Risk Pathways for Posttraumatic Stress Disorder: A Three-Wave Prospective Investigation of Pre-and Post-Trauma Cognitive Vulnerability Integrated Model of PTSD
Date Issued
2011
Date
2011
Author(s)
Su, Yi-Jen
Abstract
Epidemiologic surveys indicate that a large proportion of general population has been exposed to traumatic events, but only a minority develops PTSD. Researchers have endeavored to identify risk factors that predict the emergence of PTSD. The risk factors of PTSD can be separated into pretrauma, peritraumatic, and posttrauma predictors. From the viewpoint of cognitive vulnerability-stress model, the effects of peritraumatic and posttrauma predictors may derive from prior cognitive vulnerability. Reviewing schema-based theories of PTSD suggests that three types of schematic representations may raise the risk of PTSD, including rigid/inflexible positive schema, negative schema, and contradictory schema. These schemata may be strongly shattered or activated by traumatic stressor, further leading to negative cognitive or emotional response during or after trauma, which contribute to PTSD symptoms. Based on the above, we proposed a pre- and post-trauma cognitive vulnerability integrated model to account for the development of PTSD, which comprises pretrauma cognitive vulnerability, pretrauma predictors, peritraumatic psychological responses, and posttrauma cognitive factors. The present study used a three-wave prospective design to investigate the statistical plausibility of the model. A total of 810 college students completed the baseline survey (T0), of whom 592 (73.1%) completed 2-month follow-up surveys (T1). Among those who completed T1 survey, 88 participants (14.9%) had experienced a new trauma during T0-T1 period, of whom 73 (83.0%) continued to join 3-month follow-up survey (T2). The final sample used to examine main hypotheses were 80 recently trauma-exposed individuals, after removing 8 probable PTSD cases at baseline. Results indicated that those who held rigid positive belief did not show higher PTSD severity than those who did not. In addition, prior negative belief predicted subsequent PTSD severity. Contradictory self predicted 3- to 4-month reexperiencing severity. Path analysis indicated that the proposed integrated model did fit the data well. One of the risk pathways for PTSD may involve the co-effects of pretrauma depression, prior negative belief, peritraumatic negative emotion and dissociation, posttrauma negative cognition, and maladaptive appraisals. Another risk pathway may involve the interaction of peritraumatic and posttrauma predictors. Findings have both theoretical and clinical implications.
Subjects
posttraumatic stress disorder
cognitive vulnerability
negative cognition
schema
prospective study
Type
thesis
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