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Posttraumatic Stress Disorder Symptoms, Depressive Symptoms, Exercise, and Health in College Students

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Abstract

Posttraumatic stress disorder (PTSD) symptoms have consistently been associated with poorer health in highly traumatized samples. However, less is known about the relationship between PTSD symptoms, depressive symptoms, and health in nonclinical groups. Because exercise contributes to health, we hypothesized that PTSD symptoms and depressive symptoms would be related to poorer health status, in part, through their association with lower exercise. We examined this in a sample of 200 undergraduates. Health status variables included functional health and negative health symptoms. Results indicated that greater PTSD symptoms and depressive symptoms were associated with poorer health status, and exercise mediated these relationships, in most cases. This study has implications for future research examining the effects of PTSD and depressive symptoms on health. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

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... Physical activity may also bolster mastery and self-efficacy [14,15] or improve sleep [16,17], consequently reducing depression and anxiety. A recent study with college students found exercisemediated relationships of PTSD and depression and poorer health status outcomes, including physical pain and the degree to which health problems limited functioning [18]. Consistently, a small number of studies have found exercise interventions in humans [19,20] and animals [21] reduce PTSD and depressive symptoms. ...
... Despite preliminary evidence that physical activity may moderate the pain and PTSD [18] association in college students, this has not been empirically investigated with Veterans, to our knowledge. Further, Veterans with PTSD are known to be less physically active and present with increased body mass than their military peers without PTSD [31][32][33]. ...
... Further, Veterans with PTSD are known to be less physically active and present with increased body mass than their military peers without PTSD [31][32][33]. Given the potential importance of physical activity for pain management and known links between pain and PTSD in this population, research is needed to replicate and evaluate the generalizability of the research of Rutter et al. [18]. ...
... Available data suggest there are low rates of exercise among PTSD populations (e.g., de Assis et al., 2008;Zen, Whooley, Zhao, & Cohen, 2012). Furthermore, exercise has been found to mediate the association between PTSD and physical and functional health in a traumaexposed sample of undergraduate students, with PTSD -Hyperarousal symptoms emerging with particularly salient inverse relations with exercise (Rutter, Weatherill, Krill, Orazem, & Taft, 2011). Furthermore, several small-scale, uncontrolled intervention studies (n's = 9 to 15), based on trauma-exposed adult (Manger & Motta, 2005;Otter & Currie, 2004) and adolescent (Diaz & Motta, 2008;Newman & Motta, 2007) samples reporting varying levels of PTSD symptoms, have documented significant reductions in PTSD symptoms following aerobic exercise interventions. ...
... Thus, the current investigation is the first empirical study of the relations of smoking status and exercise with regard to PTSD symptom severity and PTSD symptom cluster severity. It was hypothesized that, among trauma-exposed persons, the interactive effect of regular smoking status (i.e., >= 10 cigarettes per day; cf., non-smoking status) and low weekly exercise levels would yield the highest levels of PTSD symptoms, generally, and PTSD -Hyperarousal symptoms, specifically (e.g., Rutter et al., 2011). Weekly exercise was expected to moderate the association between smoking status and PTSD symptoms, such that the highest levels of PTSD symptoms were expected among regular smokers reporting low levels of exercise. ...
... Interestingly, trauma-exposed individuals reporting low exercise levels, as compared to those reporting high exercise levels --regardless of smoking status --manifested the highest levels of PTSD -Hyperarousal symptoms. This finding is consistent with past work (Rutter et al., 2011), documenting especially robust associations between exercise and PTSD -Hyperarousal symptoms. It also may suggest that exercise serves a protective function with regard to hyperarousal symptoms, specifically. ...
Article
The present investigation examined the interactive effect of cigarette smoking status (i.e., regular smoking vs. non-smoking) and weekly exercise (i.e., weekly metabolic equivalent) in terms of posttraumatic stress (PTSD) symptom severity among a community sample of trauma-exposed adults. Participants included 86 trauma-exposed adults (58.1% female; Mage = 24.3). Approximately 59.7% of participants reported regular (≥10 cigarettes per day) daily smoking over the past year. The interactive effect of smoking status by weekly exercise was significantly associated with hyperarousal and avoidance symptom cluster severity (p ≤ .05). These effects were evident above and beyond number of trauma types and gender, as well as the respective main effects of smoking status and weekly exercise. Follow-up tests indicated support for the moderating role of exercise on the association between smoking and PTSD symptoms, such that the highest levels of PTSD symptoms were observed among regular smokers reporting low weekly exercise levels. Theoretical and clinical implications of the findings are discussed.
... In one set of studies, getting adequate sleep, exercising, and eating properly lowered the risk of depression and anxiety (Adams, Moore, & Dye, 2007;Dunn, Trivedi, Kampert, Clark, & Chamliss, 2005;Tyson, Wilson, Crone, Brailsford, & Laws, 2010) while health-compromising behaviors such as a lack of exercise and cigarette and alcohol use were linked to an increased incidence of depression (Fabiano et al., 2009;Kenney & Holahan, 2008;Olchowski, Graham, Beverly, & Dupkanick, 2009). Further, exercise was found to mediate the relationship between health and symptoms of posttraumatic stress and depression among college students (Rutter, Weatherill, Krill, Orazem, & Taft, 2013). Another study that examined the relationship between exercise frequency and stress among a sample of Ivy League college students found that "stressed" students exercised less often than "non-stressed" students (Hudd et al., 2000). ...
... While the existing evidence about the connection between physical health and emotional wellbeing is solid, it is unclear how these studies pertain to ethnic minority college youth, as most included samples that were predominantly Caucasian (Adams et al., 2007;Dunn et al., 2005;Fabiano et al., 2009;Hudd et al., 2000;Rutter et al., 2013;Tyson et al., 2010). As our population becomes more diverse, it can be erroneous to generalize findings from these studies to ethnic minority students, especially given ethnic minority college students have higher rates of depression and anxiety than Caucasian students (Mejia & McCarthy, 2010;Suicide Prevention Resource Center, 2004), and persons of minority race and ethnic backgrounds are more likely to experience poverty and related social stressors (Department of Health and Human Services, n.d., Pincus, Ester, Dewalt, & Callahan, 1998;Williams, 1990). ...
... Further, students who endorsed cigarette use and alcohol use also reported higher levels of depression and anxiety. These findings are consistent with the above-noted literature, and suggest self-care strategies (i.e., discouraging health compromising behaviors) may hold promise for enhancing the health of high risk, ethnic minority college students (Adams, Moore, & Dye, 2007;Dunn et al., 2005;Fabiano et al., 2009;Hudd et al., 2000;Rutter et al., 2013;Tyson et al., 2010). ...
Article
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This study investigated the relationship between depression, anxiety and health-related behaviors among ethnic minority students at an urban public university. Five hundred sixty seven students from diverse ethnic backgrounds completed a set of measures to assess symptoms of depression and anxiety, health promoting (e.g. exercise) and health compromising behaviors (e.g. cigarette and alcohol use). Students also rated their current health. Approximately 22 percent and 27 percent of participants endorsed clinically significant symptoms of depression and anxiety, respectively. No ethnic group differences were found on measures of depression and anxiety among this sample. Hierarchical regression analyses revealed subjective health ratings contributed to the highest proportion of variance for all criterion measures beyond gender. Among health behaviors, results suggest alcohol and cigarette use assert more influence on symptoms of depression and anxiety than exercise.
... People with PTSD also engage in other unhealthy behaviors, such as smoking and alcohol use, which may make it more difficult for someone with PTSD to start an exercise program or to consume a well-balanced diet (19,20). Recent evidence suggests that hyperarousal symptoms of PTSD are most strongly associated with inactivity and that a heightened concern for safety, which is common in PTSD, may interfere with exercise (21). Use of food to cope with negative affect and stress may also explain why PTSD is associated with unhealthy diet and overweight/obesity (22). ...
... Details of these studies are summarized in Tables 1 and 2. PTSD and physical activity PTSD as a correlate or predictor of physical activity. There were 10 published observational studies that reported the associations between PTSD and physical activity (21,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), all of which were conducted between 2010 and 2014. ...
... The other 5 observational studies identified in this review examined the associations between PTSD symptoms and physical activity (21,35,37,40,42). Two studies, both conducted in young adult samples (mean age, <25 years), reported that, as PTSD symptoms increased, physical activity levels decreased (21,42). ...
Article
Post-traumatic stress disorder (PTSD), a prevalent and costly psychiatric disorder, is associated with high rates of obesity and cardiometabolic diseases. Many studies have examined PTSD and risky behaviors (e.g., smoking, alcohol/substance abuse); far fewer have examined the relationship between PTSD and health-promoting behaviors. Physical activity and eating behaviors are 2 lifestyle factors that impact cardiometabolic risk and long-term health. This comprehensive review of the literature (1980-2014) examined studies that reported physical activity and eating behaviors in adults with PTSD or PTSD symptoms. A systematic search of electronic databases identified 15 articles on PTSD-physical activity and 10 articles on PTSD-eating behaviors in adults. These studies suggest that there may be a negative association among PTSD, physical activity, and eating behaviors. Preliminary evidence from 3 pilot intervention studies suggests that changes in physical activity or diet may have beneficial effects on PTSD symptoms. There was considerable heterogeneity in the study designs and sample populations, and many of the studies had methodological and reporting limitations. More evidence in representative samples, using multivariable analytical techniques, is needed to identify a definitive relationship between PTSD and these health behaviors. Intervention studies for PTSD that examine secondary effects on physical activity/eating behaviors, as well as interventions to change physical activity/eating behaviors that examine change in PTSD, are also of interest. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
... Research has demonstrated that the level of trauma exposure in college populations is comparable to community samples (Rutter et al. 2013;Anders et al. 2012). However, college students differ from adults in how they respond to adversity (Brener et al. 1999;Rind et al. 1998;Watson and Haynes 2007). ...
... Flood et al. (2009) found that substance use moderately mediated the relationship between PTSD symptoms and physical health in college students; no mediation effect was observed for smoking. Rutter et al. (2013) found that lack of exercise mediated the relationship between PTSD and depressive symptoms and poorer functional and physical health, such that participants with more psychological symptoms were less likely to engage in physical activity and more likely to have health problems. ...
... The existing research on trauma experiences in college populations does not examine the impact of cumulative exposure to adversity in childhood on health and health risk behaviors. Rather, it focuses on specific categories of childhood abuse (Runtz 2002), or broadly addresses trauma exposure across the lifespan (Anders et al. 2012;Rutter et al. 2013;Flood et al. 2009;Reed et al. 2007). Research has increasingly found that co-occurrence and polyvictimization occurs more often than single types of trauma (Hamby and Grych 2013). ...
Article
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Adverse Childhood Experiences (ACEs) are linked to poor adult health (Felitti et al. American Journal of Preventive Medicine, 14(4), 245–258, 1998; Brown et al. BMC Public Health, 10, 20, 2010). Research on ACEs exposure in college students is lacking. This study examined the impact of ACEs, health risk behaviors, and resiliency factors on objective and subjective measures of health in college students. ACEs and health risk behaviors emerged as significant predictors of health problems. However, when resiliency factors were accounted for, gender and life satisfaction were the only significant predictors of health problems. Likewise, ACEs score and health risk behaviors emerged as significant predictors of self-rated health. However, when resiliency factors were accounted for, gender, social support, and affect were the only significant predictors of self-rated health. Life satisfaction mediated the relationship between ACE score and health problems. Findings suggest that ACEs exposure has a lasting impact on health. The ability of resiliency factors to predict health has important implications for working with college students.
... Physical activity may also bolster mastery and self-efficacy [14,15] or improve sleep [16,17], consequently reducing depression and anxiety. A recent study with college students found exercisemediated relationships of PTSD and depression and poorer health status outcomes, including physical pain and the degree to which health problems limited functioning [18]. Consistently, a small number of studies have found exercise interventions in humans [19,20] and animals [21] reduce PTSD and depressive symptoms. ...
... Despite preliminary evidence that physical activity may moderate the pain and PTSD [18] association in college students, this has not been empirically investigated with Veterans, to our knowledge. Further, Veterans with PTSD are known to be less physically active and present with increased body mass than their military peers without PTSD [31][32][33]. ...
... Further, Veterans with PTSD are known to be less physically active and present with increased body mass than their military peers without PTSD [31][32][33]. Given the potential importance of physical activity for pain management and known links between pain and PTSD in this population, research is needed to replicate and evaluate the generalizability of the research of Rutter et al. [18]. ...
Article
Full-text available
Objective. Posttraumatic stress disorder (PTSD) and pain are frequently comorbid conditions that can result in bidirectional exacerbations. Initial research suggests physical activity may prevent PTSD symptoms or assist with recovery. Unfortunately, Veterans with PTSD are less likely to engage in physical activity, often citing pain as a primary reason. The current study examines the potential role of physical activity as a moderator of the pain and PTSD relationship. Design. Data were collected from 239 Veterans who were seeking PTSD treatment at a Veterans Affairs (VA) hospital between 2006 and 2013. Veterans completed the Clinician-Administered PTSD Scale (CAPS) to measure PTSD severity and self-report inventories to measure pain and physical activity. Multiple moderated linear regressions were used to examine the influence of physical activity on the relationship between pain and PTSD symptoms. Results. Pain severity and interference were associated with more severe PTSD. Physical activity did not have main effects on PTSD severity. However, it did moderate the relationship between PTSD and pain, such that those who were active, despite high levels of pain severity or pain interference, had fewer PTSD symptoms. Conclusions. For Veterans seeking treatment for PTSD, physical activity was particularly salient for those reporting high levels of pain severity and intensity. While assessment of pain is recommended with all Veterans, it may also be beneficial to evaluate physical activity in those with prominent pain complaints. Further examination of the role of exercise in integrated care for pain and PTSD is warranted.
... Keywords posttraumatic stress, PTSD, trauma, exercise, physical activity Limited literature exists regarding associations between exercise and posttraumatic stress (PTS) symptomatology among trauma-exposed populations; yet, data suggest that these individuals generally show decreased involvement in physical activity (Rutter, Weatherill, Krill, Orazem, & Taft, 2013). Additionally, PTS symptoms have been associated with poor health status, and exercise has been conceptualized as a potential mediator in these relations (Rutter et al., 2013). ...
... Keywords posttraumatic stress, PTSD, trauma, exercise, physical activity Limited literature exists regarding associations between exercise and posttraumatic stress (PTS) symptomatology among trauma-exposed populations; yet, data suggest that these individuals generally show decreased involvement in physical activity (Rutter, Weatherill, Krill, Orazem, & Taft, 2013). Additionally, PTS symptoms have been associated with poor health status, and exercise has been conceptualized as a potential mediator in these relations (Rutter et al., 2013). Indeed, preliminary data suggest that exercise-based interventions may be efficacious in reducing PTS symptoms (Manger & Motta, 2005;Newman & Motta, 2007). ...
Article
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The present investigation examined associations between intensities of exercise involvement and posttraumatic stress (PTS) symptom cluster severity (reexperiencing, avoidance/numbing, and hyperarousal). The sample was comprised of 108 adults (54.6% women; Mage = 23.9, SD = 10.22, range = 18-62), who endorsed exposure to a Diagnostic and Statistical Manual of Mental Disorders (Fourth edition, Text Revision) posttraumatic stress disorder Criterion A traumatic life event but did not meet criteria for any current Axis I psychopathology. After controlling for gender and lifetime number of trauma exposure types experienced, results indicated that vigorous-intensity exercise, but not light- or moderate-intensity exercise, was significantly inversely associated with hyperarousal symptom cluster severity. This study adds to the scarce, yet growing, body of exercise-PTS literature-by illuminating the inverse associations of vigorous-intensity exercise, specifically, and PTS hyperarousal symptom severity among trauma-exposed individuals.
... It is theorized that avoidant coping may be related to physical health outcomes through its influence on behavior, such as decreased treatment seeking and decreased engagement in activities that promote physical health (Lazarus, 1991). A recent study (Rutter, Weatherill, Krill, Orazem, & Taft, 2013) found that exercise mediated the relationship between PTSD, depression and physical health in a sample of undergraduates. PTSD, in particular, is related to avoidant coping (e.g., Coffey, Leitenberg, Henning, Turner, & Bennett, 1996;Ullman, Filipas, Townsend, & Starzynski, 2007), and trauma-specific and health-specific avoidant coping mediate the relationship between PTSD and health (Lawler et al., 2005). ...
... For example, PTSD has been associated with reduced exercise, increased sedentary behavior, higher obesity, and higher perception of pain (e.g., Engel, 2004), although these factors have just begun being examined in college women with PTSD. The one study that looked at exercise in college students with PTSD found that it mediated the relationship between PTSD and physical health symptoms (Rutter et al., 2013). The current study builds on these findings in suggesting that decreased engagement in active coping strategies is generally related to increased physical health complaints. ...
Article
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Trauma exposure and PTSD are associated with poorer physical health. Psychological and behavioral mechanisms may help account for this relationship. In this study, we tested avoidant coping and alcohol use as mediators of the relationship between trauma exposure, PTSD, and self-reported physical health complaints in female drinkers. In 827 college women, we compared three groups: women with no trauma history, women with a sexual assault but no PTSD, and women with a sexual assault and PTSD, on avoidant coping, alcohol use, and physical health complaints. We found that PTSD was positively associated with alcohol use and that PTSD and trauma exposure were associated with increased avoidant coping. We also found that avoidant coping mediated the relationship between trauma, PTSD, and physical health complaints. Alcohol use did not predict physical health but was associated with PTSD. These results suggest that in female college students, coping may be more critical in the PTSD/physical health relationship than alcohol and have implications for targeting coping in young trauma-exposed women to improve physical health.
... Symptoms of PTSD may influence PA levels in a number of ways. For example, individuals with PTSD may be less likely to exercise given a heightened concern for safety, which is common in PTSD, 35 or fear of trauma-relevant bodily arousal symptoms triggered by exercise, such as shortness of breath, increased heart rate, and perspiration. 36 This possibility is supported by recent evidence that PTSD hyperarousal symptoms (as opposed to re-experiencing or avoidance symptoms) show a particularly robust inverse relationship with exercise. ...
... 36 This possibility is supported by recent evidence that PTSD hyperarousal symptoms (as opposed to re-experiencing or avoidance symptoms) show a particularly robust inverse relationship with exercise. [35][36][37] Additionally, PTSD symptoms may undermine motivation to engage in PA and make it more difficult to start and maintain an exercise program. For example, in one study, patients with PTSD reported lack of motivation (24% before vs 71% after PTSD onset) as a justification for reducing activity. ...
Article
Introduction: Post-traumatic stress disorder (PTSD) may be associated with physical inactivity, a modifiable lifestyle factor that contributes to risk of cardiovascular and other chronic diseases; however, no study has evaluated the association between PTSD onset and subsequent physical activity (PA) changes. Method: Analyses were conducted between October 2014 and April 2016, using data from the ongoing Nurses' Health Study II (N=50,327). Trauma exposure and PTSD symptoms were assessed using two previously validated measures, the Brief Trauma Questionnaire and Short Screening Scale for DSM-IV PTSD. Average PA (hours/week) was assessed using self-report measures at six time points across 20 years (1989-2009). Linear mixed models with time-updated PTSD assessed differences in PA trajectories by trauma/PTSD status. Among a subsample of women whose trauma/PTSD onset during follow-up, group differences in PA patterns before and after onset were assessed using linear spline models. Results: PA decreased more steeply over time among trauma-exposed women reporting four or five (β= -2.5E(-3), SE=1.0E(-3), p=0.007) or six or seven PTSD symptoms (β= -6.7E(-3), SE=1.1E(-3), p<0.001) versus women without trauma exposure, adjusting for potential confounders. Among a subsample of women whose trauma/PTSD symptoms onset during follow-up, no differences in PA were observed prior to onset; after onset, women with six or seven PTSD symptoms had a steeper decline (β= -17.1E(-3), SE=4.2E(-3), p<0.001) in PA over time than trauma-exposed women without PTSD. Conclusions: Decreases in PA associated with PTSD symptoms may be a pathway through which PTSD influences cardiovascular and other chronic diseases.
... Data generally indicate that individuals with PTSD are less likely to engage in regular physical activity [32] and are more likely to be inactive than those without PTSD [33]. In addition, more severe PTSD symptoms are associated with the lower levels of physical activity [34,35]. Veterans with PTSD are less likely to engage in regular exercise than those with other mental disorders [33]. ...
... Contrary to expectation, however, results indicated that PTSD symptoms did not mediate the relation between exercise and suicide risk. Although there is some support for the relation between exercise and PTSD (Diaz & Motta, 2008;LeardMann et al., 2011;Newman & Motta, 2007;Rutter et al., 2011), this research is in a nascent stage. Furthermore, as the literature has suggested that the association between PTSD and suicide may be accounted for by co-occurring depression (Bryan & Corso, 2011;Fordwood, Asarnow, Huizar, & Reise, 2007;Holtzheimer, Russo, Zatzick, Bundy, & Roy-Byrne, 2005;Zlotnick, Mattia, & Zimmerman, 2001), it is possible that accounting for co-occurring mediators in the present analyses may have highlighted a lack of unique association between PTSD and suicide risk. ...
Article
Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this associ-ation, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.
... However, given the lack of research on PTSD in Asian American college women, it is unclear to what extent this population may demonstrate somatization in response to traumatic events. Moreover, PTSD itself has been found to be associated with somatization (e.g., Escalona, Achilles, Waitzkin, & Yager, 2004;Rutter, Weatherill, Krill, Orazem, & Taft, 2013). Given the tendency to somaticize among culturally Asian populations, examining the link between somatization and PTSD is necessary among Asian American female college victims of sexual assault. ...
Article
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The need for trauma research with monoracial groups such as Asian Americans (AA) has recently been emphasized to better understand trauma experiences and inform interventions across populations. Given AA cultural contexts, posttraumatic cognitions and somatization may be key in understanding trauma experiences for this group. AA and White American (WA) trauma-exposed college women completed a survey on sexual trauma history, posttraumatic cognitions, somatic symptoms, and PTSD severity. For the overall sample, higher negative cognitions were associated with higher somatization. Asian race was associated with higher negative cognitions, which then predicted higher PTSD. Unexpectedly, WAs more strongly endorsed somatization than AAs. These findings indicate that posttraumatic cognitions may be helpful in understanding relationships between somatization and PTSD severity among those of Asian backgrounds and that the relationship between somatization and PTSD symptoms is culturally complex.
... Despite these compelling results, this study has some potential limitations that should be addressed in future research. Although several studies have confirmed the strong association of PTSD with poorer mental health and with psychological problems, such as depression and anxiety [25], PTSD was not addressed in this study as a potential outcome of being exposed to bank robbery. Similarly, future studies should try to rule out third variable explanations, by including other variables and controlling potential confounders [26]. ...
Article
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Background – External/intrusive violence at work can result in psychological distress and can be an important risk to employee health and safety. However, the vast majority of workplace violence studies have employed cross-sectional and correlational research, designed to examine immediate reactions after being assaulted at work. Aims – To explore whether exposure to robbery as a traumatic event may contribute to the onset of typical symptoms of psychological distress (anxiety depression, dysphoria and loss of confidence) and job dissatisfaction over time. Methods – We collected data by using a two-wave panel design, in which employees working the days of bank robberies, in an Italian bank, filled in a questionnaire between 48 hours to 1 week after the robbery (T1) and two months after the robbery (T2). We performed structural equation models (SEM) to evaluate the fit of different models to our data. Results: There were 513 participants at T1 (58% women) and 175 (34%) participants at T2 (62% women). There was a simultaneous association in which psychological distress lead to job dissatisfaction both following robbery (T1, n = 513), and two months later (T2, n = 175). Conclusion – Our findings supported a synchronous effects model and suggest that interventions after suffering physical assaults, apart from helping employees to recover their health, should consider restoring their trust and confidence in the organization. This study contributes to understanding the dynamic relationships between a robbery at work and its outcomes over time, by addressing several methodological and design deficiencies in previous longitudinal studies.
... In doing so, we also wish to investigate IES-6 convergent validity. Several studies have confirmed the strong association of IES with poor mental health and psychological problems such as depression and anxiety; [15][16][17] however, very little research has been conducted in the Italian context. 13 In addition, peritraumatic risk factors have also been investigated in association with IES. ...
Article
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Bank robberies are becoming a serious problem in Italy. This study aims to evaluate the validity and the reliability of the Italian version of Impact of Event Scale (IES)-6. It is also hypothesized that a potential posttraumatic disorder, as measured by the IES-6, is associated with mental health problems and several peritraumatic variables. A database was built from data collected through a survey of victims of robbery in an Italian bank. The final sample comprised 350 employees. This study tests different models of IES, comparing the validity of IES-6 with the 22-item original version (IES-R) and the 15-item Italian version (recently adopted in a sample of flood victims). A confirmatory factor analysis supported the IES-6 three-factor solution as the best model. In addition, the internal consistency of the IES-6 and the subscales was good. Outcomes revealed a robust structure supporting the composition of the IES-6 Italian version.
... Out of 23 potentially eligible studies, 824, [37][38][39][40][41][42][43] were included in this review. Reasons for exclusion are shown in Figure 1. ...
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Background: People with posttraumatic stress disorder (PTSD) are more likely than the general population to be physically inactive. The present review systematically evaluated correlates of physical activity across the socio-ecological model for people with PTSD. Methods: Two independent reviewers searched Embase, PubMed, PsycARTICLES and CINAHL from inception until June 2015, combining the medical subject heading 'post-traumatic stress disorder' or 'PTSD', with 'physical activity' or 'exercise'. Data were extracted by the same independent researchers and summarized according to the socio-ecological model. Results: Eight papers involving 1,368 (994♂) participants (age range=18-70years) were eligible and enabled evaluation of 21 correlates. The only correlate consistently (n≥4) associated with lower physical activity participation in persons with PTSD were symptoms of hyperarousal. No consistent facilitators were identified. Conclusions: Hyperarousal symptoms are associated with lower physical activity participation among people with PTSD and should be considered in the design and delivery of individualized exercise programs targeting this population. The role of social, environmental and policy factors on physical activity participation among people with PTSD is unknown and should be addressed by future research.
... Trauma exposure among college students is unfortunately common (Marx & Sloan, 2003;Read, Ouimette, White, Colder, & Farrow, 2011;Ullman & Filipas, 2005); so too are psychological sequelae following such exposure, including posttraumatic stress disorder symptoms (PTSD; Lauterbach & Vrana, 2001;Read et al., 2011;Smyth, Hockemeyer, Heron, Wonderlich, & Pennebaker, 2008). In this population, trauma and related symptoms can lead to myriad deleterious outcomes, including academic impairment (Bachrach & Read, 2012), re-victimization (Walsh et al., 2012), health-risk behaviors Widome et al., 2011), poor physical and psychological health (Flood, McDevitt-Murphy, Weathers, Eakin, & Benson, 2009;Rutter, Weatherill, Krill, Orazem, & Taft, 2013), and alcohol or other drug misuse (McDevitt-Murphy et al., 2010;Read et al., 2012). ...
Article
Traumatic events bring an increased need for social connection but paradoxically can make relationships more difficult. The current research examines the unique role social surrogates such as favorite TV shows, books, and celebrities may play in fulfilling the social needs of people who have experienced trauma. Across two studies we predicted and found that experiencing traumatic events is associated with higher interest in using social surrogates. Furthermore, individuals who have experienced trauma without developing PTSD are able to effectively use social surrogates to combat social isolation. However, perhaps because PTSD symptoms often are associated with impaired social functioning, those with PTSD actually feel worse after social surrogate use. Implications for trauma, PTSD, social surrogates, and social self research are discussed.
... We designed a virtual advisor (VA), Sarah (Fig. 5), to encourage university students to follow healthy behaviours shown to correlate positively with study stress [76]. We have evaluated Sarah in previous studies to confirm acceptance of interaction with Sarah and that its explanations were found to be sensible and helpful with students in the same context of reducing study stress [77]. ...
Article
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Virtual advisors (VAs) are being utilised almost in every service nowadays from entertainment to healthcare. To increase the user’s trust in these VAs and encourage the users to follow their advice, they should have the capability of explaining their decisions, particularly, when the decision is vital such as health advice. However, the role of an explainable VA in health behaviour change is understudied. There is evidence that people tend to change their intentions towards health behaviour when the persuasion message is linked to their mental state. Thus, this study explores this link by introducing an explainable VA that provides explanation according to the user’s mental state (beliefs and goals) rather than the agent’s mental state as commonly utilised in explainable agents. It further explores the influence of different explanation patterns that refer to beliefs, goals, or beliefs&goals on the user’s behaviour change. An explainable VA was designed to advise undergraduate students how to manage their study-related stress by motivating them to change certain behaviours. With 91 participants, the VA was evaluated and the results revealed that user-specific explanation could significantly encourage behaviour change intentions and build good user-agent relationship. Small differences were found between the three types of explanation patterns.
... In order to better understand the barriers and facilitators of participation in physical activity in people with PTSD, Vancampfort et al. (2016b) conducted a systematic review of the correlates of physical activity in people with PTSD. Eight studies were identified that were eligible for inclusion (Arnson et al. 2007;Babson et al. 2015;Davidson et al. 2013;Harte et al. 2013;Rutter et al. 2013;Vujanovic et al. 2013), with a total of 1368 (994 males) people with PTSD (age range 18-70 years). The review found no evidence of significant demographic correlates, however, consistent evidence was found that older age was not a barrier to physical activity participation ( Vancampfort et al. 2016b). ...
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Posttraumatic Stress Disorder (PTSD) is a disorder associated with poor health outcomes including high rates of cardio-metabolic disease. Exercise and physical activity more broadly offer substantial promise as a feasible and effective component of care. Evidence to date demonstrates that exercise can improve both the physical and mental health of people with PTSD. Exercise should be included in the treatment of PTSD, across the spectrum from inpatients receiving treatment for severe PTSD, to trauma-exposed individuals living in the community with sub-syndromal symptomatology.
... 42 In addition, all MOVE!þUP inperson sessions included walking on a neighborhood sidewalk to a public park adjacent to the VA facility. The walks were intended to provide exercise, which can improve program engagement, 43 and also to experientially address hypervigilance-based activity barriers 44 and encourage walking in their own communities outside of MOVE!þUP sessions. Figure 2 depicts MOVE!þUP's overall iterative refinement process, with several examples of content and structure modified over the course of the pilot. ...
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Purpose Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting Veterans Affairs Medical Center. Participants Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = “Development” and cohort 5 [n = 8] = “Final” MOVE!+UP). Intervention MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. Analysis Baseline to 16-week paired t tests and template analysis. Results Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [ M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight ( M = −14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD ( M = −17.9 [SD = 12.2]) improvements, P < .05. Conclusions The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
... This is supported by several large cross-sectional studies that have repeatedly shown exercise to be inversely correlated to PTSD and its co-occurring conditions. More specifically, exercise has consistently been found to be inversely correlated with a PTSD diagnosis (Chwastiak, Rosenheck, & Kazis, 2011) and its symptoms, such as poor sleep quality (Talbot, Neylan, Metzler, & Cohen, 2014) and co-occurring depressive symptoms (Rutter, Weatherill, Krill, Orazem, & Taft, 2013). There is also emerging evidence supporting an inverse relationship between exercise participation and the severity of PTSD symptoms. ...
... Leveraging telehealth and community organizations to help connect students to culturally-informed, safe, and supportive environments is essential in promoting positive well-being as the effects of the COVID-19 pandemic continue. Furthermore, campus wellness centers could leverage the current findings, as well as previous research supporting regular exercise as a therapeutic technique (Rutter et al., 2013;Zhu et al., 2021). Promoting exercise as a self-care activity to enjoy individually or in groups could help to promote well-being. ...
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The current study tested whether COVID-19 disruptions and perceived discrimination were related to mental health (i.e., posttraumatic stress disorder [PTSD] symptoms and emotional, psychological, and social well-being), and whether exercise moderated relations. Additionally, we tested whether findings varied by ethnicity/race. Participants were 368 African American and Asian American emerging adults ( Mage = 19.92, SD = .34). Findings did not vary by ethnicity/race. COVID-19 disruptions predicted poorer emotional, psychological, and social well-being, and more PTSD symptoms. Discrimination predicted more PTSD symptoms. Exercise was associated with better emotional, psychological, and social well-being, and moderated the relation between COVID-19 disruptions and emotional well-being. At low levels of exercise, COVID-19 disruptions predicted poorer emotional well-being, but this relation was not significant at high levels of exercise. Findings highlight that discrimination and disruptions during the pandemic negatively affect African American and Asian American emerging adults’ mental health, but that exercise plays an important protective role.
... These results deviate to some extent from the inferences of a systematic review by Vancampfort et al. [32], suggesting that the only correlate consistently associated with low PA in people with PTSD is symptoms of hyperarousal. Our findings, however, could also be viewed in light of other studies that have suggested that physical and social inactivity may also comprise a part of avoidance symptoms and negative cognitions and mood, e.g., avoidance of trauma-related stimuli, feeling isolated, and decreased interest in activities [25,35,37,71]. Moreover, these symptom clusters may as well be closely interrelated in regard to their influence on PA, such as avoiding activities or exercise due to lack of energy or motivation, fear of bodily arousal (e.g., muscle tension, increased heart rate, shortness of breath), or fear of intrusive memories that may be triggered by physical strain. ...
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Background: Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. Methods: A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. Results: About half of the participants (53.3, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). Conclusions: Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants' health.
... In order to better understand the barriers and facilitators of participation in physical activity in people with PTSD, Vancampfort et al. (2016b) conducted a systematic review of the correlates of physical activity in people with PTSD. Eight studies were identified that were eligible for inclusion (Arnson et al. 2007;Babson et al. 2015;Davidson et al. 2013;Harte et al. 2013;Rutter et al. 2013;Vujanovic et al. 2013), with a total of 1368 (994 males) people with PTSD (age range 18-70 years). The review found no evidence of significant demographic correlates, however, consistent evidence was found that older age was not a barrier to physical activity participation ( Vancampfort et al. 2016b). ...
... Self-care strategies, including exercise, may be helpful during this stage. Given that some trauma survivors have been found to display decreased involvement in exercise (Rutter, Weatherill, Krill, Orazem, & Taft, 2013) whereas others display increased involvement (Author et al., 2016), understanding exercise motivation may improve treatment outcomes. ...
Article
The experience of exercise among women survivors of sexual violence is a multifaceted phenomenon. In effort to inform treatment interventions, we used a phenomenological approach to describe the lived experience of exercise among women survivors of sexual violence. Data analysis from a focus group discussion and individual interviews with eight women survivors receiving services at a rape crisis center (RCC) revealed four themes: exercising (and not exercising) fosters safety, exercising is risky, past trauma restricts exercise choices, and exercising is beneficial. Findings indicate that survivors’ experience of exercise is related to their connections with self and their social environment. Survivors’ choices related to exercise were impacted by their stage of recovery. A variety of social-contextual factors appeared to support or impede motivation to exercise and it was not disinterest in exercise or low confidence in the ability to exercise, but restricted exercise options perceived as safe that influenced exercise motivation.
... This is confirmed by the fact that Italian victims are more likely to report armed robberies involving the use of firearms and closer proximity to the robber. These factors have been revealed to be related to the onset of PTSD symptomatology in the aftermath of a robbery (Hansen & Elklit, 2011;Rutter, Weatherill, Krill, Orazem, & Taft, 2013). As a consequence, Italian victims were more likely to feel threatened by the robber, fearful and helpless and imagine they would be potentially harmed during the robbery. ...
Article
Although some similarities are evident in manifestations, etiology and coping, research suggests that cultural variations may explain different reactions to workplace violence. This study explores similarities and differences between Italian and Irish workers’ well-being in relation to robberies and theft exposure. A sample of Italian (N = 319) and Irish (N = 251) employees working in small businesses completed a self-report questionnaire examining post-traumatic symptoms and trauma-related coping self-efficacy. Results indicated that Italian victims reported higher post-traumatic symptoms than their Irish counterparts. When compared to those who experienced thefts only, Italian victims who had experienced both thefts and robberies experienced more post-traumatic symptoms and lower coping self-efficacy, whereas Irish employees differed significantly only in hyper-arousal symptomatology. Regression analyses revealed that coping self-efficacy had a protective role against the risk of developing post-traumatic symptomatology. In both countries, interventions fostering employees’ coping self-efficacy perceptions might stimulate psychological recovery, especially among victims of both thefts and robberies.
... Although not specified in Dedert and colleagues' model, emerging but inconclusive evidence suggests that PTSD may also be associated with inactivity and poor eating behaviors (Hall et al., 2015), which are additional risk factors for CVD, diabetes, and obesity (Danaei et al., 2009). Poorer activity and diet may be due to PTSD symptoms, such as hyperarousal (Rutter et al., 2013), sleep disturbance (Baron et al., 2013;Boutcher and Dunn, 2009;St-Onge, 2013), and social isolation (Brug, 2008;Charuvastra and Cloitre, 2008;Shaikh et al., 2008;Sherwood and Jeffery, 2000). Moreover, although Dedert et al. specified depression as a mediator only of the relationship between PTSD and health outcomes, we determined it important to examine the association of depression with health behaviors in alternative models, given that depression is highly co-morbid with PTSD (Dedert et al., 2010) and has been found to be associated with poor health behaviors (Bonnet et al., 2005;Grant et al., 2004;Lasser et al., 2000;Strohle, 2009), CVD, anddiabetes (DeHert et al., 2011), with likely shared etiologic factors such as HPA axis disruption and inflammation (Marazziti et al., 2014). ...
Article
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Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease (CVD) and diabetes. Dedert and colleagues hypothesized a model whereby PTSD leads to poor health behaviors, depression, and pre-clinical disease markers, and that these factors lead to CVD and diabetes (Ann Behav Med, 2010, 61-78). This study provides a preliminary test of that model. Using data from a mailed cross-sectional survey conducted 2012-2013, path analysis was conducted among N = 657 with complete demographic data. We first analyzed the hypothesized model, followed by four alternatives, to identify the best-fitting model. The alternate model that specified pathways from depression to health behaviors had the best fit. Contrary to hypotheses, higher PTSD symptoms were associated with better physical activity and diet quality. Of the specific indirect pathways from PTSD to Body Mass Index (BMI), only the path through depression was significant. Higher depression symptoms were significantly associated with less physical activity, poorer diet, and greater likelihood of smoking. In addition, the specific indirect effect from depression to BMI through physical activity was significant. Current smoking and higher BMI were associated with greater likelihood of diabetes, and hypertension was associated with greater likelihood of CVD. PTSD symptoms may increase risk for CVD and diabetes through the 'negative impact of depression on health behaviors and BMI. With or without PTSD, depression may be an important target in interventions targeting cardiovascular and metabolic diseases among veterans.
... 50 There is also evidence that those with PTSD may choose not to exercise due to heightened concerns for safety. 51 Other studies have noted the effects of PTSD and unhealthy relationships with food, such as emotional eating 52 and binge eating. 53 Klingaman et al. 54 found that Veterans with PTSD reported more barriers to weight loss than Veterans with no mental health problems. ...
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Introduction: Little is known about the physical health conditions experienced by United Kingdom (UK) military Veterans with posttraumatic stress disorder (PTSD) or other mental health diagnoses. We aimed to explore the prevalence of self-reported physical health complaints and health behaviours in a patient sample of UK Veterans who had engaged with mental health services. Methods: This study used questionnaire data from a cross-sectional study that sampled Veterans engaged in a UK national Veteran’s mental health charity ( N = 403). Prevalence rates of reported physical health complaints were ranked, and health behaviours were described. Adjusted multivariate logistic regression models were fitted to examine associations between the top five physical health complaints and socio-demographic factors, mental health outcomes, and health-related behaviours. Results: We observed that chronic pain (41.2%, n = 166) and poor mobility (34.2%, n = 138) were the most prevalent conditions reported. Participants with PTSD were more than twice as likely to report chronic pain (AOR = 2.25, 95% CI, 1.16–4.37, P ≤ 0.05). Of 384 Veterans in the sample, the majority had a calculated body mass index (BMI) deemed overweight or obese (76.5%, n = 294). Obese participants were 2–4 times more likely to report prevalent physical health complaints. Discussion: Veterans with complex mental health problems experience a high burden of physical health complaints. Of most concern are the associations between PTSD, obesity, pain, impairment, and the potential difficulties in recovery and treatment. These findings are important for the way health services assess and treat individuals presenting with complex mental health problems.
... These results deviate to some extent from the inferences of a systematic review by Vancampfort et al [25], suggesting that the only correlate consistently associated with low PA in people with PTSD is symptoms of hyperarousal. Our ndings, however, could also be viewed in light of other studies that have suggested that physical and social inactivity may also comprise a part of avoidance symptoms and negative cognitions and mood, e.g., avoidance of trauma-related stimuli, feeling isolated, and decreased interest in activities [18,28,47,53]. Moreover, these symptom clusters may as well be closely interrelated in regard to their in uence on PA, such as avoiding activities or exercise due to lack of energy or motivation, fear of bodily arousal (e.g., muscle tension, increased heart rate, shortness of breath), or fear of intrusive memories that may be triggered by physical strain. ...
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Background: Forced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden. Methods: A cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture. Results: About half of the participants (53.3%, 95% CI: 48.6-58.1) met the recommendations for Sufficient PA. One third of the participants (33.3%, 95% CI: 28.7-37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1-16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001). Conclusions: Insufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with better mental health in these populations. An increased focus on assessment and promotion of PA is justified during the extended time of asylum-seeking processes. The result support PA as a potentially viable treatment component in PTSD.
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This study aims to verify the main psychometric properties of the Italian version of the Impact of Event Scale - Revised (IES-R) in a sample of flood victims. The sample was composed of 262 subjects involved in the natural disaster of 2009 in the city of Messina (Italy). All participants completed the IES-R and the Dissociative Experiences Scale-II (DES-II) in order to verify some aspects of convergent validity. THE EXPLORATORY AND CONFIRMATORY FACTOR ANALYSIS, USED TO VERIFY THE CONSTRUCT VALIDITY OF THE MEASURE, SHOWED A CLEAR FACTOR STRUCTURE WITH THREE INDEPENDENT DIMENSIONS: intrusion, avoidance, and hyper-arousal. The goodness-of-fit indices (non-normed fit index [NNFI] = 0.99; comparative fit index [CFI] = 0.99; standardized root mean square residual [SRMR] = 0.04; and root mean square error of approximation [RMSEA] = 0.02) indicated a good adaptation of the model to the data. The IES-R scales showed satisfactory values of internal consistency (intrusion, α = 0.78; avoidance, α = 0.72; hyper-arousal, α = 0.83) and acceptable values of correlation with the DES-II. These results suggest that this self-reported and easily administered instrument for assessing the dimensions of trauma has good psychometric properties and can be adopted usefully, both for research and for practice in Italy.
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Post-traumatic stress disorder (PTSD), prevalent among Veterans, increases risk for having a high Body Mass Index. Although the Veterans Health Administration (VHA) offers an evidence-based behavioral weight management program called MOVE!, participants with PTSD lose less weight than those without mental health conditions, despite comparable participation. PTSD symptoms can interfere with one's ability to be physically active and maintain a healthy diet, the key targets in weight management programs. We developed and piloted a behavioral weight management program called MOVE! + UP that targets PTSD-related weight loss barriers. MOVE! + UP includes 16 group sessions with training in evidence-based weight management strategies, coupled with Cognitive Behavior Therapy (CBT) skills to address PTSD-specific barriers. The 16 sessions also include 30-min community walks to address PTSD-related barriers that may impede exercise. Two individual dietician sessions are provided. This hybrid type 1 randomized controlled trial (RCT) will compare MOVE! + UP to standard care—MOVE!—among 164 Veterans with BMI ≥ 25 who are receiving care for PTSD. We will randomize participants to MOVE! + UP or standard care and will compare absolute post-baseline change in weight at 6 (primary outcome) and 12 (secondary outcome) months, and PTSD symptom severity at 6 and 12 months (secondary outcome). Exploratory analyses will compare the treatment conditions on treatment targets measured at 6 months (e.g., physical activity, eating behavior, social support). Finally, we will estimate intervention costs, and identify MOVE! + UP implementation barriers and facilitators. If effective, MOVE! + UP could be an efficient way to simultaneously address physical and mental health for Veterans with PTSD.
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This study examined the role of college self-efficacy in the relationship between university belongingness and exercise motivation among a group of college students (N = 311). Multiple social factors have been identified as playing an important role in students’ physical health and wellness (Leslie et al., 1999; Wallace et al., 2000); however, the mechanisms by which university belongingness influences various exercise motives are unexplored. In the current study, college self-efficacy was examined as a mediator between university belongingness and six types of exercise motivation: stress management, appearance, enjoyment, revitalization, weight management, and positive health (Markland & Ingledew, 1997). Results showed that college self-efficacy mediated the relationship between belongingness and exercise motivation for stress management, enjoyment, revitalization, and positive health. These findings highlight how college self-efficacy helps explain the relationship between university belongingness and motivation to exercise, providing insight into prevention research and implications for university personnel to help foster greater health promotion on campus.
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Women experience disproportionate rates of both sexual assault and intimate partner violence (CDC, 2019 Centers for Disease Control and Prevention (CDC) . (2019). Injury prevention & control, violence prevention: Preventing sexual violence . U.S. Department of Health & Human Services. https://www.cdc.gov/violenceprevention/sexualviolence/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fsexualviolence%2Fconsequences.html [Google Scholar]). This article describes the physical, sexual, and mental health impact of these traumas for women and the parallels between feminist theory and SAMSHA’s six principles for trauma-informed care that include 1. Safety; 2. Trustworthiness and Transparency; 3. Peer Support; 4. Collaboration and Mutuality; 5. Empowerment, Voice and Choice; and 6. Cultural, Historical, and Gender Issues. By utilizing a trauma-informed framework and feminist perspective, clinicians and practitioners can better conceptualize the impact of trauma and the healing journey for survivors. Future research is needed to better understand the impact of interpersonal violence across cultures and how this trauma-informed approach can be effective in recovery.
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Posttraumatic stress disorder (PTSD) is characterized by avoidance of trauma‐related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma‐exposed individuals (65.9% female, 65.6% White, Mage = 19.24) from a university in the northeastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b=0.07, p<.001) and negative (b=0.04, p=.03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b=0.97, p=.01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b=0.13, p<.001), but not females (b=0.03, p=.08). Results suggest the importance of gender‐sensitive recommendations for assessment and treatment of emotional avoidance in PTSD. This article is protected by copyright. All rights reserved.
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Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one’s peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers.
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In the literature, there are many studies that have investigated the psychological reactions resulting from traumatic events of varying degrees, such as wars, natural disasters, and acts of violence. Few, however, are the searches performed on employees who are victims of robbery. We carried out a research to assess the psychological reactions of 644 bank employees who had been victims of robbery, especially with regard to the possible development of post- traumatic stress disorder (PTSD). The aim of this study was to evaluate the variables pre-, peri-, and postrobbery trauma in relation to the development of psychopathological symptoms. The exploration of the reactions after the robbery was carried out on 644 employees of a banking institution, present throughout the national territory, through a survey, consisting of a general description of the event, the Impact of Event Scale Revised-6 scale, and the General Health Questionnaire-12, during the days after the robbery. The analysis showed that the development of pretrauma variables is not significant and that peritrauma variables are partially significant. In particular, being directly involved in the robbery, the thought of being hurt, and the feeling of intense fear are associated with posttraumatic symptoms. Finally, among the posttrauma vari- ables, anxiety and depression played a major role. Surprisingly, a lower level of self-confidence seems to be related negatively to the PTSD symptomatology.
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Aerobic exercise seems to be effective in improving general mood and symptoms of depression and anxiety in healthy individuals and psychiatric patients. This effect is not limited to aerobic forms of exercise. There are almost no contraindications for psychiatric patients to participate in exercise programmes, provided they are free from cardiovascular and acute infectious diseases. However, very little is known about the effects of exercise in psychiatric disease other than those in depression and anxiety disorders. A few reports indicate the need for controlled investigations in psychotic and personality disorders. Unfortunately, no general concept for a therapeutic application of physical activity has been developed so far. Reliance on submaximal measures is highly recommended for fitness assessment. Monitoring of exercise intensity during training sessions is most easily done by measuring the heart rate using portable devices (whereas controlling the exact workload may be preferable for scientific purposes). Appropriate pre- and post-training testing is emphasised to enable adequate determinations of fitness gains and to eventually allow positive feedback to be given to patients in clinical settings.
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Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Article
Set correlation is a realization of the general multi variate linear model, can be viewed as a multivariate generalization of multiple correlation analysis, and may be employed in the analysis of multivariate data in any form. Set correlation supplements the four methods for analyzing two-way contingency tables de scribed by Zwick and Cramer (1986), and its applica tion to their example is illustrated. It gives the same results for the overall association, and in addition, by the use of nominal scale coding and partialling, it as sesses specific hypotheses about the details of the as sociation. Set correlation includes measures of strength of association (including correlations and proportions of variance), significance tests and estimation, power analysis, and computer programs to implement the calculations. Index terms: canonical analysis, con tingency table analysis, correspondence analysis, gen eral multivariate linear model, multivariate analysis of variance, Pearson chi-square, set correlation.
Article
In this chapter we present a psychobiological conceptual framework that accounts for the mounting evidence that posttraumatic stress disorder (PTSD) is a risk factor for medical illness. First we describe the human response to stress to provide the context for the ensuing discussion. Then we summarize the extensive literature on the relationship of chronic stress syndrome to medical illness. Next we review the biological alterations associated with chronic PTSD and how these PTSD-related psychobiological abnormalities might increase the risk for medical illness among affected individuals. Then we introduce the allostatic load model and demonstrate how this theoretical approach enables us to understand the etiological significance of such abnormalities. Finally, we discuss how the allostatic load model helps us conceptualize resilience, prevention, and treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This chapter reviews the extensive literature on mental disorders (primarily depression) and cardiovascular disease and considers the extent to which this research may be applicable to the association between posttraumatic stress disorders (PTSD) and physical disorders. The relationship between depression and coronary heart disease thus provides an excellent empirically based model that can inform questions about PTSD and health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study was conducted to investigate the long-term physical health implications of sexual assault in the rape victim. Fifty-one sexual assault victims, each with 2 or more years of time elapsed since the rape, responded to a self-administered questionnaire composed of demographics items and the Cornell Medical Index-Health Questionnaire (CMI). The victims were matched by age with a control group of 51 nonvictims. The results showed nonsignificant t-test differences between the two groups in demographic factors and in two CMI scores, Past Illness Symptoms and Family Health History. However, significant differences resulted between the groups in perceived current health status (x2 [df = 2, N = 102] = 11.26, p < 0.01) and in the CMI scores of Present Illness Symptoms (t = 5.51, p ≦ 0.01), Negative Health Behaviors (t = 6.21, p ≦ 0.01), and Female Reproductive Physiology Illness Symptoms (t = 6.21, p ≦ 0.01).
Article
A perceived availability of social support measure (the ISEL) was designed with independent subscales measuring four separate support functions. In a sample of college students, both perceived availability of social support and number of positive events moderated the relationship between negative life stress and depressive and physical symptomatology. In the case of depressive symptoms, the data fit a “buffering” hypothesis pattern, i.e., they suggest that both social support and positive events protect one from the pathogenic effects of high levels of life stress but are relatively unimportant for those with low levels of stress. In the case of physical symptoms, the data only partially support the buffering hypothesis. Particularly, the data suggest that both social support and positive events protect one from the pathogenic effects of high levels of stress but harm those (i.e., are associated with increased symptomatology) with low levels of stress. Further analyses suggest that self-esteem and appraisal support were primarily responsible for the reported interactions between negative life stress and social support. In contrast, frequency of past social support was not an effective life stress buffer in either the case of depressive or physical symptomatology. Moreover, past support frequency was positively related to physical symptoms and unrelated to depressive symptoms, while perceived availability of support was negatively related to depressive symptoms and unrelated to physical symptoms.
Article
To provide information on the use of the Beck Depression Inventory-II (BDI-II) with adolescents, the BDI-II was administered to 105 male and 105 female outpatients between 12 and 18 years old who were seeking psychiatric treatment. The internal consistency of the BDI-II was high (coefficient = .92). The mean BDI-II total score of the girls was approximately 5 points higher than that of the boys (p .001), and age (years) was positively correlated with the BDI-II total scores (r = .18, p .01). An iterated principal-factor analysis identified three factors, but only the Cognitive and Somatic-Affective factors were generalizable.
Article
This study examined the quality of the intimate relationships of male Vietnam veterans. Heterosexual couples in which the veteran had posttraumatic stress disorder (PTSD; n = 26) were compared to couples in which the veteran did not have PTSD (n = 24). Over 70% of the PTSD veterans and their partners reported clinically significant levels of relationship distress compared to only about 30% of the non-PTSD couples. Relationship difficulties appeared to encompass a wide range of areas, with PTSD veterans and their partners reporting that they had more problems in their relationships, more difficulties with intimacy, and had taken more steps toward separation and divorce than the non-PTSD veterans and their partners. The degree of relationship distress was correlated with the severity of veterans' PTSD symptoms, particularly symptoms of emotional numbing. Research and clinical implications of the results are discussed.
Article
We used path analysis to model the effects of combat exposure, posttraumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. We conclude that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship.
Article
Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.
Article
Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.
Article
We aimed to qualitatively evaluate the experiences of a group of 14 Australian Vietnam Veterans, including five who stated being diagnosed with Posttraumatic Stress Disorder, participating in a 40-week exercise programme. The veterans provided prospective feedback on perceptions, attitudes and opinions related to the programme via a series of three focus groups. A content analysis using the grounded theory approach was used to categorize the main themes to emerge from the transcribed data. The main findings included (a) the group's perceived lifestyle prior to participating in the programme, such as working long hours, social isolation and low motivation levels, (b) lifestyle and psychological changes as a result of the exercise programme, such as decreased anger levels, increased mental awareness, energy levels and daily resilience, and (c) increased social support. The veterans nominated the interaction and support arising from the classes, in addition to participation in the exercise per se, as being associated with the perceived benefits in personal lifestyle. The findings suggest that physical activity programmes set up within the community specifically for Vietnam Veterans may benefit them psychologically as well as physically.
Article
Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs healthcare system. A total of 134 patients completed an interview and questionnaires. Data on physician-diagnosed illnesses were gathered from medical records. PTSD diagnosis and symptoms were associated with a higher likelihood of circulatory and musculoskeletal disorders. In addition, PTSD symptoms were associated with more medical conditions. PTSD symptoms and diagnoses were also associated with poorer health related quality of life. Most of these findings remained significant after controlling for comorbid depressive, generalized anxiety disorder, and panic attack symptoms. Overall, gender did not moderate the relationship between PTSD and poorer health.
Article
This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.
Article
This study investigated the psychometric structure of two widely utilized measures of posttraumatic symptoms in a primarily Caucasian non-clinical sample. Given the prevalence of trauma exposure in non-referred samples, measurement of resulting symptoms is a critical issue. Exploratory factor analysis was utilized to assess and compare the factor structure of the Impact of Event Scale [IES; Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine, 41, 209-218] and the Mississippi Scale for Posttraumatic Stress Disorder, Civilian version [MIS-Civ; Vreven, D. L., Gudanowski, D. M., King, L. A., & King, D. W. (1995). The Civilian Version of the Mississippi PTSD Scale-a psychometric evaluation. Journal of Traumatic Stress, 8, 91-109] in a sample of college students reporting exposure to potentially traumatic events. The psychometric structure of the IES was largely consistent with the two-factor structure widely reported in the literature, while the structure of the MIS-Civ varied considerably in this sample. Notably, non-clinical samples tended to report fewer social and occupational dysfunction than clinical samples predominantly utilized in PTSD research. Implications for use of these instruments in screening samples are discussed.
Article
Epidemiological research examining the relationship between physical activity and depression has been conducted almost exclusively with community samples. We examined associations between physical activity, exercise coping, and depression in a sample of initially depressed patients, using four waves of data spanning 10 years. A cohort (n=424) of depressed adults completed measures of physical activity, exercise coping, depression, and other demographic and psychosocial constructs at baseline, 1-year, 4-years, and 10-years, with a 90% wave-to-wave retention rate. Multilevel modeling was used to analyze individual depression trajectories. More physical activity was associated with less concurrent depression, even after controlling for gender, age, medical problems, and negative life events. Physical activity counteracted the effects of medical conditions and negative life events on depression. However, physical activity was not associated with subsequent depression. The findings for exercise coping were comparable. Measures of physical activity and exercise coping encompassed a limited set of activities and did not include information about duration or intensity. Our results suggest that more physical activity is associated with reduced concurrent depression. In addition, it appears that physical activity may be especially helpful in the context of medical problems and major life stressors. Clinically, encouraging depressed patients to engage in physical activity is likely to have potential benefits with few obvious risks.