Elsevier

Journal of Affective Disorders

Volume 225, 1 January 2018, Pages 153-159
Journal of Affective Disorders

Research paper
Coping strategies as mediators in relation to resilience and posttraumatic stress disorder

https://doi.org/10.1016/j.jad.2017.08.049Get rights and content

Highlights

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    Prospective investigation of resilience, coping strategies, and PTSD development.

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    Recruitment from an emergency department following a Criterion A trauma.

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    Resilience negatively correlated with future PTSD symptoms.

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    Avoidant coping strategies positively correlated with future PTSD symptoms.

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    Social withdrawal mediated association between resilience and future PTSD symptoms.

Abstract

Background

Resilience has been shown to protect against the development of posttraumatic stress disorder (PTSD) in the aftermath of trauma. However, it remains unclear how coping strategies influence resilience and PTSD development in the acute aftermath of trauma. The current prospective, longitudinal study investigated the relationship between resilience, coping strategies, and the development of chronic PTSD symptoms.

Methods

A sample of patients was recruited from an emergency department following a Criterion A trauma. Follow-up assessments were completed at 1-, 3-, and 6-months post-trauma to assess PTSD symptom development (N = 164). RESULTS: Resilience at 1-month positively correlated with the majority of active coping strategies (all p < .05) and negatively correlated with the majority of avoidant coping strategies (all p < .05), as well as future PTSD symptoms (p < .001). Additionally, all avoidant coping strategies, including social withdrawal, positively correlated with future PTSD symptoms (all p < .01). After controlling for demographic and clinical variables, social withdrawal at 3-months fully mediated the relationship between resilience at 1-month and PTSD symptoms at 6-months.

Limitations

Limitations include participant drop out and the conceptual overlap between avoidant coping and PTSD.

Conclusions

These data suggest that resilience and social withdrawal may be possible therapeutic targets for mitigating the development of chronic PTSD in the aftermath of trauma.

Section snippets

Procedures

Participants were recruited in the Emergency Department of an inner city level-1 trauma center (offering comprehensive service to patients) and provided informed consent. Patients were included in the study if they were between the ages of 18 and 65, were English-speaking, were alert and oriented, and endorsed criterion A trauma (experienced, witnessed, or were confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of the

Participants

Socio-demographic information and clinical variables for adults who participated in the Emergency Department assessment are presented in Table 1. The following number of persons participated in each assessment: 341 individuals were recruited into the study and underwent an interview in the Emergency Department; 220 attended the 1-month follow-up interview; 195 attended the 3-month follow-up interview; and 164 completed the 6-month follow-up interview. As we included participants who attended

Discussion

The present prospective study found that higher resilience at 1-month post-trauma was associated with lower PTSD symptoms 6-months post-trauma, which is consistent with prior prospective findings (Daniels et al., 2012) and retrospective studies (Lee et al., 2014, Tugade and Fredrickson, 2004, Wrenn et al., 2011). The current study is the first, to our knowledge, to show that early resilience can predict PTSD symptom development as late as 6-months post-trauma. Our results stand in contrast to

Conflicts of interest

All authors declare that they have no conflicts of interest.

Contributors

Authors Thompson Fiorillo, Ressler, Rothbuam and Michopoulos all implemented the overall study design and recruitment of participants. Authors Thompson, Fiorillo, and Michopoulos collected data for the current study and undertook the data analysis. Authors Thompson and Fiorillo wrote first draft of the manuscript, to which all other authors provided feedback on interpretation and presentation.

Role of funding

The funding sources had no role in the design and conduct of the study; collection, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author note

This research was supported by NIMH (R01-MH094757).

Acknowledgements

We would like to thank Alex Rothbaum, Thomas Crow, and Becky Roffman for their support and assistance. All of this work would not have been possible without the support of all the nurses, physicians, associate providers, and staff of the Emergency Care Center at Grady Memorial Hospital. Additionally, we would like to acknowledge the patients and families that agreed to participate in both studies. The National Institutes of Health supported this work via MH094757 (KJR) and HD085850 (VM).

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