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PTSD and Depressive Symptoms in 911 Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in Predicting Risk


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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 exposure 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. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
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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
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:
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
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
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.
A total of 171 911 telecommunicators across the United States
completed the survey. The sample was predominantly female (n
126, 74%) and European American (n131, 77%) with an
average age of 38.85 (SD 9.61). Most of the participants were
married and/or living with a partner (n107, 63%), however, a
significant minority reported being single (n30, 18%) or di-
vorced (n31, 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 (n58,
34%) or some college or vocational training (n80, 47%).
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,1Once
a week or less/once in awhile,22– 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,1A little bit,2Moderately,3Quite a bit, and
4Extremely. 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
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,1Slightly,2Somewhat,3Very,
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,2Disagree,
3Somewhat disagree,4Somewhat agree,5Agree, and
6Strongly 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.
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.
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
(M7.07, 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 (N171)
123 456
1. WAS Self-worth
2. WAS Controllability .07
3. WAS Benevolence of
World .19
4. Peritraumatic Distress .21
.13 .02
5. PTSD Symptoms .16
.07 .22
6. Depressive symptoms .20
.09 .19
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).
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
SE p
PTSD Symptoms .19
PDI 2.76 .56 .000
WAS–BW 1.58 .57 .007
PDI WAS–BW 1.46 .56 .010
Depressive Symptoms .20
PDI .25 .05 .001
WAS–BW .11 .05 .021
PDI WAS–BW .13 .05 .007
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
SE p
PTSD Symptoms .18
PDI 2.89 .60 .000
WAS–SW 1.96 .58 .001
PDI WAS–SW .95 .52 .068
Depressive Symptoms .24
PDI .26 .05 .000
WAS–SW .20 .05 .000
PDI WAS–SW .11 .04 .008
Figure 3. Self-worth as a moderator of the relationship between peritrau-
matic distress and depressive symptoms.
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
SE p
PTSD Symptoms .15
PDI 2.80 .59 .000
WAS–CONT .83 .59 .160
PDI WAS–CONT 1.37 .62 .028
Depressive Symptoms .16
PDI .25 .05 .000
WAS–CONT .09 .05 .063
PDI WAS–CONT .09 .05 .093
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Received July 11, 2011
Revision received November 15, 2011
Accepted December 5, 2011
... Traumatic and chronic occupational antecedents, work-family conflict (WFC), negative appraising, and coping appear to influence susceptibility to development of PTSS in general but have not been examined as part of a comprehensive model. Recent work has demonstrated telecommunicators may experience significant traumatization following emergent and critical incidents (Lilly & Pierce, 2013;Pierce & Lilly, 2012), which may lead to increased turnover and absenteeism (Sotebeer, 2011). Furthermore, chronic occupational stressors contribute to acute stress reactivity (Wirtz, Ehlert, Kottwitz, La Marca, & Semmer, 2013) and may increase susceptibility to posttraumatic distress as witnessed in other first responder populations, such as police, fire, and emergency medical technicians (EMTs) (Berger et al., 2012), yet this link has not been explored in telecommunicators. ...
... Recent literature has revealed telecommunicators may experience traumatization as evidenced in the form of PTSS following exposure to potentially traumatizing events (Lilly & Pierce, 2013;Pierce & Lilly, 2012;Troxell, 2008); however, most research on posttraumatic stress dichotomizes stress outcomes as the presence or absence of clinical PTSD, which omits valuable information on a potentially significant portion of the population who may suffer from subclinical levels of PTSS (Lowe, Walsh, Uddin, Galea, & Koenen, 2014). Furthermore, appraisal of trauma requires assessment of individual and environmental stressors as well as assessment of individual ability to handle adversity. ...
... The transactional theory of stress and coping has been used to examine posttraumatic stress outcomes in previous research; however, with a few notable exceptions (Colwell, 2005;Salinas Farmer, 2008), research tends to omit key components, such as appraising or coping, providing limited support for the theory (Burke & Shakespeare-Finch, 2011;Ho & Lo, 2011;Hooberman, Rosenfeld, Rasmussen, & Keller, 2010;Kirby et al., 2011;LeBlanc et al., 2011;Lilly & Pierce, 2013;Pierce & Lilly, 2012;Sliter et al., 2013). These theories suggest that PTSS can be predicted by examining environmental and psychosocial factors, individual appraisals of these factors, and coping. ...
Telecommunicators (e.g., dispatchers and 911 operators) experience firsthand the death and suffering of friends, family, peers, and strangers in a chaotic work environment characterized by chronic stress and lack of support. Previous research has demonstrated telecommunicators are at increased risk for negative health outcomes; however, existing research does not identify predictive pathways to posttrauma symptoms in telecommunicators. In an application of the transactional theory of stress and coping, I used structural equation modeling to examine occupational antecedents, work-family conflict, negative appraising, and coping as predictors of posttraumatic stress symptoms in telecommunicators. A convenience sample of 103 telecommunicators, recruited through agencies across the United States, completed a series of PTSD, stress, and coping surveys. Results supported three theorems from the transactional theory of stress and coping: (a) Chronic antecedents are correlated with work-family conflict (r = .54, p < .01), (b) work-family conflict predicted negative appraising (β = .64, p < .01), and (c) coping predicted posttraumatic stress symptoms in telecommunicators (β = .30, p = .01). These findings contribute to the current body of occupational health literature by expanding understanding of telecommunicators’ occupational experiences and appraisals and provide insights into modifiable processes and policies that can enhance and protect telecommunicator long term health. Specifically, employee-focused policies directed at preserving work-home balance and reducing chronic stressors in the workplace are recommended. Additionally, further research can be initiated to evaluate effectiveness of policy changes in telecommunicator appraising, health, and wellbeing.
... Diğer yandan davranışçı yaklaşıma göre de stresörle baş edemeyeceğine yönelik inanç kişinin olay sırasında daha fazla olumsuz duygu deneyimlemesine, bu da olay sonrası TSSB geliştirme olasılığının artmasına neden olmaktadır. Alanyazında birçok çalışma hem afetzedelerde hem de polis ve acil yardım çalışanlarında olay sırasında deneyimlenen korku, çaresizlik gibi olumsuz duyguların travma sonrası stres belirtilerinin gelişmesinde önemli bir faktör olduğuna işaret etmektedir (Bryant ve Harvey, 1996;Cankardaş ve Sofuoğlu, 2019;Lilly ve Pierce, 2013;Maia ve ark., 2011). ...
... İtfaiye çalışanlarında gelişen travmatik stres belirtilerinde en yüksek etkinin olay sırasında deneyimlenen psikolojik sıkıntı olduğu, bu sıkıntı düzeyi arttıkça TSSB olasılığının 4.4 kat arttığı görülmüştür. Bu bulgu alanyazındaki peri-travmatik sıkıntının olay sonrası travmatik stres düzeyini yordadığına işaret eden çalışmaları destekler niteliktedir (Bryant ve Harvey, 1996;Cankardaş ve Sofuoğlu, 2019;Lilly ve Pierce, 2013;Maia ve ark., 2011). Seligman'ın öğrenilmiş çaresizlik yaklaşımına göre, karşılaştığı stresörü kontrol edilemez olarak algılamak travmatik olay deneyimleyen kişilerin TSSB belirtileri geliştirmelerinde önemli bir etkiye sahiptir (Maier ve Seligman, 1976). ...
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Firefighters are at high risk of experiencing mental disorders like other first responders. Although the studies on the prevalence of mental health problems in firefighters are common in the literature, it is seen that there are limited studies on the causes of these problems. This study aimed to investigate the risk of depression and traumatic stress symptoms among firefighters working in Turkey. In addition, it was aimed to investigate the variables before and during the event that predicted the traumatic stress symptoms. For this purpose, data were collected from the 468 firefighters working in the fire department of 35 provinces that agreed to participate in the study by using the Behavior, Safety, and Culture-First Responders, Patient Health Questionnaire-2, and Impact of Events Scale. It was seen that approximately half of the firefighters met the diagnosis of possible post-traumatic stress disorder, and approximately one fifth had a risk of depression. It was observed that the level of distress experienced during the event was the variable that explained the higher variance in the level of traumatic stress symptoms. Findings indicate that firefighters should have access to the psychological support system. Thus, it may be possible to prevent the continuation of mental problems and decrease in the quality of life.
... One population that merits attention in this literature is emergency telecommunicators (TCs). The emergency TC sample is distinct from those used in previous studies because it is a community sample of individuals who frequently experience work-related trauma exposure and tend to have more symptoms of psychopathology than the general population (Lilly & Allen, 2015;Lilly & Pierce, 2013). ...
... For example, emergency TCs experience a high level of occupational peritraumatic distress (distress experienced during a traumatic event; Pierce & Lilly, 2012), which is highly associated with the development of posttraumatic stress disorder and depressive symptoms (Lilly & Pierce, 2013). This is important and relevant to this work for two reasons: (1) previous research has found that the factor structure of mindfulness may be sensitive to psychopathology (Curtiss & Klemanski, 2014); and (2) emerging research shows that MBIs with emergency TCs effectively reduce stress but do not improve mindfulness (Lilly et al., 2019). ...
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Objectives There is mixed psychometric evidence for the Five-Facet Mindfulness Questionnaire’s (FFMQ) Observing factor (FFMQ-Observing). Recent efforts to improve this construct produced a new Observing Scale consisting of three factors: Body Observing, Emotion Awareness, and External Perception. Using a sample of mostly nonmeditating emergency telecommunicators (TCs), this study explored this new Observing Scale’s factor structure, its viability as a replacement for the FFMQ-Observing factor, and its convergent validity.Methods The FFMQ and additional mindfulness items from the new Observing Scale were administered via an online survey to emergency TCs (N = 242, Mage = 41.84, SD = 9.80, range = 18–72). We performed exploratory factor analysis (EFA) on the Observing Scale, confirmatory factor analysis (CFA) on a novel five-factor model integrating the Observing Scale with the FFMQ (excluding FFMQ-Observing), and correlations among the Observing Scale, the FFMQ, and mindfulness-based practices.ResultsEFA suggested four factors for the Observing Scale: Internal Body Observing, External Body Observing, Emotion Awareness, and External Perception. CFA failed to validate our integrated model, but the Observing Scale was positively correlated with the FFMQ and mindfulness-based practices.Conclusions This study provides preliminary support for an improved Observing Scale, while suggesting a novel, four-factor structure in emergency TCs. Although the Observing Scale was not compatible with the FFMQ, this may reflect measurement error rather than model misspecification given evidence of content overlap and distinctive forms of Body Observing. Future attempts to validate the new Observing Scale in larger samples are encouraged before it may be recommended as an alternative to the FFMQ-Observing factor.
... Conversely, while 9-1-1 telecommunicators are not physically on scene and do not have a physically strenuous job, they receive the first notification of an emergency; are often the only lifeline to a person until other first responders arrive; and are exposed to the sounds, emotions, and, in certain settings, videos of the events throughout the call (Pierce, & Lilly, 2012). The intense emotional stress that all first responders face may lead to adverse mental health issues, including depression, anxiety, post-traumatic stress, sleep disturbance, and suicidal behaviors (Bentley et al., 2013;CDC, n.d.c;Lilly & Pierce, 2013;Pierce & Lilly, 2012;Vargas de Barros, Martins, Saitz, & Ronzani, 2013;Violanti et al., 2016). ...
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Introduction: First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection. Methods: Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders. Results: First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts. Conclusions: While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions. Practical application: Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.
... Positive, albeit weak, correlations between the dimensions of world assumptions and post-traumatic growth (H1) are consistent with those previously obtained in various populations. For example, Lilly and Pierce [89] found that people who believe that the world is benevolent, things occur for a reason, and the self is worthy of respect display lower anxiety or depressive symptoms than their counterparts who present assumptions of the world as a dangerous place and a scarce sense of self-worth. This is possibly due to the cognitive engagement in the processing of a traumatic experience. ...
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Background: Although post-traumatic growth is believed to be the result of complex interplays between various factors, cognitive variables appear to play a special role in these interactions. Yet, research on this topic is scant. Therefore, the first purpose of this study was to verify whether there is a direct relationship between world assumptions and post-traumatic growth among Polish cancer patients. As the effect of psychological change in post-traumatic growth may be affected by basic beliefs about the world and oneself, the second goal was to assess whether this association is moderated by rumination. Methods: The study included 215 Polish cancer patients. The Post-traumatic Growth and Depreciation Inventory-Expanded version-(intrusive and deliberate rumination), the World Assumption Scale, and the Event-related Rumination Inventory were applied. Results: Positive, albeit weak, correlations were found between the dimensions of world assumptions and post-traumatic growth. Post-traumatic growth correlated negatively with intrusive rumination and positively with deliberate rumination. The outcomes show that the level of post-traumatic growth resulting from world assumptions is significantly different at various levels of intrusive and deliberate rumination. Conclusion: Lower/medium intrusive rumination seems to strengthen the relationship between benevolence of the world/worthiness of the self and post-traumatic growth, and higher deliberate rumination tends to reinforce the relationship between meaningfulness and post-traumatic growth.
... Parmi ces mé tiers exigeants se trouve celui des ré partiteurs d'urgence, travailleurs encore trop peu mis en lumiè re, qui n'é chappent pourtant pas à cette ré alité . Plusieurs chercheurs s'inté ressent aux facteurs de risques sur la santé psychologique au travail des ré partiteurs d'urgence, notamment la nature traumatisante des appels qu'ils reçoivent, la demande psychologique é levé e, la faible latitude dé cisionnelle, le soutien de l'organisation insuffisant et le manque de reconnaissance dans le leadership (Lilly & Pierce, 2013 ;Toulouse et al., 2006). De plus, la pré valence des symptô mes de dé pression modé ré s à sé vè res et de stress post-traumatique est davantage pré sentes chez les ré partiteurs que dans d'autres populations des mé tiers d'urgence comme les pompiers par exemple (Lilly & Allen, 2015 ;Meyer et al., 2012). ...
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Résumé L’objectif de cette recherche est d’évaluer les relations entre la reconnaissance au travail et la santé psychologique au travail des répartiteurs d’urgence par un devis corrélationnel prédictif. Les données collectées du questionnaire en ligne sécurisé envoyé aux répartiteurs via quatre centres d’appels d’urgence (n = 155) ont mesuré la santé psychologique au travail (Gilbert et al., 2011) et la reconnaissance organisationnelle (Brun et Dugas, 2005). Les résultats des analyses de régression linéaire multiples confirment partiellement les liens hypothétiques entre les deux variables : ils attestent que la reconnaissance provenant de l’organisation et des collègues expliquent partiellement le bien-être psychologique au travail (R² = .25, p < .001) et la détresse psychologique au travail (R² = .30, p < .001) des répartiteurs d’urgence.
... Thus, it may be not intensive enough to evoke a strong enough response to impact subsequent symptomatology (Shalev, Liberzon, & Marmar, 2017). Third, the possible predictive effect of emotional reactivity to sirens on subsequent symptomatology may depend on or be mediated by cognitive patterns or biases, which were not assessed in the current study (Bomyea, Risbrough, & Lang, 2012;Lilly & Pierce, 2013). Fourth, possible predictive effects of specific emotions such as anger (Lancaster, Melka, & Rodriguez, 2011), and fear (Rosendal et al., 2011), may be dampened by our choice to use an aggregated measure for negative and positive emotions in our models. ...
While peritraumatic negative emotions have been associated with subsequent posttraumatic stress and depression, the predictive role of real-time emotional reactions to specific stressors during prolonged stress exposure is still unclear, particularly that of positive emotions. The current study uses experience sampling methodology to examine individual general levels of negative and positive emotions, and emotional reactivity to specific stressors during war, as prospective predictors of posttraumatic stress and depression. Ninety-six civilians exposed to rocket fire during the 2014 Israel-Gaza war reported exposure to rocket warning sirens and levels of ten negative and six positive emotions twice a day for 30 days. Symptoms of posttraumatic stress and depression were then assessed two months post-war. Participants reported higher negative emotions and lower positive emotions during assessment windows with sirens. Over time, negative emotions decreased and positive emotions increased. Higher levels of overall negative emotions predicted posttraumatic stress symptoms and depression symptoms two months later. Levels of positive emotions, and negative and positive emotional reactivity to sirens, were not associated with subsequent symptomatology. Our results indicate the stronger role of overall negative emotions as predictors of symptomatology compared with momentary emotional reactivity, and the stronger predictive role of negative compared with positive emotions.
... In what little research there is, police communications' work is consistently associated with elevated rates of depression, obesity, physical health complaints, burnout, and PTSD (Author 2013(Author , 2020Lilly et al. 2016;Lilly and Pierce 2013;Pierce and Lilly 2012;Steinkopf et al. 2018;Trachik et al. 2015). Feeling undervalued and unsupported by one's organization-within a cultural context that values masculinist emotional suppression (Lennie et al. 2020)-are likely contributors to these persistent negative outcomes. ...
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Objective As central members of the emergency response system, communicators are regularly exposed to potentially traumatic events and experience some of the highest rates of posttraumatic stress. Given elevated rates of distress, they are regularly called upon to manage emotions—their own and others’—during high-risk and high-stress situations, within a highly controlled organizational context. Emotional labour (EL) theory suggests that many individuals faced with this challenge utilize a strategy in which emotions are suppressed or faked (surface acting—SA) in keeping with organizational expectations.Methods This study was designed to examine the relationships among reported EL, perceived organizational support, job stress, and severity of posttraumatic stress among a population of communicators.ResultsJob pressure and perceived lack of organizational support were positively associated with posttraumatic stress. Although the highest reported levels of SA occurred when interacting with members of the public, this SA was not associated with posttraumatic stress, unlike SA with co-workers and supervisors. SA with co-workers and supervisors was further related to perceptions of lack of organizational support.Conclusion Thus, an organization perceived as unsupportive may create a culture in which individuals are dissuaded from expressing true emotions with colleagues and supervisors, potentially magnifying the traumatic effects of exposure to critical incidents.
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Suffering. Salvation’s conduit. People are often reluctant to talk about suffering, unable to find words. This reluctance usually lasts until, in the midst of crisis, the only way ahead is through suffering. In these crises, people typically reach out to caregivers—pastors and priests, counselors and social workers. But what if the same reluctance affects these caregivers? What if they, too, are often unable to find adequate words? Jesus—Man of Sorrows—makes plain the imperative of taking up our cross. How is this accomplished? This dissertation offers an answer, a theology of suffering focused on spiritual formation—formation into the image of a suffering God. Emerging from lived experiences in valleys of adversity, this formational theology offers conceptual and practical ways to narrate biographies of adversity, then help others give sorrow words and grow, thus taking up our cross.
This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey (N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.
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A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
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Interest in critical incident stress debriefings for firefighters has grown over the last decade. Some researchers report that debriefings protect firefighters from stress-related disorders, including posttraumatic stress disorder (PTSD). Proponents of the interventions claim extraordinary need and success. Controlled and correlational studies have largely failed to demonstrate therapeutic effects, and some report iatrogenic effects. This study examined the relationships between debriefings and several mental health variables in a large sample of firefighters. Debriefing had a weak inverse correlation with negative affectivity and a weak positive correlation with positive world assumptions. No relationship was found between debriefing and PTSD.
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Work on the psychological aftermath of traumatic events suggests that people ordinarily operate on the basis of unchallenged, unquestioned assumptions about themselves and the world. A heuristic model specifying the content of people's assumptive worlds is proposed. The schema construct in social cognition is used to explore the role of these basic assumptions following traumatic events. A major coping task confronting victims is a cognitive one, that of assimilating their experience and/or changing their basic schemas about themselves and their world. Various seemingly inappropriate coping strategies, including self-blame, denial, and intrusive, recurrent thoughts, are discussed from the perspective of facilitating the victim's cognitive coping task. A scale for measuring basic assumptions is presented, as is a study comparing the assumptive worlds of people who did or did not experience particular traumatic events in the past. Results showed that assumptions about the benevolence of the impersonal world, chance, and self-worth differed across the two populations. Findings suggest that people's assumptive worlds are affected by traumatic events, and the impact on basic assumptions is still apparent years after the negative event. Further research directions suggested by work on schemas are briefly discussed.
The current study examines the relationships among world assumptions, history of adult sexual assault, depressive symptoms, and fearful attitudes toward relationships. Three hundred and sixty-one female college students completed the Assumptive World Scales and a set of questionnaires to assess their sexual assault history subsequent to age 15, levels of depressive symptoms, sexual aversion, paranoia/self-consciousness, and fear of intimacy. Factor analysis of the Assumptive World Scales items revealed five dimensions that had clear relationships with factors proposed in the initial study. These five Assumptive Worlds dimensions accounted for significant variance in depression. These dimensions also accounted for significant variance in sexual aversion, paranoia/self-consciousness, and fear of intimacy, even when controlling for levels of depressive symptoms and sexual assault severity. The implications of these findings for research on sexual assault, cognitive schema, and interpersonal functioning are discussed.
To assess whether coping styles mediated the relation between inner representations and posttraumatic stress symptomatology, a community sample of self-defined trauma survivors (N = 95) completed the World Assumptions Scale, Ways of Coping Checklist - Revised, and Trauma Symptom Inventory. Regression analyses indicted that individuals with more positive inner representations reported experiencing less symptomatology and tended to use more active and less passive coping strategies. Furthermore, the relation between inner representations and the extent of symptomatology was mediated through the use of passive coping strategies, although the latter 2 variables were likely reciprocally related. The implications of these findings for the well-being of trauma survivors were discussed.
Male firefighters (n = 94) were compared with male workers (n = 91) from a variety of blue-collar, non—emergency service occupations. Responses on the World Assumptions Scale were examined in combination with the Impact of Events Scale—Revised and the Symptom Checklist-90. Initial hypotheses suggested that firefighters would report disrupted world assumptions and that these disrupted assumptions would be linked with greater mental health symptomatology. Results revealed that firefighters were not different from controls on world assumptions and that world assumptions were unrelated to years of service. These results suggest that the psychological reactions of workers exposed to high levels of job-related traumatic stress may not be consistent with that described in previous literature regarding primary victims. Consequently, it is suggested that more research is needed that specifically addresses psychological outcomes for firefighters and other high-trauma occupations. The findings also suggest that benevolence may be particularly important in relation to mental health in firefighters and that this belief may be useful in the prevention of posttraumatic symptomatology.