1. in Assaulted Women and Related to Maintenance of Physical Health
Greater Mastery is Associated with Psychological Resistance and Recovery
in Assaulted Women and Related to Maintenance of Physical Health
Heather L Rusch1,2, Erel Shvil3,4, Sarah L Szanton5, Whitney Livingston1, Yuval Neria3,4, Jessica M Gill1
1National Institute of Nursing Research, National Institutes of Health, 2Henry M Jackson Foundation for The Advancement of Military Medicine, 3New York State Psychiatric Institute, 4Department of Psychiatry, Columbia University Medical Center, 5John Hopkins University, School of Nursing
Introduction
Women exposed to assault are at high risk for developing posttraumatic stress disorder (PTSD), general anxiety disorder (GAD), major depressive disorder (MDD), and substance-related disorders. However, this risk is not universal, and most women are resistant to the deleterious effects of trauma exposure (i.e., remain asymptomatic), or recover following a brief symptomatic period. Psychological factors may be protective in the face of challenge and contribute to psychiatric resilience. Determining these factors has significance in promoting heath and wellbeing, as well as identifying women who are most in need of resilience promoting interventions.
Aim: This study examined the psychological factors associated with resistant and recovered outcomes separately, in a sample of women exposed to assault. The aim was to determine the factors that promote resistance pre-challenge, and the factors that promote recovery following the onset of a trauma-related psychiatric disorder.
Results
Assault Exposure: The resistant group reported lower indirect exposure to assault (i.e., hearing about or observing) compared with the recovered and compromised groups (p’s<.01), and both the resistant and recovered groups reported significantly lower exposure to child and adult physical assault compared with the compromised group (p’s<.01) (Fig. 1).
Psychiatric Disorder Prevalence: The majority of total respondents (79%; 125/159) did not present with a current diagnosis of PTSD. Even in the compromised group, less than half (47%; 34/72) met criteria for a current diagnosis of PTSD (Fig. 2). The most common current psychiatric outcome was MDD, which was diagnosed in 30% (47/159) of the total sample and 65% (47/72) of the compromised group (Fig. 3).
Results
Health-Related Quality of Life: The compromised group (47.05, 13.01)* reported significant deficits on all dimensions of HRQOL, with the exception of social functioning, when compared with the resistant (66.78, 8.10) and/or recovered (58.96, 10.70) groups (p’s<.001). Compared with the resistant group, the recovered group also exhibited significantly lower HRQOL scores in areas of emotional wellbeing, energy/fatigue, physical functioning, and role limitations due to emotional difficulties (p’s<.001).
*SF-36 total score (mean, SD); lower scores indicate greater disability
Resilience-Related Factors: Multivariate force entry linear regression models were used to determine the psychological resilience-related factors most strongly associated with resistant and recovered outcomes. The significant predictors of a resistant (vs. compromised) outcome were mastery (β=-.359, t=-3.958, p<.001) and social support (β=-.226, t=-3.017, p=.003), with an overall R2=.448, f(5,113)=18.374, p<.001 (Fig. 4).
FIGURE 4. Predictors of a Resistant Outcome
The significant predictors of a recovered (vs. compromised) outcome were mastery (β=-.388, t=-3.976, p<.001) and posttraumatic growth (β=-.267, t=-3.029, p=.003), with an overall R2=.412, f(5,92)=12.893, p<.001 (Fig. 5).
FIGURE 5. Predictors of a Recovered Outcome
Conclusion
Resilience is more common than psychiatric compromise.
Resistant and recovered outcomes are two distinct constructs warranting separate examination.
MDD was the most common psychiatric outcome, which may be attributed to self-blame following assault.
Mastery and social support were associated with a resistant outcome; and mastery and posttraumatic growth were associated with recovery from a psychiatric disorder.
The resistant group reported lower assault exposure; therefore, mastery and social support may modulate the probability of subsequent assault exposure, by equipping women with vital tools to abscond pernicious situations.
Strong social support buffers the initial effects of stress, yet unsupportive social networks may hinder recovery.
The recovered group reported the highest endorsement of posttraumatic growth, depicting a curvilinear relationship.
Physical health was maintained in the resistant group and improved in the recovered group; thus, trauma-related interventions that incorporate a HRQOL component, may yield enhanced improvements in psychiatric symptoms.
Future Directions:
Examine whether psychological resilience-related factors influence the ability to seek out safe environments and discriminate between safe and threatening stimuli
Design larger longitudinal studies to clarify the factors consistently associated with resilience in women exposed to assault and determine the extent that these factors may be modified through clinical intervention
Mastery
Method
One hundred fifty-nine women between the ages of years old (mean age 34.43, SD 9.24) completed the Life Events Checklist (LEC), an itemization of exposure to potentially traumatic events, and were administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess for PTSD, GAD, MDD, substance abuse, and alcohol abuse (collectively referred herein as “psychiatric disorders”). This resulted in three groups:1 (1) resistant (no past or current psychiatric disorder diagnosis; n=56), (2) recovered (a past psychiatric disorder diagnosis, but none currently; n=31), and (3) compromised (a current diagnosis of one or more psychiatric disorders; n=72). Groups were compared on demographics, trauma exposure, psychopathology, health-related quality of life (HRQOL; SF-36*), and psychological resilience-related factors, which included positive coping behaviors (e.g., flexibility, acceptance, and humor; CD-RISC), optimism (LOT-R), mastery (i.e., competence and perceived control over one’s life; Mastery-S), social support (MOS-SSS), and posttraumatic growth (PTGI).
*See Reference section for complete assessment name highlighted in purple above.
Resistant
Challenge
Social Support
References
1.) Szanton SL, Gill JM. Facilitating resilience using a society-to-cells framework: a theory of nursing essentials applied to research and practice. ANS Advances in nursing science 2010;33:
Assessments: CD-RISC = Connor-Davidson Resilience Scale, LOT-R = Life Orientation Test- Revised, Mastery-S = Pearlin Mastery Scale, MOS-SSS = MOS Social Support Survey, PTGI = Posttraumatic Growth Inventory, SF-36 = Short Form Health Survey-36
Correspondence: Heather L. Rusch
tel: (301)
Mastery
Recovered
Challenge
MDD
PTSD
5 min
24 hrs
Post-traumatic Growth
Presented at the 2014 NIH Research Festival: The Era of the Brain
September 22, 2014
We gratefully acknowledge the research participants, for without them this research would not be possible.