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Psychological Trauma: Theory, Research,
Practice, and Policy
PTSD and Depressive Symptoms in 911
Telecommunicators: The Role of Peritraumatic Distress
and World Assumptions in Predicting Risk
Michelle M. Lilly and Heather Pierce
Online First Publication, January 9, 2012. doi: 10.1037/a0026850
CITATION
Lilly, M. M., & Pierce, H. (2012, January 9). PTSD and Depressive Symptoms in 911
Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in Predicting
Risk. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online
publication. doi: 10.1037/a0026850
PTSD and Depressive Symptoms in 911 Telecommunicators:
The Role of Peritraumatic Distress and World Assumptions in
Predicting Risk
Michelle M. Lilly and Heather Pierce
Northern Illinois University
Continued exposure to trauma increases risk for both depression and PTSD. This may be particularly
true for individuals with work-related exposure to trauma such as 911 telecommunicators, a group
with significant exposure to work-related trauma that has received limited empirical attention. The
present study examines current symptoms of PTSD and depression in telecommunicators and the
extent to which peritraumatic distress and world assumptions interact to predict psychopathology. A
sample of 171 911 telecommunicators from across the country completed a survey that assessed
current symptoms of depression and PTSD, as well as exposure to different types of work-related
events, peritraumatic distress, and world assumptions. Symptoms of PTSD and depression were
significantly related to peritraumatic distress, self-worth, and benevolence of the world. Analyses
revealed that the relationship between peritraumatic distress and both current depression and PTSD
was significantly stronger for individuals who reported more negative assumptions about the
benevolence of the world and self-worth. Further, positive assumptions regarding the controllability
of the world were associated with PTSD, particularly in individuals who reported high peritraumatic
distress. The results suggest that 911 telecommunicators experience significant work-related expo-
sure to trauma, yet retain somewhat positive world assumptions. The important role of world
assumptions in explaining the link between peritraumatic distress and posttrauma psychopathology
in the form of current PTSD and depression is discussed.
Keywords: peritraumatic distress, world assumptions, PTSD, depression, emergency responders
Research has shown PTSD symptomatology to be notably high
in adults with ongoing duty-related trauma exposure. For example,
rates of PTSD in firefighters have been estimated to range between
12.5 and 22% (Corneil, Beaton, Murphy, Johnson, & Pike, 1999;
McFarlane & Papay, 1992; Wagner, Heinrichs, & Ehlert, 1998). In
police officers, rates of PTSD have been shown to range from
13–35% (Boyle, 1987; Mann & Neece, 1990; Neylan et al., 2005;
Robinson, Sigman, & Wilson, 1997), with rates even higher in
police officers exposed to duty-related shootings (46%; Gersons,
1989). The rate of PTSD symptoms consistent with a clinical
diagnosis was 19% in police officers who worked in the aftermath
of Hurricane Katrina (West et al., 2008).
Exposure to trauma also enhances risk for depressive symptoms,
though research on rates of depression in individuals with expo-
sure to duty-related trauma has remained limited. However, re-
search has suggested that exposure to duty-related trauma in-
creases risk for depression in police officers (Hartley, Violanti,
Fekedulegn, Andrew, & Burchfiel, 2007). In a study of retired
firefighters exposed to the World Trade Center disaster, 7%
reported symptoms consistent with a diagnosis of Major De-
pression on the Center of Epidemiologic Studies Depression
Scale (CES-D-m; Radloff, 1977), with an additional 36% re-
porting symptoms considered at “elevated risk” for Major De-
pression (Chiu et al., 2010).
While trauma exposure directly increases risk for PTSD and/or
depression, empirical investigation in the last decade has identified
intervening variables that enhance risk for adverse psychological
sequelae. Emotional and cognitive factors have received signifi-
cant attention, including the extent to which an individual experi-
ences emotional distress during a traumatic event and posttrauma
cognitions. For example, greater peritraumatic emotional distress
has been especially implicated in risk for the development of
PTSD (Brunet et al., 2001; Karam et al., 2010; Ozer, Best, Lipsey,
& Weiss, 2003) and the negative self-cognitions frequently ob-
served in depression (Miller, Handley, Markman, & Miller, 2010).
The same has been found for posttrauma cognitions about the
world, or world assumptions (Janoff-Bulman, 1989, 1992).
World assumption theory states that individuals typically de-
velop in childhood the following three fundamental assumptions
that aid in organizing external input: the world is benevolent (i.e.,
most people do not expect bad things to happen to them or others),
the world is meaningful (i.e., people have control over their lives
and things happen for a reason), and the self is worthy (i.e., people
believe that they deserve good things to happen to them). These
assumptions allow an individual to navigate their social world
without anxiety that may be present if one were to believe the
Michelle M. Lilly and Heather Pierce, Department of Psychology,
Northern Illinois University.
Correspondence concerning this article should be addressed to Michele
M. Lilly, NIU, Department of Psychology, Psychology-Computer Science
Building, DeKalb, IL 60115.. E-mail: mlilly1@niu.edu
Psychological Trauma: Theory, Research, Practice, and Policy © 2012 American Psychological Association
2012, Vol. ●●, No. ●, 000– 000 1942-9681/12/$12.00 DOI: 10.1037/a0026850
1
world to be essentially malevolent or uncontrollable. World as-
sumption theory has much in common with other cognitive and
psychological theories that have been linked to the development of
psychopathology, such as the Hopelessness Theory of depression,
which contends that depression forms out of the tendency of an
individual to make cognitive attributions that are internal, global,
and stable (Abramson et al., 2002; Abramson, Metalsky, & Alloy,
1989). The world assumptions construct may also overlap with the
internal working model of attachment theory (Bowlby, 1969/
1982). This theory emphasizes how a healthy infant– caregiver
relationship produces within developing children an ability to not
only regulate emotions, but also a cognitive attributional style that
sees the world as benevolent and safe to explore, and both instills
and maintains a healthy sense of self-worth in the individual.
The theory of world assumptions argues that assumptions are
malleable and can be shattered in the face of a traumatic experi-
ence. In fact, a significant link has been found between trauma
exposure, mental health, and world assumptions. For example,
more diminished world assumptions was associated with PTSD in
South African trauma survivors (Magwaza, 1999), in a community
sample of trauma survivors (Goldenberg & Matheson, 2005), and
in survivors of intimate partner violence (Lilly, Howell, &
Graham-Bermann, in press). More negative world assumptions in
the presence of depressive symptoms have also been observed in
undergraduate students (Harris & Valentiner, 2002) and intimate
partner violence survivors (Lilly, Valdez, & Graham-Bermann,
2011). Yet, limited empirical work has examined world assump-
tions in first responders. Wagner, McFee, and Martin (2009) found
that the world assumptions of firefighters were no more negative
than a control group of blue-collar workers who did not regularly
experience job-related trauma exposure, with the exception of the
benevolence of the world subscale. The authors argued this may be
due to the fact that firefighters reported more overall job satisfac-
tion because they find their work meaningful in its contribution to
the community. Harris, Baloglu, and Stacks (2002) used structural
equation modeling to show that critical incident debriefing was
positively, though weakly, associated with better world assump-
tions in firefighters exposed to duty-related trauma, and that de-
briefing was significantly, inversely related to negative affectivity
as measured by depressive and anxiety symptoms. This might
suggest that debriefing may be related to the restoration of more
positive assumptions in the aftermath of duty-related trauma for
firefighters, and that this may be related to lowered risk for
posttrauma depression and anxiety.
In police officers, world assumptions have been linked to low-
ered risk for PTSD. Yuan et al. (2011), for example, conducted a
2-year prospective study, in which cognitions of police academy
cadets related to self-worth and benevolence of the world were
assessed. The authors found that having more positive assumptions
regarding the benevolence of the world seemed a protective factor
against developing duty-related PTSD 2 years after the completion
of training. This study suggests that beliefs in the benevolence of
the world may be a particularly important cognitive factor that
assists individuals in creating meaning around, and recovering
from, traumatic events experienced while on duty in ways that
protect against the development of PTSD. Further, Wang et al.
(2010) found that cognitions related to self-worth were important
in predicting 2-year prospective depression symptoms in police
officers. Given the centrality of self-worth in conceptualizations of
depression, this finding is not surprising. In sum, it appears as
though particular constructs within the world assumptions theory
may be more specifically related to posttrauma psychopathology in
samples of first responders. Benevolence of the world, for in-
stance, has been more strongly associated with PTSD in both
firefighters and police officers, while self-worth has been more
strongly associated with posttrauma depression scores. The world
assumptions of 911 telecommunicators, however, have never been
examined, nor has an exploration of the relationship between
world assumptions and psychopathology been conducted in this
population.
Finally, while world assumptions and peritraumatic distress
have both been shown to increase risk for depression and PTSD
independently, the ways in which these factors interact has not
been explored and may provide some theoretical support for
Janoff-Bulman’s original theory. Janoff-Bulman contends that as-
sumptions are typically positive until confronted by highly con-
tradictory information that is presented in a context of high emo-
tional distress. Yet, no research to date has explored whether there
is (a) a relationship between level of peritraumatic distress and
more diminished world assumptions, and (b) whether these factors
interact in ways that significantly predict posttrauma symptom
picture. One might theorize that peritraumatic distress will be most
deleterious for individuals that report more negative world as-
sumptions in the aftermath of trauma.
This study examines current symptoms of PTSD and depression
in a sample of 911 telecommunicators. We wished to examine
whether heightened reports of work-related peritraumatic distress
were related to more diminished world assumptions and whether
these factors interact to predict depression and PTSD symptoms.
The following hypotheses were proposed: (1) peritraumatic dis-
tress will be significantly, positively correlated with both current
PTSD and depressive symptoms, (2) assumptions regarding self-
worth, controllability and benevolence of the world will be in-
versely related to PTSD and depressive symptoms, (3) greater
levels of peritraumatic distress will be related to more diminished
assumptions of self-worth, controllability and benevolence of the
world, and (4) world assumptions will significantly moderate the
relationship between peritraumatic distress and both current PTSD
and depressive symptoms. We contend that peritraumatic distress
will be more significantly, positively correlated to PTSD and
depressive symptoms for individuals twho report more negative
world assumptions.
Method
Participants
A total of 171 911 telecommunicators across the United States
completed the survey. The sample was predominantly female (n⫽
126, 74%) and European American (n⫽131, 77%) with an
average age of 38.85 (SD ⫽9.61). Most of the participants were
married and/or living with a partner (n⫽107, 63%), however, a
significant minority reported being single (n⫽30, 18%) or di-
vorced (n⫽31, 18%). All participants were currently working as
a telecommunicator with an average of 11.85 (SD ⫽8.16) years of
service. Most participants had either a college degree (n⫽58,
34%) or some college or vocational training (n⫽80, 47%).
2LILLY AND PIERCE
Measures
PTSD symptoms. The Posttraumatic Stress Diagnostic Scale
(PDS; Foa, 1995) was used to assess severity of PTSD symptoms
in the last month. The PDS is a 49-item measure that asks partic-
ipants to identify a traumatic life event that they experienced as
“the worst” or one that “stuck with them.” Participants were asked
to focus on an upsetting event that occurred while on duty. With a
focus on this event, participants were asked whether they had
experienced symptoms of hyperarousal, reexperiencing, and
avoidance symptoms in the last month in relationship to the event,
with response options of 0 ⫽Not at all or only one time,1⫽Once
a week or less/once in awhile,2⫽2– 4 times a week/half the time,
and 3 ⫽5 or more times a week/almost always. A symptom score
was created by tallying symptom items, with higher scores indi-
cating more severe PTSD symptoms. The internal consistency of
the PDS for the present sample was ␣⫽.92.
Depressive symptoms. The Depression subscale of the
Symptom Checklist-90-R (SCL-90 –R; Derogatis, 1994) was used.
Participants are asked to consider whether they have been affected
by measure items in the past week with response options of 0 ⫽
Not at all,1⫽A little bit,2⫽Moderately,3⫽Quite a bit, and
4⫽Extremely. The Depression subscale includes 13 items and
scores are generated by averaging item responses. Higher scores
represent more disturbances related to depressive symptoms. The
internal consistency for the Depression subscale in this sample was
␣⫽.91.
Peritraumatic distress. The Peritraumatic Distress Inventory
(PDI; Brunet et al., 2001) was used to assess emotional distress
during and immediately after the participants’ most upsetting
experience at work. The PDI is a 13-item measure with response
options of 0 ⫽Not at all,1⫽Slightly,2⫽Somewhat,3⫽Very,
and 4 ⫽Extremely true. The PDI score was created by tallying all
13 items, with higher scores reflecting the presence of greater
peritraumatic emotional distress. Internal consistency for the PDI
was ␣⫽.86.
World assumptions. The World Assumptions Scale (WAS;
Janoff-Bulman, 1989) is a 32-item measure that assesses partici-
pants’ cognitions about the world and self. A 6-point scale is used
with response options of 1 ⫽Strongly disagree,2⫽Disagree,
3⫽Somewhat disagree,4⫽Somewhat agree,5⫽Agree, and
6⫽Strongly agree. The original measure contains eight subscales,
but for the present study, only the self-worth (WAS–SW), benev-
olence of the world (WAS–BW) and controllability (WAS–
CONT) subscales were used. Each of these subscales includes four
items. Examples include: “The good things that happen in this
world far outnumber the bad” (benevolence of the world), “Peo-
ple’s misfortunes result from mistakes they have made” (control-
lability), and “I often think I am no good at all” (self-worth). The
subscale scores were produced by reverse coding specified items
and tallying items on the subscale, with higher scores reflecting
more positive assumptions. The internal consistency for the sub-
scale scores were: benevolence of the world ␣⫽.86, self-worth
␣⫽.77, controllability ␣⫽.77.
Exposure to distressing calls. To assess participants’ expo-
sure to different types of work-related calls, the Potentially Trau-
matic Events Questionnaire (Troxell, 2008) was used. The ques-
tionnaire assesses whether participants have experienced 21
different types of traumatic calls that telecommunicators may field.
These events range from violent domestic calls to traffic accidents
with fatalities to calls involving family or friends. To our knowl-
edge, this is only the second time that this questionnaire has been
used. As such, the psychometric properties of the measure have not
been fully investigated.
Procedure
Participants were approached to participate in the survey
through a number of sources: recruitment letters at randomly
selected agencies, professional association list serves, professional
organization online forums, and social networking interest groups
discussion boards. The option to complete the survey online or via
hard copies was presented. No financial incentive was offered. The
study was approved by the institutional review board (IRB) at
Northern Illinois University.
Results
The sample reported exposure to an average of 15.32 different
types of potentially traumatizing calls (SD ⫽3.50). For most calls,
over 75% of the sample reported exposure to that type of call,
including calls such as structure fires, violent domestics, and
armed robbery. However, several types of calls produced more
equal distribution (i.e., calls involving friends or family; 55%) or
were comparatively underreported by the sample: riots/mob action
(38.6%), hostage situation (43.9%), plane crash (34.5%), officer
shot (31.6%), and line-of-duty death (32.3%). Despite a high rate
of exposure to potentially traumatizing duty-related events, current
PTSD symptom reports in the last month were surprisingly low
(M⫽7.07, SD ⫽8.13). The mean score for depression symptoms
was .65 (SD ⫽.68). The depression score for females and males
in the sample were at the 58th and 61st percentile, respectively, for
female and male nonpatient samples (Derogatis, 1994).
A correlation matrix examining the primary variables of interest
confirm the first hypothesis; namely, peritraumatic distress was
significantly, positively related to both PTSD symptoms (r⫽.34,
p⬍.001) and depressive symptoms (r⫽.36, p⬍.001) (see Table
1). The second hypothesis was also partially confirmed as current
PTSD symptoms were significantly, inversely related to self-worth
(r⫽⫺.16, p⫽.042) and benevolence of the world (r⫽⫺.22, p⫽
.004), and similarly, depressive symptoms were significantly, in-
versely related to self-worth (r⫽⫺.20, p⫽.011) and benevolence
of the world (r⫽⫺.19, p⫽.012). Controllability was not
significantly related to current PTSD (r⫽.07, p⫽.399) or
depressive symptoms (r⫽.09, p⫽.233). Hypothesis three was
Table 1
Correlation Matrix of Primary Variables of Interest (N⫽171)
123 456
1. WAS Self-worth —
2. WAS Controllability ⫺.07 —
3. WAS Benevolence of
World .19
ⴱ
⫺.03 —
4. Peritraumatic Distress .21
ⴱⴱ
⫺.13 .02 —
5. PTSD Symptoms ⫺.16
ⴱ
.07 ⫺.22
ⴱⴱ
.34
ⴱⴱⴱ
—
6. Depressive symptoms ⫺.20
ⴱ
.09 ⫺.19
ⴱ
.36
ⴱⴱⴱ
.65
ⴱⴱⴱ
—
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
3
PREDICTING RISK IN 911 TELECOMMUNICATORS
also only partially confirmed as peritraumatic distress was signif-
icantly related to self-worth (r⫽.21, p⫽.006), but was not
significantly associated with controllability (r⫽⫺.13, p⫽.089)
or benevolence of the world (r⫽.02, p⫽.773).
A series of moderation analyses were conducted to examine
whether world assumption variables interacted with peritraumatic
distress to predict posttrauma psychopathology. The methodology
for testing moderation prescribed by Frazier, Tix, and Barron
(2004) was used. World assumptions and peritraumatic distress
were standardized to reduce multicollinearity. The first set of
regression analyses examined benevolence of the world as a mod-
erator of the relationship between peritraumatic distress, and both
current PTSD and depressive symptoms (see Table 2). For both
outcome variables, the analyses showed main effects for greater
peritraumatic distress and more negative benevolence of the world,
with each uniquely predicting variance in PTSD and depressive
symptoms. Benevolence of the world also served as a significant
moderator of the relationship between peritraumatic distress and
both current PTSD (see Figure 1) and depressive symptoms (see
Figure 2). More specifically, peritraumatic distress conferred the
greatest risk for posttrauma psychopathology when individuals
reported beliefs that the world is unsafe and malevolent.
Similar analyses were completed substituting self-worth as the
moderator (see Table 3). Significant main effects were observed
such that greater peritraumatic distress and lower self-worth ac-
counted for unique variance in current PTSD and depressive
symptoms. A significant moderating effect was observed for de-
pressive symptoms; peritraumatic distress was more strongly as-
sociated with depressive symptoms in the presence of more dimin-
ished self-worth (see Figure 3). While reports of current PTSD
symptoms were greatest for individuals high on peritraumatic
distress with more negative self-worth, the interaction term was
not significant (p⫽.068).
The final regression analysis was performed testing controlla-
bility as the moderating variable (see Table 4). The analyses
revealed that peritraumatic distress continues to have a significant,
positive association with psychopathology in the presence of con-
trollability. No main effect was observed for controllability,
though controllability it is important to note that controllability
showed a positive relationship with current PTSD symptoms and
depressive symptoms. Further, greater peritraumatic distress con-
ferred significantly greater risk for current PTSD symptoms for
individuals that had more positive assumptions about the control-
lability of the world, not more negative assumptions (see Figure 4).
While the direction of moderating effect was the same for depres-
sion, the interaction term was not significant (p⫽.093).
Discussion
This study is the first to examine depression and PTSD symp-
toms in 911 telecommunicators, a population at great risk for
adverse mental health given high levels of duty-related trauma
exposure. We sought to examine the influence of peritraumatic
distress on current depression and PTSD symptoms, as well as to
determine whether distress is moderated by the extent to which
world assumptions are diminished in the face of trauma exposure.
While research has consistently shown relationships between peri-
traumatic distress and posttrauma psychopathology (Brunet et al.,
2001; Karam et al., 2010; Miller et al., 2010; Ozer et al., 2003), as
well as links between diminished world assumptions and both
PTSD and depression symptoms (Goldenberg & Matheson, 2005;
Harris & Valentiner, 2002; Lilly, Howell, & Graham-Bermann, in
press; Lilly, Valdez, & Graham-Bermann, 2011; Magwaza, 1999),
the present study wished to provide some preliminary support to
world assumption theory, which argues that assumptions are shat-
tered during traumatic events that are extremely emotionally dis-
tressing. Though a cross-sectional design cannot fully answer this
question, it is one step in examining whether world assumptions
Figure 1. Benevolence of the world as a moderator of the relationship
between peritraumatic distress and PTSD symptoms.
Table 2
WAS Benevolence of the World as a Moderator of the Relationship Between Peritraumatic
Distress (PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .19
PDI 2.76 .56 .000
ⴱⴱⴱ
WAS–BW ⫺1.58 .57 .007
ⴱⴱ
PDI ⫻WAS–BW ⫺1.46 .56 .010
ⴱ
Depressive Symptoms .20
PDI .25 .05 ⬍.001
ⴱⴱⴱ
WAS–BW ⫺.11 .05 .021
ⴱ
PDI ⫻WAS–BW ⫺.13 .05 .007
ⴱⴱ
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
4LILLY AND PIERCE
are connected to peritraumatic experiences, and can help explain
why peritraumatic distress has been so strongly linked to the
development of depression and PTSD symptoms.
Consistent with predictions, an interaction effect was observed
between peritraumatic distress and benevolence of the world in
predicting both current depression and PTSD symptoms. More
diminished assumptions about the benevolence of the world ac-
centuated the effect of peritraumatic distress on both depression
and PTSD symptoms. Similar effects were detected when consid-
ering self-worth as a moderator in the relationship between peri-
traumatic distress and psychopathology such that individuals at
greatest risk for depression symptoms were those that reported
both heightened levels of distress and concurrently more dimin-
ished self-worth. Given that self-worth is not a required criterion
for diagnosis of PTSD, but is for depression, it perhaps makes
sense that self-worth would be more strongly implicated in depres-
sion than PTSD. This is also consistent with previous work with
firefighters and police officers, which showed that self-worth was
implicated in depression, but not PTSD (Wagner et al., 2009;
Wang et al., 2010).
These results provide some preliminary support for the impor-
tant role of both peritraumatic distress and world assumptions in
predicting posttrauma psychopathology, which may provide im-
portant information relevant for training and preventing psycho-
pathology in telecommunicators. Specifically, strong emotional
reactions at the time of an upsetting duty-related event should be
targeted for prevention of psychopathology, and further, an em-
phasis should also be placed on the extent to which individuals
retain more positive cognitions about the benevolence of the world
and self-worth. This study suggests that individuals whose as-
sumptions are less strongly diminished in the presence of trauma
fare better, even if they have experienced significant distress
during duty-related events.
The final moderation analyses produced unanticipated results.
Though it was hypothesized that having more diminished control-
lability would be related to heightened risk for current depression
and PTSD symptoms, and further, that negative controllability
would moderate the relationship between distress and psychopa-
thology, the observed direction of effect was the opposite to that
anticipated. A significant interaction was observed between con-
trollability and peritraumatic distress in predicting PTSD, such that
having more positive assumptions about one’s control over the
world accentuated the relationship between distress and PTSD
symptoms. A similar effect was also observed for depression,
though the interaction term achieved only the level of a trend. One
possibility for these seemingly countertheoretical findings is that
controllability serves a particular occupational role for telecom-
municators. The job of a telecommunicator involves trying to
gather information from callers that are often hysterical and lack
control. If the telecommunicator is unable to sufficiently pacify a
caller to a point where the caller can communicate important
information, the telecommunicator will be ineffective. As such,
Figure 2. Benevolence of the world as a moderator of the relationship
between peritraumatic distress and depressive symptoms.
Table 3
WAS Self-Worth (WAS–SW) as a Moderator of the Relationship Between Peritraumatic Distress
(PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .18
PDI 2.89 .60 .000
ⴱⴱⴱ
WAS–SW ⫺1.96 .58 .001
ⴱⴱ
PDI ⫻WAS–SW ⫺.95 .52 .068
Depressive Symptoms .24
PDI .26 .05 .000
ⴱⴱⴱ
WAS–SW ⫺.20 .05 .000
ⴱⴱⴱ
PDI ⫻WAS–SW ⫺.11 .04 .008
ⴱⴱ
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
Figure 3. Self-worth as a moderator of the relationship between peritrau-
matic distress and depressive symptoms.
5
PREDICTING RISK IN 911 TELECOMMUNICATORS
telecommunicators may begin to believe that they possess greater
control over sometimes horrific circumstances than they actually
possess. No telecommunicator can completely control what occurs
during a call and it may be that significant peritraumatic distress is
experienced in reaction to calls over which the telecommunicator
attempted to garner control, but was unable. This may significantly
enhance risk for depression and PTSD as the telecommunicator
may feel responsible for how events unfolded or may ruminate
over what they could have done differently. These results suggest
that prevention and intervention efforts may be focused on cogni-
tions regarding control, especially in regards to PTSD. Further,
world assumptions theory needs continued empirical examination
and may be more nuanced in predicting mental health depending
on the context of the trauma and level of distress experienced.
Strengths of the present study include its emphasis on the mental
health of a population that has received strikingly limited empirical
investigation despite significant exposure to potentially traumatiz-
ing events. Limited information is known about the risk for de-
pression and PTSD among this population and further data that
may inform training and prevention efforts. The cross-sectional
design places some limitations on the conclusions that can be
drawn regarding the proposed temporal order of effects and future
research incorporating prospective designs is necessary. Because
of this limitation, it is not possible to know whether the telecom-
municators’ current symptomatology has increased, decreased, or
remained stable over time. It is possible that the cross-section of
scores for this sample represent PTSD and depression that may
have significantly remitted over time, and may have been worse
directly following exposure to upsetting calls. Continued research
to parse out the complex interrelationships between emotions and
cognitions in predicting posttrauma symptom picture is warranted.
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WAS Controllability (WAS–CONT) as a Moderator of the Relationship Between Peritraumatic
Distress (PDI) and Both PTSD Symptoms and Depressive Symptoms
Dependent variable Predictors Adj. R
2
SE p
PTSD Symptoms .15
PDI 2.80 .59 .000
ⴱⴱⴱ
WAS–CONT .83 .59 .160
PDI ⫻WAS–CONT 1.37 .62 .028
ⴱ
Depressive Symptoms .16
PDI .25 .05 .000
ⴱⴱⴱ
WAS–CONT .09 .05 .063
PDI ⫻WAS–CONT .09 .05 .093
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
Figure 4. Controllability as a moderator of the relationship between
peritraumatic distress and PTSD symptoms.
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Received July 11, 2011
Revision received November 15, 2011
Accepted December 5, 2011 䡲
7
PREDICTING RISK IN 911 TELECOMMUNICATORS
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