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Background: Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. Methods: Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. Results: In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). Conclusion: This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research. (Disaster Med Public Health Preparedness. 2015;0:1-10).

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... Studies with different groups affected by disasters agree that such events impact people's mental health, with effects that vary from short to long term, depending on the characteristics of the event, the type of victim, and the emotional vulnerability of the person (Chang et al., 2003;Loo et al., 2016). As a consequence, these tragedies can trigger a wide range of psychiatric illnesses (Laugharne et al., 2011); however, previous studies indicate that anxiety is the most recurring psychological problem (Laugharne et al., 2011;Pfefferbaum et al., 2014). ...
... Thus, mental disorders are only developed when the reactions of a situation are superior to the ability of the person to master and/or overcome them, making it impossible to resist and create strategies to deal with them (Ricea & Liub, 2016). Such strategies are described in the literature by the concept of coping-a set of resources used by people to face adverse circumstances and constituted as one of the moderating factors of mental health (Chang et al., 2003;Loo et al., 2016;Ricea & Liub, 2016). ...
... Considering that, the prevailing view of the literature indicates that emotionfocused coping strategies predict higher levels of symptoms and mental illness, while strategies to approach the problem contribute to a higher rate of psychological well-being (Chung et al., 2001a;Doley et al., 2016;Loo et al., 2016;Nagaoka & Uchida, 2014;Ricea & Liub, 2016). That is possibly because emotionally focused strategies result in cognitive defense that only alleviates unpleasant feelings and does not modify or change the adverse situation (Austenfeld & Stanton, 2004;Loo et al., 2016 ;Ricea & Liub, 2016). ...
Article
Air disasters are considered sudden and catastrophic events. In these contexts, coping strategies, characterized as cognitive and behavioral resources, are important resources that moderate psychological responses. The objective of this study was to evaluate the relationship between coping strategies and emotional symptoms related to post-traumatic stress disorder (PTSD), depression, anxiety, and stress in people exposed to air disaster, through a cross-sectional, quantitative, and explanatory study. The sample was composed by 194 people who witnessed the air disaster involving the soccer team Chapecoense. The instruments used were: Sociodemographic Data Questionnaire, Stress Scale Post-Traumatic Stress Disorder, Depression, Anxiety and Stress Scale and the Coping Strategies Inventory. The results indicated that the strategy confrontation, acceptance of responsibility, escape and avoidance, and social support showed signifcant associations with the emotional symptoms of PTSD, depression, anxiety, and stress. However, the positive reassessment resources have shown to reduce the odds of triggering the symptoms of PTSD and depression. It is concluded that the coping strategies contribute to both in increase and decrease of the symptomatology evaluated. It is expected that such information will indicate adaptive coping strategies and formulate intervention protocols to minimize emotional problems and provide people with a better post-disaster recovery
... De forma general, cesar los pensamientos y emociones negativas es la estrategia de afrontamiento más efectiva en la reducción de los niveles de estrés y en el aumento de los estados mentales positivos (Chesney et al., 2006). Sin embargo, la conducta de evitación es la más ampliamente utilizada, asociándose con niveles más altos de estrés y con el desarrollo de sintomatología postraumática (Kerai et al., 2017;Loo et al., 2016;Witt et al., 2018). Las estrategias centradas en el problema suelen correlacionarse con un menor impacto sobre la salud mental de los profesionales sanitarios (Howlett et al., 2015;Khalid et al., 2016). ...
Article
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El personal de emergencias sanitarias de Castilla y León ha formado parte de la primera línea asistencial durante la pandemia por COVID-19, siendo uno de los grupos más expuestos al contagio. Determinar el grado de autoeficacia que estos trabajadores perciben de sí mismos nos da una idea de la capacidad de adaptación y afrontamiento que han tenido ante este evento adverso. El objetivo deestudio hasido establecerel nivel de percepción en autoeficaciaen los profesionales sanitarios de la Gerencia de Emergencias Sanitarias de Castilla y León durante la pandemia por COVID-19, así como su relación con otras variables. La metodología empleada es cuantitativa de tipo descriptiva a través de encuestas. La muestra de voluntarios es de 253 participantes. Los profesionales de extrahospitalaria obtienen una puntuación media en su nivel de autoeficacia, de 72.36 ± 15.80. Se observa una mayor puntuación en los profesionales de mayor edad (p=0.030), con una mayor experiencia profesional en el ámbito extrahospitalario (p<0.001), que trabajan en asistencia directa con pacientes (p=0.028), que no han recibido previamente tratamiento psíquico (p=0.014) o que han recibido alguna dosis de la vacuna contra el SARS-CoV-2 (p=0.002). La autoeficacia de los profesionales de extrahospitalaria es buena, existiendo factores que se relacionan con un mayor o menor nivel. Los resultados ponen de manifiesto la capacidad de adaptación de estos profesionales ante situaciones adversas como la vivida durante la pandemia por la COVID-19.
... Many previous studies have demonstrated that coping style is related to psychological outcome among individuals who have experienced trauma [34,35]. Furthermore, Bonanno and his team found that deficits in coping flexibility were indicative of pathology in bereaved individuals [36]. ...
Article
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Background Floods are some of the most common and destructive natural disasters in the world, potentially leading to both physical injuries and psychological disorders, including post-traumatic stress disorder (PTSD). PTSD can damage functional capacity and interfere with social functioning. However, little is known about recovery from PTSD after floods. This study used 2013–2014 follow-up data on survivors of the 1998 Dongting Lake flood who were diagnosed with PTSD in 2000 to measure the prevalence rate of PTSD at follow-up and identify predictors of recovery from the PTSD diagnosis in 2000. Methods Participants included survivors who had been diagnosed as having PTSD in 2000 after the 1998 Dongting Lake flood. PTSD at follow-up was reassessed using the PTSD Checklist-Civilian version. Information on demographics, trauma-related stressors, post-trauma stressors, social support, and coping style were collected through face-to-face interviews. The association between the independent variables and PTSD at follow-up was analyzed using logistic regression analyses. Results A total of 201 participants with a PTSD diagnosis in 2000 were included in this study. A total of 19.4 % of the flood survivors with PTSD in 2000 continued to suffer from PTSD in 2013–2014. In the multivariable logistic regression model, individuals who had lost relatives (OR = 12.37, 95 % CI = 2.46–62.16), suffered from bodily injury (OR = 5.01, 95 % CI = 1.92–13.08), had a low level of social support (OR = 5.47, 95 % CI = 1.07–27.80), or had a negative coping style (OR = 4.92, 95 % CI = 1.89–12.81) were less likely to recover from PTSD. Conclusions The prevalence rate of PTSD at follow-up indicates that natural disasters such as floods may have a negative influence on survivors’ mental health for an extended period of time. Individuals who have lost relatives, suffered from bodily injury, had a low level of social support, or had a negative coping style were less likely to recover from PTSD. Therefore, effective psychological intervention measures are necessary for facilitating the recovery process from PTSD, especially for individuals with adverse prognostic factors.
... La calidad adaptativa de la respuesta psicológica de un sujeto ante una situación de desastre socionatural es modulada por su capacidad de afrontamiento ante el mismo. Las denominadas estrategias de afrontamiento -o coping skills-(en adelante, EA), se definen como aquellos esfuerzos cognitivos, emocionales y conductuales para manejar las demandas específicas, externas o internas evaluadas como excesivas o que sobrepasan de los recursos del sujeto (Lazarus & Folkman, 1986); y se constituyen como estrategias psicosociales frente al estrés tanto en contextos ocupacionales como situacionales varios (Loo et al., 2016). La evidencia actual categoriza a las EA dependiendo de si están focalizadas al problema o centradas en la gestión de la emoción; si son primarias (asimilativas) o secundarias (acomodativas); o si son de acercamiento o de evitación (Pfefferbaum et al., 2016). ...
Article
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This paper aimed to analyze the association between psychopathological symptomatology, stress coping strategies and sociodemographic variables related to the experience of social disaster. 399 undergraduates completed the Psychological Symptom Scales (SCL-90-R), the Coping Strategies Inventory (CSI) and a sociodemographic survey. A cross-sectional associative-comparative strategy and a natural group design were used. The results indicated the existence of differences due to sex in the psychopathological symptoms of Somatization, Depression, and Anxiety, where women scored higher. There are differences regarding the global assessment of the impact caused by the flood in all psychopathological dimensions, except for Interpersonal Sensitivity. Multiple regression analyzes showed that the psychopathological dimensions are explained by high Social Withdrawal and Desiderative Thinking. These results suggest that not only stress coping strategies, but the presence of children in the family nucleus, exposure to violence, housing deterioration and impact assessment are potent predictors of symptoms of Depression, General Symptomatic Index, Anxiety, Somatization, Obsession-Compulsion, and Total Positive Symptoms.
... These papers focus on post-disaster effects on the physiology and mental health of survivors, including their daily behaviors, physiological indicators, and mental states. [69][70]63 (2) "Public health preparedness." These papers focus on the establishment, evaluation, and management of medical rescue systems. ...
Article
This study analyzed and assessed publication trends in articles on “disaster medicine,” using scientometric analysis. Data were obtained from the Web of Science Core Collection (WoSCC) of Thomson Reuters on March 27, 2017. A total of 564 publications on disaster medicine were identified. There was a mild increase in the number of articles on disaster medicine from 2008 (n=55) to 2016 (n=83). Disaster Medicine and Public Health Preparedness published the most articles, the majority of articles were published in the United States, and the leading institute was Tohoku University. F. Della Corte, M. D. Christian, and P. L. Ingrassia were the top authors on the topic, and the field of public health generated the most publications. Terms analysis indicated that emergency medicine, public health, disaster preparedness, natural disasters, medicine, and management were the research hotspots, whereas Hurricane Katrina, mechanical ventilation, occupational medicine, intensive care, and European journals represented the frontiers of disaster medicine research. Overall, our analysis revealed that disaster medicine studies are closely related to other medical fields and provides researchers and policy-makers in this area with new insight into the hotspots and dynamic directions. ( Disaster Med Public Health Preparedness . 2018;page 1 of 8)
... En la Tabla 1.3. se pueden observar los factores de riesgo asociados con el TEPT, así como su clasificación (Loo et al., 2016;McBride et al., 2018). ...
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En esta obra el lector podrá encontrar una serie de recomendaciones para la evaluación, el diagnóstico y el tratamiento del TEPT desde un enfoque cognitivo-conductual. Si bien es cierto que está orientado hacia quienes sufrieron las consecuencias de los sismos, los contenidos pueden aplicarse a víctimas de otros acontecimientos traumáticos. Este texto presenta una serie de estrategias de intervención derivadas de evidencia empírica y con sólidos fundamentos teórico-metodológicos.
... In the study by Mattson et al. (2018) in war veterans, it was found that adaptive coping partially mediated the relationship between openness and posttraumatic growth while maladaptive coping partially mediated the relationship between neuroticism and PTSD symptoms. In the study by Loo et al. (2016) in federal disaster responders, avoidant coping behavior was most associated with probable PTSD; with control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD. In the study by Rodríguez-Rey et al. (2019) in pediatric critical care personnel, approximately 30% of the variance in PTSD was predicted by a frequent usage of the emotion-focused coping style and an infrequent usage of the problem-focused coping style. ...
Article
Firefighters are exposed continuously to intense stress situations and traumatic incidents, and are at high risk of developing posttraumatic stress disorder (PTSD). Coping mechanisms and behaviors have been examined as factors contributing to PTSD. The strategies that may be used to cope with stress and/or trauma differ between individuals and also between different professions and traumatic events (Nydegger et al., 2011). Although there is a vast literature on stress and coping processes that exists, very few studies investigated the way individual firefighters cope with trauma. Among several questionnaires that have been used to examine the effects of different types of coping mechanisms after traumatic incidents is the Albert Einstein College of Medicine-Coping Style Questionnaire (AECOM-CSQ; Plutchik and Conte, 1989). In August 2007, large areas in the Peloponnese, Greece, were devastated by wildfires. One month after the event, experienced researchers visited the affected area to provide psychological support and to investigate the psychosocial consequences among the local professional firefighters. One hundred two firefighters that were on duty for the entire period of firefighting (several days) were interviewed using several questionnaires, among them the AECOM-CSQ. Our hypothesis was that firefighters who presented with PTSD would be more inclined toward engaging in avoidance coping mechanisms. A total of 18.6% of the firefighters were found to have PTSD according to ICD-10 criteria. Logistic regression showed that firefighters using the coping mechanisms of minimization and blame were associated with the greater likelihood of PTSD. It seems that specific coping mechanisms used by firefighters immediately after the traumatic event might contribute to the development of PTSD.
... In the study by Mattson et al. (2018) in war veterans, it was found that adaptive coping partially mediated the relationship between openness and posttraumatic growth while maladaptive coping partially mediated the relationship between neuroticism and PTSD symptoms. In the study by Loo et al. (2016) in federal disaster responders, avoidant coping behavior was most associated with probable PTSD; with control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD. In the study by Rodríguez-Rey et al. (2019) in pediatric critical care personnel, approximately 30% of the variance in PTSD was predicted by a frequent usage of the emotion-focused coping style and an infrequent usage of the problem-focused coping style. ...
Article
Firefighters are exposed continuously to intense stress situations and traumatic incidents, and are at high risk of developing posttraumatic stress disorder (PTSD). Coping mechanisms and behaviors have been examined as factors contributing to PTSD. The strategies that may be used to cope with stress and/or trauma differ between individuals and also between different professions and traumatic events (Nydegger et al., 2011). Although there is a vast literature on stress and coping processes that exists, very few studies investigated the way individual firefighters cope with trauma. Among several questionnaires that have been used to examine the effects of different types of coping mechanisms after traumatic incidents is the Albert Einstein College of Medicine-Coping Style Questionnaire (AECOM-CSQ; Plutchik and Conte, 1989). In August 2007, large areas in the Peloponnese, Greece, were devastated by wildfires. One month after the event, experienced researchers visited the affected area to provide psychological support and to investigate the psychosocial consequences among the local professional firefighters. One hundred two firefighters that were on duty for the entire period of firefighting (several days) were interviewed using several questionnaires, among them the AECOM-CSQ. Our hypothesis was that firefighters who presented with PTSD would be more inclined toward engaging in avoidance coping mechanisms. A total of 18.6% of the firefighters were found to have PTSD according to ICD-10 criteria. Logistic regression showed that firefighters using the coping mechanisms of minimization and blame were associated with the greater likelihood of PTSD. It seems that specific coping mechanisms used by firefighters immediately after the traumatic event might contribute to the development of PTSD.
... However, a coping strategy frequently used by emergency workers is that of avoidance and minimization, and this strategy is associated with higher levels of stress (Brown et al., 2002;Chang et al., 2003;Kerai et al., 2017;Witt et al., 2018;Theleritis et al., 2020). Loo et al. (2016) found that in a group of emergency workers, avoidance as well as coping strategies focused on emotions were associated with the development of post-traumatic symptomatology. Rodríguez-Rey et al. (2019) revealed that among health workers working in a pediatric emergency department, approximately 30% of the variance in PTSD was explained by the frequent use of coping strategies focused on emotions and the infrequent use of those focused on the problem. ...
Article
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Coping with the coronavirus disease (COVID-19) is a significant risk factor for the psychological distress of health workers. Hence, this study explores the relationship between coping strategies used by healthcare and emergency workers in Italy to manage the stress factors related to the COVID-19 emergency, which may result in the risk of developing secondary trauma. We study differences between healthcare (n = 121) and emergency workers (n = 89) in terms of their coping strategies, emergency stress, and secondary trauma, as well as the relationships of these differences to demographic variables and other stress factors (Instructions and Equipment). For this purpose, we collected data from participants through the following questionnaires online: Secondary Traumatic Stress Scale-Italian Version, The Coping Self-Efficacy Scale-Short Form, an original questionnaire on stressors, and the Emergency Stress Questionnaire (to assess organizational-relational, physical, decisional inefficacy, emotional, cognitive, and COVID-19 stress). We performed a t-test, correlational analysis, and hierarchical regression. The analyses reveal that compared with the emergency worker group, the health worker group has greater levels of emergency stress and arousal and is more willing to use problem-focused coping. Healthcare workers involved in the treatment of COVID-19 are exposed to a large degree of stress and could experience secondary trauma; hence, it is essential to plan prevention strategies for future pandemic situations. Moreover, individual efficacy in stopping negative emotions and thoughts could be a protective strategy against stress and secondary trauma.
... However, a coping strategy frequently used by emergency workers is that of avoidance and minimization, and this strategy is associated with higher levels of stress (Brown et al., 2002;Chang et al., 2003;Kerai et al., 2017;Witt et al., 2018;Theleritis et al., 2020). Loo et al. (2016) found that in a group of emergency workers, avoidance as well as coping strategies focused on emotions were associated with the development of post-traumatic symptomatology. Rodríguez-Rey et al. (2019) revealed that among health workers working in a pediatric emergency department, approximately 30% of the variance in PTSD was explained by the frequent use of coping strategies focused on emotions and the infrequent use of those focused on the problem. ...
... Other studies conducted on firefighters have found that problem-focused coping is associated both with high levels [65] and with low levels of psychological distress [66]. However, the use of cognitive and behavioral avoidance, commonly observed after trauma, is predictive of greater psychological distress between professional firefighters and ambulance staff [66][67][68][69][70]. Loo et al. [71] found that in a group of emergency workers, emotion avoidance and coping strategies were associated with the development of post-traumatic symptoms. Rodríguez-Rey et al. [72] revealed that among medical staff working in a pediatric emergency department, approximately 30% of the variance in PTSD was explained by the frequent use of emotion-focused coping strategies and the infrequent use of problem-focused ones. ...
Article
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The work environment of emergency workers is an important factor related to stress. Coping with the COVID-19 emergency is a factor that is highly related to stress, and severe stress is a risk factor for developing secondary trauma. Coping and resilience can help rescue workers to better respond in emergency situations and could protect them from secondary trauma. We aimed to explore the relationship of emergency stress, hardiness, coping strategies, and secondary trauma among emergency workers and the mediating roles of coping strategies and hardiness on the effect of stress in producing secondary trauma. The study involved 513 emergency workers from the Red Cross Committee in Veneto, one of the Italian regions most affected by the COVID-19. Participants completed questionnaires online to measure emergency stress (physical, emotional, cognitive, organizational-relational, COVID-19, and inefficacy decisional), hardiness, coping strategies, and secondary trauma. Other variables analyzed were age, gender, weekly hours of service, and use of personal protective equipment (PPE). We performed t-tests, a correlational analysis, regressions, and a mediation analysis. Hardiness and coping strategies, in particular, which stop unpleasant emotions and thoughts and problem-focused, emerged as mediators in reducing the predicted effect of stress on secondary trauma. The mediating effects of hardiness and coping strategies were found to reduce the effect of stress on arousal by 15% and the effect on avoidance by 25%.
... The literature suggests that a widely used coping strategy is avoidance, and that this strategy is associated with higher levels of stress [38,39,[41][42][43] and the development of post-traumatic symptomatology [44]. Coping strategies focused on the problem usually tend to be correlated with lower stress levels in both healthcare workers [45][46][47][48] and other emergency workers [41]. ...
Article
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The COVID-19 crisis has placed a heavy burden on medical staff and emergency workers, who may be at risk of developing psychological distress and secondary trauma. Coping and resilience to stress during a pandemic are protective factors that can mitigate the potential adverse psychological effects. Here, we investigated the direct and mediated effects of coping strategies and hardiness on secondary trauma among Italian medical staff (physicians and nurses, n = 140) and emergency workers (firefighters, civil protection, and ambulance personnel, n = 100) involved in the first phase of the pandemic. For this purpose, we collected data from participants through online questionnaires to measure emergency stress, coping strategies, hardiness, and secondary trauma. Other variables analyzed were age, sex, direct contact with COVID-19 patients, and use of personal protective equipment (PPE). We performed a correlational analysis, regressions, and a mediation analysis. The results show that nurses and physicians experienced higher levels of emergency stress than emergency workers. Direct contact with COVID-19 patients, female sex, unexpected events, and lack of PPE were risk factors for emergency stress, while resilience and coping strategies played a protective role. Mediation analysis shows that coping strategies and hardiness are protective factors and reduce the effect of stress on secondary trauma.
... A coping strategy frequently used by emergency workers is that of avoidance and minimization, and this strategy is associated with higher levels of stress. 33 Loo et al. 34 found that in a group of emergency workers, avoidance, as well as coping strategies focused on emotions, were associated with the development of posttraumatic symptomatology. Rodríguez-Rey et al. 35 revealed that among health workers working in a pediatric emergency department, the frequent use of coping strategies focused on emotions and the infrequent use of those focused on the problem. ...
Article
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Purpose This study aimed to determine the level of secondary traumatic stress in nurses (n = 205) working with patients with suspected or confirmed COVID‐19 in Turkey. Design and Methods Data were collected using the personal information form and Secondary Traumatic Stress Scale. Findings Of the total sample, 62% were female and 52% of nurses were in the 20‐ to 30‐years age range. 67.8% of the nurses experienced high and severe secondary traumatic stress symptoms, the mean score was 49.66 ± 0.86. At the level of secondary traumatic stress subscales, the highest average score was avoidance symptom (20.09 ± 5.06). Practice Implications More than half of the nurses experienced high and severe secondary traumatic stress where the highest symptom “avoidance.” The nurses may need psychosocial support during and after the pandemic.
... Prevalence PTSD = 24% (n = 65). Loo et al. (2016) Aid workers (n = 549). ...
Article
Background: Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates. Method: Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers. Results: 1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance. Conclusions: Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.
... In a general way, stopping unpleasant emotions and thoughts is the most effective coping strategy for the reduction of stress levels and an increase in positive mental states [26]. However, avoidance behavior is the most widely used strategy, associated with higher levels of stress and the development of post-traumatic symptomology [29][30][31]. Problem-focused strategies are usually correlated with a lower impact on the mental health of HPs [32,33]. During the COVID-19 pandemic, HPs who adopted passive coping strategies presented higher levels of stress, anxiety, and depression. ...
Article
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Health professionals (HPs), especially those working in the front line, have been one of the groups most affected by the COVID-19 pandemic. The objective of this study is to identify the best available scientific evidence on the impact of the COVID-19 pandemic on the mental health of out-of-hospital HPs in terms of stress, anxiety, depression, and self-efficacy. A living systematic review of the literature was designed, consulting the electronic online versions of the CINHAL, Cochrane Library, Cuiden, IBECS, JBI, LILACS, Medline PyscoDoc, PsycoINFO, Scopus, and Web of Science databases in November 2021. Original research was selected, published in either English, Spanish, French, Italian, or Portuguese. In total, 2082 publications were identified, of which 16 were included in this review. The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection. Stopping unpleasant emotions and thoughts was the coping strategy most frequently used by these HPs.
Article
Paramedics face the need to be critically introspective, reflective and reflexive every working day. Their work involves not only the functional need to clinically assess, diagnose and manage critically ill and injured members of the public, but also a situated responsiveness to the scenes of severe trauma and death. Few other professions demand such an acute degree of personal and professional resilience; an underpinning education is therefore pivotal to facilitate the development of this resilience to equip and ensure an effective healthcare workforce. For all paramedics, the need to facilitate deconstruction of their experience and meaning-making from constituent aspects of paramedic practice, culture and context is a central element of their capacity for resilience, as well as their psychological ability to recognise and apply coping strategies in their everyday roles. This affective domain learning has been embedded across academic curricula and traditionally taught via methods such as role play, inquiry-based learning, and simulation. The current article presents gamification as another potential methodology for inclusion in undergraduate curricula that can provide the future workforce with transferable skills of reflection and reflexivity in situational responsiveness. LEGO® Serious Play® and narrative storytelling are used to illustrate this discussion; a technique that originates from business and leadership teaching and learning methodologies, but the origins of which lie in the philosophy of social constructionism. An adaptation of Gilbert's Multi-Modal Compassionate Mind Training is used to illustrate how LEGO® Serious Play® might facilitate the construction of affective domain learning for resilience in paramedic practice.
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Introduction: Traumatic events are of high incidence and affect not only the patient but also their family members, causing psychological problems such as stress and anxiety for caregivers of these patients. Therefore, the application of appropriate coping strategies by them seems necessary in order to promote mental health. Aim: To study the relationship of anxiety with coping strategies in family caregivers of trauma patients. Materials and methods: The present research was a descriptive-correlational study which was carried out on 127 family caregivers of patients with trauma in intensive care unit, surgery ward and emergency unit of Amir al-Mu'minin Hospital of Zabol, Sistan and Baluchestan Province. The respondents were selected based on the convenience sampling method. Demographics questionnaire, DASS-21, and Coping Strategies questionnaire were used for data collection. The obtained data were statistically analysed using descriptive statistics, Analysis of Variance (ANOVA), t-test, and Pearson correlation coefficient in statistical package for the Social Sciences (SPSS) version 21.0. Results: Based on the results, 89.9% of family caregivers suffer from mild to severe anxiety. The most common type of coping strategy used by the respondents was emotion-focused. The results showed no relationship between anxiety and emotion-centrism, but an inverse relationship was found between problem-centrism and anxiety. Conclusion: The majority of family caregivers had anxiety. Given, the inverse relationship between the level of anxiety and the use of problem-based coping strategy, in addition to identifying and reducing the causes of anxiety in caregivers. It is recommended that appropriate coping strategies should be trained to them.
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Post-Traumatic Stress in Disaster First Responders - Volume 10 Issue 1 - Joshua C. Morganstein, David M. Benedek, Robert J. Ursano
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Background: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. Method: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. Results: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. Conclusions: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.
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The purpose of this study was to evaluate the psychometric characteristics of the Norwegian versions of the Impact of Event Scale, the Post Traumatic Stress Scale-10 item version and General Coping Questionnaire-30 item version. A group of 40 male and 56 female medical students was tested one week and four months after having started dissection of cadavers for the first time. The results showed that all scales had good internal consistency and test–retest reliability. The student sample scored lower on the IES and PTSS-10 than comparable groups of traumatized subjects. A gender difference emerged, with female subjects scoring higher than male subjects. The factor analysis of the instruments indicated good construct validity for the symptom scales. The analysis of content validity related to DSM IV criteria indicated that the IES and PTSS-10 may have some limitations in their predictive validity of PTSD. Taken together, the three scales have shown good psychometric properties and could be used in future research and clinical work.
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Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.
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We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies. A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity. A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers. Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
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We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health. We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005. The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p < 0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR = 2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR = 4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2). Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.
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The current wars in Iraq and Afghanistan have led to an increasing number of female veterans seeking medical and mental healthcare in the Department of Veterans Affairs (VA) healthcare system. To better understand gender differences in healthcare needs among recently returned veterans, we examined the prevalence of positive screenings for depression, posttraumatic stress disorder (PTSD), military sexual trauma (MST), obesity, and chronic pain among female and male veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) receiving care at the VA Connecticut Healthcare System. We performed a retrospective, cross-sectional data analysis of OEF/OIF veterans at VA Connecticut who received services in either Primary Care or the Women's Health Clinic between 2001 and 2006. In this study, 1129 electronic medical records (1032 men, 197 women) were examined. Female veterans were more likely to screen positive for MST (14% vs. 1%, p < 0.001) and depression (48% vs. 39%, p = 0.01) and less likely to screen positive for PTSD (21% vs. 33%, p = 0.002). There was no significant gender difference in clinically significant pain scores. Men were more likely than women to have body mass index (BMI) >30 kg/m(2) (21% vs. 13%, p = 0.008). These results suggest that important gender differences exist in the prevalence of positive screenings for MST, depression, obesity, and PTSD. As the VA continues to review and improve its services for women veterans, clinicians, researchers, and senior leaders should consider innovative ways to ensure that female veterans receive the health services they need within the VA system.
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The effect of immediate exposure to traumatic events and gender differences is under-studied in the literature. Most studies focus on acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) phases in order to measure gender differences, and tend to neglect the immediate exposure to the disaster. The main hypothesis was that female rescue personnel would exhibit higher levels of acute stress symptoms, dissociation, and depressive symptoms in the 24 hours following a traumatic event. Twenty-three rescue personnel participated in a search and rescue operation at the Bet-Yehoshua train crash in Israel. The rescue personnel group was divided based on gender. Each participant completed a demographic questionnaire including questions that assessed psychological symptoms and issues such as perceived threat to life, the Impact of Event Scale Revised (IES-R), the Dissociative Experience Scale (DES), and the Center of Epidemiologic Studies Depression questionnaire (CES-D). Statistical inferences were calculated using t-tests and chi-square tests, along with testing of covariance (MANCOVA) in order to indentify which factors are related to psychiatric symptomatology following the immediate exposure to disaster. The results suggest that among rescue personnel, women did not differ in their levels of acute stress, dissociation, and depressive symptoms from men. These results suggest the possibility that the gender differences in reactions to traumatic events do not emerge in the acute stress reactions (ASR) phase (up to 24 hours after the event), but later on when people have time to process the trauma. Another possibility that may explain the discrepancy between this study and the common knowledge in the literature is that women rescue personnel are considered a highly selected group, which does not reflect on the general population of women. More studies are needed in order to substantiate these results.
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Background: The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. Methods: We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. Results: Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. Conclusions: There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.
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Several existing self-report measures of coping and the relevant research using these instruments are reviewed. Many of these coping measures suffer from a variety of psychometric weaknesses. A self-report instrument, the Multidimensional Coping Inventory (MCI), was constructed that identifies 3 types of coping styles: task-oriented, emotion-oriented, and avoidance-oriented coping. Support for the multidimensional nature of the MCI is presented, along with support for the reliability of the MCI coping scales. Two studies are presented that assessed the validity of the MCI. The 1st study assessed the construct validity of the MCI by comparing it with the Ways of Coping Questionnaire. The 2nd study also assessed the criterion validity of the MCI by comparing it with measures of depression, anxiety, Type A behaviour, neuroticism, and extraversion. Overall, the results suggest that the MCI is a valid and highly reliable multidimensional measure of coping styles.
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A company from the Norwegian Army was investigated 2 weeks and 4 months after they were hit by an avalanche during a winter exercise. The subjects were divided into victims, spontaneous rescuers, and nonexposed subjects. The results showed that exposed subjects (victims and rescuers) reported higher levels of symptoms compared to nonexposed subjects. No differences were found among exposed subjects. The level of symptoms was also higher than comparable previous research both on victims and professional rescuers or nonprofessionals assigned a role as rescuers. All groups showed decrement in symptoms on the 4-month follow-up.
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The purpose of this study was to determine predictors of posttraumatic stress disorder (PTSD) in health care workers exposed to a disaster, in order to facilitate early case identification and prevention of subsequent morbidity. Following an air disaster, 355 military medical health care workers were studied over an 18-month follow-up period. Measures included assessment of peritraumatic reactions associated with the disaster, the frequency of other stressful events after the disaster, and standard PTSD rating scales at 6, 12, and 18 months. Multivariate logistic regression of data on health care workers who cared for victims of the air disaster showed that PTSD was more likely to develop in those who had not completed college, those who had worked with burn victims, those who had experienced more stressful life events in a period of approximately 6 months following the disaster, and those who experienced emotional numbness immediately after the disaster. Results suggest that lower levels of education, exposure to grotesque burn injuries, stressful life events following exposure, and feelings of numbness following exposure are useful predictors of subsequent development of PTSD.
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The aim of the present study was to investigate the effect of different coping styles on the development of self-reported mental health problems in a radically changing context. This was investigated, using a longitudinal design, by following soldiers from before entering service to 8 months of service. Based on their scores on the 30-item General Coping Questionnaire, soldiers were allocated to one of three groups: those whose coping styles were emotional, avoidance, or task focused. These three groups were assessed four times. The General Health Questionnaire (30-item version), Ursin's Health Inventory, and the Alcohol Use Disorders Identification Test (AUDIT) were used as dependent measures. Avoidance-focused soldiers reported an increase in General Health Questionnaire scores over time. Furthermore, the avoidance-focused copers revealed higher scores on the AUDIT questionnaire as well as an increase in AUDIT scores over time. The present study showed that there was an interaction of personality variables and contextual factors involved. More specifically, young subjects with a preference for an avoidance-focused coping strategy are at greater risk of experiencing symptoms of mental health problems compared with task-focused and emotion-focused subjects when exposed to a radically changing environment.
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Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorders, and several symptoms overlap with major depressive disorders, anxiety disorders and substance abuse; this may contribute to diagnostic confusion and underdiagnosis. This anxiety disorder provokes significant occupational, psychiatric, medical and psychosocial disability, and its consequences are enormously costly, not only to the survivors and their families, but also to the health care system and society. Work impairment associated with PTSD is very similar to the amount of work impairment associated with major depression. The pathophysiology of PTSD is multifactorial and involves dysregulation of the serotonergic as well as the noradrenergic system. A rational therapeutic approach should normalize the specific psychobiological alterations associated with PTSD. This can be achieved through the use of antidepressant drugs, mainly of those that potentiate serotonergic mechanisms. Recent double-blind placebo-controlled studies report the efficacy of selective serotonin reuptake inhibitors. Several cognitive-behavioral and psychosocial treatments have also been reported to be efficacious and could be considered when treating PTSD patients.
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Data are sparse regarding the impact of psychosocial work stress on the health and well-being of aging workers, even for employees working in high-stress occupations, such as law enforcement. To improve our understanding of this issue in older workers, we assessed and characterized work stress, coping strategies, and stress-related health outcomes in a sample of police officers aged 50 years and older (n = 105). The most important risk factors associated with officers' perceived work stress were maladaptive coping behaviors (e.g., excessive drinking or problem gambling) (odds ratio [OR], 4.95; 95% confidence interval [CI], 2.11 to 11.6) and exposure to critical incidents (e.g., shootings) (OR, 3.84; 95% CI, 1.71 to 8.65). In turn, perceived work stress was significantly associated with anxiety (OR, 6.84; 95% CI, 2.81 to 16.65), depression (OR, 9.27; 95% CI, 3.81 to 22.54), somatization (OR, 5.74; 95% CI, 2.47 to 13.33), posttraumatic stress symptoms (OR, 2.89; 95% CI, 1.29 to 6.47), symptoms of "burnout" (OR, 5.93; 95% CI, 2.54 to 13.86), chronic back pain (OR, = 3.55; 95% CI, 1.57 to 8.06), alcohol abuse (OR, 3.24; 95% CI, 1.45 to 7.22), and inappropriately aggressive behavior (OR, 4.00; 95% CI, 1.34 to 11.88). These data suggest that older workers in high-stress jobs may be at increased risk for work stress-related health problems, especially if they rely on risky health behaviors to cope with stress. Given the size of the rapidly aging US workforce and the likelihood that many are employed in high-stress jobs, interventions are urgently needed to address this emerging public health issue.
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Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.
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To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
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The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.
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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.
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Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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Effective postterrorism public health interventions require the recognition that behavioral consequences are, in fact, the intent of terrorists. The authors searched published and unpublished post-1980 studies that documented population-level behavioral and psychological consequences of terrorist incidents, focusing on posttraumatic stress disorder (PTSD). Results were tabulated, and random effects models were used to calculate overall effect sizes. The analysis indicates that in the year following terrorist incidents, the prevalence of PTSD in directly affected populations varies between 12% and 16%. The review also shows that this prevalence can be expected to decline 25% over the course of that year. These prevalence estimates mask great variability, depending on who is being studied, who is conducting the study, and where the event occurred. Higher rates of disease are reported for survivors and rescue workers, and higher overall rates are also reported from studies conducted in Western Europe compared with studies conducted in North America. Prior psychiatric diagnoses are strongly associated with subsequent PTSD and may be a useful triage factor, particularly when considered together with factors such as female gender and direct exposure to events as either a survivor or rescuer. The review indicates that these associations are consistent across study types and environments and represent important variables to consider when developing triage, outreach, and treatment programs.
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Research on the core version of the Alcohol Use Disorders Identification Test (AUDIT) is reviewed. Sensitivities and specificities of the AUDIT for criteria of current hazardous use and, to a slightly lesser extent, lifetime alcohol dependence are high. In general, AUDIT scores are at least moderately related to other self-report alcohol screening tests. Several studies also show them as correlated with biochemical measures of drinking. Results of the AUDIT have also been associated with more distal indicators of problematic drinking. Indices of internal consistency, including Cronbach's α and item-total correlations, are generally in the 0.80's. Future directions for research on the AUDIT are suggested.
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Forty-three rescuers responding to a bus crash that killed 12 children and 4 adults and injured many more answered questionnaires at 1 and 13 months following the crash. This study compared the responses of the voluntary and professional helpers, using the Impact of Event Scale (IES) and the General Health Questionnaire (GHQ). For all helpers taken together, the decline in IES-intrusion and IES-total scores was significant from 1 to 13 months. The voluntary helpers reported significantly more intrusion and avoidance on the IES at 1 month than professional helpers, and for avoidance the voluntary helpers still evidenced a significantly higher score than professional helpers at 13 months. The GHQ scores at 13 months reflected that the long-term negative impact of the event was low.
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Few data prospectively address the role of coping in the development of PTSD. In the present study, 308 undergraduates were assessed for coping prior to the 9/11 WTC attack and for PTSD symptomatology at one and three-months post-9/11. Multiple regression analyses indicated that emotion-focused coping was predictive of increased symptomatology at Month 1 and Month 3, whereas problem-focused and avoidance-focused coping were not. Specifically, analyses predicting PTSD symptom factors (Intrusions, Avoidance, Dysphoria, and Hyperarousal) indicated that greater emotion-focused coping predicted increased Dysphoria symptoms at both time points and, among females, increased levels of Hyperarousal symptoms at Month 1. The role of coping style in the development of PTSD symptomatology and its clinical implications are discussed.
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Although disaster is believed to be aetiological in the development of post-traumatic stress disorder, there exist large unexplained individual differences in the severity and chronicity of symptoms. For this reason, attention has begun to focus on those variables that might mediate between disaster and subsequent outcome. One such variable is crisis support. However, it has been suggested that associations between self-report measures of support and symptoms may be a function of attributional style and coping style. It is shown in the present study that crisis support is able to predict symptoms over and above attributional style and coping style.
Article
We present the longest follow-up, to date, of probable posttraumatic stress disorder (PTSD) after the 2001 terrorist attacks on the World Trade Center (WTC) in New York City firefighters who participated in the rescue/recovery effort. We examined data from 11,006 WTC-exposed firefighters who completed 40,672 questionnaires and reported estimates of probable PTSD by year from serial cross-sectional analyses. In longitudinal analyses, we used separate Cox models with data beginning from October 2, 2001, to identify variables associated with recovery from or delayed onset of probable PTSD. The prevalence of probable PTSD was 7.4% by September 11, 2010, and continued to be associated with early arrival at the WTC towers during every year of analysis. An increasing number of aerodigestive symptoms (hazard ratio [HR] 0.89 per symptom, 95% confidence interval [CI] 0.86-.93) and reporting a decrease in exercise, whether the result of health (HR 0.56 vs no change in exercise, 95% CI 0.41-.78) or other reasons (HR 0.76 vs no change in exercise, 95% CI 0.63-.92), were associated with a lower likelihood of recovery from probable PTSD. Arriving early at the WTC (HR 1.38 vs later WTC arrival, 95% CI 1.12-1.70), an increasing number of aerodigestive symptoms (HR 1.45 per symptom, 95% CI 1.40-1.51), and reporting an increase in alcohol intake since September 11, 2001 (HR 3.43 vs no increase in alcohol intake, 95% CI 2.67-4.43) were associated with delayed onset of probable PTSD. Probable PTSD continues to be associated with early WTC arrival even 9 years after the terrorist attacks. Concurrent conditions and behaviors, such as respiratory symptoms, exercise, and alcohol use also play important roles in contributing to PTSD symptoms.
Article
Among police responders enrolled in the World Trade Center Health Registry (WTCHR), Post-traumatic Stress Disorder (PTSD) was almost twice as prevalent among women as men 2-3 years after the 9/11 attacks. Police participants in the WTCHR Wave 1 survey 2-3 years after 9/11/01, were reassessed for probable PTSD at Wave 2, 5-6 years after 9/11/01, using PCL DSM-IV criteria. Police participants in the Wave 2 survey included 2,527 men, 413 women. The prevalence of "Probable PTSD" was 7.8% at Wave 1 and 16.5% at Wave 2. Mean PCL scores increased from 25.1 to 29.9 for men and 28.6 to 32.2 for women. Prevalence of PTSD was higher for women than for men at Wave 1 (χ(2)  = 10.882, P = 0.002), but not Wave 2 (χ(2)  = 2.416, P = 0.133). Other risk factors included losing one's job after 9/11 and being disabled. Prevalence of probable PTSD among police doubled between 2003-2004 and 2006-2007. After the 2-year time span, the gender difference was no longer significant; prevalence of PTSD symptoms increased and there was a substantial amount of co-morbidity with other mental health problems. Further development of prevention and intervention strategies for police responders with symptoms of PTSD is needed. The observed upward trend in PCL scores over time in police officers with PCL scores less than 44, suggests that PTSD prevention and intervention strategies should be applied to all police affected by the 9/11 attacks, not limited just to those with PTSD symptoms.
Article
Symptoms of post-traumatic stress disorder (PTSD) have been reported even years after the terrorist attacks of September 11, 2001 (9/11). We used screening tools to assess the prevalence of probable PTSD in 9/11-exposed firefighters at two time points, within 6 months of 9/11 (baseline) and 3-4 years post-disaster (follow-up). Five thousand six hundred fifty-six individuals completed assessments at both times. 15.5% reported probable PTSD post-9/11, 8.6% at baseline and 11.1% at follow-up, on average 2.9 (SD 0.5) years later. Analyses revealed that nearly half of all probable PTSD occurred as delayed onset (absent baseline, present follow-up). Compared with the resilient group (no probable PTSD at either time), probable PTSD at baseline, and delayed onset at follow-up were each associated with concomitant functional impairment (OR 19.5 and 18.9), respectively. Similar percentages of firefighters met criteria for baseline and delayed onset probable PTSD at follow-up, years later. Both were associated with substantial functional impairment. Early risk identification could provide opportunities for mental health interventions before symptoms compromise work and social relationships.
Article
This study investigated rates of subthreshold PTSD and associated impairment in comparison to no PTSD and full PTSD and prospectively followed the course of subthreshold symptoms over 3 years. 3360 workers dispatched to the WTC site following 9/11 completed clinician interviews and self-report measures at three time points each one year apart. At Time 1, 9.7% of individuals met criteria for subthreshold PTSD. The no PTSD, subthreshold PTSD, and full PTSD groups exhibited significantly different levels of impairment, rates of current MDD diagnosis, and self-reported symptoms of depression. At Time 2, 29% of the initial sample with subthreshold PTSD continued to meet criteria for subthreshold or full PTSD; at Time 3, this was true for 24.5% of the initial sample. The study lends credence to the clinical significance of subthreshold PTSD and emphasizes that associated impairment may be significant and longstanding. It also confirms clinical differences between subthreshold and full PTSD.
Article
Police responders to the 2001 World Trade Center (WTC) disaster were previously reported to have an increased prevalence of probable posttraumatic stress disorder (PTSD). Four thousand seventeen police responders (3,435 men and 582 women) were interviewed 2-3 years after 9/11/01 as part of the World Trade Center Health Registry. Demographic, occupational, and event-specific risk factors were evaluated for probable PTSD, determined by DSM-IV criteria using the Posttraumatic Stress Checklist (PCL). Overall prevalence of probable PTSD was 8.3% (women: 13.9%; men: 7.4%, P < 0.001). Risk factors for both genders included 9/11-related injury and older age. For men, specific risk factors were: presence in WTC Towers on 9/11 and Hispanic ethnicity; and for women, witnessing horror and education less than a college degree. Significantly higher prevalence of probable PTSD was found for female police responders. Although consistent with civilian populations, this finding contrasts with other studies of PTSD and WTC rescue and recovery workers, and police prior to 9/11.
Article
Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.
Article
The psychological responses of two groups of fire fighters were examined following the performance of rescue work. Four types of responses were reported: identification with the victims, feelings of helplessness and guilt, fear of the unknown, and physiological reactions. Stress was found to be mediated by availability of social support, type of leadership, level of training, and use of rituals. Implications of these findings for preventive intervention measures are discussed.
Article
This study reports the results of an unusual opportunity to follow up a group of police officers who were involved in body-handling duties following the Piper Alpha disaster, and for whom there were available data from pre-disaster assessments. In addition, after these duties, the officers were compared with a matched control group of officers who had not been involved in such work. The comparisons failed to demonstrate high levels of post-traumatic distress or psychiatric morbidity. The results are interpreted in terms of issues such as the officers' own coping strategies, and major organisational and managerial factors.
Nine months post-disaster, 134 rescuers involved in an off-shore oil rig disaster were investigated by using a structured self report questionnaire to chart their experience of coping with disaster impact stressors and their mental and physical health 9 months after the disaster. Of the 134 rescuers, 24 were categorized as professional rescuers, 101 as non-professionals and 9 could not be classified. Of the 212 victims, all oil rig workers, 89 (42%) were rescued. Seventy-six percent of the rescuers reported they had been exposed to danger during the rescue operation, and 62% found the experience to be the worst ever. Eighty to ninety percent felt they had coped fairly well with the task, and severely disturbed coping was reported to be below 10% for decision-making, ability to judge risk, capacity to function as leader, and finally ability to cooperate and act efficiently. For the non-professionals, severe disturbance in ability to plan before acting was reported by 10% and moderate disturbance was reported by 38%. The frequency of emotional stress reactions during the rescue work can be assessed from the fact that 64% to 52% reported discouragement, restlessness, uncertainty, anxiety and irritation. The stressors inherent in this type of disaster seem to satisfy the DSM III stressor criterion for post-traumatic stress disorder. Nine months after the disaster 24% reported their mental health to be poor due to the disaster impact, and only the most experienced rescuers had a low health risk compared to the others.
Article
The prevalence and longitudinal course of post-traumatic stress disorder were studied in a group of 459 firefighters who were exposed to the Ash Wednesday bushfires in South Australia. The main finding, that the level of morbidity four months after the disaster remained almost unchanged at 29 months, indicates the long-term nature of post-traumatic stress disorder. Twenty-nine months after the fire, 21% of the firefighters were continuing to experience imagery of the disaster, in a way that interfered with their lives. The failure of present disaster management plans to recognize the psychological impact of natural disasters and the long-term nature of post-traumatic stress disorder is emphasized, and the need for preventive mental health programmes to minimize such morbidity in the future is discussed.
Article
Seventy-nine rescue, fire, and medical personnel and police officers who treated victims of an apartment building explosion completed a questionnaire describing their emotional and coping responses to the disaster. Eighty percent had at least one symptom of posttraumatic stress disorder (PTSD). Eight of 21 PTSD symptoms were present in at least 10% of respondents. The most frequently reported symptom, intrusive thoughts about the disaster, occurred in 74% of those working with or searching for victims at the disaster site. On-the-scene rescue workers had significantly more (P less than .02) PTSD symptoms than did inhospital staff. Fifty-two percent of the respondents reported that family members and coworkers were supportive or very supportive in meeting their emotional needs following the disaster; 36% noted that support networks were not helpful. The coping behaviors most frequently used were to remind oneself that things could be worse (57%) and to try to keep a realistic perspective on the situation (53%). Eleven percent reported seeking emotional support from others or looking to others for direction. Emergency workers responding to a contained, small-scale disaster are likely to experience mild stress responses. Planning for the emotional aspects of these events is needed.
Article
This study identified predictors of symptomatic distress in emergency services (EMS) personnel exposed to traumatic critical incidents. A replication was performed in 2 groups: 154 EMS workers involved in the 1989 Interstate 880 freeway collapse during the San Francisco Bay area earthquake, and 213 counterparts from the Bay area and from San Diego. Evaluated predictors included exposure, social support, and psychological traits. Replicated analyses showed that levels of symptomatic distress were positively related to the degree of exposure to the critical incident. Level of adjustment was also related to symptomatic distress. After exposure, adjustment, social support, years of experience on the job, and locus of control were controlled, 2 dissociative variables remained strongly predictive of symptomatic response. The study strengthens the literature linking dissociative tendencies and experiences to distress from exposure to traumatic stressors.
Article
Little is known of the specific effects of exposure to traumatic death, an important dimension of many disasters. This study examined acute and long-term intrusive and avoidant symptoms, depression, and posttraumatic stress disorder (PTSD) in disaster workers exposed to traumatic death after the USS Iowa gun turret explosion. Fifty-four volunteer body handlers were assessed at 1, 4, and 13 months. They were compared with 11 non-body handler disaster worker volunteers. The Impact of Events Scale, Zung Depression Scale, Symptom Checklist-90-Revised, and a multi-method assessment of PTSD were used. Intrusive and avoidant symptoms were elevated at 1, 4, and 13 months, and decreased over time. Probable PTSD was present in 11% at 1 month, 10% at 4 months, and 2% at 13 months. The frequency of depression was not increased. Single body handler disaster workers reported more avoidance (times 1 and 2) and somatization (time 1) than did married workers. Body handlers reported more intrusion, avoidance, hostility, and somatization at 1 month than did non-body handler volunteers. These results indicate that exposure to traumatic death increases intrusive and avoidant symptoms, hostility, somatization, and the risk of PTSD and that symptoms can persist for months.
Article
The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Article
Sound epidemiologic knowledge of the morbidity and mortality caused by disasters is essential when determining what relief supplies, equipment, and personnel are needed to respond effectively in emergency situations. All disasters are unique because each affected region of the world has different social, economic, and baseline health conditions. Some similarities exist, however, among the health effects of different types of disasters, that if recognized, can ensure that the limited health and medical resources of the affected community are well managed.
Article
Research on the core version of the Alcohol Use Disorders Identification Test (AUDIT) is reviewed. Sensitivities and specificities of the AUDIT or criteria of current hazardous use and, to a slightly lesser extent, lifetime alcohol dependence are high. In general, AUDIT scores are at least moderately related to other self-report alcohol screening tests. Several studies also show them as correlated with biochemical measures of drinking. Results of the AUDIT have also been associated with more distal indicators of problematic drinking. Indices of internal consistency, including Cronbach's alpha and item-total correlations, are generally in the 0.80's. Future directions for research on the AUDIT are suggested.
Article
This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.
Article
This study examines the longitudinal course and predictors of stress-specific and general symptomatic distress in emergency services personnel. A three-group quasi-experimental design was used to determine the responses of 322 rescue workers to the Loma Prieta earthquake Interstate 880 Freeway collapse and to unrelated control critical incidents. Self-report questionnaires, including measures of incident exposure, peritraumatic dissociation and emotional distress, and current symptoms, were administered 1.9 years (initial) and 3.5 years (follow-up) after the freeway collapse. Despite modest symptom improvement at follow-up, rescue workers were at risk for chronic symptomatic distress after critical incident exposure. Peritraumatic dissociation accounted for significant increments in current posttraumatic stress disorder symptoms, over and above exposure, adjustment, years of experience, locus of control, social support, and general dissociative tendencies. The results suggest that rescue workers, particularly those with more catastrophic exposure and those prone to dissociate at the time of the critical incident, are at risk for chronic symptomatic distress.
Article
Until recently, our understanding of posttraumatic stress disorder (PTSD) relied almost entirely on studies of war veterans and disaster victims. A handful of epidemiologic studies have now been conducted that investigate the natural course of PTSD as it occurs in the general population. Estimates of PTSD prevalence have tended to vary according to the diagnostic criteria used to define the disorder, assessment procedures, sample characteristics, and the definition of qualifying traumatic events. This article reviews key findings from these studies to provide insight into the burden of PTSD in the general population. Possible reasons for the observed difference in lifetime prevalence of PTSD between the sexes (a female-to-male lifetime prevalence ratio of 2:1 is typically reported) and factors thought to be associated with an increased risk for the disorder after exposure to trauma are reviewed.
Article
The present study investigated the effects of multiple trauma exposure and coping style on post-traumatic stress symptoms and quality of life. It was hypothesized that sensitization would occur in subjects repeatedly exposed to life-threatening situations (study 1), and different coping styles would act as a resilience or facilitating factor in symptom development (study 2). The results showed that the single-exposure group revealed a decrease in trauma specific stress reactions from three weeks to four months, with a persistent reduction at 12-month follow-up, while the repeated-exposure group showed an increase in symptom reporting over the 12-month period. The same pattern emerged for perceived quality of life-measured by the General Health Questionnaire (GHQ-30). The second study revealed a correlation between scores on avoidant-focused coping style and the Impact of Event Scale-avoidance dimension, Post-traumatic Symptom Scale and GHQ-30. Furthermore, only subjects with a dominant coping style of emotion-focused or task-focused coping showed a reduction in trauma-specific symptom scores over time.