Disclosure and Social Acknowledgement as Predictors of Recovery from Posttraumatic Stress: A Longitudinal Study in Crime Victims

By Mueller, Julia; Moergeli, Hanspeter et al. | Canadian Journal of Psychiatry, March 2008 | Go to article overview

Disclosure and Social Acknowledgement as Predictors of Recovery from Posttraumatic Stress: A Longitudinal Study in Crime Victims


Mueller, Julia, Moergeli, Hanspeter, Maercker, Andreas, Canadian Journal of Psychiatry


Objective: To address posttraumatic stress disorder (PTSD) predictors with research focused on the coping styles of traumatized individuals.

Method: A total of 86 crime victims (mean age 46.1, standard deviation 17.6) were assessed at 5 and 11 months post-crime. Disclosure of trauma, social acknowledgement, dysfunctional posttraumatic cognitions, and PTSD symptom severity were assessed by self-reports.

Results: Dysfunctional posttraumatic cognitions, disclosure attitudes, and social disapproval correlated positively with PTSD severity. Hierarchical regression analyses revealed the particular value of disclosure attitudes and perceived social disapproval in predicting PTSD symptom severity at 11 months post-crime.

Conclusions: In addition to known predictors of PTSD, disclosure attitudes and social acknowledgement should also be considered. Future research should focus on broader concepts such as the victim's perception of, and interaction with, their social environment, and on the objective factors of social interaction, in addition to intrapersonal processes of posttraumatic recovery.

Can J Psychiatry 2008;53(3): 160-168

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

* Disclosure attitudes, for example, the pronounced urge and (or) reluctance to talk, predict PTSD symptomatology and should be considered with PTSD patients.

* The lack of general social acknowledgement of the victim predicts PTSD symptomatology and should be considered with PTSD patients.

* Questionnaires that reliably and validly assess disclosure attitudes and social acknowledgement may be helpful in identifying individuals at risk for PTSD.

Limitations

* The low response rate of the study is a problem as the predictors that were addressed likely influenced participation.

* The study's longitudinal design is somewhat biased as we received data for only individual, 6-month courses within 1.5 years after traumatization.

* In addition to conducting questionnaire assessments, conducting field studies with trauma victims and their relatives would be helpful for obtaining objective data on the interpersonal processes of trauma recovery.

Key Words: crime victims, posttraumatic stress disorder, disclosure, social acknowledgement

Abbreviations used in this article

DTQ Disclosure of Trauma Questionnaire

IES-R Impact of Event Scale-Revised

PTCI Posttraumatic Cognitions Inventory

PTSD posttraumatic stress disorder

SAQ Social Acknowledgement Questionnaire

SD standard deviation

t1 time-1-assessments

t2 time-2-assessments

TEI Trauma Exposure Index

WR Weisser Ring

Because of the disabling nature and often chronic course of PTSD, identifying risk factors and protective factors for its development is of particular interest.1 A large body of research identified factors including prior trauma or prior psychiatric history as good predictors of PTSD.2 In addition, intrapersonal factors such as peri- and posttraumatic dysfunctional cognitions were found to influence posttraumatic recovery.2,3 Compared with intrapersonal factors, data on interpersonal processes of trauma recovery-focusing not only on the traumatized individuals but also on their social environment and their social interactions, respectively-are sparse. In addition to social support, which was found to be a strong predictor of PTSD,2,4 disclosure of trauma5,6 and social acknowledgement7,8 have emerged as relevant.

Disclosure

Disclosure, that is, the revelation of adverse life events, is assumed to have positive therapeutic effects on recovery.9 In line with this, disclosure of stressful life events through repeated expressive writing has been found to reduce psychological symptoms in healthy subjects.10-12 However, results of the effects of disclosure in trauma populations are inconsistent. …

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