Berglind Gudmundsdottir

Psychometric Properties of the Posttraumatic Cognitions Inventory (PTCI): A Replication With Motor Vehicle Accident Survivors.

This study examined the factor structure, internal consistency, concurrent validity, discriminant validity, and discriminative validity of the Posttraumatic Cognitions Inventory (PTCI; E. B. Foa, A. Ehlers, D. M. Clark, D. F. Tolin, and S. M. Orsillo, 1999) in a sample of 112 individuals who had experienced a serious motor vehicle accident. Results generally supported the 3-factor structure of the PTCI: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Subscales reflecting negative thoughts of the self and world showed adequate internal consistency, as well as good concurrent, discriminant, and discriminative validity. However, difficulties with the subscale representing self-blame emerged, specifically poor concurrent and discriminant validity. Potential reasons for this finding are discussed. The PTCI seems to be a promising measure of negative and dysfunctional posttrauma cognitions, which deserves continuing attention.

The Driving Behavior Survey: Scale construction and validation

Although long recognized in the clinical literature, problematic behavior characteristic of anxious drivers has received little empirical attention. The current research details development of a measure of anxious driving behavior conducted across three studies. Factor analytic techniques identified three dimensions of maladaptive behaviors across three college samples: anxiety-based performance deficits, exaggerated safety/caution behavior, and anxiety-related hostile/aggressive behavior. Performance deficits evidenced convergent associations with perceived driving skill and were broadly related to driving fear. Safety/caution behaviors demonstrated convergence with overt travel avoidance, although this relationship was inconsistent across studies. Safety/caution scores were associated specifically with accident- and social-related driving fears. Hostile/aggressive behaviors evidenced convergent relationships with driving anger and were associated specifically with accident-related fear. Internal consistencies were adequate, although some test-retest reliabilities were marginal in the unselected college sample. These data provide preliminary evidence for utility of the measure for both research and clinical practice.

PTSD and emotional distress symptoms measured after a motor vehicle accident: Relationships with pain coping profiles

This study explored differences among pain patients classified as Dysfunctional, Interpersonally Distressed, and Adaptive Copers on the Multidimensional Pain Inventory with respect to PTSD symptomatology, anxiety, and depression. Eighty-five patients with pain complaints who had experienced a serious motor vehicle accident were classified into these three pain coping categories and assessed using clinician and self-report measures. Results indicated that patients classified as Adaptive Copers (n = 24) showed less PTSD symptomatology, anxiety, and depressed mood, relative to individuals classified as Dysfunctional (n = 36) and as Interpersonally Distressed (n = 25), who did not differ on these dimensions. Emotional responses during the accident (fear, helplessness, danger, perceived control, and certainty that one would die) did not differentiate the groups. Pain profiles contributed to the prediction of self-reported PTSD symptoms, controlling for state anxiety. These data suggest that pain patients with both Dysfunctional and Interpersonally Distressed coping profiles are at elevated risk for a range of posttrauma problems following a serious motor vehicle accident.

Post-trauma symptoms following indirect exposure to the September 11th terrorist attacks: The predictive role of dispositional coping

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.

Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors

To date, no study has investigated the effects of avalanches on survivors health beyond the first years. The aim of this study was to examine long-term health status 16 years after exposure to avalanches using a matched cohort design. Mental health, sleep quality and somatic symptoms among avalanche survivors (n=286) and non-exposed controls (n=357) were examined. Results showed that 16% of survivors currently experience avalanche-specific PTSD symptoms (PDS score>14). In addition, survivors presented with increased risk of PTSD hyperarousal symptoms (>85th percentile) (aRR=1.83; 98.3% CI [1.23-2.74]); sleep-related problems (PSQI score>5) (aRR=1.34; 95% CI [1.05-1.70]); PTSD-related sleep disturbances (PSQI-A score≥4) (aRR=1.86; 95% CI [1.30-2.67]); musculoskeletal and nervous system problems (aRR 1.43; 99% CI 1.06-1.93) and gastrointestinal problems (aRR 2.16; 99% CI 1.21-3.86) compared to the unexposed group. Results highlight the need for treatment for long-term PTSD symptoms and sleep disruption in disaster communities.

Risk factors and health during pregnancy among women previously exposed to sexual violence

To determine whether women exposed to sexual violence in adolescence or adulthood are at increased risk of adverse maternal characteristics during subsequent pregnancies.

Effects of yoga practice on stress-related symptoms in the aftermath of an earthquake: A community-based controlled trial.

OBJECTIVES To evaluate the effect of an integrated hatha yoga practice on perceived stress and stress-related symptoms in the aftermath of an earthquake. DESIGN AND SETTING Inhabitants, aged 20-67 years, from highly exposed earthquake areas of two villages in South Iceland were offered to participate in a yoga program subsequent to an earthquake. Sixty-six individuals were self-selected into the study and divided by residential convenience into an experimental group (n=31) and a waiting list control group (n=35). INTERVENTION The yoga program was conducted twice a week for six weeks, in normal situations among the inhabitants in the community. MAIN OUTCOME MEASURES Several validated questionnaires assessing stress and stress-related symptoms, posttraumatic symptoms, depression, anxiety and health related quality of life were administered at pre- and post-intervention. RESULTS Multivariate analysis of variance (MANOVA) revealed differences between the experimental group and waiting list control group on sleep quality (p=.03) and social relations (p=.04). These differences did not prevail at Bonferroni correction for multiple testing (at alpha level of .005). Participants in both groups showed significant improvements in stress and some stress-related symptoms such as sleep, concentration, well-being, quality of life, depression and anxiety from pre- to post-intervention. CONCLUSIONS The data from this small study show no statistically significant improvement of an integrated hatha yoga program above and beyond waiting list control, following exposure to an earthquake. However, the observed trend toward improved sleep quality and social relations deserve further exploration in larger effectiveness studies on the impact of Hatha yoga on recovery after natural disaster.

Increased attendance rates and altered characteristics of sexual violence

Objective. To study the attendance rates and characteristics of sexual violence presented at emergency services for rape victims, over a 10‐year period. Design. Incidence study. Setting. Rape Trauma Service, within an emergency department at a tertiary referral university hospital. Population. The total female population in Iceland. Methods. Medical records on visits were reviewed and systematically coded. Annual attendance rates were calculated over time as number of visits per 10 000 female inhabitants aged 13–49 years. Characteristics of sexual violence, perpetrators and victims were compared between 1998–2002 and 2003–2007. Main outcome measures. Annual attendance rates and characteristics of sexual violence. Results. Of 1153 visits, 828 (71.8%) were due to severe sexual violence (penetration). Annual attendance rates of all sexual violence increased from 12.5 to 16.9 per 10 000 women aged 13–49 (p<0.01). Attendance rates due to severe sexual violence increased specifically among women aged 18–25 (p<0.01). The proportion of assaults involving multiple perpetrators increased from 13.9% in 1998–2002 to 18.9% in 2003–2007 (p=0.05). With time, a higher proportion of victims had seriously impaired consciousness due to alcohol consumption (p<0.01) and had used illegal drugs prior to assault (p<0.05). Conclusions. The findings point towards an increase in womens visits to specialized emergency services for rape victims, particularly in the age group 18–25 years. The increased role of multiple perpetrators, alcohol and illicit drugs in sexual violence calls for further attention.

The predictive role of support in the birth experience: A longitudinal cohort study

BACKGROUND Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. OBJECTIVE The aim of this study was to describe womens birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. METHOD A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11-16 weeks of pregnancy (T1, n=1111), at five to six months (T2, n=765), and at 18-24 months after birth (T3, n=657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. RESULTS The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. CONCLUSIONS Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on womens perception of birth experience.

Sixteen-year follow-up of childhood avalanche survivors

Background Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on childrens health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures. Objective Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood. Methods Childhood survivors (aged 2–19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis. Results Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p<0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F=7.62, p<0.001), poor financial status (F=12.21, p<0.001), and unemployment and/or disability (F=3.04, p<0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t=4.22, p<0.001) and traumatic reactions of caregivers (t=2.49, p<0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma. Conclusions Lingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening childrens support systems post-disaster may prevent the long-term sequelae of symptoms. Highlights of the article PTSD symptoms following avalanche exposure during childhood were associated with poorer socioeconomic status in adulthood. Lack of social support and traumatic reactions of caregivers in the aftermath of avalanches predicted PTSD symptoms among childhood survivors 16 years later. Findings underscore the importance of strengthening childrens support systems in the aftermath of disasters.