovery.
... In addition to feared external stimuli, people may fear and avoid unwanted private events such as feeling anxious, thoughts and increased heart rate. This topic was dealt with by Kashdan et al. (2009). Drawing on a community sample of Albanian civilian survivors of the Kosovo War, examined whether post-traumatic stress disorder, social anxiety disorder, major depressive disorder, and experiential avoidance were associated with mental health and quality of life outcomes. ...
... Drawing on a community sample of Albanian civilian survivors of the Kosovo War, examined whether post-traumatic stress disorder, social anxiety disorder, major depressive disorder, and experiential avoidance were associated with mental health and quality of life outcomes. Each of these conditions was associated with greater experiential avoidance, global distress, and compromised quality of life (Kashdan et al., 2009). Young people in Kosovo and Metohija show a high degree of anxiety, a tendency to experience negative emotions and to experience new situations as potentially threatening. ...
The subject of this research is the assessment of the influence of ethnic conflicts on the quality of life and health of people. The aim of the research is to identify and highlight the influence of conflicts on human health in the environments which were exposed to those conflicts at the end of the 20th and the beginning of the 21st century. The research was conducted in Kosovo and Metohija. The research covered all ethnic groups of the population that were treated in health care institutions belonging to the system of the Republic of Serbia (Health Centers in Kosovska Mitrovica and Gračanica). The ways in which trauma, gender, age, marriage and household size affect the fear of violence were investigated. The differences between types of fear were stated, i.e. it was investigated whether respondents were more concerned about their property or their personal safety
... Furthermore, armed conflicts are linked to poverty, unemployment, communal violence, unstable living conditions, and changes in the social dynamic. This makes the post-war scenario strongly linked to a lower quality of life, which leads to different mental health issues [3]. ...
... Mental illness is recognized as a major public health concern of a conflict-affected population [8][9][10]. Any traumatic event experienced during combat increases the risk of mental health issues such as post-traumatic stress disorder (PTSD), anxiety, and depression symptoms as well as worse life outcomes [3,11,12]. Being female, having a personal history of mental illness, being unemployed after the event, having persistent physical problems, and having damage to property such as a house were all risk factors for depressive symptoms [13][14][15][16]. Pre-existing factors such as substance addiction history, and post-trauma elements such as lack of food or water, injury, and loss of family member/friend have all been identified as contributing to the development of depressive symptoms [17]. ...
Background:
Depressive symptom is the most widely reported mental health consequence of natural or man-made disasters and traumatic events. Research on depressive symptoms in low-income nations is still scarce, although it can be a public health burden in post-conflict situations. Therefore, the primary objective of this study was to identify the prevalence and contributing factors of depressive symptoms among people of south Wollo zones following liberation from TPLF-led army invasions.
Methods:
A community-based cross-sectional study was conducted on South Wollo zone residents after the liberation of invasions of the TPLF-led force, from May 1st to June 1st, 2022. A self-administered questionnaire was used to collect data from residents chosen using a simple random sampling technique. This study used both descriptive and inferential analysis. To investigate the relationship between response and predictor variables, the chi-squared test of association was performed. The logistic regression was performed to identify predictors of depressive symptoms among residents.
Results:
The overall prevalence of depressive symptoms among residents was 51.0% [95% C.I: 48.01, 53.99]. Being female [AOR = 1.428, 95% C.I: 1.044-1.955], being an alcohol consumer [AOR = 2.051, 95% C.I: 1.349-3.119], chewing Khat [AOR = 4.617, 95% C.I: 2.873-7.418], history of mental illness [AOR = 4.316, 95% C.I: 1.263-14.751], destruction of personal property [AOR = 2.909, 95% C.I: 2.028-4.175], lacked basic needs such as food and water [AOR = 2.738, 95% C.I: 1.922-3.900], and illness without medical care [AOR = 2.369, 95% C.I: 1.684-3.331] were all found to be statistically significant at the 5% level of significance in a multivariable binary logistic regression.
Conclusions:
The main finding of this study discovered that residents had a higher prevalence of depressive symptoms following liberation from TPLF-led army invasions. Being an alcoholic, chewing Khat, having a previous history of mental illness, destruction of personal property, lack of food or water, and illness without medical care were associated with an increased risk of developing depressive symptoms. Interventions based on influencing factors should be performed to ensure residents' mental health.
... All these causes lead to an inflexible coping mechanism and inability to separate one's sense of self and behavior which can have a negative impact such as the use of alcohol, drugs, or a relapse [5][6][7] and psychological distress. 4,8,9 It also prevents opportunities to experience valuable events. In summary, experiential avoidance is caused by human language proficiency and human nature which leads to a certain state of psychopathology. ...
... Meanwhile, the Thai version of the MEAQ had admissible levels of construct to measure before modification. Still, after modification and elimination of some items, which had factor load below 0.4 22 and/ or low R 2 , there was relatively high measurement error (the eliminated items were 1, 2, 4, 6,7,8,13,16,18,19,21,23,24,26,30,31,34,39,46,48,53,54,62). This made the model more consistent with empirical data and thus confirmed that the Thai version of MEAQ was a sixfactor model which correlated with the study by Gamez, Chmielewski 12 and Rochefort, Baldwin. ...
Objective: To study and compare the psychometric properties, reliability, and validity of the Acceptance and Action Questionnaire (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ), which were translated into Thai. Materials and Methods: This study used the AAQ-II and MEAQ, which were back translated into Thai. The Depression Anxiety Stress Scale 21 (DASS-21) and Satisfaction with Life Scale (SWLS) were used in conjunction to collect data from 35 graduate students (females 77.1%) and 462 people from the general population of Bangkok (females 74.2%). Result: Item Objective Congruence (IOC) of AAQ-II and MEAQ was 0.79 and 0.87, respectively. Both had high correlation coefficients with DASS-21 and SWLS, indicating criteria-related validity. Moreover, Confirmatory Factor Analysis (CFA) was also carried out. The correlation coefficient to the original was high (0.96 for AAQ-II and MEAQ, and subscales ranging from 0.83-0.94). They also had high internal consistency, with Cronbach’s alpha being 0.89 in AAQ-II and 0.92 in MEAQ, with high construct reliability (0.88 and 0.79-0.86). Conclusion: The translated versions of AAQ-II and MEAQ have good psychometric properties. When comparing AAQ-II with MEAQ, it was noted that the correlation between AAQ and other scales was higher than MEAQ, which only had a moderate correlation. AAQ-II also tends to have a high association with distress variables. However, it is still possible to assess experiential avoidance. Thus, the use of each questionnaire will be depended on certain objectives.
... Since the end of the Cold War and subsequent growing involvement of the United Nations in peace operations in contexts of civil wars, when brokered peace agreements are officially attained there are serious concerns over the extent that people's beliefs, meaning attributions and behaviours are informed by or discontinued from the civil wartime patterns and relations (Kubota, 2017). Interrogations around continuities and discontinuities also consider the risk of families and communities succumbing to stress and suspicion, which can ignite new cycles of precarity and collective violence (Hanlon, 1996;Kashdan et al., 2009;Mueggler, 2001;Perera, 2001). Such concerns are further aggravated by the absence of government and development agencies focused on addressing some of the most locally insidious legacies of civil wars over time (De Schryver et al., 2015;Gatewood & Price, 2017;Jayawickreme et al., 2017;Maynard, 1997;Stys et al., 2022). ...
The existing literature on post-civil war processes has inadequately addressed the diversity of challenges of social reconstruction and community development arising from the fragmentation of cultural practices informing the creation and maintenance of family and social networks, and a variety of locally specific risks impacting the lives of survivors and subsequent generations. This paper addresses this gap by empirically investigating how unre-solved legacies of Mozambique's civil war (1976-1992) have fueled a network of local problems in the Gor-ongosa district. We used network analysis of cases presented in community courts over a decade (2002-2012) to reveal the existence of entrenched disputes involving spouses, divorce cases, domestic violence incidents, financial debts, accusations of wartime violations, and a range of adverse wellbeing outcomes. The conflicts and relationship dynamics vary in intensity over time but remain closely linked to civil war-induced risks, such as disrupted practices of premature marriages and interpersonal mistrust. Taking together these results reinforce the need to address disrupted patterns of family relations, lingering accusations of wartime violations, and to enhance the capacity of local community institutions and courts as part of social reconstruction efforts and development goals.
... Social abilities are compromised in PTSD patients due to the cognitive and emotional symptoms characterising the disease [40]. For example, negative assumptions about the self /the others and negative emotions easily generate social withdrawal, altering the predisposition towards the others [41,42]. In our PTSD model we previously found that male rats exposed to footshocks manifest reduced social interaction compared to non-footshock exposed rats [23]. ...
... Lisäksi on havaittu, että lapsuuden traumaattiset kokemukset ovat yhteydessä myö hempään alkoholin väärinkäyttöön, ja erityisesti traumaperäinen välttelyoireilu vahvistaa tätä yh teyttä (Müller ym., 2015). Kokemuksellinen vält tely on myös yhteydessä PTSDoireiluun liitty vään heikentyneeseen elämänlaatuun (Kashdan, Morina & Priebe, 2009). ...
Tässä tapaustutkimuksessa pyritään kuvaamaan ja arvioimaan traumaperäisen välttelyoireilun roolia lasten PTSD:ssä, välttelyoireilun näkymistä hoidon aikana, sekä välttelyoireilun muuttumista hoidon myötä. 7-vuotiaan pakolaislapsen PTSD:n hoitoa ja hoidon tuloksellisuutta esitellään yksityiskohtaisesti. Hoitomuotona on traumafokusoituneen kognitiivisen käyttäytymisterapian ja narratiivisen altistusterapian yhdistelmähoito. Hoidon tuloksellisuutta ja sen mahdollisia vaikutusmekanismeja pohditaan tieteellisen tutkimuksen valossa. Erityisesti keskitytään kuvaamaan ja pohtimaan välttelyn merkitystä PTSD:n kehittymisessä ja oireiden pitkittymisessä. Välttelyllä nähdään yleisesti olevan keskeinen merkitys PTSD:n kehittymisessä, ja välttelyn eri osa-alueet (kognitiivinen, emotionaalinen, toiminnallinen) vaikuttavat oireiluun eri tavoin riippuen mm. siitä, miten pitkä aika traumatapahtumasta on kulunut. Välttelyoireilun merkityksestä lasten PTSD:ssä on kuitenkin ristiriitaisia näkemyksiä, eikä tutkimuksia ole juurikaan tehty lapsilla. Tämä tapaustutkimus lisää tietoa välttelyn merkityksestä sekä hoidon tuloksellisuudesta lasten PTSD:ssä, ja on ensimmäinen, joka esittelee traumafokusoituneen kognitiivisen käyttäytymisterapian ja narratiivisen altistusterapian yhdistelmähoitoa.
... In the Tigray region, millions of people, including athletes, get traumatized. As many scholars proved that, anyone who has experienced war, genocide or torture, is often severely traumatized (Schaal & Elbert), and such people are considered to be particularly at risk to develop psychiatric disorders such as anxiety, depression and PTSD [10][11][12]. Studies evaluating psychiatric disorders have identified depression, PTSD, and anxiety disorders as the most common disorders diagnosed due to a war situation [13]. ...
The war in northern Ethiopia (November 4, 2020-November 2, 2022) caused unimaginable suffering to the people of Tigray. Psychological suffering is among the many. It is well known that war affects all people living in the war zone and alters life dramatically, as its effects can be both physical injury of varying degrees of severity and the dangerous invisible wounds caused by psychological trauma and stress. As far as this issue is concerned, numerous research results have shown the psychological impact of war on the general population. However, no research has been carried out on the psychological impact of war on athletes. So, the main objective of this study was to assess the psychological impact of the Northern Ethiopia civil war on Tigray Athletes. To achieve the purpose of this study, a total of 144 athletes from various clubs in the Tigray area were selected using the convenience sampling method. The anxiety symptom was assessed using the Generalized Anxiety Disorder Scale (GAD-7) and the depression symptom was assessed using the Centre for Epidemiologic Studies (CES-D) depression scale. The data gathered was analyzed using the SPSS statistical package (version 25 for Windows). Of 144 participants, 1 (0.7%) showed minimal anxiety; 4 (2.8%) showed mild anxiety; 29 (20.1%) showed moderate anxiety; and 110 (76.4%) showed severe anxiety. And regarding depression, all of the participants were shown symptoms of depression as their score was higher than 16 points. As the result shows, almost all participants have a risk of anxiety and depression. It can thus be concluded that the two-year war in northern Ethiopia had a negative psychological impact on Tigray athletes.
... Changes in social dynamics, unemployment, intergroup aggression, poverty, and unstable living conditions are all results of armed conflicts. Therefore, there is a clear relationship between the post-war period and a lower quality of life, which leads to a range of mental health problems, including anxiety (15). ...
Background
Anxiety symptoms are the most frequent mental health problems in the world, and it is a serious public health concern, especially among adolescents, because if left untreated, adolescent anxiety can have a number of detrimental effects, including lower academic performance, strained relationships with friends and family, substance addiction, thoughts of suicide and homicide, and trouble finding work. While this vulnerability is concerning in all situations, it is particularly critical in armed conflict areas. Ethiopia is one of the most recent war-affected countries, but to the best of our knowledge, limited studies focused on adolescents in this context. Therefore, this study assessed the experience of war trauma and its effects on anxiety symptoms among high school students in Woldia town, Ethiopia.
Objective
We assessed the experience of war trauma and its effects on anxiety among high school students, as well as associated risk factors, in war-affected areas in Woldia town, northeast Ethiopia.
Methods
A cross-sectional study design was conducted from May 23 to June 08 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression analyses were used to identify independent factors associated with anxiety.
Results
A total of 624 out of 660 students participated in the study (94.5% response rate). The prevalence of anxiety among high school students in Woldia town was 39.7%. In the multivariable analysis, having depression (AOR = 9.24, 95% CI: 6.27, 13.64), witnessing the murder of family/friends (AOR = 1.93, 95% CI: 1.05, 3.57), being of female sex (AOR=1.59, 95% CI: 1.08, 2.36), and having a family history of mental illness (AOR=1.69, 95% CI: 1.00, 2.85) were factors significantly associated with anxiety.
Conclusions and recommendations
The prevalence of anxiety in this study was approximately two in five high school students. Therefore, we recommend that the Ministry of Education collaborate with the Ministry of Health to expand and implement mental health services in high schools to promote the wellbeing of students for the prevention of anxiety.
... These efforts to control inner experiences can exacerbate distress and restrict behavior (Goodarzi et al., 2021;Sedighi Arfaee et al., 2021). In this way, experiential avoidance aims to reduce or change distressing thoughts and feelings and is seen with symptoms of depression in individuals (Kashdan et al., 2009;Levin et al., 2018). Experiential avoidance provides a short-term and hasty relief for the individual by controlling or minimizing the impact of distressing experiences, which negatively reinforces the individual's behavior. ...
Objective: The aim of the present study was to predict distress tolerance in the elderly based on experiential avoidance and spiritual intelligence. Method: This was a descriptive correlational study. The population included all elderly individuals aged between 65 and 80 years who visited community centers in Tehran in 2022, from whom a sample of 300 was selected using cluster sampling. The Emotional Distress Tolerance Scale by Simons and Gaher (2005), the Spiritual Intelligence Scale by King (2008), and the Experiential Avoidance Questionnaire by Gámez et al. (2011) were utilized for data collection. Data were analyzed using regression analysis. Findings: The results indicated that experiential avoidance significantly negatively predicted distress tolerance. Additionally, spiritual intelligence significantly positively predicted distress tolerance. Conclusions: Based on the findings of the current study, it can be concluded that this predictive model could serve as an effective framework in counseling and psychotherapy centers to enhance distress tolerance among the elderly.
... This disorder has a significant impact on a person's life, as it disrupts a person's mental life and social performance and also causes a decrease in the level of psychological health of a person (4). People who suffer from this disorder have characteristics such as low self-confidence, high violence, low correlation with family members and society, and high levels of conflict (5). ...
Background: Caring for war veterans causes suffering and stress in their caregivers. Therefore, it is necessary to use non-pharmacological methods to reduce anxiety and increase the resilience of caregivers. Objectives: The main objective of this study was to evaluate the effect of spiritual self-care patterns (SSCP) on the resilience of spouses of veterans with post-traumatic stress disorder (PTSD). Methods: This semi-experimental study was conducted on 30 spouses of veterans with PTSD, who were selected randomly and divided into two groups, including the control group (fifteen people) and the experimental group (fifteen people). For the experimental group, training intervention was implemented by SSCP, while no intervention was performed for the control group. The Conner-Davidson Resilience Scale (CD-RIS) questionnaire was used to evaluate the level of resilience. Finally, the results obtained before and after the intervention were analyzed using SPSS software version 21 and relevant statistical tests at a significance level of α = 0.05. Results: The results showed that the mean resilience score in the control group before and after the intervention was 46.5 ± 5.7 and 47.0 ± 6.2, respectively, which did not have a significant difference (P = 0.70). This value for the experimental group was 3.8 ± 44.5 and 8.8 ± 62.5, respectively, and the difference in the average of these two scores was statistically significant (P < 0.001). Conclusions: Based on the results, the intervention of training by spiritual self-care pattern (SSCP) can reduce stress and increase the resilience of spouses of veterans with PTSD.
... Therefore, PTSD sufferers always feel anxious and have difficulty focusing or even have difficulty sleeping. AVOIDANCE Avoidance is one way a person evaluates negative tendencies toward unwanted feelings, thoughts, and sensations; in other words, proving his inability to tolerate personal memories and desire to control and come to terms with those memories (Kashdan et al., 2009). Thus, someone who has a psychological disorder tends to stay away from everything that reminds him of the trauma he experienced, whether in the form of the same person, place or activity. ...
Almost everyone has experienced traumatic events that lead to trauma. Trauma is a form of psychological experience that has a serious impact on mental health. The impact of trauma itself can vary, such as anxiety, depression, dissociation, and PTSD. In the novel All Her Little Secrets, Ellice, the main character, is described as suffering from PTSD due to childhood trauma. This study aims to determine how the character Ellice is described as suffering from PTSD and what trauma she has experienced. This research uses a qualitative descriptive method referring to two types of data, namely primary data and secondary data. Primary data were taken from the All Her Little Secrets novel in the form of narrative, dialogue and monologue. Meanwhile secondary data were taken from journals, books and articles related to the research topic. Several steps were taken to obtain data, namely reading the novel repeatedly and carefully, identifying data, classifying data, and reducing power. The results of this study concluded that Ellice as a PTSD sufferer was described through the symptoms she experienced. Ellice's PTSD symptoms include re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Meanwhile, the forms of childhood trauma that Ellice experienced included bullying, child maltreatment, and exposure to domestic and community violence
... As such, experiential avoidance has been conceptualized as separate from, and even a risk factor for the development of PTSS after experiencing a traumatic event . Additionally, experiential avoidance has been found to be a mediator of PTSS and several outcomes, including shame (Leonard et al., 2020), social support (Kelly et al., 2019), and quality of life (Kashdan et al., 2009). Experiential avoidance may maintain PTSD by preventing processing of trauma memories (Kelly et al., 2019;Palm & Follette, 2011) or integration of new information to form more adaptive fear structures (Rauch & Foa, 2016), and may exacerbate the negative effects of PTSS directly or indirectly through motivating the use of maladaptive coping (see Morissette et al., 2023, for a study of the impact of cannabis use and PTSS on academic outcomes). ...
The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants ( N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.
... The avoidance-oriented strategy appears to be characteristic of many older respondents and promotes the persistence of trauma (Chudzicka-Czupała et al., 2023). However, as research with civilian survivors of the Kosovo war has shown, this strategy may play a positive role in the short-term alleviation of distress in response to threats (Kashdan et al., 2009). Considering the above data, the low severity of somatic symptoms associated by respondents with the outbreak of war and the situation a year later may be surprising; nevertheless, it may be the result of different types of symptoms existing before the start of the war or the aforementioned avoidance strategy. ...
Introduction and objective: Older Poles are a group particularly exposed to mental health disturbances in connection with the war in Ukraine. The aim of this research was to determine the severity and dynamics of post-traumatic stress disorder (PTSD), depression and somatic symptoms in the first year of the war in Ukraine, the relationship between PTSD and depression and sociodemographic factors, as well as to identify factors that increase the risk of PTSD and depression persisting a year after Russia’s aggression against Ukraine. Materials and methods: People aged ≥50 years (N = 116) were included in the study. The respondents were asked to complete the questionnaires twice, i.e. taking into account 2022 (beginning of war) and 2023 (a year after the outbreak). The International Trauma Questionnaire (ITQ), Patient Health Questionnaire (PHQ-9) and 8 items from the Patient Health Questionnaire – Somatic Symptoms (PHQ-15) were used. Results: In 2022, nearly 40% of respondents presented with PTSD, and over 60% showed depressed mood. In 2023, the number of people meeting the criteria for PTSD and depression decreased. Women showed higher levels of PTSD and depression. Higher levels of PTSD symptoms were observed among people with higher education. A greater decrease in the severity of PTSD was found among those declaring involvement in providing help for Ukraine. Older age and a higher baseline ITQ or PHQ-9 score favoured the persistence of PTSD and depression in 2023. Conclusions: Factors contributing to poor mental health other than the war itself may include the negative effects of the COVID-19 pandemic, current socioeconomic changes and past traumas.
... This variation could be due to repeated exposure to the traumatic event, and having a prior displacement history could make them easily vulnerable to other displacement-related suffering and trouble [38]. On the other hand, our result was higher than the other studies, including 26.4% among survivors of the Kosovo War [39], 11.8% in Uganda [40], 28% in the war-affected population of South Sudan [10], and 19.4% among Dessie town residents [41]. The current study was carried out less than eight months after the start of the war, whereas other studies delayed carrying out the study after the war. ...
Background
Post-Traumatic Stress Disorder (PTSD) is a chronic condition that affects a significant proportion of war survivors following war and conflict. If PTSD is not managed, it can lead to decreased quality of life and impairments in daily functioning and lead to death. This study aimed to assess the prevalence of post-traumatic stress disorder and its associated factors among residents in a war-affected area, Dessie Town, Northeast Ethiopia.
Methods
A community-based cross-sectional study was conducted among adult residents in the war-affected area, Dessie Town. A total of 615 individuals were selected by a systematic random sampling method. PTSD was assessed using the Post-Traumatic Stress Disorder Checklist, Civilian Version. Multivariable logistic regressions were used to measure the associated factors. Associations between variables were described using odds ratios, 95% confidence intervals, and a p-value less than 0.05.
Results
The prevalence of PTSD was 34.5% (95% CI: 31–38). Female sex (AOR: 1.82; CI: 1.18–2.82), divorced or widowed (AOR: 2.12, CI: 1.23–3.66), having only primary schooling (AOR: 2.17; CI: 1.25–3.78), depression (AOR: 2.03; CI: 1.34–3.08), experienced ill health without medical care during the wartime (AOR: 2.97; CI: 1.43–6.16), forced separation from family (AOR: 1.90; CI: 1.16–3.12), and experienced stressful life events (AOR: 1.60; CI: 1.06–2.42) were significantly associated with PTSD.
Conclusion
A significant rate of PTSD was found among residents of the war-affected area, Dessie Town. One in three people was experiencing PTSD. As a result, post-war mental health early screening and intervention is a priority, particularly for females, those who are separated or divorced, and those who have experienced stressful life events due to the war.
... Furthermore, cross loadings are also plausible with respect to Traumatic Avoidance and Social Anxiety on both the Distress and Obsessions/Fear Factors. Indeed, we know from trauma research that traumatic avoidance, social anxiety and depression often cooccur (e.g., Kashdan et al., 2009). Residuals of Appetite Gain and Appetite Loss factors were allowed to correlate, given their large residual value (−4.86) in our dataset, as well as in other samples (Wester et al., 2022). ...
Background
The Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure comprising 99 items divided into 18 non-overlapping scales that allows for a dimensional assessment of depression, anxiety, and bipolar symptoms. The IDAS-II is currently available in English, Turkish, Spanish, German, and Swedish. This study’s major goal was to adapt and validate the IDAS-II to the Romanian population.
Method
Participants from a community sample (N = 1,072) completed the IDAS-II (Romanian version) and additional measures assessing depression and anxiety disorders.
Results
Item-level factor analyses validated the unidimensionality of the scales, and internal consistency results indicated that most symptom scales had satisfactory alpha coefficient values. Based on previous structural analyses, a confirmatory factor analysis (CFA) on the IDAS-II scales confirmed a three-component model of “Distress,” “Obsessions/Fear,” and “Positive Mood.” Convergent and discriminant validity were established by correlational analyses with other symptom measures.
Limitations
This study was conducted using a sample from the general population and several of the employed measures have limitations. Specifically, the current study was unable to employ Romanian versions of the gold-standard instruments that assess well-being, obsessive–compulsive disorder, and claustrophobia.
Conclusion
The IDAS-II (Romanian version) is the first clinical measure to assess internalizing dimensions of the Hierarchical Taxonomy of Psychopathology (HiTOP) model that is available for the Romanian population.
... Se puede entender la aceptación experiencial como un constructo salugénico, transdiagnóstico y centrado en el desarrollo del bienestar humano. Una mayor aceptación experiencial se asocia a mayor bienestar (Machell et al., 2014), calidad de vida (Kashdan et al., 2009) y una menor prevalencia de patologías o desórdenes mentales (Hayes et al., 1996). ...
Objetivo. Analizar las propiedades psicométricas del AAQ-II en población adulta ecuatoriana con to-mas presenciales, aumentando la fiabilidad de la muestra. Método. En este estudio se evaluaron las propiedades psicométricas de la Acceptance and Action Questionnaire-II (AAQ-II) en población ecuatoriana. Participaron 450 personas entre 18 y 53 años, de las cuales un 46.7% fueron mujeres y un 53.3% hombres. Resultados. En el análisis factorial confirmatorio se encontró una estructura de tres dimensiones: evitación de recuerdos, evitación emocional y falta de autodominio. Un análisis de invarianza reveló que la escala es invariante entre hombres y mujeres. Se encontró que la escala presenta buena consistencia interna (α = .90). Se discute la validez de la AAQ-II como una herramienta para evaluar la evitación experiencial en población adulta ecuatoriana.
... Nonetheless, acceptance, which implies accommodating the situation as it is, appears to be the strongest negative predictor for war-associated anxiety. This was extensively confirmed by many other studies [50][51][52][53][54][55][56]. ...
On 24 February 2022, the Russian Federation invaded Ukraine, starting a military conflict that soon turned into a full-scale war. The Romanians have been actively involved in helping their neighbors, causing the accumulation of emotional and mental pressure upon the Romanian population exposed to such a close military conflict. This cross-sectional study assessed, through an online survey (1586 adult Romanian residents), the primary coping mechanisms, quality of life and anxiety levels in response to the psychological trauma associated with the Russo—Ukrainian war. Based on the results, focusing on and venting emotions along with behavioral disengagement were the coping strategies that had the strongest negative impact on anxiety and well-being. On the other hand, positive reinterpretation and growth were associated with less anxiety, a higher degree of overall health and better quality of life. To the best of our knowledge, this study is the first of its kind to be performed among the Romanian population so far. Thus, we equip mental health practitioners with the tools (real-life evidence data) that will allow them to establish a more meaningful doctor—patient relationship, maximizing therapy results.
... As many scholars proved that, anyone who has experienced war, genocide or torture, is often severely traumatized [11], and such people are considered to be particularly at risk to develop psychiatric disorders such as anxiety, depression and PTSD [12][13]. Studies evaluating psychiatric disorders have identi ed depression, PTSD, and anxiety disorders as the most common disorders diagnosed due to a war situation [14]. ...
Background:The civil war in northern Ethiopia (November 4, 2020 – November 2, 2022) caused unimaginable suffering to the people of Tigray. Psychological suffering is among the many. It is well known that war affects all people living in the war zone and alters life dramatically, as its effects can be both physical injury of varying degrees of severity and the dangerous invisible wounds caused by psychological trauma and stress. As far as this issue is concerned, numerous research results have shown the psychological impact of war on the general population. However, no research has been carried out on the psychological impact of war on athletes. So the main objective of this study was to assess the psychological impact of the Northern Ethiopia civil war on Tigray Athletes.
Methods: To achieve the purpose of this study, a total of 144 athletes from various clubs in the Tigray area were selected using the convenience sampling method. The anxiety symptom was assessed using the Generalized Anxiety Disorder Scale (GAD-7) and the depression symptom was assessed using the Centre for Epidemiologic Studies (CES-D) depression scale. The data gathered was analyzed using the SPSS statistical package (version 25 for Windows).
Results: Of 144 participants, 1 (0.7%) showed minimal anxiety; 4 (2.8%) showed mild anxiety; 29 (20.1%) showed moderate anxiety; and 110 (76.4%) showed severe anxiety. And regarding depression, all of the participants were shown symptoms of depression as their score was higher than 16 points.
Conclusions: As the result shows, almost all participants have a risk of anxiety and depression. It can thus be concluded that the two-year civil war in northern Ethiopia had a negative psychological impact on Tigray athletes.
... From most of the research gathered, there is either a direct link ijps.ccsenet.org International Journal of Psychological Studies Vol. 15, No. 2;2023 between the symptomatology of PTSD and exposure to traumatic events of wars (Seino et al., 2008;Kashdan et al., 2009;Abu-El-Noor et al., 2020a, 2020bKakaje et al., 2021), or indirect, i.e., without investigating only this disorder or only this factor (Mufti et al., 2007). ...
PTSD has been linked in the literature to traumatic experiences of car accidents, natural disasters, sexual assaults and especially war. This is evidenced by the relevant literature research reported in the thesis. The research was guided by PRISMA 2020, which helped to ensure the quality of the research (Page et al., 2021a; 2020b). Initially, research was sought that addressed the association between this disorder and experiences of war. Of the found sources of material, a part was the category of previous similar type of research (N=7) on the relevant topic, from which the usefulness of the present study became apparent, with the limited Greek literature and the focus of the existing one on veteran soldiers. An important finding was the much higher prevalence of the general population and children and youth, compared to veterans. The association between PTSD and war, its intensity and prevalence, depends on other factors such as demographics, the type of trauma, the psychosocial make-up of the individual and his/her socio-cultural identity. There is a need for further research into this phenomenon, with the aim of formulating targeted policies for prevention, treatment-intervention and rehabilitation of people who have experienced the inhuman situations of war.
... This study also showed that the rainstorm-related stresses experienced more than 3 times were significantly associated with more severe psychological symptoms (PTSD, anxiety, depression and stress). This finding was in line with many previous studies, which established that the degree of exposure to a disaster was among the most robust predictive factors of psychiatric disorders [51]. Hashemian F et al. also reported that compared with those exposed to low-intensity warfare, individuals exposed to both high-intensity warfare and chemical weapons were at an 18.6 times higher risk of PTSD and a 14.6 times higher risk of anxiety [52]. ...
Background:
In 2021, a once-in-a-century heavy rainstorm suddenly attacked Zhengzhou, an important inland city in northern China. However, there have been no studies on the psychological health of disaster-stricken residents. This study is the first to comprehensively report on the mental health status and related factors of local ordinary residents after the heavy rainstorm.
Objective:
The purpose of this study is to investigate the mental health status and related influencing factors of local ordinary residents after the flood disaster, and to provide reference for government departments to formulate disaster psychological intervention countermeasures based on evidence-driven strategies.
Methods:
The snowball sampling technique was used in this study, and measurement tools of Rainstorm Exposure Questionnaire, Subjective Perception of Rainstorm, Post-Traumatic Stress Disorder Checklist-Civilian version (PCL-C), Depression, Anxiety and Stress Scale-21 (DAS-21) and Chinese version of Social Support Rating Scale (SSRS) were used to evaluate the rainstorm exposure, subjective perception of the rainstorm, psychological symptoms and social support of the disaster-stricken residents within a week after the rainstorm. Logistic regression analysis was used to examine the psychological status and related factors of local residents after the rainstorm disaster.
Results:
A total of 469 valid samples were obtained in this study. All the subjects were in the disaster area and experienced the rainstorm personally, with normal intelligence. The statistical results showed that 25.37% people had experienced at least three rainstorm-related stresses, nearly 20.26% people had post-traumatic stress disorder (PTSD) symptoms, and 39.3%, 53.92% and 65.83% people had depression, anxiety and stress symptoms, respectively. Multivariable logistic regression analyses indicated that female (all p < 0.05), the divorced, agricultural workers/farmers (all p < 0.05), students (all p < 0.05), people experiencing at least three rainstorm-related stresses (p < 0.05 or p < 0.01), people with lower satisfaction at the social flood fighting measures (p < 0.05 or p < 0.01) and people with low social support (p < 0.05 or p < 0.01) were all independent risk factors for poor psychological health, and college education or above (p < 0.05 or p < 0.01), the lower degree of worrying about themselves (all p < 0.01), family members (all p < 0.01) and family property (all p < 0.01) were all related to higher psychological health among flood survivors after the disaster.
Conclusions:
Rainstorm could cause local residents to have various degrees of psychological symptoms. This study identified factors associated with the psychological health of disaster-stricken residents, which could be used to develop psychological interventions in improving psychological health of local residents.
... Relational frames exist as associations that individuals develop toward objects, ideas, and individuals, and a relational frame forms the base unit of a highly dynamic, ever-expanding, linguistic and cognitive network that all humans possess. These relational frames develop contextually and automatically on a constant basis (Hayes, 2019 (Gardner & Moore, 2004;Kashdan et al., 2009;Serrano et al., 2017). ACT, therefore, uses strategies to aid individuals in overcoming experiential avoidance by moving towards the things that matter to them, known as their values, despite the inevitable discomforts they may experience. ...
Music performance anxiety (MPA) seriously affects nearly all musicians at some point in their lives and may cause musicians to abandon their careers or develop maladaptive coping mechanisms to manage their symptoms. While peer-reviewed studies have explored a broad array of psychological treatments for MPA, a paucity of research exists regarding expert classical guitarists’ recommendations for MPA symptom management. Since all post-secondary guitar instructors at the expert level interact with MPA in themselves and their students, and each instrumental discipline has idiosyncratic presentations of MPA, this dissertation seeks to understand common approaches and MPA management strategies from the perspective of classical guitar instructors at the post-secondary level—a cohort which includes the researcher. The project compares guitar experts’ recommendations with existing treatment protocols from psychology to understand MPA from a deeper scientific and heuristic perspective while providing pathways for novel research in this topic.
This research concluded that guitarists’ approaches prioritized performance excellence and complete mental and physical preparation to manage MPA, while psychological treatments prioritized cognitive components of MPA, musician’s well-being, and symptom reduction. An impressive convergence of approaches appeared in the guitar and psychology literature, particularly regarding the use of mindfulness strategies and strategies from sports psychology.
... According to previous refugee-related studies (65), trauma survivor groups exhibit high proportions of major depressive and social anxiety disorders. Studies on war survivors showed that social anxiety hinders one's ability to cultivate satisfying social relationships and prevents exposure to situations that cause positive emotional experiences, slowing recovery as a result (66). In addition, the biggest difficulty in supporting NKDs is their "anxiety and distrust" (67). ...
Background
North Korean defectors (NKDs) are known to be vulnerable to depression due to the influence of various psychosocial factors during their settlement process. Therefore, this study aimed to explore different trajectories of depressive symptoms in NKDs and identify predictors of the worsening of depressive symptoms. In particular, the focus was on whether posttraumatic stress disorder (PTSD) functions as a significant predictor.
Methods
Participants consisted of 300 NKDs who settled in South Korea within 3 years of entering in the country. Five waves of longitudinal data collected from 2016 to 2019 were used. In this study, the North Korean Composite International Diagnostic Interview (NK-CIDI), a diagnostic interview tool, was conducted at baseline and depressive symptoms were measured at each wave. Trajectory identification was based on latent class mixed modeling. Logistic regression was used to extract the significant factors predicting a high/increasing depressive symptom trajectory.
Results
Two trajectories of depressive symptoms were identified: “low/stable symptom” (76.7% of participants) and “high/increasing symptom” (23.3% of participants). Predictors of the high/increasing symptom group were being female and a low use of mental health services. Generalized anxiety disorder, social phobia, and alcohol dependence acted as significant predictors. Although PTSD was not a significant predictor, self-reported PTSD symptom scores were high in the high/increasing symptom group.
Conclusions
Identifying the trajectories of depressive symptoms in NKDs helps identify the risk factors of clinically vulnerable groups. In the process of establishing government-level interventions, it may be helpful to create a therapeutic environment. In addition, when evaluating initial psychiatric problems, it is important to primarily consider NKDs' anxiety levels and alcohol problems. There should also be an appropriate consideration of PTSD symptoms.
... As self-concealment is a deliberate emotion regulation strategy, prisoners used a form of emotion-focused coping to some extent (Lazarus, 1993;Lazarus & Folkman, 1984), in which they attempted to reduce distress by concealing information related to the trauma from others (Larson & Chastain, 1990;Larson et al., 2015) without changing the stressful situation itself. However, such coping has been associated with poor quality of life and psychiatric comorbidity in trauma victims (Amstadter & Vernon, 2008;Chung et al., 2016;Gross & John, 2003;Kashdan et al., 2009;Tull et al., 2004Tull et al., , 2007. Hiding stressful emotions, rather than processing them, can impact on the physiological and neurological systems, leading to health problems (Pennebaker, 1995), psychological symptoms (e.g., Amstadter & Vernon, 2008) and negative affect (Gross & John, 2003). ...
Background:
Research reported prevalence of post-traumatic stress disorder (PTSD) among prisoners varies between countries, with most studies based on Western samples. The trajectory of symptoms has also been controversial. Trauma can affect prisoners' emotions and their emotional regulation tends to be maladaptive.
Aims:
To examine changes in PTSD and psychiatric comorbidity among prisoners in China over time and to determine whether anger and self-concealment predicts later distress.
Method:
In a longitudinal, prospective study, sentenced men in one prison in China were asked to complete a demographic page and several self-rating scales: the Post-traumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Clinical Anger Scale and the Self-Concealment Scale at baseline and at 6 and 12 months after the initial assessment.
Results:
More than half of the 496 participating men were diagnosed with PTSD. For those completing the scales at each evaluation, PTSD-DS scores were significantly lower at baseline than at the 6-month and 1-year assessments. No significant differences were found between the two follow-up scores. There was no significant difference in psychiatric comorbidity between the three phases. At the cross-sectional level, after controlling for age and education level, PTSD, anger and self-concealment were associated with psychiatric comorbidity. At the prospective level, anger predicted PTSD 6 months and 1 year later. Self-concealment predicted psychiatric comorbidity over time.
Conclusions:
Among these prisoners the prevalence of chronic PTSD was far higher than in general population estimates. Early identification of aspects of coping styles is likely to help predict disorder trajectory and inform interventions. Early signs of anger were indicative of the chronic severity of trauma reactions, while the intention to hide distress was related to other later mental health problems.
Forced migration, as exemplified by the ongoing Syrian refugee crisis, has been linked to elevated psychiatric issues such as post-traumatic stress disorder (PTSD), depression, anxiety, and increased suicide risk. This study explores the mediating role of anxiety sensitivity (AS) in the relationship between PTSD symptoms and suicide risk among Syrian refugees in Turkey. Data were collected from 574 Syrian refugees aged 18–65 years residing in Bursa province, using validated self-report scales, including the Impact of Events Scale-Revised (IES-R), the Beck Depression Inventory (BDI), the Anxiety Sensitivity Index-3 (ASI-3), and the Suicide Probability Scale (SPS). Pearson correlation, independent samples t-test, and multiple binary logistic regression were employed for statistical analysis, while mediation analyses were performed using PROCESS for SPSS. The prevalence of PTSD among participants was 81.2%. Regression analyses indicated that while IES-R intrusion and hyperarousal subscales increased suicide risk, IES-R avoidance and ASI-3 physical concern subscales decreased it. Mediation analysis revealed a partial mediating effect of ASI-3 cognitive concern in the relationship between PTSD symptoms and suicidal ideation. Findings suggest that addressing cognitive concern may help mitigate suicide risk in PTSD-affected migrants. Additionally, avoidance and physical concern may act as temporary protective factors against suicide. These results highlight the need for tailored, trauma-focused mental health interventions to stabilize suicide risk before commencing PTSD treatment in forcibly displaced populations.
Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition characterized by impaired fear extinction and disruptions in social behavior. The neural mechanisms underlying resilience and susceptibility to the development of PTSD remain poorly understood, particularly the role of prefrontal-amygdala circuits. In this study, we investigated the functional contributions of top-down projections from the infralimbic cortex (IL) to the basolateral amygdala (BLA) and bottom-up BLA-to-IL projections in resilient and susceptible phenotypes. Using an animal model of PTSD that was implemented in our laboratories, we used two different phenotypes of in-bred rats, PTSD-resilient and susceptible animals based on their fear-related behaviors following trauma exposure. Optogenetic inhibition of glutamatergic neurons projecting from the IL to the BLA was performed in resilient animals, while BLA-to-IL projections were inhibited in susceptible animals. With the support of behavioral assays, contextual fear conditioning and social interaction tests, we assessed fear extinction and social behavior, respectively, to explore circuit-specific roles through the effects of the optogenetic manipulation. It was hypothesized that the optogenetic inhibition on resilient rats would impair traumatic memory extinction, likely due to reduced top-down control exerted by the IL. Conversely, in susceptible rats, the same inhibition was expected to enhance traumatic memory extinction by reducing excitatory input from the amygdala.
Our findings demonstrate that with the inhibition of BLA-IL pathway, susceptible animals had an accelerated fear extinction without any influence on social behavior; conversely, the inhibition of IL-BLA pathway in resilient animals had no influence on freezing behavior, while causing significantly reduced levels of social interaction. These results suggest distinct prefrontal-amygdala circuits that mediate different aspects of trauma-related behavior, with the BLA-IL pathway contributing to the extinction in susceptible phenotype, while IL-BLA pathway supporting the social regulation in resilient animals. Importantly, our findings emphasize the heterogeneity of PTSD-related circuits and the need for targeted therapeutic interventions based on individual profiles.
This study advances the understanding of the neural mechanism underlying PTSD and resilience to the disease, providing a foundation for developing circuit-specific approaches to treating trauma-related disorders. By the leverage of optogenetic tools, we reveal the role of prefrontal-amygdala pathways to the behavioral effects of PTSD, offering new opportunities for translational research.
The study was conducted during the first 8 months of the Russo-Ukrainian war, investigating an interplay of resilience, coping strategies and perceived stress in Ukrainians of various age groups, war experiences and displacement statuses. The study was conducted on the sample of 18–76-year-old Ukrainians ( n = 337) using the COPE, CD-RISC-10 and PSS-14 scales. It aimed to understand how Ukrainians cope with war-stressors and stay resilient. Data analyses, including Bayesian ANOVA, independent samples t-tests, linear regressions and bivariate correlation, were conducted using JASP and IBM SPSS-23. The results of the quantitative study showed that Ukrainians attributed their resilience to perceived self-efficacy, regulating emotions and flexibility. It was also found that the pattern of most and least preferred coping strategies was relatively consistent across all the sample subgroups. Thus, to cope with war, Ukrainians relied on ‘planning’, ‘positive interpretation and growth’, ‘acceptance’ and ‘active coping’ and refrained from ‘behavioural disengagement’, ‘denial’ and ‘substance use’. It was concluded that coping strategies may be significant predictors of Ukrainians’ resilience.
Background: Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders.
Aims: This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions.
Methods: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis.
Results: The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country’s economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries.
Conclusions: The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses.
PROSPERO registration number: CRD42023416096.
Given the increasing population of elderly in different societies, it is important to pay attention to their basic needs and their physical, mental health and quality of life. Therefore, the present study aimed to determine the causal model of quality of life of the elderly based on anxiety sensitivity through the mediating role of experiential avoidance. It was a descriptive and structural equations study. The statistical population of this study included all elderly people living in nursing homes in Ardabil, among which two homes, Mandegaran and Atta, were randomly selected, and 150 elderlies were selected using convenience sampling. World Health Organization quality of life questionnaire, Reiss and Peterson anxiety sensitivity questionnaire, acceptance and action questionnaire of Hayes et al. were used to collect data. Data were analyzed using structural equation modeling using SPSS 23 and Lisrel 8.8. Based on the results, the causal model confirmed the relationship between anxiety sensitivity, experiential avoidance and life quality of elderly based on different fit indices. Anxiety sensitivity and experiential avoidance showed a direct influence on quality of life of the elderly; also, anxiety sensitivity indirectly effected on life quality of the elderly through experiential avoidance (P<0.05). Therefore, anxiety sensitivity and experiential avoidance play an important role in life quality of the elderly and targeting these two components by psychological therapies could be effective in enhancing life quality of the elderly.
Стаття присвячена питанням адаптації до складних життєвих обставин людей із соціальним тривожним розладом. У статті аналізуються та висвітлюються стратегії опанування дистресу через уникнення, а також їхня роль у патогенезі соціальної тривоги й фобії та адаптації до умов війни. Обговорюється теоретичний взаємозв’язок між когнітивними стратегіями уникнення, соціальною тривогою та розвитком посттравматичних порушень. Зазначене обумовлює актуальність обраної теми. У статті продемонстровані результати емпіричного дослідження впливу когнітивних стратегій уникнення на психоемоційний стан осіб із соціальним тривожним розладом у контексті воєнного періоду. Автор вказує на те, що уникнення може бути короткостроковою спробою контролювати психоемоційний стан та адаптуватися до стресових обставин воєнного періоду. Зазначено, що особи із соціальним тривожним розладом в анамнезі мають вищу схильність до використання стратегій когнітивного уникнення, що в довгостроковій перспективі можуть поглибити соціальну фобію та обмежити адаптацію і якість життя. Означені стратегії є основним предиктором психоемоційного дистресу в робочій та повсякденній діяльності, а також корелюють зі зростанням клінічної симптоматики соціального тривожного розладу та психоемоційним дистресом через соціальне уникнення. Автор зазначає, що соціальне уникнення, яке може бути наслідком стратегій когнітивного уникнення, також може сприяти погіршенню клінічних симптомів соціального тривожного розладу. Відмова від соціальних ситуацій або уникнення соціальних взаємодій може призвести до соціальної ізоляції та подальшого заглиблення тривожних симптомів. Крім того, погіршення самоусвідомленості та емоційної гнучкості може бути результатом надмірного використання стратегій уникнення. Це може ускладнити процес адаптації до стресових ситуацій та опрацювання травматичного досвіду. Додатково продемонстровано вплив вимушеного переселення через війну як одного з модифікуючих факторів загострення проблем асоційованих як із травматичним досвідом, так і із соціальним тривожним розладом. Дослідження підкреслює важливість розгляду індивідуальних переконань та стратегій уникнення в контексті соціальної фобії, а також необхідність розвитку програм психосоціальної підтримки для цільової групи.
Actuality. Long-term exposure to stressors associated with martial law hurts the mental state of the country's population. One of the risk groups is education seekers, for whom it is possible to sum up the stressful impact of education and other zonal factors. Earlier, in the example of countries in Africa, the Middle East and Kosovo, it was proven that the symptoms of anxiety and depressive disorders increased during military conflicts, particularly among medical students.
The work aimed to study the symptoms of anxiety and depression in students of higher medical education at the Dnipro State Medical University and to determine their impact on the mental component of quality of life.
Materials and methods: a four-fold one-moment cross-sectional survey questionnaire was conducted on the Google Forms platform. We interviewed 193 medical students of the Dnipro State Medical University. Data were collected after one, three, ten months and one year from the beginning of martial law. The level of anxiety was assessed using the generalized anxiety disorder scale (GAD-7), depression was assessed using the Patient Health Questionnaire (PHQ-9), and the mental component of quality of life was assessed using a self-administered questionnaire based on the VAS.
Results. The median level of anxiety symptoms according to GAD-7 at the first stage of the study was 8 [5; 14] points with further reduction in the fourth stage to 5.5 [3.5; 7.5] points. The median level of depressive symptoms determined by PHQ-9 varies from 11 [6; 14] points after 1 month to 7.5 [4; 10] points 1 year after the start of martial law. Subjective assessment of working capacity in the subjects was 4 [3; 7] points for VAS with dynamics from 6 [4; 8] after 1 month of martial law, to 4.5 [4; 6] points after 1 year. According to the results of the correlation analysis, a relationship between indicators of anxiety, depression and the mental component of the quality of life was revealed. The correlation between anxiety and depression persisted as the duration of martial law increased, as did the relationship between anxiety and the mental component of quality of life at 1, 3, and 10 months of martial law. But after 12 months of martial law, anxiety ceases to affect the quality of life of the surveyed education seekers.
Conclusions. Univariate and multiple logistic analyses were used to explore the psychometric characteristics that correlated with achieving a sufficient level of the mental component of quality of life. The combination of GAD-7 ≥ 10 and PHQ-9 ≥ 10 had the best predictive ability among the constructed models, for which the AUC was 0.777 (95% CI 0.711 – 0.834). By incorporating the ability to work into the model, we enhance its predictive power, resulting in an AUC of 0.844 (95% CI 0.785 – 0.892), which signifies its exceptional predictive capabilities. Thus, the presence of anxiety for GAD-7 more than 10 points increases the chances of not achieving quality of life by 2.885 (95% CI 1.167 – 7.133) times, the presence of depression for PHQ-9 more than 10 points – by 2.689 (95% CI 1.182 – 6.117) times, and subjectively reduced ability to work – 1.434 (95% CI 1.193 – 1.725) times.
This study investigated the intergenerational transmission of trauma from Croatian war veterans to their children who were born after the war. This was done by measuring the frequency of relational anger and relational guilt expressed by children of Croatian war veterans in structured interviews. Children were administered: a demographic questionnaire; the Trauma Symptom Checklist for Children (TSCC); and the Relationship Anecdotes Paradigm (RAP) structured interview. Comparing children with high and low paternal exposure to combat trauma was defined narrowly as the father’s veterans’ status–former POW or non-former POW. The results did not support the hypotheses that greater parental exposure to war trauma would be related to children expressing relational anger and relational guilt more frequently. An alternative and more comprehensive measure of parental trauma was then developed that combined self-reports of wartime experiences and current sense of safety by both parents. This broader and more comprehensive measure of trauma did find that children who expressed more relational anger and guilt had parents with higher rates of exposure to war trauma. The results suggested the importance of assessing parental exposure to trauma comprehensively – both parents with dimensional rather than categorical measures of trauma exposure – in order to better identify children who may be struggling with difficult though sub-clinical posttraumatic emotions like relational anger and guilt. The clinical implications of the study are that clinicians can help veterans’ families overcome the potentially limited awareness and restrictive coping strategies they may have developed in response to parental trauma. Therapists can help children explore the combination of curiosity and anxiety they may feel about their parents’ past traumatic experiences, and the post-traumatic worldviews and interpersonal styles they may have internalized from their parents. Ukrainian translation of the paper was provided by Kateryna Bagan.
The protracted war in Ukraine, sparked in 2014 and persistently escalating, has significantly impacted the country’s healthcare system. It has amplified existing challenges, such as shortages of medical supplies and personnel, outdated infrastructure, and restricted access to healthcare services. Destruction of medical facilities, non-adherence to prevention and treatment standards, lack of medical personnel and supplies, and logistical disruptions are hampering the provision of timely healthcare to the Ukrainian population. This study employed a rapid review methodology to synthesize available research concerning the healthcare crisis in Ukraine, with an explicit focus on the war’s sustained impact on the healthcare system. Through this review, a series of critical challenges facing Ukraine’s healthcare system were identified. These included the shortage of medical supplies and personnel, insufficient infrastructure, and funding deficits. Additionally, the review brought to light various interventions and strategies aimed at counteracting these challenges. These comprised international aid and support, initiatives enhancing the resilience of the Ukrainian health system, and others. Given the ongoing war, this review highlighted the pressing need for continuous support and investment in the Ukrainian healthcare system. This commitment is essential to guarantee access to quality healthcare for the Ukrainian population during the war and in its aftermath. The findings presented here can serve as a guide for policymakers and healthcare professionals working not only in Ukraine but also in other regions impacted by war. These insights can inform the development and implementation of effective strategies and interventions tailored to such challenging contexts.
Latinx persons are exposed to higher rates of traumatic events and conditional risks for developing posttraumatic stress disorder (PTSD) symptoms and comorbid mental health symptoms compared to other minority groups. The study evaluated PTSD symptom severity for global and specific cluster severity relating to co-occurring anxiety, social anxiety, depression, and suicidal ideation among 326 Latinx adults who endorsed trauma exposure. Results indicated that global PTSD symptom severity was significantly related to greater social anxiety, anxious arousal, depression, and suicidal ideation symptoms. PTSD arousal and reactivity symptom cluster had the strongest relation to anxious arousal, social anxiety, and depression, whereas negative alterations in cognitions and mood symptoms had the strongest association with social anxiety, depression, and suicidal ideation. The findings suggest that global PTSD symptom severity, alongside arousal and reactivity and negative alterations in cognitions and mood, are related to a range of concurrent negative mental health symptoms among trauma exposed Latinx young adults.
Numerous randomized controlled trials have shown cognitive behavior therapy (CBT) to be effective in treating social anxiety disorder (SAD). Yet, less is known about the effectiveness of CBT for SAD conducted by psychotherapists in training in routine clinical practice. In this study, 231 patients with SAD were treated with CBT under routine conditions and were examined at pre‐ and post‐treatment as well as at six and 12 months follow‐up. We applied self‐reports to assess symptoms of SAD (defined as primary outcome), depression and psychological distress (defined as secondary outcome). We conducted both completer and intent‐to‐treat analyses and also assessed the reliability of change with the reliable change index. Results revealed significant reductions in symptoms of SAD between pre‐ and post‐assessments, with effect sizes ranging from d = 0.9 to 1.2. Depending on the SAD specific questionnaire applied, 47.8% to 73.5% of the sample showed a reliable positive change, whereas 1.9% to 3.8% showed a reliable negative change. Depressive symptoms and psychological distress also decreased significantly from pre‐ to post‐assessment, with large effect sizes. Significant treatment gains regarding both primary and secondary outcomes were further observed at six and 12 months follow‐up. The current findings based on a large sample of patients suggest that psychotherapists in CBT training working under routine conditions can effectively treat symptoms of SAD, depression and psychological distress.
Deployment-related posttraumatic stress disorder (PTSD) impacts social functioning in families. Therefore, it is important to examine the factors that contribute to social functioning in families that are confronted with deployment-related PTSD. The goal of this study was to assess the association between PTSD symptom severity and social functioning using self-report questionnaires in an outpatient veteran sample and to test the mediating roles of emotion regulation (Study 1, N = 100) and mentalization (Study 2, N = 38). Study 1 demonstrated that emotion regulation problems fully mediated PTSD associated family dysfunctioning. Study 2 did not demonstrate a mediation role of mentalization, but also did not demonstrate an association between PTSD and social dysfunctioning. Maladaptive mentalization was associated with poor child adjustment. Critically, a between-study comparison revealed that PTSD symptom severity was significantly higher in Study 1 than in Study 2. Overall, our findings suggest that social dysfunctioning may only appear when a given severity threshold of PTSD is reached, in which emotion regulation might be a key clinical factor. Maladaptive mentalization may be critical for post-deployment child adjustment. Future research should further examine social functioning in samples with different PTSD severity profiles and include the role of mentalization. Longitudinal data are needed to gain further insight into the causal relationships among the factors considered and the etiological pathways that lead to developing social dysfunction over time.
Background: Increasing age, decreasing social efficacy perception due to retirement, and getting the children away cause feeling loneliness in the elderly. Aims: this study was conducted to investigate the role of experiential avoidance and psychological capitals in predicting feeling loneliness by mediating the meaning in life in the elderly in the city of Isfahan.
Method: The study was descriptive-correlational of structural equation modeling type. The statistical population of the study included the elderly in the city of Isfahan in 2018. The study sample was 253 elderly people who were selected through convenience sampling. The applied instruments included the loneliness scale (Russel, 1996), the psychological capital questionnaire (Lotanz and Olio, 2007), the meaning in life questionnaire(Stagger et al., 2006), and the acceptance and action questionnaire (Bond et.al, 2011). After collecting questionnaires, the data were analyzed through Pearson correlation and structural equation modeling methods.
Results: The results showed that there were significant relationships between the variables (p˂0/001). Moreover, the mediating role of the meaning in life in the relations of experiential avoidance and psychological capitals to feeling loneliness in the elderly was confirmed.
Conclusions: Developing meaning in life in elderly, can overcome felling of loneliness and experiential avoidance.
This study aimed to explore the background of traumatic events and possible preventive measures among health care workers. We analyzed data from 84 compensated health care workers who experienced traumatic events between 2010 and 2017. We found that about half of the workers had encountered violence, and nearly half were alone at the time of the violence event. In addition, the victims were not helped by colleagues at the time of the violence event because their colleagues could not help them quickly enough. The assailants most likely experienced symptoms from dementia or mental illness, which contributed to the traumatic events. However, in the majority of cases, any underlying disease or symptoms the assailants who caused the traumatic events might have experienced had not been recognized. In addition, the particular complaints of the assailants, such as “I want to go home,” might have been background factors that contributed to the events. In order to create a safe workplace where health care workers can provide high quality care, it is necessary to enhance the mental health care system and train health care workers in and increase their knowledge about preventing violence. Moreover, it is also critical to establish a system that encourages the application of this knowledge in the workplace.
Structural equation modeling procedures were used to examine relationships among several war zone stressor dimensions, resilience–recovery factors, and post–traumatic stress disorder symptoms in a national sample of 1,632 Vietnam veterans (26% women and 74% men). A 9-factor measurement model was specified on a mixed-gender subsample of the data and then replicated on separate subsamples of female and male veterans. For both genders, the structural models supported strong mediation effects for the intrapersonal resource characteristic of hardiness, postwar structural and functional social support, and additional negative life events in the postwar period. Support for moderator effects or buffering in terms of interactions between war zone stressor level and resilience–recovery factors was minimal.
The coping behaviors and posttraumatic stress disorder (PTSD) symptoms of 215 female assault victims (103 rape victims and 112 nonsexual assault victims) were assessed within 2 weeks following the assault (Time 1), and 133 of them (62%) were followed up 3 months later (Time 2). Posttrauma symptom severity significantly decreased during the 3-month study period, but PTSD severity levels at Times 1 and 2 were highly correlated. Three coping scales were constructed on the basis of exploratory factor analyses: Mobilizing Support, Positive Distancing, and Wishful Thinking. Three months postassault, rape victims showed higher levels of wishful thinking and PTSD than nonsexual assault victims. Wishful thinking showed a positive association and positive distancing a negative association with PTSD severity, controlling for assault type, initial levels of PTSD severity, and other coping strategies. The clinical relevance of these findings is discussed.
Extrapolating from B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions, the authors hypothesized that positive emotions are active ingredients within trait resilience. U.S. college students (18 men and 28 women) were tested in early 2001 and again in the weeks following the September 11th terrorist attacks. Mediational analyses showed that positive emotions experienced in the wake of the attacks - gratitude, interest, love, and so forth - fully accounted for the relations between (a) precrisis resilience and later development of depressive symptoms and (b) precrisis resilience and postcrisis growth in psychological resources. Findings suggest that positive emotions in the aftermath of crises buffer resilient people against depression and fuel thriving, consistent with the broaden-and-build theory. Discussion touches on implications for coping.
The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region. and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.
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.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAO) were then examined in 8 additional samples. All totaled, over 2,400
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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)
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
In this commentary we review the theoretical positions of Roemer and Orsillo and identify several key issues. First, the specificity of their arguments to generalized anxiety disorder (CAD) compared to the other anxiety disorders are explored. For example, the proposed distinctions between worry in CAD and worry associated with the other anxiety disorders are examined in light of available empirical evidence. Second, the proposed disjunctions between mental content and both actual experience and emotional/physiological responding are placed in the context of current theoretical and empirical work. Finally, possible therapeutic mechanisms of change for mindfulness/acceptance-based treatments and the roles of control and predictability in anxiety disorder treatment are discussed.
The present study investigates experiential avoidance and forgiveness, two general
response styles to emotional distress that may impact reactions to trauma exposure,
as potential mediators of the link between interpersonal trauma exposure and
Posttraumatic Stress Disorder (PTSD) symptoms in a cross–sectional survey of 229
undergraduate students reporting interpersonal trauma exposure. Utilizing structural
equation modeling techniques, both constructs were found to significantly
partially mediate the relation between interpersonal trauma exposure and PTSD
symptoms; experiential avoidance reduced the relation between interpersonal
trauma exposure and PTSD symptoms by 22% while forgiveness reduced this relation
by 14%. Thus, individuals who were lower in forgiveness and higher in experiential
avoidance reported higher PTSD symptoms than those higher in forgiveness
and lower in experiential avoidance. Implications for treatment and prevention of
PTSD symptoms are discussed.
Psychological abuse in childhood has been linked to psychological
distress in adulthood, although the interceding variables or
possible mediators for the adult distress have not been adequately examined.
Identification of mediating variables may provide important opportunities
for targeting intervention and prevention efforts following
psychological abuse. Experiential avoidance, a response style characterized
by avoidance of negative private events, was examined as a potential
mediator of the relationship between reports of childhood psychological
abuse and current mental health symptoms in a cross-sectional
sample of 987 college undergraduates. Utilizing structural equation
modeling techniques, experiential avoidance was found to significantly
mediate the relationship between childhood psychological abuse and
current mental health symptoms, reducing the direct effect by 77%. A
history of childhood psychological abuse was related to increased levels
of experiential avoidance and current mental health symptoms, and experiential
avoidance was also directly related to increased levels of current
mental health symptoms. Implications for treatment following
psychological abuse are discussed.
Analytical solutions for point and variance estimators of the mediated effect, the ratio of the mediated to the direct effect, and the proportion of the total effect that is mediated were studied with statistical simulations. We compared several approximate solutions based on the multivariate delta method and second order Taylor series expansions to the empirical standard deviation of each estimator and theoretical standard error when available. The simulations consisted of 500 replications of three normally distributed variables for eight sample sizes (N = 10, 25, 50, 100, 500, 1000, and 5000) and 64 parameter value combinations. The different solutions for the standard error of the indirect effect were very similar for sample sizes of at least 50, except when the independent variable was dichotomized. A sample size of at least 500 was needed for accurate point and variance estimates of the proportion mediated. The point and variance estimates of the ratio of the mediated to nonmediated effect did not stabilize until the sample size was 2,000 for the all continuous variable case. Implications for the estimation of mediated effects in experimental and nonexperimental studies are discussed.
Background: This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence.
Method: We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events.
Results: The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD.
Conclusion: The findings suggest that many cases of PGD would be missed by an exclusive focus on PTSD among bereaved war survivors.
Aims: The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS).
Methods: In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression.
Results: Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24—42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD.
Conclusion: The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.
Posttraumatic stress disorder (PTSD) is a psychiatric condition that is directly precipitated by an event that threatens a person's life or physical integrity and that invokes a response of fear, helplessness, or horror. In recent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an important challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summarizes the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergency room immediately following trauma exposure. In the aggregate, these studies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time compared to those who do not. In contrast, certain features associated with PTSD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immediate aftermath of a traumatic event, which in turn leads to a maladaptive psychological state.
Confirmatory factor analysis was used to compare 6 models of posttraumatic Stress disorder (PTSD) symptoms, ranging from I to 4 factors, in a sample of 3,695 deployed Gulf War veterans (N = 1,896) and nondeployed controls (N = 1,799). The 4 correlated factors-intrusions, avoidance, hyperarousal; and dysphoria-provided the best fit. The dysphoria factor combined traditional markers of numbing and hyperarousal. Model superiority was cross-validated in multiple subsamples, including a subset of deployed participants who were exposed to traumatic combat stressors. Moreover, convergent and discriminant validity correlations suggested that intrusions may be relatively specific to PTSD, whereas dysphoria may represent a nonspecific component of many disorders. Results are discussed in the context of hierarchical models of anxiety and depression.
Worldwide, post-traumatic stress disorder (PTSD) is among the most common psychological disorders; over the past three decades researchers have made considerable progress in understanding the prevalence of PTSD and its psychological and biological underpinnings, while developing methods for its assessment and treatment. Only included in the diagnostic nomenclature since 1980, the history of PTSD extends as far back as the oldest literature in Western civilization. Homer's Iliad and Odyssey capture the impact of war on combatants and civilians, as do many of the works of writers and artists across the centuries. The focus of this chapter is on the integration of contemporary work on traumatic stress exposure, psychological dissociation, and the development of PTSD, a disorder characterized by concurrent high levels of anxiety and depression and, in many instances, considerable chronicity and disability. More than 50 randomized controlled treatment outcome studies suggest that cognitivebehavioral treatments are especially effective, and support the use of exposure therapy, stress management therapy, cognitive therapy, cognitive processing therapy, and eye movement desensitization and reprocessing in treating PTSD. All these approaches constitute key evidence-based psychological treatments for PTSD. Future work will determine which treatments used by which therapists are best for patients with specific symptoms and concomitant conditions.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
In this commentary we review the theoretical positions of Roemer and Orsillo and identify several key issues. First, the specificity of their arguments to generalized anxiety disorder (CAD) compared to the other anxiety disorders are explored. For example, the proposed distinctions between worry in CAD and worry associated with the other anxiety disorders are examined in light of available empirical evidence. Second, the proposed disjunctions between mental content and both actual experience and emotional/physiological responding are placed in the context of current theoretical and empirical work. Finally, possible therapeutic mechanisms of change for mindfulness/acceptance-based treatments and the roles of control and predictability in anxiety disorder treatment are discussed.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:593-602), an author’s name was inadvertently omitted from the byline and author affiliations footnote on page 592, and another author’s affiliation was listed incorrectly. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” The author affiliations footnote should have appeared as follows: “Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler; Mss Demler and Walters; and Mr Jin); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); and Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Rockville, Md (Dr Merikangas).” On page 601, the first sentence of the acknowledgment should have appeared as follows: “The authors appreciate the helpful comments of William Eaton, PhD, and Michael Von Korff, ScD.” Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
The ascendance of emotion theory recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts rite development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.
Armed conflict is a major cause of injury and death worldwide, but we need much better methods of quantification before we can accurately assess its effectArmed conflict between warring states and groups within states have been major causes of ill health and mortality for most of human history. Conflict obviously causes deaths and injuries on the battlefield, but also health consequences from the displacement of populations, the breakdown of health and social services, and the heightened risk of disease transmission. Despite the size of the health consequences, military conflict has not received the same attention from public health research and policy as many other causes of illness and death. In contrast, political scientists have long studied the causes of war but have primarily been interested in the decision of elite groups to go to war, not in human death and misery.We review the limited knowledge on the health consequences of conflict, suggest ways to improve measurement, and discuss the potential for risk assessment and for preventing and ameliorating the consequences of conflict. Summary points Conflict related death and injury are major contributors to the global burden of disease Information systems break down during conflict, leading to great uncertainty in the magnitude of mortality and disability The World Health Survey may provide a reliable and valid basis for assessing conflict related mortality and disability Forecasting models may provide a plausible basis for assessing risk of conflict and thus prevention Improved collaboration between political scientists and experts in public health would benefit measurement, prediction, and prevention of conflict related death
The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the Mini the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-IH-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxietydisorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Inter-rater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-HI-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.
Reports on the development of the Lancashire Quality of Life Profile by G. W. Torrance (1987) for evaluating services to the chronically mentally ill. The term "quality of life" is defined and its components enumerated. The process of questionnaire piloting is recounted, and the results of reliability and validity testing procedures are presented and discussed. The profile was found to be reliable and valid to acceptable levels, easy to administer, and well received by clients. However, problems have been encountered in worker compliance with routine evaluation within service settings that can affect implementation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the absence of any comprehensive or sophisticated empirical literature on the relationship between gender and posttraumatic stress disorder (PTSD), this chapter should be viewed as an exploration of the possible relationships between these 2 constructs and, particularly, about why data appears to conclude that women are more vulnerable to traumatic events than men. We specifically outline areas of study that can lead to the development of further empirical study of the relationship between gender and PTSD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The ability of the self to alter its own responses, including thoughts, emotions, impulsive behaviors, and performances, is powerfully adaptive, and failures of selfcontrol contribute to most personal and social problems. A program of laboratory studies suggests that self-control depends on a limited resource, akin to energy or strength. Acts of self-control and, more generally, of choice and volition deplete this resource, thereby impairing the self's ability to function. These effects appear after seemingly minor exertions because the self tries to conserve its remaining resources after any depletion. Rest and positive affect help restore the self's resources.
Posttraumatic stress disorder (PTSD) is the only anxiety disorder for which a specific event is seen as responsible for the
etiology of the symptoms. More specifically, PTSD is diagnosed when a person has been exposed to a potentially traumatic event
(e.g., sexual assault, combat, motor vehicle accident), during which the person experienced intense fear, helplessness, or
horror (American Psychiatric Association, 1994), followed by a particular constellation of resulting symptoms. There are three
main classes of symptoms in PTSD: reexperiencing, avoidance, and arousal. Reexperiencing symptoms may include distressing
memories, nightmares, flashbacks, and intense distress or physiological reactivity upon exposure to internal or external cues
related to the event.
Many psychotherapeutic traditions have conceptualized clinical levels of anxiety as resulting from the avoidance of threatening or emotional material. In this paper, we examine behavioral models of avoidance of emotions and emotional material, integrating findings that support established behavioral theories of emotional avoidance and anxiety, and that extend these theories to further explain the intense, intrusive,
and interfering nature of clinical anxiety. Research on the suppression and avoidance of emotional material suggests that emotional avoidance and thought suppression may not only hinder the learning process and maintain anxious responding, but may also (a) paradoxically heighten anxious responding to threatening cues and (b) interfere with emotion functionality, thereby further impeding adaptive responding. Findings are discussed in terms of future research and implications for clinical treatment of anxiety disorders.
The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview, developed in clinician (MINI-CR) and patient-rated (MINI-PR) formats, for 17 Diagnostic and Statistical Manual (DSM)-III-R Axis I psychiatric disorders. This study, which investigates the validity of the MINI in relation to the Structured Clinical Interview for DSM-III-R Patients (SCID-P), was conducted in conjunction with a similar study, investigating the validity of the MINI in relation to the Composite International Diagnostic Interview (CIDI) for International Statistical Classification of Disease (ICD)-10. Both studies also examined the inter-rater and test-retest reliability of the MINI. Three hundred and seventy subjects (330 in Florida and 40 in Paris) participated in the validation of the MINI versus the SCID-P. Of these, 308 had at least one psychiatric disorder and 62 were non-patient adult controls. Eighty of the subjects (40 in Florida and 40 in Paris) also participated in the parallel study of the validity of the MINI versus the CIDI. The 330 Florida subjects first completed the patient-rated version of the MINI. All subjects were administered the MINI-CR (after the MINI-PR in the case of the Florida subjects), followed by the SCID-P. The MINI-CR was rated by two interviewers for 42 subjects in Florida and 42 in Paris (inter-rater reliability test) and readministered by a third blind interviewer one to two days after the initial rating (test-retest reliability test). Overall, the results supported the validity and reliability of the MINI. In addition, administration of the MINI-CR took half as long as administration of corresponding sections of the SCID-P. The application of short structured interviews in clinical and research settings is discussed.
This study examined the role of two aspects of emotion in the psychological distress of individuals with and without a history of childhood sexual abuse (CSA). It was hypothesized that experiential avoidance and expressivity would mediate the relationship between CSA status and psychological distress. Ninety-nine participants completed measures that assessed for a CSA history, experiential avoidance, emotional expressivity, and psychological functioning. The results indicated that CSA status, experiential avoidance, and emotional expressivity were significantly related to psychological distress. However, only experiential avoidance mediated the relationship between CSA status and distress. These results contribute to the growing body of literature indicating that experiential avoidance has an influential role in the development of psychological symptoms.
Research has indicated significant comorbid psychopathology with chronic posttraumatic stress disorder (PTSD) in samples of war veterans. The present paper examines the issue of comorbidity in a disaster sample to learn whether findings from veterans generalized to this event. A total of 193 subjects exposed to the Buffalo Creek dam collapse of 1972 were examined 14 years later using diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Past and present PTSD was found in a significant portion of the sample. Major depression was the next most common diagnosis and was highly related to PTSD. Anxiety disorders were also common. The overlap with other diagnoses was quite similar to that found in a sample of Vietnam veterans we studied earlier, except that the disaster sample had fewer dysthymic disorders, substance abusers, and antisocial personality disorders. Possible explanations for comorbidity in chronic PTSD were discussed and it was suggested that the morphology of PTSD may be quite stable in at least some other nonveteran trauma populations.