How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population

Abstract

BackgroundWhile studies with survivors of single traumatic experiences highlight individual response variation following trauma, research from conflict regions shows that almost everyone develops posttraumatic stress disorder (PTSD) if trauma exposure reaches extreme levels. Therefore, evaluating the effects of cumulative trauma exposure is of utmost importance in studies investigating risk factors for PTSD. Yet, little research has been devoted to evaluate how this important environmental risk factor can be best quantified.MethodsWe investigated the retest reliability and predictive validity of different trauma measures in a sample of 227 Ugandan rebel war survivors. Trauma exposure was modeled as the number of traumatic event types experienced or as a score considering traumatic event frequencies. In addition, we investigated whether age at trauma exposure can be reliably measured and improves PTSD risk prediction.ResultsAll trauma measures showed good reliability. While prediction of lifetime PTSD was most accurate from the number of different traumatic event types experienced, inclusion of event frequencies slightly improved the prediction of current PTSD.ConclusionsAs assessing the number of traumatic events experienced is the least stressful and time-consuming assessment and leads to the best prediction of lifetime PTSD, we recommend this measure for research on PTSD etiology.

Defining the index trauma in post-traumatic stress disorder patients with multiple trauma exposure: impact on severity scores and treatment effects of using worst single incident versus multiple traumatic events

“…Kessler et al, 2017, 1995; Smith, Summers, Dillon, & Cougle, 2016). Besides the type of trauma, numerous studies have found that cumulative trauma, mostly defined as the number of different trauma types, is associated with greater PTSD risk and symptom severity (Green et al, 2000; Karam et al, 2014; Wilker et al, 2015). Simpson, Comtois, Moore, and Kaysen (2011) found that the prevalence of PTSD increased from 53.7% to 67.2% when patients were asked to rate their symptoms for their complete trauma history instead of for only their worst event.…”

Commentary on Scheidell et al. (2018): En‐counting adversities; the ‘building blocks’ of psychopathology

“…the trauma, depends upon several factors. These include the type, proximity and frequency of traumata and previous experiences as well as the genetics, epigenetics, resilience, gender, age or cognitive capacity of the individual who encounters trauma [1][2][3][4][5].Given this variation, it is surprising that merely counting traumatic exposures can predict detrimental consequences for psychological functioning. This was, however, shown in the seminal Adverse Childhood Experiences (ACE) studies, and now Scheidell and colleagues demonstrate that it also occurs for substance use and abuse [6].…”

“…the trauma, depends upon several factors. These include the type, proximity and frequency of traumata and previous experiences as well as the genetics, epigenetics, resilience, gender, age or cognitive capacity of the individual who encounters trauma [1][2][3][4][5].…”

Dissemination psychotherapeutischer Module für traumatisierte Geflüchtete

“…Wie in zahlreichen Forschungsarbeiten gezeigt werden konnte, erhöht das mehrfache Erleben verschiedenartiger traumatischer Ereignisse das Risiko, eine posttraumatische Belastungsstö-rung (PTBS) zu entwickeln [5,19,26,41]. Mit jedem erneuten Erleben eines traumatischen Stressors steigt die Wahrscheinlichkeit einer Traumafolgestörung, ein Effekt, der in der Literatur als Bausteineffekt beschrieben wurde [36].…”