Man Cheung Chung

A multiple-indicator multiple-cause model for posttraumatic stress reactions : Personality, coping, and maladjustment

Objective: This study aimed to develop a multiple-indicator multiple-cause model (MIMIC) to describe the relationship among posttraumatic stress (PTSD) responses, general health problems, death anxiety, personality factors, and coping strategies among community residents exposed to the technological disasters of aircraft and train crashes. Materials and Methods: One hundred forty-eight community residents, after exposure to the aircraft or train crash, were assessed using the Impact of Event Scale, the General Health Questionnaire-28, the Death Anxiety Scale, the Eysenck Personality Questionnaire, and the Ways of Coping Checklist. The control group (n = 90) comprised members of the general public, who had not been exposed to the disasters, from another city. Results: The model showed significant associations between the impact of the disaster and general health problems, which varied depending on where community residents lived in relation to the disaster site, whether they were present when the disaster occurred, and the type of disaster. The model also suggested that death anxiety was associated with type of disaster and neuroticism. The model supported the interactive model in that personality factors interacted with coping strategies in maintaining or generating PTSD and general health problems. Conclusions: After exposure to technological disasters, community residents could develop PTSD and general health problems; however, increased death anxiety was a separate psychological reaction. The interaction between certain personality traits and coping strategies was one reason for PTSD and general health problems. MIMIC = multiple-indicator multiple-cause model; PTSD = posttraumatic stress disorder; POWS = prisoners of war; IES = The Impact of Event Scale; GHQ-28 = The General Health Questionnaire; DAS = The Death Anxiety Scale; EPQ-R = The Eysenck Personality Questionnaire-R Short Scale; WOC = The Ways of Coping Checklist; ANOVA = analysis of variance; RMSEA = root mean square error of approximation.

Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction.

More research is needed to further our understanding of posttraumatic stress responses and comorbidity following myocardial infarction (MI), and to help us identify more clearly the personality traits which indicate that a person is more prone to developing post-MI posttraumatic stress disorder (PTSD). This study aimed to 1) investigate the comorbidity of patients who suffered from different levels of posttraumatic stress disorder following myocardial infarction (i.e. post-MI PTSD), and 2) investigate to what extent patients with different levels of post-MI PTSD differed in their personality traits. One hundred and twenty MI patients from two general practices were recruited for the study. They were asked to complete the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the NEO-Five Factor Inventory (NEO-FFI). They were divided into a no-PTSD group, a partial-PTSD group and a full-PTSD group, according to the scores of the PDS. One hundred and sixteen members of the general public were also recruited for comparison purposes. They were asked to complete the GHQ-28. The results showed that patients with full-PTSD reported significantly more somatic problems, anxiety, social dysfunction and depression than the other two patient groups and the control group. When age, bypass surgery, mental health problems before MI and angioplasty were controlled for, patients with full-PTSD also reported greater symptom severity of the four GHQ subscales than the other two patient groups. Patients with full-PTSD were significantly more neurotic than those with no-PTSD and partial-PTSD. Patients with full-PTSD were less agreeable than patients with no-PTSD. Regression analyses showed that personality did not moderate the relationship between PTSD and comorbidity. To conclude, following MI, those with full-PTSD tend to report more severe comorbidity than those who have not developed PTSD fully. The former can also be distinguished from the latter by virtue of their specific personality traits.

Locus of control among spinal cord injury patients with different levels of posttraumatic stress disorder.

Two hypotheses were investigated in the present study: 1) Patients with full posttraumatic stress symptoms following spinal cord injury (SCI) would experience more general health problems than those with partial posttraumatic stress disorder (PTSD), with no-PTSD and the control group; 2) Patients with full PTSD would endorse the external locus of control more than those with partial PTSD, no-PTSD and the control group. Sixty-two patients were recruited from a specialized rehabilitation clinic for spinal cord injury. The control group comprised 60 participants without SCI. Patients with SCI were assessed using the Posttraumatic Stress Disorder Checklist, the General Health Questionnaire-28 (GHQ-28) and the Multidimensional Health Locus of Control (MHLC). The control group was assessed using the GHQ-28 and the MHLC. The full PTSD group experienced more somatic problems, anxiety, social dysfunction and depression than the partial PTSD, the no-PTSD and the control groups. The results also showed that the full PTSD group endorsed significantly more external health locus of control than the control group. However, no significant differences were found between the three patient groups in health locus of control. The three PTSD sub-scales were positively correlated with general health problems. Further analyses showed that partial PTSD patients with paraplegia and partial PTSD patients whose SCI had a medically related cause were more likely to report less internal locus of control than other patients. Patients who suffered from full PTSD experienced more general health problems than those with fewer PTSD symptoms and those without SCI. External locus of control was a distinctive strategy that SCI-PTSD patients used in coping with the effects of SCI-PTSD.

Stress, psychiatric co-morbidity and coping in patients with chronic idiopathic urticaria

This study examined life event stress, perceived stress and psychiatric co-morbidity among patients with Chronic Idiopathic Urticaria (CIU). It also investigated the relationship between coping, stress, the severity of CIU and psychiatric co-morbidity. Total of 100 CIU patients and 60 allergy patients participated in the study. They completed the General Health Questionnaire, the Social Readjustment Rating Scale, the Perceived Stress Scale, and the Ways of Coping Checklist. Compared with allergy patients, CIU patients had worse co-morbidity and higher levels of life event stress and perceived stress. Emotion-focussed coping was associated with the severity of CIU; perceived stress was associated with co-morbidity.

A narrative exploration of the sense of self of women recovering from childhood sexual abuse

Objectives: To explore how the sense of self evolves through the recovery process after intensive therapy that focuses on issues pertaining to childhood sexual abuse (CSA). Design: A retrospective qualitative study. Method: Four women with CSA experiences, who completed a local sexual abuse intervention group programme, participated in the study. They were interviewed using a narrative life story approach and a narrative analysis was conducted on the data. Results: Participants had a ‘traumatised self’ characterised by shame and guilt, leading to self-perceptions of being insignificant and undeserving. After intervention, an overall positive sense of self resulted characterised by an increased sense of self-awareness, self-acceptance and self-confidence. This was enhanced by being able to externalise their abuse and to shift the responsibility of the abuse from the abused to the abuser. Self-control was gained through the use of effective coping strategies. Being part of a group with similar experiences was found to enhance feelings of solidarity and commonality and instilled a sense of optimism about the future. Conclusions: After therapy, the concept of sense of self evolved from a traumatised self to a more enduring positive sense of self. The participants made self-improvements, connections with people and were able to live autonomous lives.

Posttraumatic stress and co-morbidity following myocardial infarction among older patients: The role of coping

This study aimed to investigate co-morbidity and coping strategies among older patients who suffer from different levels of posttraumatic stress disorder (PTSD) following myocardial infarction. Ninety-six older myocardial infarction (MI) patients were recruited from two general practices and completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the COPE Scale. Ninety-two older patients with no previous MI experience constituted the control. Using the PDS, 30, 42 and 28% had full, partial and no-PTSD respectively. There were significant differences between the patient groups and the control on all GHQ-28 sub-scales. Significant differences were also identified between the patient groups in the following coping strategies: seeking emotional social support, suppression of competing activities, restraint coping, focusing on and venting of emotion, mental and behavioural disengagement. Controlling for bypass surgery, previous mental health difficulties, angioplasty, heart failure and angina, MANCOVA results did not change the overall results of the GHQ-28 but changed the results of coping in that seeking emotional social support and behavioural disengagement stopped being significant. Coping was a partial mediator between different levels of post-MI PTSD and co-morbidity. Depending on the severity of PTSD symptoms, co-morbidity and coping strategies can vary among older patients. Older patients with full-PTSD tend to use both maladaptive coping strategies as well as problem-focused coping.

A review assessing the current treatment strategies for postnatal psychological morbidity with a focus on post-traumatic stress disorder

OBJECTIVE to conduct a systematic review of randomised controlled trials investigating the efficacy of treatments used to manage postnatal psychological morbidity. DESIGN a systematic review was conducted of studies in English published from 1995 to 2011. Studies were included in the review if they were randomised controlled trials and had extractable data on symptoms of psychological morbidity after an intervention designed to manage the disorders in postnatal women. Eight studies met the criteria and were included in the review. FINDINGS the number of participants ranged from 58 to 1745. The interventions included group and individual counselling, debriefing and expressive writing. Authors of only three studies reported fewer symptoms of PTSD after the intervention. Those that appeared to be helpful were counselling and expressive writing. However most authors did not assess pre-existing PTSD. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the review revealed that there was no standardised scale used for diagnosis of post-traumatic stress disorder across the studies and no single efficacious treatment. A universal instrument for diagnosis of postnatal post-traumatic stress disorder is required. The intrapartum relationship with midwives appears to be an important contributor to prevention of PTSD and this requires further investigation.

How do people with intellectual disabilities and diabetes experience and perceive their illness

INTRODUCTION Diabetes is a significant health problem amongst people with intellectual disabilities, yet there is a lack of qualitative literature looking specifically at their experiences and perceptions of living with this chronic illness. METHOD Using Interpretative Phenomenological Analysis, this study explored the experiences and perceptions of four people with intellectual disabilities and diabetes. RESULTS Results showed that participants demonstrated some knowledge of the language surrounding diabetes, but considerable confusion and uncertainty about their illness. The impact of diabetes was described in terms of physical, emotional and social consequences, and participants spoke of diabetes in the context of co-existing health problems. CONCLUSIONS People with intellectual disabilities and diabetes face many challenges when perceiving and coping with their illness. Gaining insight into these challenges could help health professionals work together more effectively and provide appropriate support to people with intellectual disabilities and diabetes.

Trauma exposure characteristics, past traumatic life events, coping strategies, posttraumatic stress disorder, and psychiatric comorbidity among people with anaphylactic shock experience

OBJECTIVES This study investigated the interrelationship between trauma exposure characteristics, past traumatic life events, coping strategies, posttraumatic stress disorder (PTSD) symptoms, and psychiatric comorbidity among people after anaphylactic shock experience. METHOD The design was cross-sectional in that 94 people with anaphylactic shock experience responded to a postal survey. They completed the Posttraumatic Stress Disorder Checklist, the General Health Questionnaire 28, and the COPE Scale. They also answered questions on trauma exposure characteristics. The control group comprised 83 people without anaphylaxis. RESULTS Twelve percent of people with anaphylactic shock experience fulfilled the diagnostic criteria for full PTSD. As a group, people with anaphylaxis reported significantly more past traumatic life events and psychiatric comorbidity than did the control. Partial least squares analysis showed that trauma exposure characteristics influenced postanaphylactic shock PTSD symptoms and psychiatric comorbidity, which, in turn, influenced coping strategies. CONCLUSIONS People could develop PTSD and psychiatric comorbidity symptoms after their experience of anaphylactic shock. The way they coped with anaphylactic shock was affected by the severity of these symptoms. Past traumatic life events had a limited role to play in influencing outcomes.

Death Anxiety and Well-Being; Coping With Life-Threatening Events

Research was conducted among people who have experienced trauma to see the influence of coping factors on death anxiety, PTSD, and psychiatric comorbidity. The intent was to consider the role of death anxiety in relationship to PTSD and mental health among people who have experienced a life-threatening event. It examined both self-efficacy and religious coping as possible factors of death anxiety resilience in relation to trauma. This study was conducted using undergraduate university students in Lithuania. The study (N = 104) did not find evidence to support the significance of religious coping as important factor; however, self-efficacy emerged as significantly related to psychiatric comorbidity and death anxiety. However the results found that self-efficacy did not act as a mediating factor and was independently related to death anxiety and psychiatric comorbidity. Results were discussed in light of theories regarding death anxiety and the agentic model.