John R. Freedy

Understanding acute psychological distress following natural disaster

A household probability sample of 229 adults was interviewed four to seven months after the Sierra Madre earthquake (June 28, 1991; Los Angeles County). The study predicted psychological distress from these variables: demographics, traumatic event history, low magnitude event history, earthquake related threat perceptions, and earthquake related resource loss. Based on the Conservation of Resources (COR) stress model, it was predicted that resource loss would be central in predicting psychological distress. Three major hypotheses were supported: (1) resource loss was positively associated with psychological distress; (2) resource loss predicted psychological distress when other predictors were statistically controlled; and (3) resource loss was associated with mild to moderate elevations in of psychological distress. The findings support COR stress theory. Theoretical and practical implications are discussed.

Conservation of Social Resources: Social Support Resource Theory

A motivational model of social support was developed, based on a general stress model termed Conservation of Resources Theory (COR). COR suggests that individuals have, as a primary goal to preserve and protect those resources that they value. This resource conservation is made possible, in turn, by possessing a strong resource pool such that resource strength preserves further resource development and resource security. Resources, in other words, are both valued directly and valued indirectly as they serve to protect other resources. Social support provides a major reservoir for resources outside those endowed to the self (e.g. high self-esteem, sense of mastery). Examining our model and those proposed recently by others, we suggest that social support may be a central building block of health and well-being because together with personal resources t is related to overall sense of identity. Corollaries of this theory were also developed and supporting research was presented. Implications of our social support resource theory for social support intervention were considered.

Stress inoculation for reduction of burnout: A conservation of resources approach

Abstract We evaluated the efficacy of two programs designed to reduce stress among nurses by increasing their coping resources. The interventions were based on principles of Stress Inoculation Training and Conservation of Reources stress theory. A dual resource intervention targeted the enhancement of both social support and mastery resources. A single resource intervention targeted the enhancement of only mastery resources. Both interventions were contrasted to a no intervention control condition. Participants in the dual resource intervention experienced significant enhancements in social support and mastery compared to the no intervention control. The social support enhancement persisted through a five-week follow-up. Participants in the dual resource intervention with low initial levels of social support or mastery experienced significant reductions in psychological distress. Participants in the single resource intervention experienced a slight enhancement in mastery compared to the no intervention co...

The Psychological Adjustment of Recent Crime Victims in the Criminal Justice System

The goals of this investigation were to examine the prevalence of Post-Traumatic Stress Disorder (PTSD) and victim service utilization among crime victims and family members recently involved in the criminal justice system ( N = 251). About one half of the participants met PTSD diagnostic criteria during their lifetime. Females were overrepresented in the more violent crimes (e.g., homicide and sexual assault). Victims of more violent crimes—who sustained physical injuries, who perceived that they would be seriously injured, and who perceived their lives were threatened—were more likely to suffer from PTSD than victims who did not have these characteristics. Most participants believed the criminal justice system should provide a range of victim services. However, most participants reported inadequate access to services. Also, receipt of psychological counseling and diagnostic status were significantly associated with crime type. Results imply that crime victims involved in the criminal justice system are at risk for developing PTSD, which often never is addressed by a mental health professional due to inadequate access to health care services.

Psychosocial resource loss as a mediator of the effects of flood exposure on psychological distress and physical symptoms.

This study used the Conservation of Resources stress model to examine the role of psychosocial resource loss in the aftermath of Midwest flooding. Questionnaires were distributed through churches and completed by 131 adults in flood-affected communities 6 weeks and 6 months after the floods crest. Frequent psychosocial losses included losses of routine, sense of control, sense of optimism, accomplishing goals, and time with loved ones. Path analysis revealed that psychosocial resource loss mediated the effects of flood exposure on both psychological distress and physical symptoms at 6 months postflood. The findings suggest that interventions designed to prevent psychosocial resource loss may reduce the long-term effects of disasters.

Post-traumatic stress disorder screening test performance in civilian primary care

PURPOSE we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslaus scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslaus scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslaus scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.

Gender Differences in Traumatic Event Exposure and Mental Health Among Veteran Primary Care Patients

OBJECTIVE This study evaluated gender differences in lifetime traumatic events, PTSD, and depression among VA primary care patients. METHOD Participants were 865 adults attending primary care at one of four VA health centers (n = 681 males, 184 females). RESULTS Mental health findings included: male PTSD 12.3% vs. female PTSD 9.2% (p > 0.05); male depression 15.9% vs. female depression 29.3% (p < 0.001). Men reported more war zone exposure (p < 0.001). Women reported more physical and sexual victimization (p < 0.001). Male logistic regression equations determined PTSD was associated with disability (OR = 3.42; 1.74-6.72, 95% CI) and war zone exposure (OR = 7.14; 3.82-13.30, 95% CI); depression was associated with war zone exposure (OR = 2.27; 1.40-3.68, 95% CI) and interpersonal violence (OR = 1.75; 1.10-2.79, 95% CI). Female PTSD was associated with sexual victimization (OR = 4.50; 1.20-16.80, 95% CI); depression was not predicted. CONCLUSIONS We discuss findings in terms of the crucial need to improve identification and management of PTSD within VA primary care settings.

Crime-Related fears and demographic diversity in los angeles county after the 1992 civil disturbances

The purpose of this research was to assess demographic differences in exposure to traumatic events and fear of crime. This is part of a larger project that assessed the impact of the 1992 Los Angeles civil disturbances on psychological functioning. Random digit dialing methods were used to obtain an adult household probability sample (age 18 or older) representative of the targeted region (Los Angeles County). A total of 1200 individuals completed a 40-minute comprehensive telephone interview. Four hundred interviews were sampled from South Central (the area most heavily affected by the rioting), and 800 were sampled from the remainder of L.A. County. A series of chi-square analyses indicated that there were differences in (a) prevalence of lifetime and past year victimization, (b) perception of neighborhood problems, (c) exposure to the disturbances, and (d) fear of crime as a function of demographic characteristics (i.e., gender, race, ethnicity, community). A hierarchical multiple regression was conducted using demographic variables, victimization, and exposure to the disturbances to predict fear of crime. Results indicated that demographic variables were significantly predictive of crime fear, but that report of neighborhood problems was the strongest predictor. Additionally, exposure to the disturbances remained a significant predictor of crime fear after controlling for the effects of victimization, demographics, and neighborhood problems. Results suggest that while diverse community, race, ethnicity, and gender variables contribute to differences in crime fear, neighborhood problems may be the most important predictor across all groups of subjects.

Balint Groups: The Nuts and Bolts of Making Better Doctors

Balint Group seminars were developed by Michael and Enid Balint based on the application of psychological principles in a group setting for the purpose of developing an improved understanding of the doctor-patient relationship. This article focuses on the development and application of the Balint method to the training of resident physicians (particularly Family Physicians) within the United States. An effort is made to describe the practicalities of resident physician Balint training (e.g., size, frequency, duration of such groups), conceptual underpinnings (e.g., biphasic nature of patient identification, disease versus illness concept, transference/counter-transference, over-identification, under-identification, biphasic nature of physician empathy), and pedagogic goals (mastering empathic skills inherent in being a good doctor) of residency-based Balint groups. In aggregate, this article provides a useful framework for behavioral science educators interested in applying the Balint seminar method to resident physician training. The authors encourage both the continued study and educational application of the Balint seminar method in the training of physicians both within and outside of the United States.

Life events, war and adjustment: Lessons for the middle east

This article focused on traumatic stress and adjustment in the Middle East. Conservation of Resources (COR) stress theory was proposed as a template to explain the relationship between traumatic circumstances and subsequent adjustment. According to COR theory, moderate and major life events produce negative psychological, functional, and health sequelae to the extent that resource loss is experienced. Resource loss that is developmentally overwhelming, or chronic, or a threat to survival was proposed to produce extreme or prolonged adjustment difficulties. Conversely, the replenishment of resources was seen as alleviating psychological suffering. COR theory was applied broadly to children, adults, civilians, and military personnel.