Background: The development of posttraumatic stress symptoms (PTS) following a traumatic event is related to significant functional impairment, diminished quality of life, and physical health issues. Yet it is not entirely clear why some traumatized individuals experience negative outcomes while others do not. The purpose of this study is to determine the role of several influential factors related to PTS severity and negative outcomes, such as diminished quality of life and physical health issues, following traumatic events. Method: One hundred and twenty-two trauma-exposed adults were recruited through the University of South Florida’s SONA system and through flyers on campus. Subjects were administered the following self-report measures in a counter-balanced manner: the PTSD Checklist-Civilian, the Trauma History Questionnaire-Short, The Anxiety Sensitivity Index-3, Depression and Anxiety Stress Scale 21, Sheehan Disability Scale, WHOQOL-BREF, and the Economic Impact Questionnaire-Revised. Results: Posttraumatic stress symptom severity was positively correlated with depressive symptom severity, chronicity of the most distressing trauma and number of traumas. Posttraumatic stress symptom severity and anxiety sensitivity were significantly related to all of the outcomes examined including three domains of disability, four domains of quality of life, burden and physical health issues. Main effects were found for PTS severity, anxiety sensitivity, and depressive symptom severity on quality of life domains. Posttraumatic stress symptom severity mediated the relationship between anxiety sensitivity and physical health issues such that the relationship between AS and physical health issues is dependent on PTS severity. Implications: This study helps clarify the role of various factors in the relationship between trauma and negative outcomes. Clinical and research implications are discussed, including early detection of PTS and an increased awareness of the relationship between PTS, anxiety sensitivity and physical health issues.

published_or_final_version / Mental Health / Master / Master of Social Sciences

This study examined the effects of a smoking cessation program using vouchers as reinforcers with individuals with traumatic brain injury and a history of substance abuse. The intervention was conducted at a residential facility that houses individuals with Traumatic Brain Injury (TBI). Vouchers were delivered contingent on reductions of carbon monoxide (CO) samples of 5 ppm or less across a shaping phase, and an abstinence induction phase. A standard pay phase was added at the end of the study to examine the effects of a standardized reinforcement scale with the abstinence criterion set at 8 ppm or less. Reductions in CO were not robust in the shaping and abstinence induction phase. The standard pay schedule showed some improvements in CO levels with less variability for two of the three participants.

Falls among the elderly population continue to be a growing concern in the healthcare industry and are marked by staggeringly high social and economic costs. The incidence of falls is known to increase with age, and currently the elderly population is growing at an astounding rate as baby-boomers are now entering this age group. Also, recovery following fall-related injuries decreases with increased age. These confounding factors currently make falls a very important area of research. Of the injuries typically seen in falls among the elderly, head injuries are one of the most debilitating. Death due to head trauma among the elderly is gaining national attention; head trauma is now considered the number one cause of death among elders who fall1. Among other technologies, medical helmets are often employed to protect against such injuries, but patient compliance with these helmets remains an issue. Current helmets use foams and cotton as padding, contributing to clumsy designs. Dilatent and honeycomb materials may be the future of this industry as their low weight and high efficacy per thickness make them ideal materials for thinner, lighter, less cumbersome head protection devices. This study outlines various modes of head injury and then highlights several head protection measures. The newer materials are tested using various methods to determine the most promising candidates for prototype designs. Next, three prototypes are assembled from the newer materials and compared directly based on the protection measures established. Finally, the top-performing prototype is compared against two existing medical helmets in a similar fashion. The results show that the best prototype significantly outperforms one of the existing medical helmets, and shows slight improvement over the other. These results establish the promise of these newer materials in the application of head protection devices.

This exploratory study examines the lived experience of Green Cross traumatologists deployed to the New York City World Trade Center disaster. The deployment took place five days after the terrorist attacks on September 11, 2001. The author was a member of a ten member advance team that provided crisis stabilization services to an international union in Lower Manhattan. Disaster Mental Health Services and community outreach were provided for a month. The purpose of the study was to describe in an anthropologically holistic perspective the lived experience of traumatologists, who as Americans were also affected by the terrorist disaster. Thirty-one traumatologists participated in the study. Ethnographic methods included participant observation and informal interviews during the first week of the deployment. In-depth interviews were conducted after deployment and ranged from one to three hours in length. Interviews were audio taped, transcribed and analyzed with the assistance of N-vivo software. The author's story is among the narratives. Narratives of lived experience reflect the continuity of life and give meaning to experience within a cultural context. Findings reveal the shared meaning attributed to lived experience in a disaster environment, cultural continuity and change and impact of disaster deployment on the health and safety of the helper. Recommendations for future research, policy and training are offered.

PTSD (Post Traumatic Stress Disorder) has impacted veterans of combat throughout history. With current advances in protective combat armor and in combat medical treatment, more and more of the soldiers who would have perished in the battlefield are being saved and returned home. While their physical wounds may heal, the traumatic events experienced on the battlefield continue to impact their personal, social, and vocational lives. This study explores the perceptions of veterans with respect to their vocational stability and the impact that PTSD has had on their vocational functioning. Eleven veterans were selected to participate in this qualitative study. These veterans were all veterans of combat actions ranging from the Vietnam War to the current military actions in Iraq and Afghanistan. Once selected, these veterans participated in interviews which explored their vocational history, their perceptions of their employment instability, and their perceptions of the impact that PTSD had on their vocational functioning and employment instability. Once the interviews were completed, they were transcribed and analyzed using open coding to identify common themes throughout the data. These themes included behavioral issues, perception of treatment, and their military experiences. Each theme was explored and interpreted to identify how PTSD impacted these participants in maintaining employment instability. Interpretations of the data lead to the conclusion that combat-related PTSD does, as the literature identifies, cause vocational instability. However, the data shows that while the participants did experience vocational instability, it was not because they were typically fired or dismissed from employment, but rather, they quit jobs prior to being fired. The participants were able to identify their triggers and stressors to the point that they simply quit their jobs when these triggers and stressors arose. Thus, much of their vocational instability may possibly have been prevented had they been able to effectively communicate their stressors and triggers to their employers and co-workers. Limitations of the study as well as implications for practice and future research are discussed. / text

A critical review of evidence-based literature addressing screening, barriers to treatment, treatment modalities and programs of care for posttraumatic stress disorder and depression in active duty military members was conducted using the Galvan method. The ONS levels of evidence and the ONS weight of evidence scale were used to critique and analyze extant research. Programs of care and their evaluation were reviewed. Gaps in research were identified and suggestions for evidence-based treatment and program evaluation of evidence-based treatment of PTSD and depression in military members are proposed.

<p>Explosions are associated with more than 80% of the casualties in the Iraq and Afghanistan wars. Given the widespread use of thoracic protective armor, the most prevalent injury for combat personnel is blast-related traumatic brain injury (TBI). Almost 20% of veterans returning from duty had one or more clinically confirmed cases of TBI. In the decades of research prior to 2000, neurotrauma was under-recognized as a blast injury and the etiology and pathology of these injuries remains unclear.</p><p>This dissertation used the finite element (FE) method to address many of the biomechanics-based questions related to blast brain injuries. FE modeling is a powerful tool for studying the biomechanical response of a human or animal body to blast loading, particularly because of the many challenges related to experimental work in this field. In this dissertation, novel FE models of the human and ferret head were developed for blast and blunt impact simulation, and the ensuing response of the brain was investigated. The blast conditions simulated in this research were representative of peak overpressures and durations of real-world explosives. In general, intracranial pressures were dependent on the peak pressure of the impinging blast wave, but deviatoric responses in the brain were dependent on both peak pressure and duration. The biomechanical response of the ferret brain model was correlated with in vivo injury data from shock tube experiments. This accomplishment was the first of its kind in the blast neurotrauma field.</p><p>This dissertation made major contributions to the field of blast brain injury and to the understanding of blast neurotrauma. This research determined that blast brain injuries were brain size-dependent. For example, mouse-sized brains were predicted to have approximately 7 times larger brain tissue strains than the human-sized brains for the same blast exposure. This finding has important implications for in vivo injury model design, and a scaling model was developed to relate animal experimental models to humans via scaling blast duration by the fourth-root of the ratio of brain masses. </p><p>This research also determined that blast neurotrauma is correlated to deviatoric metrics of the brain tissue rather than dilatational metrics. In addition, strains in the blasted brain were an order-of-magnitude lower than expected to produce injury with traditional closed-head TBI, but an order-of-magnitude higher in strain rate. The 50th percentile peak principle strain metric of values of 0.6%, 1.8%, and 1.6% corresponded to the 50% risk of mild brain bleeding, moderate brain bleeding, and apnea respectively. These findings imply that the mechanical thresholds for brain tissue are strain-based for primary blast injury, and different from the thresholds associated with blunt impact or concussive brain injury because of strain rate effects.</p><p>The conclusions in this dissertation provide an important guide to the biomechanics community for studying neurotrauma using in vivo, in vitro, and in silico models. Additionally, the injury risk curves developed in this dissertation provide an injury risk metric for improving the effectiveness of personal protective equipment or evaluating neurotrauma from blast.</p> / Dissertation

Correctional services are viewed as a high-risk profession, given the exposure to violence and other stressors that characterises the work. These factors contribute to occupational stress and the possible development of Post-traumatic Stress Disorder (PTSD) among correctional officers. There is an abundance of intemational literature on the development of PTSD in various populations, but almost no literature that examines the prevalence of PTSD amongst correctional officers in other countries as well as in South Africa. This study is aimed at exploring occupational stress, PTSD and coping strategies in South African correctional officers, using demographic data, the Impact of Events Scale-Revised, the Occupational Stress Indicator and the Coping Resources Inventory. Results, as measured by the Impact of Event Scale-Revised (IES-R), revealed that correctional officers who worked directly with prisoners, and were therefore exposed to violence, experienced PTSD symptoms. Coping style findings (Coping Resources Inventory) showed that unmarried officers tended to use avoidance coping strategies to deal with occupational stress, whereas married officers tended to use approach coping strategies. It seems that marriage is a protective factor or buffer against stress. Surprisingly, results of the Occupational Stress Inventory did not reveal high levels of stress overall amongst correctional officers. Higher occupational stress was found amongst officers who had been in the correctional services for more than six years. The implications of the above findings indicate that correctional officers, who suffer from PTSD and occupational stress, must be identified and treated. The study further hopes that the findings and associated recommendations made can inform prevention and intervention programmes in the correctional services. Prevention and intervention programmes should impact at the level of the individual and the organisation through programmes such as stress management, stress inoculation and critical incident stress debriefing as well as, structural administrative and environmental change programmes within the correctional services. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

This research has focused on the concept of intergenerational trauma, elaborating on the post-Apartheid condition. Drawing on trauma theory, such as that provided by clinical and psychoanalytic approaches on the one hand, and on narrative and identity theory on the other, the project examines the long-term implications of Apartheid, particularly for the identities of post-Apartheid generations. The families who participated in this study all experienced a particular traumatic event, personally experiencing the political violence of Apartheid. However, the study focused on how this event has been integrated into and represented in family histories, how what is ‘said’ and what remains ‘unsaid’ within families functions and constitutes their identities in their ongoing lived experiences. Women’s narratives, often considered secondary to the grand narratives of struggle and conflict, are drawn out to show the ways, as primary caregivers, they form the pivot for the (intergenerational) transmission of secondary traumatisation or for negotiating new versions of family history that make it possible for both them and their children to create meaningful lives in the shadow of their tragedies. Utilising a narrative method which explores the interactional dynamics, structure and content of participants’ stories, the narratives of these women and their children are analysed first for the ways in which what was said (and even what remained ‘unsaid’) was complicated by the ‘interactional dynamics’ of research and, in particular, research across a language divide. The second layer of analysis attends to the narrative structure or form in which the stories are told. The final phase of analysis focuses on the thematic content of the narratives. In telling classic ‘trauma’ stories, of the political deaths of family members and partners under Apartheid, these women spoke of events which marked ‘turning points’ in their lives and which continue to leave their mark in their embodied experience. They also told of navigating a context of continued and pervasive violence, speaking of the violences of today, particularly domestic and sexual violence and HIV/AIDS, and they link these to their own embodied experiences after the political trauma event. Through intergenerational talk on relationships and sexuality, mothers attempt to navigate and negotiate new versions of family history for their children, as they try to create lives for their children that are dissimilar to their own, particularly with regard to violence. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.