Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder (PTSD) in women as a result of their labor and delivery experiences, and identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Four to six weeks postpartum, telephone interviews were conducted with participants (n = 499) and explored the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty-eight women (5.6%) met DSM-IV criteria for acute posttraumatic stress disorder. Antenatal variables were not found to contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (beta = .351, p <.0001) and the perception of inadequate intrapartum care (beta = .319, p <.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder following childbirth is an under-recognized phenomenon. Women who experienced both a high level of obstetric intervention and were dissatisfied with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. Such findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the psychological care provided to birthing women.

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition that can develop following exposure to a traumatic event involving actual or threatened death or serious injury. Responses include intense fear, helplessness or horror. Symptoms are characterised into clusters, described as re-experiencing, avoidance, and arousal. These symptoms, which are also evident in other conditions, have been associated with dysfunctions in the central acetylcholinergic system. Benefits from administering acetylcholinesterase inhibitors (AChEI) to people suffering these symptoms have been demonstrated. Donepezil hydrochloride, a reversible inhibitor of the enzyme acetylcholinesterase, is used in the treatment of conditions with difficulties in cognitive function, but has not been used in PTSD. The aim of this thesis was to determine (1) whether there was a difference in the ACh system in people with PTSD and (2) whether administration of an AChEI would change the symtomatology. IDEX (I¹ ² ³ iododexetimide) has been useful in imaging muscarinic-ACh receptors using Single Photon Emission Computerised Tomography (SPECT) and was utilised to investigate whether cholinergic activity in PTSD is altered. One hundred and sixty eight potential subjects were screened and eleven PTSD subjects were enrolled in the IDEX SPECT study. Three healthy non-PTSD control subjects also completed the study. Due to technical complications only the data obtained from eight PTSD and two control subjects was available for analysis. Imaging data for 2 further healthy non-PTSD control subjects were obtained from another study. Sixteen subjects were enrolled in the donepezil open label study (assessed at baseline, Week 2, 6 and 10). Nine PTSD subjects completed the 10-week trial and seven withdrew prematurely (at or after Week 2) due to side effects or a worsening of PTSD symptoms. For the IDEX SPECT study, a voxel-by-voxel statistical analysis of the PTSD subject group versus the control group showed both areas of reduced and increased IDEX uptake. Significant clusters in the PTSD group with a reduced IDEX uptake centred around the bilateral hippocampus, left insula and right precuneus, while increased IDEX uptake appeared in the caudate head. For the donepezil study, in the per-protocol analysis (including only the 9 subjects that completed the protocol), all psychological assessments revealed a difference between the totals obtained at the Week 10 visit compared to those at the Baseline visit and the improvement was in the order of 51%. The intention-to-treat analysis (including all 16 subjects), a repeated measures Analysis of Variance (ANOVA) with a mixed models approach showed that all psychological measures demonstrated statistically significant benefits of the treatment. All subjects who completed the protocol recounted considerable improvement in their overall PTSD symptom profile, which covered symptoms in each of the three clusters. The results of the IDEX SPECT study suggest that alterations in ACh binding in PTSD are evident and may begin to explain a part of the altered cognitive symptomatology apparent in this condition. The pilot open label donepezil trial provided some preliminary evidence that treatment with an AChEI can lessen the intrusions and distress associated with traumatic memories in people with PTSD. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374974 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Medicine, 2009

The Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen (Prins et al., 2003) is used by the Department of Defense to identify military members who are at increased risk of PTSD. This screen has been offered to all returning deployers since 2005. However, validation studies of PC-PTSD scores from military samples have seldom employed a significant number of female subjects and no published studies have examined it for gender bias. Ruling out bias is important because routine under-identification of PTSD risk in any group could result in hindered access to needed assessment and/or care. With the current proportion of military females historically high (Women’s Research & Education Institute, 2007), it is imperative that the PC-PTSD be analyzed to ensure measurement equivalence across gender. Using a large sample of male and female veterans returning from deployment, the validity of the PC-PTSD scores was first examined by conducting a differential item functioning (DIF) analysis across male and female subgroups. Then, using a clinical diagnosis as the criterion, both logistic regression and diagnostic likelihood ratio methods were employed to assess for differential predictive validity by gender. Finally, confirmatory factor analysis (CFA) was used to examine convergent and divergent validity in a two-factor model containing both PC-PTSD and depression screen responses. Results revealed no statistically significant gender-related DIF or differential prediction of PTSD by PC-PTSD scores. Good convergent and divergent validity were also observed in the CFA analysis. The results generally supported the continued use of the PC-PTSD with both male and female military veterans returning from deployment. Limitations of the study and recommendations for future research were discussed.

Lucid Dreaming (LD) is defined as the phenomenon of becoming consciously aware of dreaming while still dreaming. In sleep laboratory experiments LD has been verified to occur during REM sleep stage by proficient lucid dreamers who have signaled while becoming lucid through specific pre-determined eye-movements. Using this method, (lucid) dreamed activity has been shown to correlate with both psychophysiological and neurophysiological responses to those observable if the same activity was to be performed during wakefulness. LD has also shown potential to be of therapeutic value, in reducing recurrent nightmare frequency. Recurrent nightmare sufferers engaging in Lucid Dreaming Treatment (LDT) show reduced nightmare frequency after treatment. As such, LDT has been suggested to be effective in the treatment of posttraumatic nightmares in Posttraumatic Stress Disorder (PTSD). The attitude and feeling of control provided by LDT has been shown to be fruitful also in fearful waking situations, indicating that LDT might be effective in disorders epitomized by fear.

The main aim of this thesis was to longitudinally investigate the potential occurrence of posttraumatic stress disorder (PTSD) among parents of children on cancer treatment (Study I). Additional aims were to describe parents’ perceptions of emotional support and satisfaction with the child’s care (II), perceptions of the child’s symptom burden (III), and parents’ stories about having a child on cancer treatment (IV). The design was prospective, longitudinal, and data was collected at: one week, two months, and four months after the child’s diagnosis and one week/six months after the end of successful treatment/transplantation. Parents (N=259) were consecutively included during the years 2002-2004 and answered questionnaires and open-ended questions over the telephone. Parenting a child with cancer is a very demanding, potentially traumatic, event. Approximately a fourth of the parents report symptoms corresponding to PTSD. The symptom level is related to being a mother, not working before the child’s diagnosis, and to previous trauma experience. Less than half of those who report a need to talk with a psychologist report having had the opportunity to do so. Parents are generally satisfied with the care and report the highest satisfaction with the technical care. Emotional distress, fatigue, nutrition, and pain are, according to parents, the most problematic symptom areas for their children. Pain is identified as especially problematic. Parents in paediatric oncology care should be acknowledged as potential care-recipients. In order to prevent development of PTSD parents of children on cancer treatment should be supported to maintain an ordinary life, for example pursue work and/or activities, and to get sufficient rest. As a means towards this parents need help with e.g. household duties and childcare. In addition to this, parents in approximately two fifths of the families need extended psychosocial support aiming at reducing posttraumatic stress.

A growing body of literature is focusing on the influence of personality and emotion regulation on psychological health. Using archival data from an expressive writing project, the current study investigated the relationship between perfectionistic self-presentation and emotion regulation, and the influence of the interaction of these variables on psychological health among trauma survivors. The results indicate that both perfectionistic self-presentation and more difficulties in emotion regulation contribute to symptoms of distress. As well, higher levels of perfectionistic self-presentation were associated with more difficulties in emotion regulation. Further, emotion regulation mediated the relationship between perfectionistic self-presentation and psychological distress but not common physical complaints. More specifically, the non-acceptance subscale of emotion regulation was found to be significant in a test of multiple mediator model.

As men and women return from serving on the frontlines of Operations Enduring Freedom (OEF; Afghanistan) and Iraqi Freedom (OIF; Iraq), many struggle with emotional or behavioral difficulties stemming from the stresses of battle. However, research has shown that these service members may be unwilling or unable to recognize or report such difficulties due to such factors as amnesia, avoidance, or cognitive impairment. Hence, the burden to recognize distress and encourage treatment increasingly falls on peers, friends, and especially intimate partners. Given that this responsibility is often placed on significant others, it is imperative to determine which symptoms are amenable to detection by informants and which are not. The current study examined the ability of female spouses of Vietnam veterans to report on various indicators of posttraumatic stress disorder (PTSD) using the Mississippi Scale for Combat-Related PTSD. Item response theory (IRT) analyses were conducted with a dataset composed of both self- and informant reports using the same items regarding the same individual in order to examine the item-level properties. Results from these analyses indicated that the ability of both spouses and veterans to detect PTSD symptoms varies across item content and that items themselves do not relate equally to, or become diagnostic at the same level of, PTSD. Overall, veterans showed greater sensitivity to their own symptoms and were able to provide more information than their spouses for nearly every item rated by independent experts to be overt or covert. However, some items provided greater information when endorsed by the spouse versus the veteran even though, consistent with the majority of other items, these items were endorsed by the spouse only once the PTSD symptoms had reached greater severity. Implications of these findings as well as future directions for research regarding observer reports of PTSD symptomatology were explored.

This study investigated the experience of posttraumatic growth for breast cancer survivors who volunteered to complete a survey (N = 277). A number of participants also provided narrative responses containing their personal experiences of breast cancer (N = 100). Demographic characteristics, breast cancer variables, optimism, coping strategies, and participation in psychosocial interventions were examined in relation to posttraumatic growth as measured by the Posttraumatic Growth Inventory. Differences between those who participated in psychosocial interventions versus those who did not were examined. The relation of coping strategies utilized and optimism level to interventions accessed was also of interest. Predictors of posttraumatic growth were examined via generalized linear modeling. Finally, the narrative responses were investigated by means of content analysis. The results provided evidence that demographic characteristics (i.e., affiliation with religion and lower levels of education) and one breast cancer variable (i.e., increased number of years since diagnosis) were related to experiences of posttraumatic growth for breast cancer survivors. Use of active forms of coping, optimism level, and participation in recreational interventions were also related to posttraumatic growth. Those who participated in psychosocial interventions were more likely to be employed and have higher levels of education than those who did not access interventions. Use of several active coping strategies and one passive coping strategy increased the likelihood of accessing a number of different psychosocial interventions. Posttraumatic growth was predicated by affiliation with religion, lower levels of education, increased number of years since diagnosis, knowledge of breast cancer stage, higher levels of optimism, and use of one passive and two active coping strategies. Many of these findings support previous research, however some conflict with prior results. The narrative responses contained information regarding diagnosis and treatment, impact of breast cancer, coping with breast cancer, and support accessed. Although the negative impact of breast cancer was discussed in terms of short and long-term, positive long-term changes were also reported. A variety of coping strategies and supports were utilized by the participants as well.

Expressive Writing (EW) involves asking participants to write emotionally about stressful life events and has been associated with improvements in psychological and physical health. The purpose of the current study was to extend previous work by examining the moderating and mediating role of emotion regulation within the EW intervention. Sixty participants who had experienced a traumatic event were recruited from the community and were assigned to an EW or control writing condition. Measures assessing emotion regulation and indices of psychological and physical health were administered at baseline and one month follow-up to determine changes in symptomatology. In comparison to control writing, EW led to significant improvements in depression, emotional clarity, and to a lesser degree emotional awareness. Although no other group differences were found, all participants demonstrated significant improvements in their symptoms of posttraumatic stress, reported physical health, overall emotion regulation abilities, their ability to accept their emotions, engage in goal directed behaviour when distressed, and access emotion regulation strategies they perceive as effective. No support was found for our moderation hypothesis. However, a significant moderation was discovered revealing that difficulties engaging in goal directed behaviour when distressed moderated improvements in posttraumatic stress symptoms. Specifically, control participants with this emotion regulation deficit demonstrated significantly poorer outcomes than control participants without this deficit; in comparison to the EW group participants who improved similarly on posttraumatic stress symptoms regardless of their level of difficulties at baseline engaging in goal directed behavour when distressed. Additionally, baseline emotion regulation abilities predicted improvements on psychological health (but not physical health) outcome measures for both groups. No support was found for our mediation hypothesis. Exploratory analyses revealed that the EW group demonstrated greater emotional arousal in response to their writing in sessions 1 and 2, but that by session 3 their arousal had significantly decreased and was equivalent to that of the control group, which showed no changes in arousal across sessions. No support was found for the moderating or mediating influence of arousal on outcome. Results will be discussed within a model of emotional expression and emotion regulation and compared to the existing EW literature.

This study investigated the experience of posttraumatic growth for breast cancer survivors who volunteered to complete a survey (N = 277). A number of participants also provided narrative responses containing their personal experiences of breast cancer (N = 100). Demographic characteristics, breast cancer variables, optimism, coping strategies, and participation in psychosocial interventions were examined in relation to posttraumatic growth as measured by the Posttraumatic Growth Inventory. Differences between those who participated in psychosocial interventions versus those who did not were examined. The relation of coping strategies utilized and optimism level to interventions accessed was also of interest. Predictors of posttraumatic growth were examined via generalized linear modeling. Finally, the narrative responses were investigated by means of content analysis. The results provided evidence that demographic characteristics (i.e., affiliation with religion and lower levels of education) and one breast cancer variable (i.e., increased number of years since diagnosis) were related to experiences of posttraumatic growth for breast cancer survivors. Use of active forms of coping, optimism level, and participation in recreational interventions were also related to posttraumatic growth. Those who participated in psychosocial interventions were more likely to be employed and have higher levels of education than those who did not access interventions. Use of several active coping strategies and one passive coping strategy increased the likelihood of accessing a number of different psychosocial interventions. Posttraumatic growth was predicated by affiliation with religion, lower levels of education, increased number of years since diagnosis, knowledge of breast cancer stage, higher levels of optimism, and use of one passive and two active coping strategies. Many of these findings support previous research, however some conflict with prior results. The narrative responses contained information regarding diagnosis and treatment, impact of breast cancer, coping with breast cancer, and support accessed. Although the negative impact of breast cancer was discussed in terms of short and long-term, positive long-term changes were also reported. A variety of coping strategies and supports were utilized by the participants as well.