Research Article
An Investigation of Depression, Trauma History, and Symptom Severity in Individuals Enrolled in a Treatment Trial for Chronic PTSD
Michele Bedard-Gilligan,
Jeanne M. Duax Jakob, Lisa Stines Doane, Jeff Jaeger, Afsoon Eftekhari, Norah Feeny, Lori A. Zoellner,
Corresponding Author
Michele Bedard-Gilligan
University of Washington
Please address correspondence to: Michele Bedard-Gilligan, University of Washington Department of Psychiatry, Box 354944, Seattle WA 98195. E-mail: [email protected]Search for more papers by this authorMichele Bedard-Gilligan,
Jeanne M. Duax Jakob, Lisa Stines Doane, Jeff Jaeger, Afsoon Eftekhari, Norah Feeny, Lori A. Zoellner,
Corresponding Author
Michele Bedard-Gilligan
University of Washington
Please address correspondence to: Michele Bedard-Gilligan, University of Washington Department of Psychiatry, Box 354944, Seattle WA 98195. E-mail: [email protected]Search for more papers by this authorMichele Bedard-Gilligan is now at the University of Washington, Department of Psychiatry, Jeanne M. Duax is now at the VA Ann Arbor Healthcare System and University of Michigan Medical School, Lisa Stines Doane is now at Cleveland State University, Jeff Jaeger is now at The Kansas City Center for Anxiety Treatment, and Afsoon Eftekhari is now at the Palo Alto VA Healthcare System.
This research was funded in part by grants from the National Institute of Mental Health R01 MH066347 (PI: Zoellner) and F31 MH74225 (PI: Bedard). NIMH had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Abstract
Objective
To explore how factors such as major depressive disorder (MDD) and trauma history, including the presence of childhood abuse, influence diverse clinical outcomes such as severity and functioning in a sample with posttraumatic stress disorder (PTSD).
Method
In this study, 200 men and women seeking treatment for chronic PTSD in a clinical trial were assessed for trauma history and MDD and compared on symptom severity, psychosocial functioning, dissociation, treatment history, and extent of diagnostic co-occurrence.
Results
Overall, childhood abuse did not consistently predict clinical severity. However, co-occurring MDD, and to a lesser extent a high level of trauma exposure, did predict greater severity, worse functioning, greater dissociation, more extensive treatment history, and additional co-occurring disorders.
Conclusion
These findings suggest that presence of co-occurring depression may be a more critical marker of severity and impairment than history of childhood abuse or repeated trauma exposure. Furthermore, they emphasize the importance of assessing MDD and its effect on treatment seeking and treatment response for those with PTSD.
References
- Berkson, J. (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics Bulletin, 2(3), 47–53.
- Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–35.
- Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.
- Breslau, N., Davis, C. G., Peterson, E. L., & Schultz, L. R. (2000). A second look at comorbidity in victims of trauma: The posttraumatic stress disorder-major depression connection. Biological Psychiatry, 48, 902–909.
- Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.
- Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66–77.
- Carlson, E., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6(1), 16–27.
- Chaffin, M., Wherry, J., & Dykman, R. (1997). School age children's coping with sexual abuse: abuse stresses and symptoms associated with four coping strategies. Child Abuse and Neglect, 21, 227–240.
- Chambless, D. L., & Crits-Christoph, P. (2006). What should be validated? In J. C. Norcross, L. E. Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions (pp. 131–160). Washington, DC: American Psychological Association.
- Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70(5), 1067–1074.
- Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36, 119–124.
- Cloitre, M., Petkova, E., Wang, J., & Lu, L. F. (2012). An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related childhood abuse. Depression and Anxiety, 29(8), 709–717.
- Cloitre, M. K., Stovall-McClough, K. C., & Levitt, J. T. (2004). Treating life impairing problems beyond PTSD: Reply to Cahill, Zoellner, Feeny, and Riggs (2004). Journal of Consulting and Clinical Psychology, 72, 549–551.
- Davidson, J. R., Hughes, D., Blazer, D. G., & George, L. K. (1991). Post-traumatic stress disorder in the community: An epidemiological study. Psychological Medicine, 21, 713–721.
- Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28, 771–784.
- Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD severity. Behavior Therapy, 41, 587–598.
- Fassler, I. R., Amodeo, M., Griffin, M. L., Clay, C. M., & Ellis, M. A. (2005). Predicting long-term outcomes for women sexually abused in childhood: Contribution of abuse severity versus family environment. Child Abuse and Neglect, 29, 269–284.
- Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964.
- Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaoum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–473.
- Forbes, D., Parslow, R., Creamer, M., O'Donnell, M., Bryant, R., McFarlane, A., … & Shalev, A. (2020). A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with Fear and Anxious-Misery disorders: Implications for DSM-V. Journal of Affective Disorders, 127(1), 147–152.
- Ford, J. D., & Kidd, P. (1998). Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic PTSD. Journal of Traumatic Stress, 18, 743–761.
- Goodman, M. (2012). Complex PTSD is on the trauma spectrum: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 254–255.
- Green, B. L., Grace, M. C., Lindy, J. D., Gleser, G. C., & Leonard, A. (1990). Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans. American Journal of Psychiatry, 147, 729–733.
- Green, B. L, Krupnick, J. L., Chung, J, Siddique, J., Krause, E. D., Revicki, D., … & Miranda, J. (2006). Impact of PTSD comorbidity on one-year outcomes in a depression trial. Journal of Clinical Psychology, 62, 815–835.
- Hamilton, M. (1960). A rating scale for depression. Journal of Neurological and Neurosurgical Psychiatry, 23, 56–62.
- Hankin, C. S., Spiro, A., Miller, D. R., & Kazis, L. (1999). Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: The veterans health study. American Journal of Psychiatry, 156, 1924–1930.
- Helzer, J. E., Robins, L. N., & McEvoy, L. (1987). Post-traumatic stress disorder in the general population: Findings of the Epidemiologic Catchment Area Survey. New England Journal of Medicine, 317, 1630–1634.
- Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
- Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.
- Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.
- Lindauer, R. J. L. (2012). Child maltreatment–clinical PTSD diagnosis not enough?! Comment on Resick et al. (2012). Journal of Traumatic Stress, 25, 258–259.
- MacMillan, H. L., Fleming, J. E., Streiner, D. L., Lin, E., Boyle, M. H., Jamieson, E., … & Beardslee, W. R. (2001). Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry, 158(11), 1878–1883.
- McDonagh, A., Friedman, M. J., McHugo, G., Ford, J., Sengupta, A., Mueser, K., … & Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 515–524.
- Mullen, P. E, Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1996). The long-term impact of the physical, emotional, and sexual abuse of children: A community study. Child Abuse & Neglect, 20(1), 7–21.
- Mullen, P. E., Romans-Clarkson, S. E., Walton, V. A., & Herbison, G. P. (1988). Impact of sexual and physical abuse on women's mental health. The Lancet, 841–845.
- O'Donnell, M. L., Creamer, M., & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry, 161, 1390–1396.
- Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.
- Paolucci, E. O., Genuis, M. L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. The Journal of Psychology, 135(1), 17–36.
- Polusny, M. A., & Follette, V. M. (1995). The long term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology, 4, 143–166.
- Post, L. M., Zoellner, L. A., Youngstrom, E., & Feeny, N. C. (2011). Understanding the relationship between co-occurring PTSD and MDD: Symptom severity and affect. Journal of Anxiety Disorders, 25, 1123–1130.
- Putnam, F. W. (2003). Ten-year research update review: Child sexual Abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 269–278.
- Rehm, L. P., & O'Hara, M. W. (1985). Item characteristics of the Hamilton Rating Scale for Depression. Journal of Psychiatric Research, 19(1), 31–41.
- Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70(4), 867.
- Resnick, H. S., Best, C. L., Freedy, J. R., Kilpatrick, D. G., & Falsetti, S. A. (1993). Trauma assessment for adults (TAA). Unpublished manuscript.
- Romans, S., Martin, J., & Mullen, P. (1997), Childhood sexual abuse and later psychological problems: Neither necessary, sufficient nor acting alone. Criminal Behavior and Mental Health, 7, 327–338.
10.1002/cbm.193 Google Scholar
- Rytwinski, N. K., Scur, M. D., Feeny, N. C., & Youngstrom, E. A. (2013). The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: A meta analysis.Journal of Traumatic Stress, 26(3), 299–309.
- Schnurr, P., Friedman, M., Engel, C., Foa, E., Shea, M., Chow, B., … & Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297, 820–830.
- Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50, 965–974.
- Sheehan, D.V. (1983). The anxiety disease. New York: Scribner's.
- Shore, J. H., Vollmer, W. M., & Tatum, E. L. (1989). Community patterns of posttraumatic stress disorders. Journal of Nervous and Mental Disease, 177, 681–685.
- Skre, I., Onstad, S., Torgeson, S., & Kringlen, E. (1991). High interrater reliability for the structured clinical interview for DSM-III-R axis I. (SCID-1). Acta Psychiatrica Scandinavica, 84, 167–173.
- Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1992). The Structured Clinical Interview for DSM-III-R (SCID I): History, rationale, and description. Archives of General Psychiatry, 49, 624–629.
- Stirman, S., & DeRubeis, R. (2006). Research patients and clinical trials are frequently representative of clinical practice. In: J. Norcross, L. Beutler, & R. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. Washington, DC: American Psychological Association.
- Terr, L. C. (1991). Childhood trauma: An outline and overview. American Journal of Psychiatry, 148, 10–20.
- van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389–399.
- Westen, D. (2006). Discovering what works in the community: Toward a genuine partnership of clinicians and researchers. In S. Hofmann & J. Weinberger (Eds.), The art and science of psychotherapy (pp. 22–46). London: Routledge.
- Westreich, D. (2012). Berkson's bias, selection bias, and missing data. Epidemiology, 23(1), 159–164.
- Zlotnick, C., Zakriski, A. L., Shea, M. T., & Costello, E. (1996). The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. Journal of Traumatic Stress, 9(2), 195–205.
