Thesis (Ph. D.)--Drexel University, 2007. / Includes abstract and vita. Includes bibliographical references (leaves 72-81).

Perinatal mood disorders such as postpartum depression and postpartum posttraumatic stress disorder are an area of growing concern. There have been few studies regarding ways to identify women at risk of developing these disorders in the antepartum period. During the antepartum period, women attend prenatal appointments with their provider to assess the health of their pregnancy. This period is ideal to administer emotional health questionnaires to identify if patients may be at risk of developing postpartum mood disorders. The aim of this study was to identify if there are differences on antepartum emotional health questionnaire scores between women who have postpartum mood disorders, and those who do not. The data come from 19 women undergoing scheduled cesarean deliveries at Boston Medical Center. The questionnaires collected information about stress, depression, anxiety, and symptoms of postpartum depression and posttraumatic stress disorder. We compared the scores of the women who had postpartum depression and postpartum posttraumatic stress disorder to the women who did not, to examine if the scores in the antepartum period correlated with postpartum mood disorders. We did not find any differences between the postpartum depression group, but did find a difference on one questionnaire between the postpartum posttraumatic stress disorder group. Within our cohort, we found similar incidences of postpartum depression, postpartum posttraumatic stress disorder, and self-harm/suicidal ideations compared to national incidences. Future studies should include more participants and a more heterogenous cohort as it pertains to cesarean delivery type, indication for cesarean delivery, intrapartum events, and histories of depression, anxiety, posttraumatic stress disorder, and other mood disorders. Although we only found a difference on one questionnaire for one of the postpartum mood disorders, future studies should prioritize the antepartum period as a time to identify and address concerns of postpartum mood disorders.

The diagnosis of Complicated Grief (CG) is being proposed for inclusion in DSM–5. As such, it has been the focus of several studies purporting to build evidence of its validity and its conceptual and statistical distinction from Posttraumatic Stress Disorder (PTSD) and depression (Bonanno et al., 2007; Golden & Dalgleish, 2010; Prigerson et al., 1995b). However, previous research has focused predominantly on bereavement caused by non-violent means (e.g., prolonged terminal illness). This study attempts to explore the nature of CG among a sample of students who survived a mass shooting. Exploratory and confirmatory factor analytic procedures were used to examine and confirm the factor structure of CG as reported in previous studies (e.g., Boelen & van den Bout, 2005; Dillen, Fontaine, & Verhofstadt-Denève, 2008). A refined CG scale was then used as a criterion to demonstrate how different types of traumatic exposure contribute to symptoms of CG and/or posttraumatic stress (PTS). It was hypothesized that exposure items related to bereavement would be more related to CG than to PTS, whereas direct exposure to the shootings would be more closely related to PTS than to CG. Results of exploratory and confirmatory factor analyses supported CG as a unitary construct distinct from PTS and from anxiety/depression. Logistic regression results demonstrated that bereavement status was significantly predicted by CG but not PTS: Participants who scored 1 standard deviation above the mean on the CG scale were 14.64 times more likely to have been bereaved than were those who scored at the mean. SEM analyses were used to provide an additional test of this hypothesis. The final model had acceptable fit as assessed by RMSEA = .046, CI = .043–.049, SRMR = .048, and CFI = .990; however, the Satorra-Bentler Scaled Ï 2 = 1507.82, df = 589, p < .001, did not support the model. Overall, results of SEM suggested that interpersonal loss (i.e., whether a friend was killed, injured, or escaped from the shootings) predicted CG but not PTS, whereas perceived threat predicted both CG and PTS. / Ph. D.

This study investigated the use of "naturalistic stressors" such as physical restraint and animal pheromones on the etiology of Posttraumatic Stress Disorder in a murine model. Pilot data suggest that stress effects may lead to an increase in the amount of time needed for cutaneous wounds to heal. Pilot data to support the creation of this model are presented suggesting that a delayed stress response may inhibit healing rates. In the present study an animal model of PTSD was used to investigate the effect of stress on the immune system. Yehuda and Antelman's (1993) nonhuman animal model of Posttraumatic Stress Disorder was tested with respect to the animals' immune response to cutaneous wounding. Additionally, effects of stress on exploratory behavior and activity were examined. The findings support the hypothesis that restraint and pheremonal stress and housing arrangements influence the ability of mice to heal a 1.5 mm punch biopsy, and exploratory behavior. The findings also support a profile for the Post-Traumatic Mouse. / Ph. D.

Posttraumatic stress disorder (PTSD) is accompanied by marked alterations in cognition and behavior, particularly when negative, high-value information is present (Aupperle, Melrose, Stein, & Paulus, 2012; Hayes, Vanelzakker, & Shin, 2012) . However, the underlying processes are unclear; such alterations could result from differences in how this high value information is updated or in its effects on processing future information. To untangle the effects of different aspects of behavior, we used a computational psychiatry approach to disambiguate the roles of increased learning from previously surprising outcomes (i.e. associability; Li, Schiller, Schoenbaum, Phelps, & Daw, 2011) and from large value differences (i.e. prediction error; Montague, 1996; Schultz, Dayan, & Montague, 1997) in PTSD. Combat-deployed military veterans with varying levels of PTSD symptoms completed a learning task while undergoing fMRI; behavioral choices and neural activation were modeled using reinforcement learning. We found that associability-based loss learning at a neural and behavioral level increased with PTSD severity, particularly with hyperarousal symptoms, and that the interaction of PTSD severity and neural markers of associability based learning predicted behavior. In contrast, PTSD severity did not modulate prediction error neural signal or behavioral learning rate. These results suggest that increased associability-based learning underlies neurobehavioral alterations in PTSD. / Master of Science

The present study aimed to investigate sleep disturbances and negative emotions as predictors of posttraumatic stress disorder (PTSD) symptom trajectories in a publicly available longitudinal dataset of patients (N = 1127; mean age = 36.53; SD = 13.29; 65.5% women) who presented to a U.S. emergency department (ED) in the early aftermath of a trauma exposure. Latent growth curve models were fitted iteratively to characterize PTSD symptom trajectories over 1-year. Models then examined the simultaneous influence of sleep disturbances (i.e., insomnia symptoms, nightmares, and sleep duration) and negative emotions (i.e., feelings of anxiety and depression) on PTSD symptom trajectories, as well as whether negative emotions mediate the link between sleep disturbances and PTSD symptom trajectories. Results indicated that (a) PTSD symptom trajectories reflected a quadratic trend across time, although there was variability between individuals, (b) both sleep disturbances and negative emotions were uniquely associated with PTSD symptom trajectories, and (c) negative emotions partially explained associations between sleep disturbances and PTSD symptom trajectories. The results from this study can potentially aid detection of modifiable risk factors during the early course of PTSD and inform cognitive-behavioral intervention efforts.

Exaggerated cardiovascular reactivity (CVR) to stress has been implicated in the increased risk for cardiovascular disease (CVD) in individuals with posttraumatic stress disorder (PTSD), yet mixed results have been reported. The CVR research may have been confounded by underrepresentation of women, few studies using sophisticated cardiovascular measurement, and a lack of analyses of PTSD symptom clusters. The purpose of the present study was to examine if young civilian women (M ± SD = 29.89±7.33) with PTSD (n=17) demonstrate greater CVR than women with depression (n=12) or no mental illness controls (n=18), and to explore the relationships between CVR and PTSD symptom clusters. Participants were 56% Caucasian, 21% African American, 19% Hispanic, and 4% other. Systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and impedance cardiography derived cardiac output (CO) and total peripheral resistance (TPR) were utilized to examine CVR during speech preparation/delivery and math tasks. Between-group effects were observed during speech preparation - specifically, lower DBP reactivity for the PTSD group compared to the depression group (p < .05). Between-group effects were also evident during speech delivery, with a trend toward lower DBP reactivity for the PTSD group than the depression group (p <.08), higher CO reactivity for the PTSD group than controls (p <.01), and lower TPR reactivity for the PTSD group than the depression (p <.01) and control groups (p <.01). PTSD severity scores for DSM-IV-TR and DSM-5 were used as independent predictors of CVR in multiple regressions variables. The DSM-IV analysis did not provide significant associations. The DSM-5 yielded significant associations of avoidance and arousal clusters with SBP reactivity during math, a significant association avoidance with DBP reactivity during math, and significant associations of avoidance and arousal with HR reactivity during math. Further exploration of PTSD symptom clusters may provide a clearer picture of the relationship between PTSD/CVR. Higher reactivity and lower reactivity may both be associated with risk for CVD, albeit through separate mechanisms.

A prospective study of pregnant women was undertaken to provide an estimate of rates of Posttraumatic Stress Disorder after childbirth that takes into account pre-existing trauma; to explore risk factors associated with the development of traumatic stress after birth; and to better understand incidence and risk factors associated with fear of childbirth, which is thought to contribute to postpartum Posttraumatic Stress Disorder. Ninety participants in their last trimester of pregnancy completed questionnaires that included depression, trait anxiety, PTSD, anxiety sensitivity, childbearing fear, and self-efficacy for labor. Four weeks after delivery 73 of these women completed questionnaires concerning delivery, posttraumatic stress related to childbirth, and depression. Levels of childbearing fear were similar to studies of non U.S. women but did not predict traumatic reactions to childbirth. First-time mothers and those with prior miscarriage, traumatic birth, and childhood sexual assault were not more fearful of childbirth although women reporting repeat sexual victimization that started in childhood were. Women with comorbid Posttraumatic Stress Disorder and depression during pregnancy were significantly more fearful of childbirth. Higher trait anxiety and anxiety sensitivity, and lower labor self-efficacy predicted greater fear of childbirth. Women who underwent operative deliveries became more fearful of childbirth after delivery whereas women who underwent unassisted vaginal deliveries showed a reduction in fear. Five percent of women developed new cases of Posttraumatic Stress Disorder attributable to childbirth. An additional five percent who had received a trauma diagnosis during pregnancy met criteria for Posttraumatic Stress Disorder resulting from childbirth. Higher trait anxiety predicted postpartum trauma symptoms and greater self-efficacy for childbirth moderated this relationship. Women assigned a diagnosis of Posttraumatic Stress Disorder or co-morbid PTSD and depression during pregnancy, and women who underwent operative or instrument deliveries (i.e. caesarian section, forceps deliveries, or vacuum extraction), were significantly more likely to receive a diagnosis of PTSD or trauma-related Adjustment Disorder as a consequence of their experience of childbirth. Results suggest that increasing self-efficacy for labor and treating psychopathology present during pregnancy may be fruitful targets for efforts to prevent the development of traumatic reactions to childbirth.

Thesis advisor: Ce Shen / A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress (Ehlers & Clark, 2000). However, very few studies have examined how cognitive appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The major purpose of this study was to examine the relationship between negative appraisal and PTSD symptoms among adults diagnosed with SMI. It was hypothesized that negative appraisal would have a positive and significant association with traumatic stress symptoms in a clinical sample of community clients diagnosed with major mood and schizophrenia-spectrum disorders when controlling for gender, total lifetime trauma, substance use, and severity of symptoms associated with SMI. Multiple regression was employed to conduct a secondary analysis of clinical data from 291 community support clients who were receiving services from three community mental health centers in the state of Rhode Island during March to September 2009. Results supported the main hypotheses that all three types of negative appraisal with respect to self, world /others, and self blame as well as overall appraisal were positively and significantly associated with PTSD symptoms. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

M.A., Faculty of Humanities, University of the Witwatwersrand, 2011 / Posttraumatic growth has been an ongoing area of interest in the field of positive psychology. In recent years posttraumatic growth has been linked with the presence of posttraumatic stress symptomatology. The existence of posttraumatic growth has been validated in a number of cultures. There are certain domains that have been implicated in the construction of the phenomenon which taps into different aspects of people’s lives like relating to others, personal strength, new possibilities and appreciation of life. Particular interest has risen with regard to whether this phenomenon develops as a function of ethnic and cultural influences. This study aimed to investigate whether there are differences in posttraumatic growth and posttraumatic stress symptoms as a function of ethnocultural identity. This was investigated by the use of self-report measures of MEIM (Phinney, 1992), Traumatic Stress Schedule (Norris, 1990), Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) and the Impact of Events Scale Revised (Weiss & Marmar, 1997). The sample consisted of 80 students from the Faculty of Humanities and the Faculty of Commerce, Law and Management, at the University of Witwatersrand. Results of the multivariate analysis showed that ethnocultural identity interacts with ethnicity to moderate posttraumatic stress symptoms. Specifically, findings suggested that Black South African and Indian students who identified with their ethnocultural heritage, reported fewer PTSD symptoms. Whereas the converse was true for White South Africans and Black Africans from other countries. The more they adopted ethnoculturally informed beliefs, the more likely they were to report symptoms of PTSD. There were no significant findings regarding ethnocultural identity in relation to posttraumatic growth. Implications for further research and clinical intervention are discussed.