Danger- and non-danger-based stressors and their relations to posttraumatic deprecation or growth in Norwegian veterans deployed to Afghanistan

Abstract

Objective: This study aimed to explore how exposure to danger-based and non-dangerbased stressors may influence personal changes in veterans (N = 4053) after deployment to Afghanistan. Method: Twelve war zone related traumatic events were used to form two stressor categories. The non-danger-based category included two stressor types: Moral Challenges and Witnessing, and the danger-based category included one type: Personal Threat. Thus, three stressor types were explored in relation to self-reported personal changes after war zone stressor exposure, e.g. negative changes labelled posttraumatic deprecation, positive changes labelled posttraumatic growth or no major change. Furthermore, the relationship between the stressor types and reported levels of distress were explored. Results: The two non-danger-based stressor types, Moral Challenges (p < .001) and Witnessing (p < .001), were both significantly more associated with deprecation rather than growth, when compared to Personal Threat. Moreover, the non-danger-based stressors were significantly associated with a rise in posttraumatic stress symptoms, as well as a rise in symptoms of depression, anxiety and insomnia (p < .001). In contrast, exposure to the danger-based stressor was only significantly associated with a rise in the posttraumatic stress symptoms in the current model (p < .001). Reports of no-change were significantly associated with low degrees of exposure to all the three stressor types (p < .001). Conclusion: The current study highlights the special adverse effects of non-danger-based stressors. Our findings show that they are more associated with posttraumatic deprecation rather than with growth. This underscores the heterogeneity of responses to traumatic events and adds to the current knowledge about the impact of various stressor types.

The impact of trauma exposure and moral injury on UK military veterans: a qualitative study

“…More positively, some veterans across all three groups described experiences of posttraumatic growth, including a greater appreciation for life and improved connections with loved ones (Tedeschi & Calhoun, 2004). This experience of psychological growth is in line with previous research in morally injured Norwegian military personnel (Nordstrand et al, 2019). Veterans exposed to morally injurious or 'mixed' events also described a growth in their spirituality or faith following the event; however, this was not consistently observed, and PMIE exposed veterans also described a loss of spiritual beliefs.…”

“…Bryan et al, 2014;Jones, 2018;Williamson et al, 2019). The present study illustrates that moral injury can be experienced by veterans following events that were both ethically challenging and life-threatening or otherwise consistent with PTSD criterion A in DSM-5 (Nordstrand et al, 2019). This is notable as the majority of the moral injury literature thus far has not made this distinction; for example, one of the most commonly cited definitions of moral injury (Litz et al, 2009) does not include a reference to the fact that the PMIE may simultaneously be threatening.…”

A Cross-sectional Study of Mental Health, Posttraumatic Stress Symptoms and Post Exposure Changes in Norwegian Ambulance Personnel

“…However, in many traumatic situations, peritraumatic fear may not be present, and a physical threat may not be the most stressful part of the incident [33,34]. Accordingly, recent studies have distinguished between danger-based and non-danger-based stressors [35]. In the context of the current study, this may help explain why perceptions of inadequacy and even shame, also committing errors, may lead to increased posttraumatic stress reactions.…”

Caring for Coronavirus Healthcare Workers: Lessons Learned From Long-Term Monitoring of Military Peacekeepers

“…Moreover, studies have demonstrated strong correlations between morally challenging traumas and socially inhibitory feelings such as guilt and shame (Ramage et al, 2016;Jordan et al, 2017;Nordstrand et al, 2019), thus increasing reticence to talk about such experiences (Pietrzak et al, 2009;Gray et al, 2012). Accordingly, it may be important to not only be aware of the potentially morally challenging stressors HCWs face but also help lower barriers toward disclosing such stressors to significant others.…”