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Social relationship satisfaction and PTSD: which is the chicken and which is the egg?

Freedman SA, Gilad M, Ankri Y, Roziner I, Shalev AY - Eur J Psychotraumatol (2015)

Bottom Line: The cross-lagged effect of SRS on PTSD was statistically significant (β=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (β=-0.02, p=0.67).Both relationships were non-significant among survivors who received CBT.SRS impacts natural recovery, but not effective treatment.

View Article: PubMed Central - PubMed

Affiliation: Center for Traumatic Stress Studies, Hadassah University Hospital, Jerusalem, Israel; sarafreedman@gmail.com.

ABSTRACT

Background: Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD.

Objective: This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two.

Method: Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n=501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms.

Results: The cross-lagged effect of SRS on PTSD was statistically significant (β=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (β=-0.02, p=0.67). Both relationships were non-significant among survivors who received CBT.

Discussion: SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.

No MeSH data available.


Related in: MedlinePlus

Structural equation model of cross-lagged relationship satisfaction and PTSD effects with standardized parameters. χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037. The solid lines indicate paths statistically significant at p<0.05. The dotted lines indicate non-significant paths. NLE, negative life effects; SRS, social relationship satisfaction; WL, waiting list; PE/CT, prolonged exposure/cognitive therapy.
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Figure 0001: Structural equation model of cross-lagged relationship satisfaction and PTSD effects with standardized parameters. χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037. The solid lines indicate paths statistically significant at p<0.05. The dotted lines indicate non-significant paths. NLE, negative life effects; SRS, social relationship satisfaction; WL, waiting list; PE/CT, prolonged exposure/cognitive therapy.

Mentions: As the first stage of the main analyses, we tested the measurement model. It yielded acceptable results: χ2 (46, N=501)=66.26, p=0.03, TLI=0.995, CFI=0.996, SRMR=0.030, RMSEA=0.030 (90% CI=0.010; 0.045). We proceeded then to test the cross-lagged panel model. To this model, we added the two dummy variables expressing membership in the two RCT experimental groups as predictors of both T1 and T2 relationship satisfaction and PTSD. Parceling out the group membership from T1 measures allowed us to account for the initial imbalance in the groups’ composition. The group membership effects upon the T2 measures controlled for T1 measures allow us to estimate the RCT impact upon the change over time in these measures. We also added to the model, as predictors of each of the four content variables, those sociodemographic and background variables that were correlated with any of the content research variables (Table 1). This structural model fit the data well, with χ2 (114, N=501)=208.80, p<0.0001, TLI=0.978, CFI=0.983, SRMR=0.039, and RMSEA=0.041 (90% CI=0.032; 0.049). In this model, all the paths emitted from two control variables, number of children and self-reported income, were not statistically significant. These variables were deleted from the model. The paths from NLE to relationship satisfaction and PTSD at T2 were also non-significant and were therefore fixed to zero. The resulting model (Fig. 1) showed good fit to the data, with χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037 (90% CI=0.027; 0.047).


Social relationship satisfaction and PTSD: which is the chicken and which is the egg?

Freedman SA, Gilad M, Ankri Y, Roziner I, Shalev AY - Eur J Psychotraumatol (2015)

Structural equation model of cross-lagged relationship satisfaction and PTSD effects with standardized parameters. χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037. The solid lines indicate paths statistically significant at p<0.05. The dotted lines indicate non-significant paths. NLE, negative life effects; SRS, social relationship satisfaction; WL, waiting list; PE/CT, prolonged exposure/cognitive therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696463&req=5

Figure 0001: Structural equation model of cross-lagged relationship satisfaction and PTSD effects with standardized parameters. χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037. The solid lines indicate paths statistically significant at p<0.05. The dotted lines indicate non-significant paths. NLE, negative life effects; SRS, social relationship satisfaction; WL, waiting list; PE/CT, prolonged exposure/cognitive therapy.
Mentions: As the first stage of the main analyses, we tested the measurement model. It yielded acceptable results: χ2 (46, N=501)=66.26, p=0.03, TLI=0.995, CFI=0.996, SRMR=0.030, RMSEA=0.030 (90% CI=0.010; 0.045). We proceeded then to test the cross-lagged panel model. To this model, we added the two dummy variables expressing membership in the two RCT experimental groups as predictors of both T1 and T2 relationship satisfaction and PTSD. Parceling out the group membership from T1 measures allowed us to account for the initial imbalance in the groups’ composition. The group membership effects upon the T2 measures controlled for T1 measures allow us to estimate the RCT impact upon the change over time in these measures. We also added to the model, as predictors of each of the four content variables, those sociodemographic and background variables that were correlated with any of the content research variables (Table 1). This structural model fit the data well, with χ2 (114, N=501)=208.80, p<0.0001, TLI=0.978, CFI=0.983, SRMR=0.039, and RMSEA=0.041 (90% CI=0.032; 0.049). In this model, all the paths emitted from two control variables, number of children and self-reported income, were not statistically significant. These variables were deleted from the model. The paths from NLE to relationship satisfaction and PTSD at T2 were also non-significant and were therefore fixed to zero. The resulting model (Fig. 1) showed good fit to the data, with χ2 (92, N=501)=158.92, p<0.0001, TLI=0.984, CFI=0.988, SRMR=0.037, and RMSEA=0.037 (90% CI=0.027; 0.047).

Bottom Line: The cross-lagged effect of SRS on PTSD was statistically significant (β=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (β=-0.02, p=0.67).Both relationships were non-significant among survivors who received CBT.SRS impacts natural recovery, but not effective treatment.

View Article: PubMed Central - PubMed

Affiliation: Center for Traumatic Stress Studies, Hadassah University Hospital, Jerusalem, Israel; sarafreedman@gmail.com.

ABSTRACT

Background: Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD.

Objective: This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two.

Method: Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n=501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms.

Results: The cross-lagged effect of SRS on PTSD was statistically significant (β=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (β=-0.02, p=0.67). Both relationships were non-significant among survivors who received CBT.

Discussion: SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.

No MeSH data available.


Related in: MedlinePlus