Changes in affect after completing a mailed survey about trauma: two pre- and post-test studies in former disability applicants for posttraumatic stress disorder

Abstract

BackgroundOne potential concern with using mailed surveys containing trauma-related content is the possibility of re-traumatizing survivors without a trained mental health professional present. Prior research provides insufficient guidance regarding the prevalence and magnitude of this risk because the psychological harms of trauma-related surveys have typically been estimated using single post-test observations. Post-test observations cannot quantify magnitude of change in participants’ emotional states and may over or under estimate associations between participants’ characteristics (risk factors) and post-survey upset.MethodsWe conducted two pre- and post-test studies in samples of former applicants for posttraumatic stress disorder disability benefits: 191 males who served during Gulf War I plus 639 male and 921 female Veterans who served sometime between 1955 and 1998. We used two 9-point items from the Self-Assessment Manikins to measure participants’ valence (sadness/happiness) and arousal (tenseness/calmness) before and after they completed mailed surveys asking about trauma-related symptoms or experiences. We examined the following potential predictors for post-survey sadness and tenseness: screening positive for posttraumatic stress disorder, having a serious mental illness, and history of military sexual assault or combat.ResultsAfter the survey, across the groups, 29.3–41.8% were sadder, 45.3–52.2% had no change in valence, and 12.9–22.5% were happier; 31.7–40.2% were tenser, 40.6–48.2% had no change in arousal, and 17.3–24.0% were calmer. The mean increase in sadness or tenseness post-survey was less than one point in all groups (SD’s < 1.7). Cohen’s d ranged from 0.07 to 0.30. Most hypothesized predictors were associated with greater baseline sadness or tenseness, but not necessarily with larger post-survey changes. Women with a history of military sexual assault had the largest net post-survey changes in sadness (mean = 0.7, SD = 1.4) and tenseness (mean = 0.6, SD = 1.6).ConclusionWhile a substantial minority of Veterans reported more sadness or tenseness post-survey, the net change in affect was small. Most hypothesized risk factors were actually associated with higher baseline sadness or tenseness scores. When receiving unsolicited, trauma-related surveys by mail, separate protections for Veterans with the risk factors studied here do not seem necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-017-0357-x) contains supplementary material, which is available to authorized users.

Protecting nurse survey participants: Ethical considerations for conducting survey research among nurses

“…In some cases, study participants noted feeling a benefit from the opportunity to reflect on distressing events. 22,23…”

“…In some cases, study participants noted feeling a benefit from the opportunity to reflect on distressing events. 22,23 Researchers must be mindful of sensitive or distressing items, but this does not necessarily mean these questions should not be used. Pilot testing the survey in individuals representing the study population is a valuable way to evaluate participant responses to sensitive or intrusive items.…”

Impact of different cover letter information and incentives on Veterans’ emotional responses to an unsolicited mailed survey about military traumas: a randomized, 3x2x2 factorial trial

“…We anticipated that cover letter warnings would be most helpful to those with the relevant trauma history –that is, telling sexual assault survivors that the survey asked about unwanted sexual attention would be more effective in reducing post-survey upset than telling them the survey asked about combat. Other personal vulnerability factors that we thought might moderate associations between cover letter information and post-survey upset included whether the participant had a diagnosis of PTSD or of other serious mental illness [ 7 – 10 ]. We also speculated that participants more recently separated from military service might experience more post-survey upset compared to those with more distant military service.…”

“…We also speculated that participants more recently separated from military service might experience more post-survey upset compared to those with more distant military service. Most prior research examining Veterans’ emotional reactions to military trauma-related surveys have included samples who separated from military service 2 to 3 decades earlier [ 7 , 8 , 10 ]. Having had several years in which to process or learn to cope with trauma reminders, such survey recipients might not react as strongly to unexpected trauma reminders compared to individuals with more recent experiences…”