Grant N. Marshall

A National Survey of Stress Reactions after the September 11, 2001, Terrorist Attacks

BACKGROUND People who are not present at a traumatic event may also experience stress reactions. We assessed the immediate mental health effects of the terrorist attacks on September 11, 2001. METHODS Using random-digit dialing three to five days after September 11, we interviewed a nationally representative sample of 569 U.S. adults about their reactions to the terrorist attacks and their perceptions of their childrens reactions. RESULTS Forty-four percent of the adults reported one or more substantial stress symptoms; 91 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress syndromes. They coped by talking with others (98 percent), turning to religion (90 percent), participating in group activities (60 percent), and making donations (36 percent). Eighty-five percent of parents reported that they or other adults in the household had talked to their children about the attacks for an hour or more; 34 percent restricted their childrens television viewing. Thirty-five percent of children had one or more stress symptoms, and 47 percent were worried about their own safety or the safety of loved ones. CONCLUSIONS After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians who practice in regions that are far from the recent attacks should be prepared to assist people with trauma-related symptoms of stress.

Distinguishing optimism from pessimism: Relations to fundamental dimensions of mood and personality.

Contrary to unidimensional conceptions of optimism and pessimism, factor analysis of 2 widely used instruments revealed that optimism and pessimism are empirically differentiable, but related, constructs. Moreover, consistent with expectations, optimism and pessimism were differentially linked with fundamental dimensions of mood and personality. Pessimism was principally associated with neuroticism and negative affect. Optimism was primarily associated with extraversion and positive affect. Findings are discussed with reference to current conceptual and measurement models of optimism and pessimism and their relations to broad dimensions of mood and personality

Race/ethnicity, Language, and Patients' Assessments of Care in Medicaid Managed Care

OBJECTIVE Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language. DATA SOURCES Data were derived from the National CAHPS Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000. DATA COLLECTION The CAHPS data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent. STUDY DESIGN Data were analyzed using linear regression models. The dependent variables were CAHPS 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health. PRINCIPAL FINDINGS Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities. CONCLUSIONS This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid-enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.

All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress.

This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.

The Five-Factor Model of Personality as a Framework for Personality-Health Research

The NEO Five Factor Personality Inventory (NEO-FFI; Costa & McCrae, 1989) and representative personality scales drawn from health psychology were administered to 2 samples of male military recruits (Ns = 296 and 502). Factor analysis of health-related personality scales revealed 3 conceptually meaningful domains. Examination of these domains and their constituent scales, with reference to the 5-factor model of personality, permits 3 general conclusions. First, most health-relevant dimensions and scales appear to be complex mixtures of broad personality domains. Second, variation in many health-related personality instruments is explained to a significant degree by the 5-factor model. Third, 2 of the 5 personality domains (i.e., conscientiousness and openness) appear to be substantially neglected in health psychology research.

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.

Anxiety Sensitivity and PTSD Symptom Severity Are Reciprocally Related: Evidence From a Longitudinal Study of Physical Trauma Survivors

Cross-lagged panel analysis of interview data collected from survivors of traumatic physical injury (N = 677) was used to examine the temporal relationship between anxiety sensitivity and posttraumatic stress disorder (PTSD) symptom severity. The 2 constructs were assessed at 3 time points: within days of physical injury, at 6-month follow-up, and at 12-month follow-up. Results indicated that anxiety sensitivity and PTSD symptom severity were reciprocally related such that anxiety sensitivity predicted subsequent PTSD symptom severity, and symptom severity predicted later anxiety sensitivity. Findings have both theoretical and clinical implications.

Four-Year Cross-Lagged Associations Between Physical and Mental Health in the Medical Outcomes Study

This article provides an application of structural equation modeling to the evaluation of cross-lagged panel models. Self-reports of physical and mental health at 3 different time points spanning a 4-year interval were analyzed to illustrate the cross-lagged analysis methodology. Data were collected from a sample of 856 patients with hypertension, diabetes, heart disease, or depression (or any combination of these) participating in the Medical Outcomes Study. Cross-lagged analyses of physical and mental health constructs revealed substantial stability effects across time. A structural model with standard effects revealed positive effects of physical health on mental health but negative (suppression) effects of mental health on physical health. The effects of mental health on physical health became nonsignificant when the model was revised by adding nonstandard effects (direct effects of measured variable residuals on latent variables). Recommendations for structural equation modeling of cross-lagged panel data are provided.

Trauma, Depression, Coping, and Mental Health Service Seeking Among Impoverished Women

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women.

The Structure of Patient Satisfaction with Outpatient Medical Care.

Patient satisfaction data for 2,226 patients in the Medical Outcomes Study were used to determine the dimensions of satisfaction with medical care, the relation between direct and indirect methods of assessing global satisfaction with care, and the extent to which visit-specific and global satisfaction with ones medical care covary. Results supported the multidimensionality of satisfaction ratings but showed substantial covariation among some dimensions. Direct and indirect methods of assessing global satisfaction with care also covaried markedly. Global satisfaction was significantly, albeit modestly, correlated with visit-specific satisfaction