Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2018

Open Access 01-12-2018 | Research

Post-traumatic cognitions and quality of life in terrorism victims: the role of well-being in indirect versus direct exposure

Authors: Miriam Bajo, Amalio Blanco, Maria Stavraki, Beatriz Gandarillas, Ana Cancela, Blanca Requero, Darío Díaz

Published in: Health and Quality of Life Outcomes | Issue 1/2018

Login to get access

Abstract

Background

The effect of indirect (versus direct) exposure to a traumatic event on the quality of life of terrorist attack victims has received considerable attention in the literature. However, more research is required to examine whether the symptoms and underlying processes caused by both types of exposure are equivalent. Our main hypothesis is that well-being plays a different role depending on indirect vs. direct trauma exposure.

Methods

In this cross-sectional study, eighty direct victims of 11-M terrorist attacks (people who were traveling in trains where bombs were placed) and two-hundred indirect victims (individuals highly exposed to the 11-M terrorist attacks through communications media) voluntarily participated without compensation. To test our hypothesis regarding the mediating role of indirect exposure, we conducted a biased corrected bootstrapping procedure. To test our hypothesis regarding the moderating role of direct exposure, data were subjected to a hierarchical regression analysis.

Results

As predicted, for indirect trauma exposure, well-being mediated the relationship between post-traumatic dysfunctional cognitions and trauma symptoms. However, for direct trauma exposure, well-being moderated the relationship between post-traumatic dysfunctional cognitions and trauma symptoms.

Conclusions

The results of our study indicate that the different role of well-being found between indirect (causal factor) and direct exposure (protective factor) should be taken into consideration in interventions designed to improve victims’ health.
Footnotes
1
To discard that PWB mediates the relationship between NCS and DTS and SoWB mediates the relationship between NCW and DTS in direct victims, we employed the same procedure as in the previous section. The results of these bootstrapping procedures revealed that the 95% confidence interval of the indirect effect did not include zero (PWB: Indirect Effect a x b = .09, CI95% = from −.03 to .25; SoWB: Indirect Effect a x b = .06, CI95% = from −.07 to .24). Therefore, the mediations by PWB or SoWB are not supported.
 
Literature
1.
Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38:467–80.CrossRefPubMed
2.
Zimering R, Gulliver SB, Knight J, Munroe J, Keane TM. Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to ground zero. J Trauma Stress. 2006;19:553–7.CrossRefPubMed
3.
Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, et al. Psychological reactions to terrorist attacks: findings from the National Study of Americans’ reactions to September 11. JAMA. 2002;288:581–8.CrossRefPubMed
4.
Silver RC, Holman EA, McIntosh DN, Poulin M, Gil-Rivas V. Nationwide longitudinal study of psychological responses to September 11. JAMA. 2002;288:1235–44.CrossRefPubMed
5.
Otto MW, Henin A, Hirshfeld-Becker DR, Pollack MH, Biederman J, Rosenbaum JF. Posttraumatic stress disorder symptoms following media exposure to tragic events: impact of 9/11 on children at risk for anxiety disorders. J Anxiety Disord. 2007;21:888–902.CrossRefPubMed
6.
Propper RE, Stickgold R, Keeley R, Christman SD. Is television traumatic? Dreams, stress, and media exposure in the aftermath of September 11, 2001. Psychol Sci. 2007;18:334–40.CrossRefPubMed
7.
Goodwin R, Lemola S, Ben-Ezra MJ. Media use and insomnia after terror attacks in France. Psychiatry Res. 2017;98:47–50.CrossRef
8.
Suvak M, Maguen S, Litz BT, Silver RC, Holman EA. Indirect exposure to the September 11 terrorist attacks: does symptom structure resemble PTSD? J Trauma Stress. 2008;21:30–9.CrossRefPubMed
9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994.
10.
Weathers FW, Keane TM. The criterion a problem revisited: controversies and challenges in defining and measuring psychological trauma. J Trauma Stress. 2007;20:107–21.CrossRefPubMed
11.
Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45.CrossRefPubMed
12.
Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99:20–35.CrossRefPubMed
13.
Janoff-Bulman R. Shattered Asumptions: toward a new psychology of trauma. New York: Free Press; 1992.
14.
Karatzias T, Shevlin M, Fyvie C, Hyland P, Efthymiadou E, Wilson D, et al. Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). J Affect Disord. 2017;207:181–7.CrossRefPubMed
15.
Epstein S. The self-concept, the traumatic neurosis, and the structure of personality. In: Ellis A, Grieger R, editors. Handbook of rational emotive therapy. New York: Springer; 1991. p. 3–34.
16.
Janoff-Bulman R. Assumptive worlds and the stress of traumatic events: applications of the schema construct. Soc Cogn. 1989;7:113–36.CrossRef
17.
Blanco A, Blanco R, Díaz D. Social (dis)order and psychosocial trauma: look earlier, look outside, and look beyond the persons. Am Psychol. 2016;71:187–98.CrossRefPubMed
18.
Kilpatrick D, Resnick H, Milanak M, Miller M, Keyes K, Friedman M. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress. 2013;26:537–47.CrossRefPubMedPubMedCentral
19.
Morina N, Wicherts JM, Lobbrecht J, Priebe S. Remission from post-traumatic stress disorder in adults: a systematic review and meta-analysis of long term outcome studies. Clin Psychol Rev. 2014;34:249–55.CrossRefPubMed
20.
Foa EB, Huppert JD, Cahill SP. Emotional processing theory: an update. In: Rothbaum BO, editor. Pathological anxiety: emotional processing in etiology and treatment. New York: Guilford Press; 2006. p. 3–24.
21.
Foa E, Ehlers A, Clark D, Tolin D, Orsillo S. The post-traumatic cognition inventory (PTCI): development and validation. Psychol Assess. 1999;11:303–14.CrossRef
22.
Ryff C. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57:1069–81.CrossRef
23.
24.
Keyes C. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73:539–48.CrossRefPubMed
25.
26.
Dunmore, E, Ehlers A, Clark DM. A prospective investigation of the role of cognitive factors in persistent Posttraumatic Stress Disorder (PTSD) after physical or sexual assault. Behav Res Ther. 2001;39:1063–84.
27.
Rosenthal R. Covert communication in classrooms, clinics, courtrooms, and cubicles. Am Psychol. 2002;57:839–49.CrossRefPubMed
28.
Davidson JRT, Book SW, Colket JT, Tupler LA, Roth S, David D, et al. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med. 1997;27:153–60.CrossRefPubMed
29.
Bobes J, Calcedo-Barba A, García M, Francois M, Rico-Villademoros F, González M, et al. Evaluation of the psychometric properties of the Spanish version of five questionnaires for the assessment of post-traumatic stress disorders. Actas Esp Psiquiatr. 2000;28:207–18.PubMed
30.
Blanco A, Díaz D, Gaborit M, Amaris MC. World Schema and self Schema: the posttraumatic cognitions inventory (PTCI) in Hispanic population. Rev Lat Am Psicol. 2010;42:97–110.
31.
Díaz D, Rodríguez-Carvajal R, Blanco A, Moreno-Jiménez B, Gallardo I, Valle C, et al. Spanish adaptation of the psychological well-being scales (PWBS). Psicothema. 2006;18:572–7.PubMed
32.
Díaz D, Blanco A, Durán MM. The structure of well-being: the empirical encounter of three traditions. Rev Psicol Soc. 2011;26:357–72.CrossRef
33.
Van Dierendonck D, Díaz D, Rodríguez-Carvajal R, Blanco A, Moreno-Jiménez B. Ryff’s six-factor model of psychological well-being, a Spanish exploration. Soc Indic Res. 2008;87:473–9.CrossRef
34.
Blanco A, Díaz D. Social well-being: theoretical structure and measurement. Psicothema. 2005;17:582–9.
35.
Díaz D, Blanco A, Bajo M, Stavraki M. Fatalism and well-being across hispanic cultures: the social fatalism scales (SFS). Soc Indic Res. 2015;124:929–34.CrossRef
36.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMed
37.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis. New York: Guilford Press; 2013.
38.
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36:717–31.CrossRefPubMed
39.
Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychol Methods. 2002;7:422–45.CrossRefPubMed
40.
Foa EB, Rothbaum BO. Treating the trauma of rape: cognitive-behavioral therapy for PTSD. New York: Guilford Press; 1998.
41.
McCann IL, Pearlman LA. Vicarious traumatization: a framework for understanding the psychological effects of working with victims. J Trauma Stress. 1990;3:131–49.CrossRef
42.
Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60:748–56.CrossRefPubMed
43.
Dunmore E, Clark DM, Ehlers A. A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. Behav Res Ther. 2001;39:1063–84.CrossRefPubMed
44.
McLean CP, Yeh R, Rosenfield D, Foa EB. Changes in negative cognitions mediate PTSD symptom reductions during client-centered therapy and prolonged exposure for adolescents. Behav Res Ther. 2015;68:64–9.CrossRefPubMedPubMedCentral
45.
Moser JS, Hajcak G, Simons RF, Foa EB. Posttraumatic stress disorder symptoms in trauma-exposed college students: the role of trauma related cognitions, gender and negative affect. J Anxiety Disord. 2007;21:1039–49.CrossRefPubMedPubMedCentral
46.
Blanco A, Díaz D. The twofold face of fatalism: collectivist fatalism and individualist fatalism. Psicothema. 2007;19:552–8.
47.
48.
Carmassi C, Akiskal HS, Bessonov D, Massimetti G, Calderani E, Stratta P, et al. Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L’Aquila earthquake. J Affect Disord. 2014;160:55–61.CrossRefPubMed
49.
Nawijn L, van Zuiden M, Frijling JL, Koch SB, Veltman DJ, Olff M. Reward functioning in PTSD: a systematic review exploring the mechanisms underlying anhedonia. Neurosci Biobehav Rev. 2015;51:189–204.CrossRefPubMed
50.
Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and emotional granularity: examining the benefits of positive emotions on coping and health. J Pers. 2004;72:1161–90.CrossRefPubMedPubMedCentral
51.
Littleton H, Horsley S, John S, Nelson DV. Trauma coping strategies and psychological distress: a meta-analysis. J Trauma Stress. 2007;20:977–88.CrossRefPubMed
52.
53.
54.
Foa EB, Dancu CV, Hembree EA, Jaycox LH, Meadows EA, Street GP. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol. 1999;67:194–200.CrossRefPubMed
55.
Shahar G, Noyman G, Schnidel-Allon I, Gilboa-Schechtman E. Do PTSD symptoms and trauma-related cognitions about the self constitute a vicious cycle? Evidence for both cognitive vulnerability and scarring models. Psychiatry Res. 2013;205:79–84.CrossRefPubMed
56.
Powers MB, Halpern JM, Ferenschak MP, Gillihan SJ, Foa EB. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clin Psychol Rev. 2004;30:635–41.CrossRef
57.
Klein B, Mitchell J, Abbott J, Shandley K, Austin D, Gilson K. A therapist-assisted cognitive behavior therapy internet intervention for posttraumatic stress disorder: pre-, post- and 3-month follow-up results from an open trial. J Anxiety Disord. 2010;24:635–44.CrossRefPubMed
58.
Cruz-Feliciano MA, Miranda-Diaz C, Fernandez-Santos DM, Orobitg-Brenes D, Hunter-Mellado RF, Carrion-Gonzalez IS. Quality of life improvement in latinas receiving combined substance use disorders and trauma-specific treatment: a cohort evaluation report. Health Qual Life Outcomes. 2017;15:90.CrossRefPubMedPubMedCentral
Metadata
Title
Post-traumatic cognitions and quality of life in terrorism victims: the role of well-being in indirect versus direct exposure
Authors
Miriam Bajo
Amalio Blanco
Maria Stavraki
Beatriz Gandarillas
Ana Cancela
Blanca Requero
Darío Díaz
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2018
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-018-0923-x

Other articles of this Issue 1/2018

Health and Quality of Life Outcomes 1/2018 Go to the issue

Research

Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs

Short report

Test-retest reliability and measurement error of the Danish WHO-5 Well-being Index in outpatients with epilepsy

Research

Health-related quality of life impact of minor and major bleeding events during dual antiplatelet therapy: a systematic literature review and patient preference elicitation study

Research

Quality of life in small-scaled homelike nursing homes: an 8-month controlled trial

Research

EQ-5D-5L norms for the urban Chinese population in China

Research

Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India