Yael Caspi

Personality traits, coping style, and perceived threat as predictors of posttraumatic stress disorder after exposure to a terrorist attack : A prospective study

Objectives: This prospective study examined the role of pretraumatic personality factors, coping style, proximity to a terrorist attack, and its perceived threat to the survivors in the prediction of posttraumatic stress disorder (PTSD) after a suicide bombers attack on a bus. Method: The study sample consisted of 180 undergraduate students who were coincidentally evaluated 2 weeks before a terrorist explosion in a bus heading toward their university and reevaluated 1 week, 1 month, and 6 months after the explosion. Results: A hierarchal regression model revealed that increased risk for PTSD was associated with direct exposure to the attack, indirect exposure to the attack, preattack harm avoidance personality dimension, state avoidance coping style, and perceived threat posed by the attack. Conclusions: The findings indicate that premorbid personality characteristics, as well as subjective and objective factors related to the traumatic exposure, increased the risk for the development of PTSD. ANOVA = analysis of variance; CI = confidence interval; COPE = Multidimensional Coping Inventory; DSM = Diagnostic and Statistical Manual of Mental Disorders; HA = harm avoidance; MANOVA = multivariate analysis of variance; NS = novelty-seeking; OR = odd ratio; PTSD = posttraumatic stress disorder; PTSS = posttraumatic stress symptoms; RD = reward dependence; SCID = Structured Clinical Interview for Axis I DSM-IV Disorders; TPQ = Tridimensional Personality Questionnaire.

The Relation between Memory of the Traumatic Event and PTSD: Evidence from Studies of Traumatic Brain Injury:

Objective: This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occuring model for traumatic exposure that is often associated with memory impairment. Method: We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group. Results: The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors—even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD. Conclusions: The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of trauamtic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired—or even old—traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.

Acute stress reactions among medical and non‐medical personnel in a general hospital under missile attacks

Background: Recent mass level traumatic events further boosted the growing interest in understanding the effects of primary (direct) and secondary (indirect) traumatic exposure on “helping professionals.” The objectives of this study are: (1) to assess the rates and severity of PTSD symptoms (PS) among hospital workers operating under fire while treating war‐related injured patients, (2) to explore the effect of PS on level of functioning in real time, and (3) to estimate the added effect of secondary traumatization over and above that of primary traumatization. Methods: Rates of PS, level of psychological distress, and level of functioning were assessed in 412 medical and non‐medical personnel working in a hospital that was under missile attacks during the Second Lebanon War in the summer of 2006. The Posttraumatic Stress Disorder Scale (PSS) was used to assess severity of PS, as well as to estimate probable DSM‐IV diagnosis of PTSD. Results: The mean number of reported PS was 8.6 (SD=4.4). Forty‐three (10.2%) of the participants met the symptom and severity threshold for a probable diagnosis of PTSD, however only 13 of these 43 reported impaired level of functioning. There were no significant differences between personnel who had direct exposure to injured or traumatized casualties of the war and those who were not on PS severity and frequency of probable PTSD. Conclusions: These findings suggest that hospital workers operating under prolonged life‐threatening conditions are at moderate risk for PTSD. However, they do not support an incremental effect of secondary traumatic exposure. Depression and Anxiety, 2009.

TRAUMA EXPOSURE AND POSTTRAUMATIC REACTIONS IN A COMMUNITY SAMPLE OF BEDOUIN MEMBERS OF THE ISRAEL DEFENSE FORCES

Background: Limited available data indicate that minorities in military service face heightened risks for traumatic exposure and more severe posttraumatic reactions. This study explored traumatic exposure and impact on mental and physical health, functioning, and medical services utilization in a previously unstudied ethnic minority group of Bedouins enlisted in the Israeli Defense Forces. Methods: Participants were 317 community‐based Bedouin servicemen recruited through community outreach efforts. Axis I psychiatric diagnoses were determined by the Structured Clinical Interview for DSM‐IV Disorders; posttraumatic symptoms were measured with the Screen for Posttraumatic Stress Symptoms; and depression and anxiety symptoms were assessed by the Hopkins Symptom Checklist −25 (HSCL‐25) Arabic version. Functional impairment and health service utilization were measured by a self‐report questionnaire. Results: Use of a stringent definition of trauma, restricted to experiences involving physical presence at the scene of the event, revealed that 75% of respondents reported potentially traumatizing events. Cap of these nearly 20% were diagnosed with posttraumatic stress disorder (PTSD), which was mostly co‐morbid with depression, alcohol abuse, or both. In spite of the widespread trauma exposure in this community, only those trauma‐exposed men who developed PTSD experienced extensive impact on their health, as indicated by associations with poor health status, physician‐diagnosed medical conditions, health‐related impairment in daily functioning, and frequent use of primary or specialty care services. Mental health services were typically not utilized. Conclusions: Detection of PTSD among Bedouin servicemen necessitates deliberate diagnostic efforts within primary care settings. Depression and Anxiety 25:700–707, 2008.

Memory of the Traumatic Event is Associated With Increased Risk for PTSD: A Retrospective Study of Patients With Traumatic Brain Injury

ABSTRACT Studies of the relationship between explicit episodic memory of a traumatic event (MTE) and posttraumatic stress disorder (PTSD) are inconclusive. The authors examined whether memory for the details of the traumatic event as reported by patients with mild traumatic brain injury was associated with the development of PTSD. In a retrospective study of 120 participants, MTE was found to be associated with an increased risk of PTSD, particularly for the reexperiencing symptom cluster. Although less frequently, PTSD was nonetheless present even in the absence of explicit memory. Possible explanations for mechanisms that enable this phenomenon are considered.

Resource loss and posttraumatic responses in Bedouin members of the Israeli Defense Forces

This study examined the impact of exposure to traumatizing events in an ethnic minority group of Bedouin members of the Israel Defense Forces (N = 317). Guided by the conservation of resources (COR) theory (Hobfoll, 1988), the authors hypothesized that loss of resources would mediate the relationship between trauma and posttraumatic responses. We found that loss of personal resources (e.g., self-esteem, self-mastery) was the best predictor of psychological distress among traumatized Bedouin servicemen. Our findings suggest the significance of personal resources within collectivist communities in coping with trauma and maintaining resilience. This study contributes to the understanding of the ethnocultural aspects of trauma and the potential interventions that may be tailored for minority groups.

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury.

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.

Trauma amid ‘culture of avoidance’: Symptom profile of PTSD in Bedouin members of the Israel Defense Forces

The appropriateness and cultural relevance of the construct of posttraumatic stress disorder (PTSD) has been questioned by previous studies of non-Western populations. The current study examined the symptom profile of PTSD in an ethnic minority group of Bedouin members of the Israel Defense Forces (N=317). Comparing individuals with PTSD to traumatized individuals without PTSD, we identified a pattern of symptoms that differed between the groups: while symptoms from the re-experiencing cluster were those most frequently reported by the PTSD group, avoidance symptoms were the most frequently reported by the traumatized group without PTSD. Our findings highlight the role of sociocultural considerations in the development of trauma-related problems and the special meaning of avoidant strategies for traumatized individuals from non-Western backgrounds.

Cultural Perspectives on the Aftereffects of Combat Trauma: Review of a Community Study of Bedouin IDF Servicemen and Their Families

Combat trauma may affect servicemen from indigenous, traditional communities in ways that warrant special attention. The Bedouins, who enlist in the Israel Defense Forces (IDF) voluntarily, represent a unique, closed, collectivist cultural minority, potentially in a predicament in light of ongoing sociopolitical events. This paper summarizes findings and lessons learned from a community study of Bedouin IDF servicemen and their families residing in Israel’s Western Galilee. This is the only research endeavor to have addressed trauma exposure and posttraumatic reactions in this community. The sampling strategies and interview schedule were designed in consideration of participation barriers typical of hard-to-reach populations. Data collection followed an extended phase of liaising with key informants and building trust. Study limitations are discussed in terms of the challenges presented by this type of research. Interviews conducted with 317 men, 129 wives, and 67 mothers revealed high levels of trauma exposure and posttraumatic stress disorder (PTSD) in the men, and related distress in wives and mothers, but not in the children. The role of aggression in mediating the impact of PTSD and concepts such as shame, the loss of personal resources, and beliefs about retribution are highlighted as key issues for a culturally relevant understanding of traumatized indigenous communities.

Military trauma and its sequel in families of Bedouin servicemen

Posttraumatic responses of veterans have an adverse impact on the family unit. These impacts include a variety of psychiatric, emotional, and behavioral problems in the veterans partner and children. Despite the increased attention given today to the central role of the family in the aftermath of trauma, studies in families of non-Western minority servicemen almost do not exist. The current study examined the associations between veterans’ posttraumatic symptoms and familial distress in an ethnic minority sample of 112 families of Bedouin members of the Israeli Defense Forces. Specifically, we have studied the relationship between the mens posttraumatic symptoms, wifes psychological symptoms, and maternal reports about childrens wellbeing. Results showed that while fathers’ posttraumatic symptoms were related to their wives’ psychological distress, they were not related to maternal reports about childrens problems. However, mothers with higher levels of depression and anxiety tended to report more emotional and behavioral problems of their children. This study sheds light on the various trajectories by which military trauma affects different family members in a traditional, non-clinical population, and emphasizes the need to address trauma from a systemic perspective that goes beyond the individualistic approach to posttraumatic stress disorder.