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1.  Personality, posttraumatic stress and trauma type: factors contributing to posttraumatic growth and its domains in a Turkish community sample 
European Journal of Psychotraumatology  2012;3:10.3402/ejpt.v3i0.17303.
Background
Posttraumatic growth (PTG) is conceptualized as a positive transformation resulting from coping with and processing traumatic life events. This study examined the contributory roles of personality traits, posttraumatic stress (PTS) severity and their interactions on PTG and its domains, as assessed with the Posttraumatic Growth Inventory Turkish form (PTGI-T). The study also examined the differences in PTG domains between survivors of accidents, natural disasters and unexpected loss of a loved one.
Method
The Basic Personality Traits Inventory, Posttraumatic Diagnostic Scale, and PTGI-T were administered to a large stratified cluster community sample of 969 Turkish adults in their home settings.
Results
The results showed that conscientiousness, agreeableness, and openness to experience significantly related to the total PTG and most of the domains. The effects of extraversion, neuroticism and openness to experience were moderated by the PTS severity for some domains. PTG in relating to others and appreciation of life domains was lower for the bereaved group.
Conclusion
Further research should examine the mediating role of coping between personality and PTG using a longitudinal design.
doi:10.3402/ejpt.v3i0.17303
PMCID: PMC3402104  PMID: 22893832
Domains of posttraumatic growth; personality traits; posttraumatic stress; traumatic event types
2.  Resiliency and Religious Orientation: Factors Contributing to Posttraumatic Growth in Iranian Subjects 
Iranian Journal of Psychiatry  2011;6(4):145-150.
Objective
This study investigated the relationship between resilience and religious orientation (internal and external) with posttraumatic growth (PTG). This study also examined the impact of marriage and sex variables on growth.
Method
Participants were selected based on prescreening of a larger group of students enrolled in the University of Shiraz. Participants were recruited in two stages. Three hundred fifty students were randomly selected in the first stage, and those students who experienced a minimum of one traumatic event within the last five years were selected in the second stage. They completed the Traumatic Life Event Questionnaire (TLEQ), the Posttraumatic Growth Inventory-Iranian version (PTGI-I), and the Religious Orientation Scale (ROS).
Results
According to stepwise regression analysis, two subscales of resiliency, novelty seeking and positive future orientation, and a subscale of religious orientation, intrinsic orientation, were related to PTG. In addition, compared to singles, the married subjects experienced greater degree of growth. Personal extrinsic orientation and emotional regulation factor of resilience had a positive and meaningful relationship with PTG, although they were omitted from the regression analysis model. Sex and Socio-Extrinsic religious orientation were not related to PTG.
Conclusion
Some subscales of resiliency and religious orientation could predict posttraumatic growth in Iranian subjects, but there were no gender differences. The intrinsic orientation had the greatest significance in predicting posttraumatic growth. The personal extrinsic orientation had a significant positive correlation with post-traumatic growth, no significant correlation was observed between social extrinsic orientation and post-traumatic growth. The openness to experience was an important feature for proper growth of people facing a trauma. Optimistic subjects showed more flexibility in their coping strategies, and therefore had a tendency to adapt themselves to problematic situations.
PMCID: PMC3395957  PMID: 22952540
Psychological resilience; Religion and psychology; Trauma
3.  Posttraumatic Growth, Social Support and Social Constraint in Hematopoietic Stem Cell Transplant Survivors 
Psycho-oncology  2011;22(1):195-202.
Objective
The relation between posttraumatic growth (PTG) and aspects of the social context, such as social support and social constraint, continues to be unclear in cancer survivors. Social-cognitive processing theory is a useful framework for examining the effect of the social context on PTG. In theory, support interactions may either facilitate or hinder cognitive processing and thus lead to different PTG outcomes. The current study tested the hypothesis that emotional support and instrumental support would each explain a unique amount of the variance in PTG in distressed hematopoietic stem cell transplant (HSCT) survivors. Additionally, it was predicted that social constraint on cancer-related disclosure would be negatively with PTG.
Methods
Forty-nine distressed HSCT survivors with a spouse or partner completed the posttraumatic growth inventory (PTGI) and measures of social support received from their spouse/partner and social constraint from people close to them as part of a larger clinical trial.
Results
Both emotional and instrumental social support were positively correlated with PTG and social constraint on disclosure was not associated with PTG. Contrary to hypotheses, instrumental support was the only unique social contextual predictor of PTG. Conclusions: The results of this study highlighted the importance of examining the effects of subtypes of social support on PTG separately. Findings are discussed in the context of the cognitive (i.e. processing of the traumatic event) versus non-cognitive (i.e. buffering stress) pathways between the social context and PTG. Future research directions are presented.
doi:10.1002/pon.2073
PMCID: PMC3760719  PMID: 21972000
cancer; oncology; posttraumatic growth; social support; social constraint
4.  Use of the Revised Posttraumatic Growth Inventory for Children 
Journal of traumatic stress  2009;22(3):248-253.
Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children (PTGI-C-R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI-C-R demonstrated good reliability. Analyses focused on trauma-related variables in predicting PTG. Child-reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow-up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI-C-R may assist efforts to understand children’s responses posttrauma.
doi:10.1002/jts.20410
PMCID: PMC2827205  PMID: 19462437
5.  A Prospective Study of Posttraumatic Growth as Assessed by Self Report and Family Caregiver in the Context of Advanced Cancer 
Psycho-Oncology  2011;20(5):479-487.
Objective
The study of posttraumatic growth (PTG) has burgeoned over the last decade, particularly in the area of oncology. The aims of the study were to: (1) describe PTG in patients with hepatobiliary carcinoma, (2) examine agreement between the patient and caregiver measures of patient PTG, and (3) test the associations between PTG and other better established psychological factors and clinically relevant outcomes.
Methods
Two hundred and two patients with hepatobiliary carcinoma completed a battery of standardized questionnaires that measured posttraumatic growth, depressive symptoms, optimism, expressed emotion, and quality of life. A subsample of family caregivers also completed ratings of patient PTG, using the Posttraumatic Growth Inventory (PTGI, as well as their own PTG.
Results
No significant increase in PTG was observed between diagnosis and 6-months follow-up with the exception of the Relating to Others subscale of the PTGI. PTG was not found to be associated with quality of life or depressive symptoms. At diagnosis, the agreement between the patients' PTG and family caregivers' rating of PTG was found to be high (ICC= 0.34-0.74, p=0.001-0.05). Posttraumatic growth was found to be significantly associated with optimism [r=0.20 p=0.02-.0.05] and traumatic life events reported in the past three years including recent losses [F(1,52)=6.0, p=0.02] and severe physical injury [F(1,52)=5.5, p=0.02]. Caregivers reported PTG as a result of their loved one's diagnosis of cancer.
Conclusion
Preliminary results suggest that PTG is relatively stable over the first 6-months after diagnosis and results in changes as a result of a diagnosis of cancer were reported, and possibly observed, by others. Family caregivers also experience PTG as a result of their loved one's diagnosis of advanced cancer.
doi:10.1002/pon.1746
PMCID: PMC3290514  PMID: 20878841
6.  Psychological well-being and posttraumatic growth in caregivers of cancer patients 
Frontiers in Psychology  2014;5:1342.
Introduction: Although research has shown that many cancer patients report positive life changes following cancer diagnosis, there are few data in the literature related to PTG in caregivers of cancer patients. However, the few studies available have shown that this kind of positive changes can also be experienced by family members. The aims of this study were to explore PTG in caregivers of cancer patients and to investigate correlations between the Posttraumatic growth, psychological status and QoL of caregivers and those of patients, taking into account also clinical and socio-demographic aspects.
Methods: We enrolled 60 patient/caregiver pairs in the Department of Medical Oncology of the National Research Center “Giovanni Paolo II” in Bari. Both patients and caregivers were assessed using the following scales: Posttraumatic growth Inventory (PTGI); Hospital anxiety and depression scale; Short Form (36) Health Survey (SF-36); ECOG Performance Status. Clinical and socio-demographic data were collected.
Results: Caregivers showed significantly higher scores than patients in the dimension of “personal strength.” Furthermore, we found a significantly close association between anxiety and depression of caregivers with those of patients. Younger caregivers were better than older ones in terms of physical activity, vitality, mental health, and social activities. Although the degree of relationship with the patient has no significant effect on the dependent variables of the study, it was found that caregivers with a degree of kinship more distant to the patient have less physical pain than the closest relatives.
Conclusion: Results of the present study show that caregivers of cancer patients may experience post-traumatic growth as the result of their caregiver role. It would be interesting to investigate in future research which factor may mediate the presence of post-traumatic growth.
doi:10.3389/fpsyg.2014.01342
PMCID: PMC4238371  PMID: 25477853
posttraumatic growth; quality of life; caregivers; depression; cancer
7.  Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway 
Background
Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.
Methods
Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.
Results
All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.
A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.
Conclusions
Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.
doi:10.1186/1477-7525-10-84
PMCID: PMC3416737  PMID: 22824521
8.  The spectral analysis of photoplethysmography to evaluate an independent cardiovascular risk factor 
Background
In this study, we evaluate homeostatic markers correlated to autonomic nervous and endothelial functions in a population of coronary artery disease (CAD) patients versus a control group. Since CAD is the highest risk marker for sudden cardiac death, the study objective is to determine whether an independent cardiovascular risk score based on these markers can be used alongside known conventional cardiovascular risk markers to strengthen the understanding of a patient’s vascular state.
Materials and methods
Sixty-five subjects (13 women) with a mean age of 62.9 years (range 40–80 years) who were diagnosed with CAD using coronary angiography (group 1) and seventy-two subjects (29 women) with a mean age of 45.1 years (range 18–85 years) who claimed they were healthy (group 2) were included in the study. These subjects underwent examination with the TM-Oxi and SudoPath systems at IPC Heart Care Centers in Mumbai, India. The TM-Oxi system takes measurements from a blood pressure device and a pulse oximeter. The SudoPath measures galvanic skin response to assess the sudomotor pathway function. Spectral analysis of the photoplethysmograph (PTG) waveform and electrochemical galvanic skin response allow the TM-Oxi and SudoPath systems to calculate several homeostatic markers, such as the PTG index (PTGi), PTG very low frequency index (PTGVLFi), and PTG ratio (PTGr). The focus of this study was to evaluate these markers (PTGi, PTGVLFi, and PTGr) in CAD patients against a control group, and to calculate an independent cardiovascular risk factor score: the PTG cardiovascular disease risk score (PTG CVD), calculated solely from these markers. We compared PTGi, PTGVLFi, PTGr, and PTG CVD scores between the CAD patient group and the healthy control group. Statistical analyses were performed using receiver operating characteristic curves to determine the specificity and sensitivity of the markers to detect CAD at optimal cutoff values for PTGi, PTGVLFi, PTGr, and PTG CVD. In addition, correlation analyses between these markers and conventional autonomic nervous system and endothelial function markers were performed to understand the possible underlying physiological sources of the differences observed in marker values between CAD patients and healthy control patients. Additionally, t-tests were performed between two subgroups of the CAD patient group to determine whether diabetic or coronary artery bypass grafting (CABG) patients have significantly different PTGi marker values.
Results
Each spectral analysis PTG marker yielded a high specificity and sensitivity to detect CAD. Most notably, the PTG CVD score had a sensitivity of 82.5% and specificity of 96.8%, at a cutoff of 2, when used to detect CAD (P=0.0001; area under the receiver operating characteristic curve =0.967). The PTG spectral analysis markers were well-correlated to other autonomic nervous system and endothelial function markers. CAD diabetic patients (n=27) had a lower PTGi value compared with the CAD non-diabetic patients (n=38): and patients that underwent CABG (n=18) had a higher PTGi value compared with the CAD without CABG surgery patients (n=47).
Conclusion
The spectral analysis of the photoplethysmography method is noninvasive, fast, operator-independent, and cost-effective, as only an oximeter and galvanic skin response device are required in order to assess in a single testing the autonomic nervous system and endothelial function. The spectral analysis techniques used on the photoplethysmogram, as outlined in this study, could be useful when used alongside conventional known cardiovascular disease risk markers.
doi:10.2147/IJGM.S70892
PMCID: PMC4267520  PMID: 25525382
coronary artery disease; PTG spectral analysis; PTGi; PTGVLFi; PTGr; PTG CVD score
9.  Predictors of posttraumatic growth in women with breast cancer 
Psycho-oncology  2013;22(12):10.1002/pon.3298.
Objective
Posttraumatic growth (PTG) is defined as ‘positive psychological change experienced as a result of a struggle with highly challenging life circumstances’. The current study examined change in PTG over 2 years following breast cancer diagnosis and variables associated with PTG over time.
Methods
Women recently diagnosed with breast cancer completed surveys within 8 months of diagnosis and 6, 12, and 18 months later. Linear mixed effects models were used to assess the longitudinal effects of demographic, medical, and psychosocial variables on PTG as measured by the Posttraumatic Growth Inventory (PTGI).
Results
A total of 653 women were accrued (mean age = 54.9, SD = 12.6). Total PTGI score increased over time mostly within the first few months following diagnosis. In the longitudinal model, greater PTGI scores were associated with education level, longer time since diagnosis, greater baseline level of illness intrusiveness, and increases in social support, spirituality, use of active–adaptive coping strategies, and mental health. Findings for the PTGI domains were similar to those for the total score except for the Spiritual Change domain.
Conclusion
PTG develops relatively soon after a breast cancer diagnosis and is associated with baseline illness intrusiveness and increases in social support, spirituality, use of active–adaptive coping strategies, and mental health.
doi:10.1002/pon.3298
PMCID: PMC3884903  PMID: 24136875
10.  Posttraumatic Growth Associated With a Relative's Serious Illness 
Posttraumatic growth (PTG) involves personal psychological growth in response to a traumatic or very stressful event. Using theoretical guidance from Tedeschi and Calhoun's cognitive model, this study evaluated the relationship between specific individual, distress, and stress-processing factors and PTG among young adults who experienced an illness-related trauma earlier in life through a relative's serious illness. Sixty individuals with a relative with a serious illness completed measures of PTG, posttraumatic stress symptoms (PTSS), anxiety, and coping. PTG was positively associated with trait anxiety, PTSS, and the use of active, problem-focused coping strategies. Factors associated with PTG development in individuals who have a relative with a chronic illness are similar to that of individuals who had a serious illness themselves. The relationship between PTSS and PTG is moderated by whether the relative's current illness status is resolved versus not resolved.
doi:10.1037/a0023043
PMCID: PMC3090141  PMID: 21417525
posttraumatic growth; posttraumatic stress; chronic illness; relatives
11.  Posttraumatic Stress and Posttraumatic Growth Among Low-Income Mothers who Survived Hurricane Katrina 
Objective
The purpose of the study was to explore the relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG) after Hurricane Katrina, and the role of demographics, pre-disaster psychological distress, hurricane-related stressors, and psychological resources (optimism and purpose) in predicting each.
Method
Participants were 334 low-income mothers (82.0% non-Hispanic Black) living in the New Orleans area prior to Hurricane Katrina, who completed surveys in the year prior to the hurricane (T1), and one and three years thereafter (T2 and T3).
Results
Higher T2 and T3 PTS full-scale and symptom cluster subscales (intrusion, avoidance, and hyperarousal) were significantly associated with higher T3 PTG, and participants who surpassed the clinical cut-off for probable PTSD at both T2 and T3 had significantly higher PTG than those who never surpassed the clinical cut-off. Older and non-Hispanic Black participants, as well as those who experienced a greater number of hurricane-related stressors and bereavement, reported significantly greater T3 PTS and PTG. Participants with lower T2 optimism reported significantly greater T3 intrusive symptoms, whereas those with higher T1 and T2 purpose reported significantly greater T3 PTG.
Conclusions
Based on the results, we suggest practices and policies that identify disaster survivors at greater risk for PTS, as well as longitudinal investigations of reciprocal and mediational relationships between psychological resources, PTS, and PTG.
doi:10.1037/a0033252
PMCID: PMC3904670  PMID: 23750467
posttraumatic growth; posttraumatic stress; natural disasters; optimism; sense of purpose
12.  Understanding the Relationship of Perceived Social Support to Post-trauma Cognitions and Posttraumatic Stress Disorder 
Journal of anxiety disorders  2011;25(8):1072-1078.
Poor social support in the aftermath of a traumatic event is a well-established risk factor for posttraumatic stress disorder (PTSD) among adult trauma survivors. Yet, a great deal about the relationship between social support and PTSD remains poorly understood. In this study, we analyzed data from 102 survivors of a serious motor vehicle accident (MVA) at 4 weeks (Time 1) and 16 weeks (Time 2) post-MVA. We assessed the role of perceived dyadic social support, positive dyadic interaction, and negative dyadic interaction in the development and maintenance of PTSD. In addition, we examined how these social support constructs work together with negative post-trauma cognitions to affect the maintenance of PTSD. Neither perceived social support nor the quality of social interaction (i.e., positive or negative) was associated with PTSD symptom severity at Time 1. However, among those with elevated PTSD symptom severity at Time 1, greater social support and positive social interaction and lower negative social interaction were each associated with reductions in PTSD symptom severity from Time 1 to Time 2. For social support and negative social interaction, this association ceased to be significant when jointly assessed with negative post-trauma cognitions, suggesting that perceived social support and negative dyadic interaction were associated with maintenance of PTSD symptom severity because of their association with negative post-trauma cognitions. These results provide support to models and treatments of PTSD that emphasize the role of negative post-trauma cognitions in maintenance of PTSD.
doi:10.1016/j.janxdis.2011.07.004
PMCID: PMC3444153  PMID: 21820854
13.  Interaction Between Genetic Variants and Exposure to Hurricane Katrina on Post-Traumatic Stress and Post-Traumatic Growth: A Prospective Analysis of Low Income Adults 
Journal of affective disorders  2013;0:10.1016/j.jad.2013.09.018.
Background
There is considerable variation in psychological reactions to natural disasters, with responses ranging from relatively mild and transitory symptoms to severe and persistent posttraumatic stress (PTS). Some survivors also report post-traumatic growth (PTG), or positive psychological changes due to the experience and processing of the disaster and its aftermath. Gene-environment interaction (GxE) studies could offer new insight into the factors underlying variability in post-disaster psychological responses. However, few studies have explored GxE in a disaster context.
Methods
We examined whether ten common variants in seven genes (BDNF, CACNA1C, CRHR1, FKBP5, OXTR, RGS2, SLC6A4) modified associations between Hurricane Katrina exposure and PTS and PTG. Data were from a prospective study of 205 low-income non-Hispanic Black parents residing in New Orleans prior to and following Hurricane Katrina.
Results
We found a significant association (after correction) between RGS2 (rs4606; p=0.0044) and PTG, which was mainly driven by a cross-over GxE (p=0.006), rather than a main genetic effect (p=0.071). The G (minor allele) was associated with lower PTG scores for low levels of Hurricane exposure and higher PTG scores for moderate and high levels of exposure. We also found a nominally significant association between variation in FKBP5 (rs1306780, p=0.0113) and PTG, though this result did not survive correction for multiple testing.
Limitations
Although the inclusion of low-income non-Hispanic Black parents allowed us to examine GxE among a highly vulnerable group, our findings may not generalize to other populations or groups experiencing other natural disasters. Moreover, not all participants invited to participate in the genetic study provided saliva.
Conclusions
To our knowledge, this is the first study to identify GxE in the context of post-traumatic growth. Future studies are needed to clarify the role of GxE in PTS and PTG and post-disaster psychological responses, especially among vulnerable populations.
doi:10.1016/j.jad.2013.09.018
PMCID: PMC3873605  PMID: 24161451
Genes; Adversity; Hurricane; Post-traumatic stress; Post-traumatic growth; resilience
14.  Posttraumatic Growth and PTSD Symptomatology among Colorectal Cancer Survivors: A Three-Month Longitudinal Examination of Cognitive Processing 
Psycho-Oncology  2009;18(1):30-41.
Introduction
The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment.
Methods
Fifty-five post-treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of thirteen months post-diagnosis, were recruited from a state cancer registry and completed baseline and three-month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal) and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity).
Results
PTSD symptomatology was positively associated with depression, anxiety and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted three-month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting three-month PTG.
Conclusions
Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer.
doi:10.1002/pon.1367
PMCID: PMC3319916  PMID: 18481837
posttraumatic growth; PTSD symptomatology; cognitive processing; psychological adjustment; cancer; oncology
15.  The role of attachment in recovery after a school-shooting trauma 
European Journal of Psychotraumatology  2014;5:10.3402/ejpt.v5.22728.
Background
Survivors of life-endangering trauma use varying resources that help them to recover. Attachment system activates in the times of distress, and is expected to associate with stress responses, arousal regulation, and mental health.
Objective
We examined the associations of attachment style with posttraumatic stress disorders (PTSD) symptoms and dissociative symptoms, and posttraumatic growth (PTG) among students exposed to a school shooting in Finland in a three-wave follow-up setting.
Method
Participants were students (Mage=24.9 years; 95% female) who were followed 4 (T1, N=236), 16 (T2, N=180), and 28 months (T3, N=137) after the shooting. The assessments included the Attachment Style Questionnaire, the Impact of Event Scale, part of the Adolescent Dissociative Experiences Scale and the Posttraumatic Growth Inventory.
Results
Securely attached survivors had lower levels of posttraumatic stress and dissociative symptoms than preoccupied at T1 and T2 as hypothesized. At T3 survivors with avoidant attachment style had higher levels of intrusive and hyperarousal symptoms than those with secure style. Concerning PTG, survivors with avoidant attachment style scored lower in PTG at T3 than survivors with both secure and preoccupied style.
Conclusion
Secure attachment style was beneficial in trauma recovery. A challenge to the health care systems is to acknowledge that survivors with preoccupied and avoidant attachment styles react uniquely to trauma, and thus need help in different doses, modalities, and timings.
doi:10.3402/ejpt.v5.22728
PMCID: PMC4082197  PMID: 25018861
Attachment style; school violence; dissociation; posttraumatic stress symptoms; posttraumatic growth
16.  Alcohol Use Disorder History Moderates the Relationship Between Avoidance Coping and Posttraumatic Stress Symptoms 
Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid post-traumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6-weeks post accident for AUD history (i.e. diagnoses of current/past alcohol abuse/dependence) and AVC. PTSS were assessed 6-weeks and 6-months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (BAC ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce avoidance coping soon after trauma may help to buffer the development of PTSD+AUD comorbidity.
doi:10.1037/a0022439
PMCID: PMC3178002  PMID: 21443298
Avoidance coping; Alcohol use disorder; Substance use disorder; Posttraumatic stress disorder (PTSD)
17.  Posttraumatic Symptoms and Posttraumatic Growth of Israeli Firefighters, at One Month following the Carmel Fire Disaster 
Psychiatry Journal  2012;2013:274121.
Wildfire disasters are potentially traumatic events which directly and indirectly affect both citizens and first responders. The study of posttraumatic growth is scarcely found in the context of firefighters and only few studies have addressed this construct. In the current study, posttraumatic symptoms and posttraumatic growth were investigated among Israeli firefighters (N = 65), approximately one month after the Carmel Fire Disaster. Eight firefighters (12.3%) were found to be above the cut-off score for probable PTSD, with intrusion symptoms as the most frequent finding compared to avoidance and hyper-arousal symptoms. Posttraumatic growth (PTG) was evident to a small but considerable degree; noticeable changes were found regarding personal strength and appreciation of life. Results also revealed significant linear and quadratic relationships between PTSD and PTG. Results are discussed in light of past research on psychological responses among firefighters and first responders.
doi:10.1155/2013/274121
PMCID: PMC3839653  PMID: 24286064
18.  Cardiovascular Correlates of Motor Vehicle Accident Related Posttraumatic Stress Disorder and its Successful Treatment 
Persons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.
doi:10.1007/s10484-006-9027-1
PMCID: PMC1705541  PMID: 17094031
heart rate; MVA; PTSD; treatment
19.  The validation of the Polish version of the Posttraumatic Diagnostic Scale and its factor structure 
European Journal of Psychotraumatology  2012;3:10.3402/ejpt.v3i0.18479.
Background
Posttraumatic Diagnostic Scale (PDS) is a self-descriptive measure developed to provide information regarding posttraumatic stress disorder (PTSD) diagnosis and symptom severity.
Objectives
The aim of this article is to report on the validation of the Polish version of PDS and to test its factor structure with reference to two models: an original three-factor model (Reexperiencing, Avoidance, and Arousal) and alternative five-factor model (Reexperiencing, Avoidance, Numbing, Dysphoric Arousal, and Anxious Arousal).
Method
The validation procedure included three studies conducted on samples of separate populations: university-level students (n=507), individuals who had experienced various traumas (n=320), and treatment-seeking survivors of motor vehicle accidents (MVA) (n=302). Various other measures of trauma-related psychopathology were administered to participants, as well as the PTSD module of the Structured Clinical Interview (SCID) in the case of MVA patients.
Results
PDS showed high internal consistency and test–retest reliability, good diagnostic agreement with SCID, good sensitivity but relatively low specificity. The satisfactory convergent validity was supported by a large number of significant correlations with other measures of trauma-related psychopathology. Confirmatory factor analysis (CFA) generally confirmed both the three-factor structure and the alternative five-factor structure of the questionnaire.
Conclusions
The results show generally good psychometric properties of the Polish version of PDS.
doi:10.3402/ejpt.v3i0.18479
PMCID: PMC3416974  PMID: 22893850
posttraumatic stress disorder; PDS; questionnaire; validity; reliability; factor analysis
20.  Potential impact of propofol immediately after motor vehicle accident on later symptoms of posttraumatic stress disorder at 6-month follow up: a retrospective cohort study 
Critical Care  2012;16(5):R196.
Introduction
Critically injured patients are at risk of developing posttraumatic stress disorder (PTSD). Propofol was recently reported to enhance fear memory consolidation retrospectively. Thus, we investigated here whether administration of propofol within 72 h of a motor vehicle accident (MVA) affects the subsequent development of PTSD symptoms.
Methods
We examined data obtained from a prospective cohort study of MVA-related injured patients, admitted to the intensive care unit of a general hospital. We investigated the effect of propofol administration within 72 h of MVA on outcome. Primary outcome was diagnosis of full or partial PTSD as determined by the Clinician-Administered PTSD Scale (CAPS) at 6 months. Secondary outcomes were diagnosis of full or partial PTSD at 1 month and CAPS score indicating PTSD at 1 and 6 months. Multivariate analysis was conducted adjusting for being female, age, injury severity score (ISS), and administration of ketamine or midazolam within 72 h of MVA.
Results
Among 300 patients recruited (mean ISS, 8.0; median Glasgow Coma Scale (GCS) score, 15.0; age, 18 to 69 years), propofol administration showed a higher risk for full or partial PTSD as determined by CAPS at 6 months (odds ratio = 6.13, 95% confidence interval (CI): 1.57 to 23.85, P = 0.009) and at 1 month (odds ratio = 1.31, 95% CI: 0.41 to 4.23, P = 0.647) in the multivariate logistic regression. Multivariate regression analysis showed a trend toward adverse effects of propofol on PTSD symptom development at 6 months after MVA (β = 4.08, 95% CI: -0.49 to 8.64, P = 0.080), but not at 1 month after MVA (β = -0.42, 95% CI: -6.34 to 5.51, P = 0.890).
Conclusions
These findings suggest that using propofol in the acute phase after MVA might be associated with the development of PTSD symptoms 6 months later. However, since the design of this study was retrospective, these findings should be interpreted cautiously and further study is warranted.
doi:10.1186/cc11681
PMCID: PMC3682298  PMID: 23075426
21.  Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review 
PeerJ  2014;2:e256.
Background. The impact of head and neck cancer (HNC) in long-term survivors differs widely among individuals, and a significant number of them suffer from the negative effects of disease, whereas others report significant positive effect. This systematic review investigated the evidence the implications of treatment for HNC and subsequent development of Benefit Finding (BF) or Posttraumatic Growth (PTG).
Purpose. To understand how differing medical, psychological and social characteristics of HNC may lead to BF/PTG and subsequently inform post-treatment interventions to encourage positive outcomes.
Method. In February 2012, five databases including Pubmed, and Psych Info, were searched, for peer-reviewed English-language publications. Search strings included key words pertaining to HNC, BF, and PTG. One thousand three hundred and sixty three publications were identified, reviewed, and reduced following Cochrane guidelines and inclusion/exclusion criteria specified by a group of maxillofacial consultants and psychologists. Publications were then quality assessed using the CASP Cohort Critical Appraisal tool.
Findings. Five manuscripts met the search and selection criteria, and were sourced for review. All studies were identified as being level IIb evidence which is a medium level of quality. The majority of studies investigated benefit finding (80%) and were split between recruiting participant via cancer clinics and postal survey. They focused on the medical, psychological and social characteristics of the patient following completion of treatment for HNC.
Conclusion. Demographic factors across the papers showed similar patterns of relationships across BF and PTG; that higher education/qualification and cohabitation/marriage are associated with increased BF/PTG. Similarly, overlap with disease characteristics and psychosocial factors where hope and optimism were both positively correlated with increased reported BF/PTG.
doi:10.7717/peerj.256
PMCID: PMC3933269  PMID: 24688840
Posttraumatic growth; Benefit finding; Head and neck; Cancer; Silver lining questionnaire; Posttraumatic growth inventory; Quality of life; Systematic review
22.  Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES 
Journal of traumatic stress  2006;19(1):119-128.
Data indicates that millions of motor vehicles accidents (MVA) occur each year and that MVAs are one of the leading causes of posttraumatic stress disorder (PTSD). Despite these findings, PTSD screening tools have not been identified for MVA populations. The current study examines two potential PTSD screening tools, the Impact of Event Scale (IES) and the PTSD Symptom Scale, Self-Report (PSS-SR), in a large sample of MVA survivors. For the IES using a cutoff score of 27, sensitivity was .91, specificity was .72 and overall correct classification was .80. For the PSS-SR using a cutoff score of 14, sensitivity was .91, specificity was .62 and overall correct classification was .74. These data support the use of the IES and the PSS-SR as PTSD screening tools in MVA samples.
doi:10.1002/jts.20106
PMCID: PMC1424666  PMID: 16568464
PTSD; motor vehicle accident; screening; self-report measures; assessment
23.  Traumatic Severity and Trait Resilience as Predictors of Posttraumatic Stress Disorder and Depressive Symptoms among Adolescent Survivors of the Wenchuan Earthquake 
PLoS ONE  2014;9(2):e89401.
Purpose
To examine the associations between trauma severity, trait resilience, and posttraumatic stress disorder (PTSD) and depressive symptoms among adolescent survivors of the Wenchuan earthquake, China.
Methods
788 participants were randomly selected from secondary schools in the counties of Wenchuan and Maoxian, the two areas most severely affected by the earthquake. Participants completed four main questionnaires including the Child PTSD Symptom Scale, the Center for Epidemiologic Studies Depression Scale for Children, the Connor and Davidson’s Resilience Scale, and the Severity of Exposure to Earthquake Scale.
Results
After adjusting for the effect of age and gender, four aspects of trauma severity (i.e., direct exposure, indirect exposure, worry about others, and house damage) were positively associated with the severity of PTSD and depressive symptoms, whereas trait resilience was negatively associated with PTSD and depressive symptoms and moderated the relationship between subjective experience (i.e., worry about others) and PTSD and depressive symptoms.
Conclusions
Several aspects (i.e., direct exposure, indirect exposure, worry about others, and house damage) of earthquake experiences may be important risk factors for the development and maintenance of PTSD and depression. Additionally, trait resilience exhibits the beneficial impact on PTSD and depressive symptoms and buffers the effect of subjective experience (i.e., worry about others) on PTSD and depressive symptoms.
doi:10.1371/journal.pone.0089401
PMCID: PMC3935868  PMID: 24586751
24.  Exploring the Association between Posttraumatic Growth and PTSD: A National Study of Jews and Arabs Following the 2006 Israeli-Hezbollah War 
Posttraumatic Growth (PTG) – deriving benefits following potentially traumatic events – has become a topic of increasing interest. We examined factors that were related to self-reported PTG, and the relationship between PTG and symptoms of posttraumatic stress (PTS) following the 2006 Israel-Hezbollah. Drawing from a national random sample of Israel, data from 806 terrorism-exposed Israeli adults were analyzed. PTG was associated with being female, lower education, greater recent terrorism exposure, greater loss of psychosocial resources, greater social support, and greater self-efficacy. PTG was a consistent predictor of PTS across hierarchical linear regression models that tested whether demographic, stress, or personal resources moderated the relationship between PTG and PTS. PTG did not relate to PTS differently for people who differed by age, sex, ethnicity, education, religiosity, degree of terrorism exposure, self-efficacy, non-terrorism stressful life events, and loss of psychosocial and economic resources. PTG was not related to well-being for any of these subgroups.
doi:10.1097/NMD.0b013e3181d1411b
PMCID: PMC3652393  PMID: 20215994
posttraumatic stress disorder; posttraumatic growth; war; terrorism
25.  Posttraumatic Growth in Young Adults who Experienced Serious Childhood Illness: A Mixed-Methods Approach 
Sixty young adult survivors of a serious childhood illness completed quantitative and qualitative measures assessing the relationship between specific disease and distress factors and posttraumatic growth (PTG). Individuals who had recovered from their illness reported greater growth than those who were currently experiencing their illness. The regression model accounted for 47% of the variance in PTG, with perceived severity, illness status, and posttraumatic stress symptoms emerging as significant predictors. Qualitative analyses identified salient positive and negative factors associated with having had an illness, such as a positive shift in perspective and frequent medical requirements. Being past the daily demands of illness management may allow for greater PTG. Realization of positive aspects of having had an illness may require prompting.
doi:10.1007/s10880-010-9210-7
PMCID: PMC3032397  PMID: 21076935
posttraumatic growth; posttraumatic stress; chronic illness; young adulthood

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