Bernice Andrews

Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in Trauma-Exposed Adults

Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.

Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse.

To examine the role of cognitive-affective appraisals and childhood abuse as predictors of crime-related posttraumatic stress disorder (PTSD) symptoms, 157 victims of violent crime were interviewed within 1 month post-crime and 6 months later. Measures within 1 month post-crime included previous physical and sexual abuse in childhood and responses to the current crime, including shame and anger with self and others. When all variables were considered together, shame and anger with others were the only independent predictors of PTSD symptoms at 1 month, and shame was the only independent predictor of PTSD symptoms at 6 months when 1-month symptoms were controlled. The results suggest that both shame and anger play an important role in the phenomenology of crime-related PTSD and that shame makes a contribution to the subsequent course of symptoms. The findings are also consistent with previous evidence for the role of shame as a mediator between childhood abuse and adult psychopathology.

Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale

OBJECTIVE To investigate whether previous findings from interview studies of a prospective relationship between shame and psychopathology (e.g. Andrews, 1995) could be replicated using questionnaires. DESIGN A total of 163 university students participated in a longitudinal questionnaire study. METHOD The Experience of Shame Scale (ESS), a questionnaire based on a previous interview measure, and an established shame scale (TOSCA), were considered in their relation to depressive symptoms assessed at two time points 11 weeks apart. RESULTS Both scales made significant independent contributions to depressive symptoms at time 1. However, only the ESS predicted additional significant variance in time 2 symptoms when time 1 symptoms were controlled. CONCLUSIONS It was concluded that the reason for the differential performance of the two scales was that the ESS, like the shame interview, assesses specific areas of shame related to self and performance, whereas the TOSCA assesses general shame and may therefore be more prone to mood-state effects.

Brief screening instrument for post-traumatic stress disorder

BACKGROUND Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AIMS To test and cross-validate a brief instrument that is simple to administer and score. METHOD Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. RESULTS Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. CONCLUSIONS Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.

Gender, social support, and PTSD in victims of violent crime

Gender differences in social support levels and benefits were investigated in 118 male and 39 female victims of violent crime assessed for PTSD symptomatology 1 and 6 months postcrime. Within 1 month postcrime both genders reported similar levels of positive support and support satisfaction, but women reported significantly more negative responses from family and friends. Women also reported an excess of PTSD symptoms that was similar at 1 and 6 months postcrime, and negative responses mediated the relationship between gender and later symptoms. Overall negative response and support satisfaction, but not positive support, were significantly associated with PTSD symptoms. However, the effects of support satisfaction and negative response on 6-month symptoms were significantly greater for women than men. The findings are consistent with previous studies of predominantly female assault victims concerning the stronger impact of negative over positive support, and might help explain womens higher PTSD risk in civilian samples.

Fear, helplessness, and horror in posttraumatic stress disorder : Investigating DSM-IV criterion A2 in victims of violent crime

A DSM-IV diagnosis of posttraumatic stress disorder (PTSD) required for the first time that individuals must report experiencing intense fear, helplessness, or horror at the time of the trauma. In a longitudinal study of 138 victims of violent crime, we investigated whether reports of intense trauma-related emotions characterized individuals who, after 6 months, met criteria for PTSD according to the DSM-III-R. We found that intense levels of all 3 emotions strongly predicted later PTSD. However, a small number of those who later met DSM-III-R or ICD criteria for PTSD did not report intense emotions at the time of the trauma. They did, however, report high levels of either anger with others or shame.

Self-esteem and depression. II. Social correlates of self-esteem.

SummaryThe Self-Evaluation and Social Support Schedule (SESS), an interview-based instrument, is described, which aims to give a comprehensive description of a persons social milieu in terms of ‘objective’ and ‘subjective’ measures. On the basis of a population survey of 400 largely working-class women, a tentative causal model is developed which relates both the quality of current interpersonal ties and childhood experiences to current negative and positive measures of self-esteem. A major purpose of the execrise is to develop positive and negative indices of the social environment that can be used to elucidate the aetiological role of self-esteem in the development of depression. This is the task of a third paper.

Self-esteem and depression. III, Aetiological issues

SummaryThis is the last of a series of three papers dealing with the role of self-esteem in the onset of clinical depression. On the basis of a longitudinal population enquiry a comprehensive psychosocial model of depression is developend. It is concluded that self-esteem (primarily in terms of a negative measure) does play a significant role. However, this can be only properly interpreted in the light of the full model. This highlights: 1. the importance of the occurrence of both a negative enviromental factor (negative interaction with children or husband for married or negative interaction with children or lack of a very close tie for single mothers)and a negative psychological factor (low self-esteem or chronic subclinical condition); and 2. how a relatively small group of high risk women in these terms (23% of total at risk based on measures collected well of onset of depression occurring over a 12 month period.

Self-esteem and depression. IV, Effect on course and recovery

SummaryThe present paper, the fourth and last in a series examining the role of self-esteem in depressive disorder in the general population, deals with recovery/improvement from a disorder at a case level. Both positive evaluation of self (NES) measured during a chronic episode are related to subsequent recovery or improvement. A causal effect is suggested since the measure adds over and above to that of environmental factors previously established to relate to recovery/improvement — the reduction of an ongoing difficulty or fresh-start event. Positive evaluation of self was also related to recovery/improvement from subsequentonsets of case depression. In this instance unlike that for the chronic conditions, self-esteem was measured outside the episode of depression. A causal effect was also suggested because it made an independent contribution vis-a-vis the effect of fresh-start events. Given the small size of the sample the study should be seen as an exploratory one.

The relationship between shame, eating disorders and disclosure in treatment.

BACKGROUND This study considered shame in 68 women who had received treatment for eating disorders (EDs) compared to 72 non-clinical controls, and shame in relation to disclosure in treatment. METHOD All participants completed questionnaires on ED and depressive symptoms, and bodily, behavioural and characterological shame and shame around eating. ED women also answered questions on disclosure in treatment. RESULTS The ED group scored significantly higher than controls on all shame areas when depression was controlled. ED women who were currently symptomatic and those who had recovered scored higher than controls on bodily and characterological shame and shame around eating. Non-disclosure in treatment was reported by 42% of the ED group and was associated with higher shame in all areas except bodily shame. CONCLUSIONS The study is the first to show a relationship between shame and ED in a clinical sample. It supports existing evidence regarding the importance of bodily shame in women with EDs, and extends the literature in terms of the importance of other shame aspects for ED symptomatology and disclosure. Implications for treatment are discussed.