The prediction of levels of posttraumatic stress levels by depression among veterans with disabilities.Epidemiological studies give evidence that posttraumatic stress disorder Posttraumatic stress disorder An anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life. (PTSD PTSD posttraumatic stress disorder. PTSD abbr. posttraumatic stress disorder Post-traumatic stress disorder (PTSD) ) is a mental health issue among many different cross-sections of society (Breslau, Davis, Andreski, & Peterson, 1991; Breslau et al., 1998; Davidson, Hughes, & Blazer, 1991; Helzer, Robins, & McEvoy, 1987). Awareness of PTSD has heightened in the past few decades, which may be partially as a result of the American Psychiatric Association's (APA (All Points Addressable) Refers to an array (bitmapped screen, matrix, etc.) in which all bits or cells can be individually manipulated. APA - Application Portability Architecture ) introduction in 1980 of PTSD into official American psychiatric nomenclature (APA, 1980). PTSD is characterized by an individual's exposure to one or more events that involve death, threat to life or limb The phrase within the Fifth Amendment to the U.S. Constitution, commonly known as the Double Jeopardy Clause, that provides, "nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb," pursuant to which there can be no , or serious injury (APA, 2000) and a cluster of psychological responses to the memories of those events, consisting of intrusive, avoidant, and hyperarousal symptoms. Researchers have investigated the coexistence of PTSD with other psychiatric disorders, such as depressive disorders Depressive Disorders Definition Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. , anxiety disorders Anxiety disorders A group of distinct psychiatric disorders characterized by marked emotional distress and social impairment, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. , and substance abuse (Keane & Kaloupek, 1997; Kessler, Sonnega, Bromet, & Nelson, 1995; Kulka et al., 1990; Yehuda & McFarlane, 1995). In view of the limited number of empirical studies Empirical studies in social sciences are when the research ends are based on evidence and not just theory. This is done to comply with the scientific method that asserts the objective discovery of knowledge based on verifiable facts of evidence. on the association between PTSD and depression among individuals who have disabilities (Martz, 2004), the purpose of this study is to investigate whether depression predicts posttraumatic posttraumatic /posttrau·mat·ic/ (post?traw-mat´ik) occurring as a result of or after injury. post·trau·mat·ic adj. Following or resulting from injury or trauma. stress levels, after controlling for demographic variables, among U.S. veterans with service-connected disabilities. The following sections will briefly review selected demographic factors that have been found to be related to posttraumatic stress levels. Age Age has not always been found to be a predictor of PTSD, though the trend appears to be that a younger age predicts higher posttraumatic stress levels. Cordova Cordova, Spain: see Córdoba. et al. (1995) found that among women who had received treatment for breast cancer, age was the only significant predictor of posttraumatic stress levels, with a younger age related to higher levels of posttraumatic stress. Perry, Cella, Falkenberg, Heidrich, and Goodwin (1987) found that among individuals with severe burns, those who exhibited PTSD were significantly younger than those without PTSD. Thompson (1999) found that among individuals who had experienced a myocardial infarction myocardial infarction: see under infarction. , age was significantly related to posttraumatic stress levels, with a younger age related to higher levels of PTSD. In contrast, Roca, Spence, and Munster (1992) indicated that age did not significantly predict posttraumatic stress levels among 43 individuals with burn injuries. Education Findings are mixed on whether education level is a significant predictor of posttraumatic stress levels. The National Comorbidity Survey found education was not a significant predictor of PTSD after controlling for gender, age, and marital status marital status, n the legal standing of a person in regard to his or her marriage state. (Kessler, Sonnega, Bromet, & Nelson, 1995). Breslau, Davis, Andreski, Peterson, and Schultz (1997) found that education level was not significantly associated with PTSD. Yet, Breslau et al. (1991) found that individuals with lower levels of education had a greater percentage of PTSD than those with higher levels of education. Gender Multiple research studies have demonstrated that, in general, women have higher rates of PTSD than men (Breslau et al., 1997; Helzer, Robins, & McEvoy, 1987; Kessler, Sonnega, Bromet, & Nelson, 1995; Zlotnick, Zimmerman, Wolfsdorf, & Mattia, 2001). Kessler and colleagues (1995) estimated that the prevalence of PTSD among American women (10.4%) was twice as likely as men (5%). In contrast to the percentages observed in a community population, the National Vietnam Veterans This article is about the French band. For veterans of the Vietnam War, see Vietnam veteran. The Vietnam Veterans were a six-person French psychedelic group that released six records in the 1980s. The band was praised by many alternative music publications. Readjustment re·ad·just tr.v. re·ad·just·ed, re·ad·just·ing, re·ad·justs To adjust or arrange again. re Study (NVVRS) found that among Vietnam theater veterans, PTSD was more common in men (15.2%) than in women (8.5%) (Kulka et al., 1990). Findings are mixed regarding the prevalence of PTSD in gender categories among individuals who have experienced an injury or disability. Perry, Cella, Falkenberg, Heidrich, and Goodwin (1987) found that individuals who had severe burns and PTSD were more likely to be male than those with burns and without PTSD. Roca, Spence, and Munster (1992) found that gender did not significantly predict posttraumatic stress levels among individuals with burn injuries. Powers, Cruse, Daniels, and Stevens (1994) found that gender approached significance (p = .0545) between those with PTSD and those without PTSD who had experienced burns. Marital Status Findings are mixed on whether marital status predicts PTSD. The National Comorbidity Survey found that marital status was a significant predictor of PTSD after controlling for age (Kessler, Sonnega, Bromet, & Nelson, 1995). More specifically, men and women who had been previously married (i.e., were separated, divorced, or widowed) were significantly more likely to have a lifetime prevalence of PTSD than men and women who were currently married. Further, the lifetime prevalence of PTSD, after controlling for age, was higher among married men than it was among men who had never married, which was a trend that was also true for women (Kessler, Sonnega, Bromet, & Nelson, 1995). Perry, Cella, Falkenberg, Heidrich, and Goodwin (1987) found that among individuals with severe burns, those with PTSD were significantly more likely to be married than individuals without PTSD. Coexistence of PTSD and depression In a community sample of 1200 young adults, Breslau, Davis, Andreski, and Peterson (1991) found the occurrence of PTSD diagnosis with another psychiatric diagnosis in 82.8% of the individuals; 36.6% had major depression along with PTSD. McFarlane and Papay (1992) found that major depression was the most common diagnosis coexisting with a PTSD diagnosis among 147 volunteer fire fighters. In a sample of 20 individuals who had experienced a motor vehicle accident motor vehicle accident Public health A morbid condition that kills 45,000/yr–US; 60% are < age 35; MVAs account for 500,000 hospitalizations and most 20,000 spinal cord injuries, at a cost of $75 billion/yr and reported pain problems, Hickling and Blanchard (1992) found that five of the 10 individuals who had a diagnosis of PTSD also had Major Depressive Disorder Major depressive disorder A mood disorder characterized by profound feelings of sadness or despair. Mentioned in: Conduct Disorder major depressive disorder . Shalev et al.'s (1998) prospective study on PTSD among trauma survivors with non-permanent, physical injuries who were seen in an emergency room (N = 211) found that at one month after the trauma, 44.4% of the individuals with a PTSD diagnosis had major depression. Zayfert, Becker, Unger, and Shearer (2002) found that among individuals referred for treatment for anxiety disorders (N = 310), 36% had a PTSD diagnosis, while 48% of that group had a coexisting diagnosis of Major Depressive Disorder. In a random sample of 50 individuals who were utilizing services at the Boston PTSD Center, Keane and Wolfe (1990) found a coexistence of PTSD with major depression among 68% of this group and a coexistence with dysthymia dysthymia /dys·thy·mia/ (-thi´me-ah) dysthymic disorder. dys·thy·mi·a n. A mood disorder characterized by despondency or mild depression. among 34% of this sample. Roszell, McFall, and Malas malas (m  ·läsˑ),n. (1991) found that among a sample of 48 Vietnam veterans, 64.6% had major depression concurrent with a PTSD diagnosis. Zatzick and colleagues (1997) examined data on 1,200 male Vietnam veterans and found that the odds of PTSD were 17.6 times greater among individuals who had major depression. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. Hankin, Spiro, Miller, and Kazis (1999), 55% of 2,160 U.S. veterans who had depression also had PTSD. Stein, McQuaid, Pedrelli, Lenox, and McCahill (2000) assessed for PTSD among 368 individuals who used a primary care clinic, of which 11.8% screened positive for PTSD (full or partial PTSD). Of the individuals with PTSD, 61.1% also had Major Depressive Disorder. In view of the above research, the purpose of this study is to examine whether depression levels predict posttraumatic stress levels, after controlling for demographic variables, among veterans with disabilities. Method Participants This study involved an analysis of archival data from case records of U. S. military veterans (N = 245) with service-connected disabilities, who received services from a private provider of vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment rehabilitation - the restoration of someone to a useful place in society services in Montana. No identifying information was provided in the archival data that would allow the researchers to connect the data with any one individual. In this sample, 82.2% were male and 17.8% were female. The mean age of this sample was 37.5 years (SD = 9.4), ranging from 21 to 60 years old. The years of education averaged 13.07 years (SD = 1.55) and ranged from 7 to 18 years of education. The marital status included 63.3% married, 17.1% divorced, 13.3% separated, .4% widowed, and 5.9% other or no answer. Although there was a broad range of disabilities reported, 60% of this sample listed problems in the musculoskeletal system Noun 1. musculoskeletal system - the system of muscles and tendons and ligaments and bones and joints and associated tissues that move the body and maintain its form as the primary disability, followed by psychosocial (7.9%) and circulatory circulatory /cir·cu·la·to·ry/ (ser´ku-lah-tor?e) 1. pertaining to circulation, particularly that of the blood. 2. containing blood. cir·cu·la·to·ry n. 1. (5%) systems. Because many veterans reported multiple disabilities, there was no straightforward way to create a "severity of disability" composite variable from this archival database and thus, such data were not reported. The veterans were from the following branches: 59.7% Air Force, 22.9% Army, 12.7% Navy, 4.2% Marine Corps; and .4% Coast Guard. The total years of active duty averaged 11.9 (SD = 7.9). Only part of the sample reported combat tours (N = 48). The extent of combat exposure was not available in this data. The average total years of reserve duty was minimal (M = .04, SD = .59). Procedures Institutional Review Board (IRB IRB See: Industrial Revenue Bond ) approval was obtained for the analysis of this secondary data. A separate IRB approval for primary data analysis had been given to the researcher (T. B.), who originally collected the data during his provision of vocational rehabilitation sessions to the veterans. Information from the vocational rehabilitation reports, written by T.B., was later entered into a database. All information that would enable the identification of a subject was removed from the database before the data was obtained for this study. Instruments For this secondary data analysis, the following instruments were used: a. Minnesota Multiphasic Personality Inventory-2 (MMPI-2): The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) is a self-report psychological instrument consisting of 567 true-false questions. It provides 3 validity, 10 clinical scales, and supplementary scales (Graham, 2000). Three scales were used in this study: one 57-item Depression scale (D) and two supplementary scales: the 46-item Posttraumatic Stress Disorder-Keane scale [PK] (Keane, Malloy, & Fairbank, 1984), and the 60-item Posttraumatic Stress Disorder-Schlenger [PS] (Schlenger & Kulka, 1987). Though these 2 PTSD scales were originally developed among samples of combat veterans, they have subsequently been used among other veteran and civilian samples (Graham, 2000; Miller, Goldberg, & Streiner, 1995). The Cronbach's alpha Cronbach's  (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. in a MMPI-2 normative sample was reported as [alpha] = .85 for men and
[alpha] = .87 for women in the PK scale (Graham, 2000), or [alpha] = .86
for males and [alpha] = .89 for females (Briere, 2004). Internal
consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. was found to be [alpha] = .89 for men and [alpha] = .91 for
women in the PS scale (Graham, 1990). Briere (2004) reported research
that found a higher Cronbach's [alpha] = .95 for the PK scale.
Cronbach's alpha coefficients were not available for this archival
research, because the database contained total scores only for the
MMPI-2 scales. Briere (2004) summarized studies that analyzed the
discriminant validity Discriminant validity describes the degree to which the operationalization is not similar to (diverges from) other operationalizations that it theoretically should not be similar to. of the PK and PS scales.Standardized T scores were used in this analysis. In this sample, the PK scale M = 54.45 (SD = 14.40) and PS scale M = 54.82 (SD = 14.66). The Pearson correlation coefficient Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: between the PK and PS scales was high, r = .96, p < .001, which was similar to the findings of Miller, Goldberg, and Streiner (1995). Both the PK and PS scales were utilized in this study as a form of cross-validating the results of the statistical analyses. Because the PK and PS scales measure PTSD symptoms, then using both scales in separate statistical analyses demonstrated whether the results of the regressions were similar for both scales. In this study, the topic of interest was the variance of posttraumatic stress levels (as measured by the PS and PK scales of the MMPI-2) and not the existence of a PTSD diagnosis. Posttraumatic stress levels, not PTSD diagnosis, were the focus of the study for several reasons. Shalev et al. (1998) advocated for decreasing the use of categorical PTSD measures (e.g., diagnosis) and for utilizing continuous dimensions of response to trauma (e.g., posttraumatic stress levels). Researchers have cautioned that the PK and PS scales should not be the sole means of making a PTSD diagnosis, because according to some research, there is some overlap of these scales with indicators of general psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. (Miller, Goldberg, & Streiner, 1995; Wise, 1996). More importantly, in view of the six criteria needed to diagnosis PTSD (APA, 2000), information on factors such as an experience of an overwhelming trauma that involved threat to life or limb (Criterion A) and time since trauma (Criterion E) are not included in the PTSD scales in the MMPI-2 assessment. Thus, the MMPI MMPI abbr. Minnesota Multiphasic Personality Inventory MMPI Child psychiatry A personality assessment tool widely used in making psychologic evaluations, which is normally given at age 16 and older. Personality testing 2 inventory alone should not be used for a PTSD diagnosis. Although clinical cut-off cut-off Anesthesiology The point at which elongation of the carbon chain of the 1-alkanol family of anesthetics results in a precipitous drop in the anesthetic potential of these agents–eg, at > 12 carbons in length, there is little anesthetic activity, scores on the PTSD scales may signal the existence of PTSD symptoms, other means of assessment should be used to make a PTSD diagnosis (Miller, Goldberg, & Streiner, 1995). In view of the possibility that some of this sample may have over-reported PTSD symptoms to receive greater monetary compensation, it was debated whether the F scale (Infrequency scale) or the K scale (Correction or Subtle Defensiveness scale) of the MMPI-2 should be utilized in this study to detect "malingering Malingering Definition In the context of medicine, malingering is the act of intentionally feigning or exaggerating physical or psychological symptoms for personal gain. ." Yet, multiple studies have indicated that individuals who have experienced trauma demonstrated elevated F scales, due to managing a greater level of psychological distress (see Elhai, Ruggiero, Frueh, Beckham, & Gold, 2002). Further, Elhai et al. (2002) reported an overlap of items of the PK and PS with the K scale, which may elevate K scores if people expressed reactions to trauma. Therefore, the use of the F or K scales among a population who has experienced trauma (such as a disability) appeared problematic and thus, was not used in this research. b. Demographics: Demographic information, such as age, education, gender, and marital status, was collected during interviews by the provider (T. B.) of vocational rehabilitation services. Results Two hierarchical multiple regression Multiple regression The estimated relationship between a dependent variable and more than one explanatory variable. analyses were run with the two PTSD scales (as measured by the PK and PS scales of the MMPI-2) as the separate dependent variables. For each regression, the independent variables were entered in two blocks, in order to control for the influence of the demographic variables. The first block contained the following demographic variables: age, education, gender, and marital. The second block contained only the depression variable (as measured by the D scale of the MMPI-2). In each of the multiple regression analysis of one PTSD scale, the block of demographic variables was not significant (see Table 1), nor were the regression coefficients of the demographic variables significant in this step in both analyses. With the addition of depression in the second step of the regression, the variance explained in each of the PTSD scales (see Table 1) became significant. In each of the regression equations, depression had a significant regression coefficient. Depression explained 44% of the variance in the PK scale and 46% of the variance in the PS scale after controlling for demographic variables. Discussion The purpose of this study was to examine whether depression levels predicted posttraumatic stress levels after controlling for demographic variables. The results indicated that depression explained almost half (44-46%) of the variance in PTSD levels among veterans with disabilities, over and above the insignificant variance explained by demographic variables. These relatively strong results among veterans with disabilities concur with the findings regarding the elevated co-occurrence of depression and PTSD among a veteran population in general (Hankin, Spiro, Miller, & Kazis, 1999; Keane & Wolfe, 1990; Roszell, McFall, & Malas, 1991; Stein, McQuaid, Pedrelli, Lenox, & McCahill, 2000). These findings also are in accordance with the few studies that have examined the coexistence of depression and PTSD among individuals with disabilities or severe injuries (Hickling & Blanchard, 1992; Martz, 2004; Shalev et al., 1998). This study provides more information about ability of depression to predict the existence of posttraumatic stress levels among veterans with disabilities. It is also noteworthy that all of the four demographic variables (age, education, ethnicity, and marital status) predicted an insignificant amount of posttraumatic stress levels in this study. This indicated that posttraumatic stress levels, in general, were not more elevated in certain subgroups of this sample, when making comparisons by demographics. Having elevated posttraumatic stress levels may interfere with the rehabilitation process (Keim, Malesky, & Strauser, 2003; Strauser & Lusting, 2001). Thus, it is important for rehabilitation counselors to become more cognizant of PTSD and what factors may increase the likelihood of elevated posttraumatic stress levels. Awareness of PTSD is growing in the field of rehabilitation counseling rehabilitation counseling, n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the . Penk and Flannery (2000) wrote a multifaceted mul·ti·fac·et·ed adj. Having many facets or aspects. See Synonyms at versatile. Adj. 1. multifaceted - having many aspects; "a many-sided subject"; "a multifaceted undertaking"; "multifarious interests"; "the multifarious chapter about psychosocial rehabilitation, suggesting some specific techniques to use in order to pormote coping with traumatic memories. Strauser and Lusting (2001) and Martz (2001a, 2001b) wrote about PTSD in the context of disability and vocational rehabilitation. This study indicates that higher levels of depression in rehabilitation clients significantly predicted elevated levels of posttraumatic stress. Rehabilitation counselors can use these findings as a guidepost for what kind of psychological assessments (e.g., an assessment for PTSD) should be requested for their rehabilitation clients. Thus, rehabilitation counselors should consider requesting an assessment for PTSD if they notice elevated depression in their clients. Limitations This archival research is limited in several ways. The sample included only veterans with disabilities who utilized vocational rehabilitation services in Montana. The sample also was composed primarily of males. This constricts the generalizability to a similar population and geographical area. Due to the correlational nature of this study, the hypothesis that depression levels predicted posttraumatic stress levels could have been reversed (i.e., posttraumatic stress levels predicting depression). Such a reversal would have given different information; but the authors wanted to focus in the study on PTSD and its ramifications ramifications npl → Auswirkungen pl . Further, because this research was archival, no connections could be made between posttraumatic stress levels and the type of trauma that triggered posttraumatic reactions. Many kinds of traumatic events, other than military events or disability, may have caused PTSD symptoms. Conclusions The results of this study indicated that depression levels predicted almost half of the fluctuation in PTSD levels among veterans with disabilities after controlling for demographic variables. A clinical implication of these results is that if a veteran with a disability exhibits some form of depression, then the possibility of the simultaneous existence of posttraumatic stress symptoms should be investigated. Such knowledge can provide more information and understanding about the client's psychological status, which rehabilitation counselors can utilize to facilitate movement toward psychological adjustment.
Table 1
Hierarchical multiple regression of PTSD levels
Adj. [DELTA] =
Variable/step [R.sup.2] [R.sup.2] [R.sup.2]
PK Scale
Step 1 .01 -.01 .01
Marital [beta] = .08
Gender [beta] = -.05
Age [beta] = -.04
Education [beta] = -.06
Step 2 .45 .44 .44
Depression [beta] = .67 *
PS Scale
Step 1 .02 .00 .02
Marital [beta] = .13
Gender [beta] = -.05
Age [beta] = .02
Education [beta] = -.04
Step 2 .48 .47 .46
Depression [beta] =.68 *
Variable/step F df [DELTA] = F
PK Scale
Step 1 .76 4,210 .76
Marital [beta] = .08
Gender [beta] = -.05
Age [beta] = -.04
Education [beta] = -.06
Step 2 34.14 5,209 165.33 *
Depression [beta] = .67 *
PS Scale
Step 1 1.18 4,210 1.18
Marital [beta] = .13
Gender [beta] = -.05
Age [beta] = .02
Education [beta] = -.04
Step 2 39.01 5,209 186.17 *
Depression [beta] =.68 *
* Significant at p < .01
Acknowledgments We would like to thank Stephen Leierer, Ph.D., Kristy Brumfield, and Niki Termine, from Louisiana State University Louisiana State University and Agricultural and Mechanical College, generally known as Louisiana State University or LSU, is a public, coeducational university located in Baton Rouge, Louisiana and the main campus of the Louisiana State University System. Health Sciences Center, for help with data management. References American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. . (1980). Diagnostic and statistical manual of mental disorders Diagnostic and Statistical Manual of Mental Disorders /Di·ag·nos·tic and Sta·tis·ti·cal Man·u·al of Men·tal Dis·or·ders/ (DSM) a categorical system of classification of mental disorders, published by the American Psychiatric Association, that delineates objective (3rd ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Breslau, N., Davis, G. C, Andreski, P., & Peterson, E. L. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry Archives of General Psychiatry is a monthly professional medical journal published by the American Medical Association. Archives of General Psychiatry publishes original, peer-reviewed articles about psychiatry, mental health, behavioral science and related fields. , 48, 216-222. Breslau, N., Davis, G., Andreski, P, Peterson, E., & Schultz, L. (1997). Sex differences in posttraumatic stress disorder. Archives of General Psychiatry, 54 (11), page ??. Breslau, N., Kessler, R. C., Howard, D. C, Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area survey of trauma. Archives of General Psychiatry, 55, 626-632. Briere, J. (2004). Psychological assessment of adult posttraumatic states: Phenomenology phenomenology, modern school of philosophy founded by Edmund Husserl. Its influence extended throughout Europe and was particularly important to the early development of existentialism. , diagnosis, and measurement (2nd ed.). Washington, D.C.: American Psychological Association The American Psychological Association (APA) is a professional organization representing psychology in the US. Description and history The association has around 150,000 members and an annual budget of around $70m. . Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2: Minnesota Multiphasic Personality Inventory-2: Manual for administration and scoring. Minneapolis: University of Minnesota Press The University of Minnesota Press is a university press that is part of the University of Minnesota. External link
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Paper presented at the 95th annual meeting of the American Psychological Association, New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of . Shalev, A. Y., Freedman freed·man n. A man who has been freed from slavery. freedman Noun pl -men History a man freed from slavery Noun 1. , S., Peri, T., Brandes, D., Sahar, T., Orr, S. P., & Pittman, R. K. (1998), Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 155 (5), 630-637. Stein, M., McQuaid, J., Pedrelli, P., Lenox, R., & McCahill, M. (2000). Posttraumatic stress disorder in the primary care medical setting. General Hospital Psychiatry, 22, 261-269. Strauser, D. R., & Lusting, D. C. (2001). The implications of posttraumatic stress disorder on vocational behavior and rehabilitation planning. Journal of Rehabilitation, 67 (4), 26-30. Thompson, R. N. (1999). Prediction of trauma responses following myocardial infarction. Unpublished doctoral dissertation. Morgantown, West Virginia West Virginia, E central state of the United States. It is bordered by Pennsylvania and Maryland (N), Virginia (E and S), and Kentucky and, across the Ohio R., Ohio (W). Facts and Figures Area, 24,181 sq mi (62,629 sq km). Pop. : West Virginia University West Virginia University, mainly at Morgantown; coeducational; land-grant and state supported; est. and opened 1867 as an agricultural college, renamed 1868. . Wise, E. A. (1996). Diagnosing posttraumatic stress disorder with the MMPI clinical scales: A review of the literature. Journal of Psychopathology and Behavioral Assessment, 18 (1), 71-82. Yehuda, R., & McFarlane, A. C. (1995). Conflict between current knowledge about Posttraumatic stress disorder and its original conceptual basis. American Journal of Psychiatry, 152, 1705-1713. Zatzick, D. F., Marmar, C. R., Weiss, D. S., Browner, W. S., Metzler, T. J., Golding, J. M., Stewart, A., Schlenger, W. E., & Wells, K. B. (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 154 (12), 1690-1695. Zayfert, C., Becker, C. B., Unger, D. L., & Shearer, D. K. (2002). Comorbid anxiety disorders in civilians seeking treatment for posttraumatic stress disorder. Journal of Traumatic Stress Traumatic stress is recognized by the Diagnostic and Statistical Manual of Mental Disorders [1] as an acute emotional condition associated with reactive anxiety. , 15 (1), 31-38. Zlotnick, C., Zimmerman, M., Wolfsdorf, B., & Mattia, J. (2001). Gender differences in patients with posttraumatic stress disorder in a general psychiatric practice. American Journal of Psychiatry, 158, 1923-1925. Erin Martz University of Missouri, Columbia Kristin Birks, University of Missouri, Columbia Terry L. Blackwell Louisiana State University Erin Martz, Ph.D., C.R.C., Rehabilitation Counseling Program, Educational, School, and Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. Department, 4B Hill Hall, University of Missouri, Columbia, MO 65211-2130 Email: martze@missouri.edu |
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