Predicting Factors of PTSD 1
Predicting Factors of Post-Traumatic Stress Disorder (PTSD)
Shane Moore
HDFS 312W
Professor Laura Simone
The Pennsylvania State University- York Campus
Predicting Factors of PTSD 2
Topic Paragraph
Post-Traumatic Stress Disorder (PTSD) is defined as a psychological reaction that occurs
after experiencing a highly stressing event; it is usually characterized by depression, anxiety,
flashbacks, recurrent nightmares, and avoidance of reminders of the event (Merriam-Webster
Student Dictionary, 1999). PTSD can lead into serious health and mental issues of the individual
and can affect all age groups. It is possible that PTSD can be triggered by an individual’s current
socioeconomic status. Research shares that an individual can suffer from PTSD after
experiencing or witnessing rape, a natural disaster, terrorist attack, violent death, personal
assault, or a situation that cased fear, shock, or helplessness. The main focus of this study is to
investigate the influence of various environmental and intrapersonal factors upon PTSD and how
it affects emerging adults.
Annotated Bibliography
Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood
sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A
mediational model of posttraumatic stress disorder and physical health outcomes. Journal
of Consulting and Clinical Psychology, 76(2), 194-207. doi: 10.1037/0022006X.76.2.194
This study examined childhood sexual abuse, adult sexual assault, intimate partner
violence, and sexual harassment in predominately African Americans (N=268 female
veterans) that were randomly selected. The hypothesis is that these variables listed are
associated with PTSD, and that PTSD mediates the association between violence and
physical health outcomes in women. This is a cross sectional study, since it is mainly
observing and comparing different individuals at the same time. Researchers used a
Predicting Factors of PTSD 3
questionnaire (survey) which measured these components: Childhood sexual assault, adult
sexual assault, intimate partner violence, sexual harassment, and posttraumatic stress
symptomatology. Also, they created a correlation table among the variables in the Health
Impact Model for women’s health. The researchers in this study where able to show that
when PTSD is entered into the model, the association between violence and health indicators
decreased, because PTSD helps to explain, statistically, some of the strength of the initial
association between violence and health indicators. The limitation of the study is that of
short-behavioral assessments (questionnaires), it only allowed researchers of the study to
only learn about the specific acts that were listed in the study. They could have included a
measure of stalking or physical abuse as a child. The questionnaire that was given only
inquired about male-perpetrated assaults against women, which neglected same-sex assaults.
The strength of this study was that the results were consistent with the growing knowledge of
PTSD as a mediator of physical health.
Chemtob, C. M., Nomura, Y., Rajendran, K., Yehuda, R., Schwartz, D., & Abramovitz, R.
(2010). Impact of maternal posttraumatic stress disorder and depression following
exposure to the september 11 attacks on preschool children's behavior. Child
Development, 81(4), 1129-1141. doi:10.1111/j.1467-8624.2010.01458.x
This study examined behavioral problems of terrorism-exposed preschool children
(N=116; 18-54 months) with mothers who have post- traumatic stress disorder, depression, both
post- traumatic stress disorder and depression, or neither disorder. The hypotheses are that posttraumatic stress disorder, depression or both contribute to behavioral problems in children 18-54
months of age. There appears to be a gap in literature suggesting that the influence of maternal
psychopathology on pre-school children is not yet completely understood, with the majority of
Predicting Factors of PTSD 4
studies focusing on older children. The studies that have been completed relied on the mothers’
interpretation of children’s behavior creating a systematic bias in the ratings of the child's
behavior. The research found that teachers created this same systematic bias in the ratings of the
child's behavior. Examining both allowed the opportunity to evaluate the independent ratings of
children’s behavior. This study also compared women to men indicating that a women with
maternal post-traumatic stress disorder is more vigilant and irrational with regards to a possible
threat indicating that the danger to herself and child may be down played, the mother with PTSD
may not be able to create a sense of safety within the child compared to a mother with depression
who exhibits a lack of control. Mothers with depression are withdrawn and inaccessible and
display inconsistency in how the child is treated and disciplined. The study presents a strong
indication that mothers with both PTSD and depression have a profound impact on the child's
emotional and behavioral regulation, greater than mothers with depression alone. The strength of
this study is that it looked in depth at PTSD in relations to 9/11 World Trade Center attack; it
studied variables in relation to a crisis. The weakness of this study is the authors used PTSD as a
categorical variable; they did not look at the full spectrum of PTSD symptomology.
Cornelius, J. R., Kirisci, L., Reynolds, M., Clark, D. B., Hayes, J., & Tarter, R. (2010). PTSD
contributes to teen and young adult cannabis use disorders. Addictive Behaviors, 35(2),
91-94. doi: http://dx.doi.org/10.1016/j.addbeh.2009.09.007
This study examines the offspring of adult men who in the past engaged in substance
abuse. The children were studied for cannabis use disorder (CUD) and PTSD transitioning into
young adult hood. The researchers looked for groups of children who were most at risk for
substance use disorder (SUD). Biases were eliminated by using multiple sources and 89% of
families were recruited through public service announcements and 11% by marketing research
Predicting Factors of PTSD 5
companies. Families with a history of mental retardation, psychosis, and neurological injury
were excluded from the group. The study focused on children ages 10-12 for the initial study
with follow up being conducted at ages 12-14, 16, 19, 22 and 24. A longitudinal study was
completed over 5 years with a total of 693 subjects, 31 of the subjects met diagnostic criteria for
PTSD. There were 662 participants who did not meet the criteria and 73 met the criteria for
anxiety disorders other than PTSD. A longitudinal study was completed to observe CUD leading
to PTSD and PTSD leading to CUD where (N=343) of fathers who had SUD and those with no
lifetime history of SUD (N=350). Participants who met the criteria were more than likely to be
female (48%-vs-26.9%) being men chi square being just 6.8. Because the study is not a random
study and the majority of participants were more men than women, the sample was not a random
sample from across the United States, so the results may not generalize to the United States as a
whole. Future studies need to clarify the role of PTSD vs. the role played by other anxiety
disorders.
Davis, T. D., Sullivan, G., Vasterling, J. J., Tharp, A. L. T., Han, X., Deitch, E. A., & Constans,
J. I. (2012). Racial variations in post-disaster ptsd among veteran survivors of hurricane
katrina. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 447-456.
doi: 10.1037/a0025501
This study examined the racial differences in post-disaster clinical outcomes such as
vulnerability factors, during-disaster factors, and post-disaster factors. After controlling for these
factors 304 military veterans were exposed to Hurricane Katrina (N=304, n=149 AfricanAmerican, n= 155 White survivors). All participants were between the ages of 18 and 60. The
prediction was that African American veterans are more likely to have post-Katrina
Posttraumatic Stress Disorder than Whites (40% African Americans vs. 27% Whites). This is a
Predicting Factors of PTSD 6
longitudinal study. The VA administrative files found at the Austin Information Technology
Center were used to identify veterans with pre-hurricane mental illnesses and veterans with no
pre-hurricane mental illnesses. Telephone interviews were used to obtain information on race. A
conceptual model was used to organize the controversies of each factor. Bivariate analyses were
performed to compare post-Katrina diagnoses across the racial groups. The main finding was
that White veterans were more likely to have more chronic medical issues and a higher chance of
lifetime traumatic events than African-American veterans. However, African-American veterans
reported to have more Katrina traumatic events than White veterans, and are more likely to be
labeled or screened positive than Whites for post-hurricane PTSD. This supported the hypotheses
proposed by the researchers. The limitation was that the researchers used data from a study that
was not specifically designed to assess the relationships between the two ethnic groups and the
post disaster outcomes, causing potentially important variables to be unmeasured.
Dekel, S., Ein-Dor, T., & Solomon, Z. (2012). Posttraumatic growth and posttraumatic distress:
A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy,
4(1), 94-101. doi: 10.1037/a0021865
This is a longitudinal study that examined the bidirectional relation between
posttraumatic growth and distress. The prediction is that traumatic events jeopardize physical
and psychological equilibrium, and that these events give rise to a range of physical and mental
health complications. Researchers used data from a longitudinal study on the psychological
implications of war. A group of Israeli veterans (N=240) from the Yom Kippur War participated
in this study and were followed for over 17 years by researchers at three time periods: 1991(T1),
2003 (T2), and 2008 (T3). An informed consent was signed before a questionnaire was
administered in the home of the veterans. The main finding is that post-traumatic growth is a
Predicting Factors of PTSD 7
response to posttraumatic distress. The limitations of the study is that it provides predictions but
and does not allow clear-cut conclusion regarding causation relations. However, this study gives
knowledge on the fact that distress is vital in setting growth in motion.
Guanghua, C., Huizhang, S., & Guangming, C. (2012). A cross-sectional study on
posttraumatic stress disorder among elderly qiang citizens 3 years after the wenchuan
earthquake in china. Canadian Journal Of Psychiatry, 57(9), 547-553.
This study examines PTSD and seeks to identify associated risk in elderly citizens in the
Qiang ethnic group 3 years after the Wenchuan earthquake in China. Earthquakes can be
devastating and traumatic leaving a person feeling a sense of terrible loss and most often leads to
mental health issues, with the elderly being most vulnerable. Various studies have reported rates
of PTSD among survivors at a rate of 2% to 87%. The study that was conducted was a crosssectional design implicating limitations due to being conducted in one single region with a small
sample size. The subjects were surveyed from July 4, 2011 to August 16, 2011. A minimum of
300 participants were required for a 95% confidence rate in the study. An assessment
questionnaire was used consisting of two parts about sex, age, marital status, education level,
monthly income, witnessed casualties, bodily injury, relative loss, bereavement, and received
social support. PTSD was assessed using the CAPS for DSM-IV, a widely used clinicianadministered instrument. The analysis used frequencies, means, standard deviation, and
proportions. Significantly more females took part in the study than males. The study showed
that at least out of 88.3% of the participants, 81 year old or people with low social support were
2.5 times more likely to exhibited signs of PTSD, and the widowed elderly were at least 3.0 more
times likely to exhibit PTSD than people who had a higher education.
Predicting Factors of PTSD 8
Goodman, R. D., Miller, M. D., & West-Olatunji, C. (2012). Traumatic stress, socioeconomic
status, and academic achievement among primary school students. Psychological
Trauma: Theory, Research, Practice, and Policy, 4(3), 252-259. doi: 10.1037/a0024912
The study examines the under achievement of lower socioeconomic status and how
psychological trauma may be related and predicts educational achievement. The study used 5th
grade students from a nationally representative Early Childhood Longitudinal Study, The Class
of 1998-99 database. A regression analyses was used to determine whether or not Post
Traumatic Stress Disorder and SES are related. Because trauma is often over looked in children,
only recently has PTSD and SES been acknowledge in young children indicating the need for all
providers as well as teachers to be educated and aware of this possibility. The data set collected
by the National Center for Education Statistics (NCES) and ECLS-K, a national representative
longitudinal study was designed to measure the cognitive, social, emotional and physical
development in the home and school environment. The assessments included parent interviews
and teacher assessments from 1999-2002. The composite variable was from the parent’s
occupation, education level, and income. The latent independent variable, traumatic stress was
identified through re-experiencing, avoidance, and arousal as either internalizing or externalizing
behaviors. The total weighted sample size was 3,387,565 fifth grade students, with 58.9% being
White students, African American students making up 14.4%, Latino students 19.3% and Asian
students 2.9% with the remaining students as other making up 4.5%. The study found that as
PTSD declined SES increased. The study also found that for students with both PTSD and lower
SES, reading and math levels significantly declined. Thus an important finding of this study is
that children who experience PTSD and lower SES are likely to have poorer school performance.
Predicting Factors of PTSD 9
A large nationally representative sample was used in the ECLS-K. However, further research
could give insight into developmental process that helps to explain this association.
Read, J.P., Colder C. R., Merrill, J. E., Ouimette, P., White, J., & Swartout, A. (2012). Trauma
and posttraumatic stress symptoms predict alcohol and other drug consequence
trajectories in the first year of college. Journal of Consulting and Clinical Psychology,
80(3), 426. Retrieved from http://search.proquest.com/docview/1018051142?accountid=13158
This study examines PTSD and trauma associated with alcohol and other substance
abuse. Matriculating college students (N=997) complete surveys through their first year of
college. Latent growth analysis with trajectories of alcohol and drug related consequences were
modeled to examine how trauma symptoms predicted the trajectories. Traumas among college
students is very high includes sexual assault and types of violence. Research supports a
dimensional model of psychological responses to traumas, with PTSD. Out of the (N=997) 68%
were female, 73% were Angelo Caucasian (n=723), 11% were Asian (n=113), 9% were African
American (n=90), 3% were Hispanic (n=33). Initial screening included a target longitudinal
sample of college students. Students were sent emails with links to the survey. Students had to
report at least one traumatic event or experienced PTSD. Measures included alcohol use, alcohol
related consequences, illicit substance use and illicit substance related consequences. Seventy
four percent (n=735) endorsed at least one criterion and that being some type of trauma. The
results indicated that PTSD and trauma may not have caused alcohol and other substance abuse,
but it is one of many common factors.
McDermott, B. M., Lee, E. M., Judd, M., & Gibbon, P. (2005). Post-traumatic stress disorder
and general psychopathology in children and adolescents following a wildfire disaster.
Predicting Factors of PTSD 10
The Canadian Journal of Psychiatry / La Revue Canadienne De Psychiatrie, 50(3), 137143. Retrieved from http://search.proquest.com/docview/620732210?accountid=13158
This study examines PTSD in children that had exposure to a wild life disaster. The
method used in this study was a school based program related to wild life disaster events. The
screen included 222 children with a mean age of 12.5, SK 2.48; range 8 to 18 years of age. 9% of
students reported severe to very severe PTSD. Younger children experienced higher levels of
PTSD. While female students experienced a higher perception of a threat, they did not indicate
higher levels of PTSD. There are limitations on this type of study solely relying on parents and
teachers observations. There was also no measure of pre-disaster resilience and vulnerability
factors. The Post Traumatic Stress Disorder Reaction Index, a 20-item measure of PTSD was
used along with “The Strengths and Difficulties” Questionnaire, to assess child and adolescent
psychopathology. The screening program identified individuals who had direct exposure
reported higher levels of PTSD and emotional problems at follow-up.
Tang, S. S. S., & Freyd, J. J. (2012). Betrayal trauma and gender differences in posttraumatic
stress. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 469-478.
doi: 10.1037/a0025765
This study was designed to examine the role of betrayal trauma in explaining why women
report higher rates of post-traumatic stress than men. Betrayal trauma has been linked to poor
mental health, depression, anxiety, and PTSD. It is possible that closeness to the perpetrator acts
as a partial mediator of gender differences. Nationwide studies have reported rates of PTSD to
range from 5% to 6% in men and 10% to 13% in women. Despite the higher rates of PTSD in
women, men reported higher overall rates of traumatic events. A meta-analysis of studies over
the past 25 years reported rates of PTSD by gender to investigate whether the type of trauma
Predicting Factors of PTSD 11
accounts for gender differences in PTSD. For traumatic events including but not limited to
natural disasters, physical assault, accidents and combat, women had higher rates of PTSD with
greater severity than men. Participants for the study were from the University of Oregon
Psychology Department Human Subjects pool and also the greater community. Participants
were not informed of the content of the survey, with 1,047 completing the survey. Of the 1,047,
six participants were excluded leaving 1,041 participants, 705 were women and 336 were men.
The age group was 16 to 54 and 87% of the sample were 18 to 21 years of age. The survey was
conducted online and asked demographic questions and measured psychological symptoms of
distress. A meta-analysis concluded that estimates of abuse are likely to underestimate the true
prevalence when base upon a single report. The study shows women are more likely than men to
suffer from PTSD, but this study does not necessarily explain why. Further investigation of
social contextual factors needs to be done to have a better understanding of the causes of gender
differences in post-traumatic stress.
The Current Study
Research Question #1:
1. What is the relationship between traumatic events and PTSD?
Hypothesis #1:
It is hypothesized that severity of traumatic events will be positively associated with PTSD
symptomology.
Research Question #2:
2. Does substance abuse moderate the association between traumatic events and PTSD?
Hypothesis #2:
It is hypothesized that substance abuse will moderate the association between traumatic events
and PTSD, such that the influence of traumatic events on PTSD will be even stronger for those
who engage in substance abuse.
Predicting Factors of PTSD 12
Research Questions #3:
3. Will pre-existing diagnoses (i.e., anxiety, depression, behavioral disorders, and emotional
disorders) moderate the association between traumatic events and PTSD? That is, will the
influence of traumatic events on PTSD be even stronger for those with such diagnosed
conditions?
Hypothesis #3:
It is expected that pre-existing diagnoses will moderate (i.e., exacerbate) the influence or
association between traumatic events and PTSD, such that those with such diagnoses will
experience more severe PTSD symptomology.
Predicting Factors of PTSD 13
Model 1. Substance Abuse Moderating the Association between Traumatic Events and PTSD
Substance
Abuse
Traumatic Events

Natural Disaster

Accidents

Violent Crime
Post Traumatic Stress
Disorder (PTSD)
Predicting Factors of PTSD 14
Model 2. Pre-Existing Diagnoses Moderating the Association between Traumatic Events and PTSD
Pre-Existing
Psychological Diagnosis

Anxiety

Depression

Emotional
Disorder

Behavioral
Disorder
Traumatic Events

Natural Disaster

Accidents

Violent Crime
Post Traumatic Stress
Disorder (PTSD)
Predicting Factors of PTSD 15
Sampling Technique and Sampling description
Due to the fact that my target audience is a large population, I will be using the stratified sampling technique. I can than divide my
target groups into subgroups, making sure that each age group is represented. The advantage of the stratified sample is that the sample
will be representative of the population. The disadvantage of the stratified is that a sampling frame has to be prepared according to
each group of interest; this will take more time and precision, and it will be more expensive than nonprobability sampling techniques.
Sampling description
The research study will incorporate emerging adults 18-25 years of age with a diverse background and will include men and women.
Operational Definition
PTSD will be measured according to The Post-Traumatic Stress Diagnostic Scale (PDS). Individuals will be in the study if they have
ratings of moderate to severe (21-35) and severe ratings to be greater than 36. (Categorical variable)
Research Design
I will use the longitudinal research method. I will be looking for a relationship between variables, traumatic events, and PTSD
where the subjects will have different backgrounds and experiences; this study will be conducted over a period of 2 years. Groups
will be selected based off of what type of traumatic event they were exposed to. The longitudinal study allows for flexibility and
changes over time and also allows for the study to be shifted while data is being collected. With the longitudinal study time can be a
factor. Because the longitudinal study can be time consuming maintaining a committed research team can be a factor along with
maintaining the original participants in the study. This type of study can also be a financial burden.
Statistical Analysis
Predicting Factors of PTSD 16
Within this longitudinal study, data will be collected, analyzed, interpreted, and presented. I will conduct a collection of data
through surveys, questionnaires, and interviews. The surveys will be read, and the findings will be presented.
First, means and standard deviations of all study variables will be presented. Second, intercorrelations among all study variables
will be presented. Third, analyses will be conducted that test all hypothesized associations as illustrated within the conceptual models
and articulated in the study hypotheses. For each model, separate regression analyses will be conducted.
For the first model, each form of traumatic event will be entered as a separate IV predicting PTSD. This will test for the main
effect of each IV. Next, interaction terms will be created and entered, which will examine the statistical interaction (i.e., moderation)
of substance abuse with each traumatic event. Terms created will include “Natural disaster X Substance Abuse,” “Accidents X
Substance Abuse,” and “Violent Crime X Substance Abuse.” All interaction terms that are significant will be graphed to show how the
association between traumatic events and PTSD varies depending on substance abuse.
For the second model, each form of traumatic event will be entered as a separate IV, again, predicting PTSD. Interaction terms
entered for this second model will examine the statistical interaction (i.e., moderation) of each pre-existing diagnosed condition with
each traumatic event. Each pre-existing diagnosis will be multiplied by each traumatic event. All interaction terms that are significant
will be graphed to show how the association between traumatic events and PTSD varies depending on pre-existing diagnosis.
Post-Traumatic Stress Disorder (PTSD) Index
1. Have you ever been involved in a traumatic event?
Y/N
2. Do you fear loud noises?
Y/N
3. Have you ever felt helpless?
Y/N
4. Do you have flashbacks to the traumatic events?
Y/N
5. Do you find your mind wandering?
Y/N
Predicting Factors of PTSD 17
6. Do you have trouble sleeping?
Y/N
7. Are you easily scared?
Y/N
8. Are you hopeless about the future?
Y/N
9. Do you hear things that are not there?
Y/N
10. Do you see things that are not there?
Y/N
11. Do you find yourself being close to many people?
Y/N