Disaster‐related posttraumatic stress symptoms and sustained attention: Evaluation of depressive symptomatology and sleep disturbances as mediators

Abstract

Research about attentional functioning following trauma has almost exclusively been performed in patient populations with combat-related posttraumatic stress disorder (PTSD). In this study the relationship between sustained attention and PTSD symptoms was examined in a community sample of survivors of a major disaster using the Paced Auditory Serial Addition Task (PASAT) and the SelfRating Scale for PTSD (SRS-PTSD) 2-3 years postdisaster. Analyses revealed low but significant partial correlations between PTSD symptoms and the least difficult subtests, ruling out the effects of age, education, depressive symptomatology, and sleep disturbances. These results demonstrate that PTSD symptoms link to attentional dysfunction 2-3 years postdisaster.Studies investigating attention in survivors of traumatic events with posttraumatic stress disorder (PTSD) have almost exclusively focused on treatment-seeking patients with combat-related trauma. Although these studies have produced mixed results, many report attentional deficits in PTSD (e.g., Gilbertson, Gurvits, Lasko, Orr, & Pitman, 2001;Sachinvala et al., 2000;Vasterling et al., 2002). Deficits in sustained attention, which cause difficulties in executing a long-lasting task, were found most frequently.Characteristics of the participants in the above mentioned studies include high symptom severity and coexisting psychopathology, especially substance abuse dis- orders. Likely, these studies may represent populations that could differ from community samples in important ways. Therefore, the purpose of the present study was to investigate sustained attention in relation to PTSD symptom severity in a community sample of inhabitants of an area afflicted by a major disaster. To our knowledge, this is the first study of attention in such a unique population. After a traumatic event the most frequently developed disorders are major depressive disorder (MDD) and PTSD. Symptoms of these disorders overlap and high comorbidity up to 40% is reported. Knowing that both disorders are characterized by symptoms of impaired attention (DSM-IV; American Psychiatric Association, 1994), we raise the question whether this symptom is independent of depressive symptoms in PTSD. Therefore, we investigated whether attention in survivors is still related to PTSD symptom severity when we control for the influence of depressive symptoms. Furthermore, to assure that worsened attentional performance is not the consequence of sleep disturbances, we also examined the effect of sleep disturbances in the relationship between PTSD symptoms

The role of major depression in neurocognitive functioning in patients with posttraumatic stress disorder

“…It would be interesting to examine especially sustained attention in samples with PTSD+MDD versus PTSD alone, as depressive symptoms were also found to play a role in sustained attention in PTSD (Meewisse et al, 2005). As our sample consisted of PTSD patients seeking help for single traumatic events, results are not necessarily representative for other PTSD populations.…”

Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence

“…Those that do not return to these lower manageable levels of responding are at considerable risk for eventual development of PTSD (McNally et al, 2003;Shalev & Freedman, 2005). Further, even if their hyperarousal, increased emotional lability, and distress symptoms do diminish, such heightened emotional states are likely to interfere with sleep (DeViva, Zayfert, Pigeon, & Mellman, 2005;Ironson et al, 1997;Meewisse et al, 2005) and daily functioning, such as concentration and social interaction. This hyperarousal can have a major effect on risk perception, such that the external environment is perceived as potentially harmful beyond any proportion to the available objective information.…”

Sleep as a Mediator in the Pathway From Violence-Induced Traumatic Stress to Poorer Health and Functioning: A Review of the Literature and Proposed Conceptual Model

“…Of note, several articles identified in the searches have examined the role of sleep as a potential mediator and have reported partial or complete mediation of health and psychological outcomes by sleep characteristics, but they have investigated exposure to events or conditions that were not considered to induce traumatic stress, or did not include in their methods a measure of traumatic stress, or both: e.g., postoperative pain and subsequent knee function (Cremeans-Smith, Millington, Sledjeski, Greene, & Delahanty, 2006), socio-economic status and psychological/physical health (Moore, Adler, Williams, & Jackson, 2002; Mulatu & Schooler, 2002), racism and depressive symptoms (Steffen, & Bowden, 2006), social support and myocardial infarction (Nordin, Knutsson, & Sundbom, 2008), “daily stress” and immune function (Miller et al, 2004), emotional insecurity and children’s adjustment and academic performance (El-Sheikh, Buckhalt, Cummings, & Keller, 2007), and organizational justice and psychiatric morbidity (Elovainio, Kivimaki, Vahtera, Keltikangas-Jarvinen, & Virtanen, 2003). One additional study (Meewise et al, 2005) was not included because it was unclear from the description of the methods the degree to which the sleep measure was formally tested as a mediator. Also, as mentioned previously, a small number of studies investigated the effect of posttraumatic stress-related sleep disturbances on physical or psychological outcomes independent of non-sleep-related post-traumatic stress symptoms, but they did not test for mediation (Clum et al, 2001; Krakow et al, 2000, 2002; Nishith et al, 2001) and were therefore not included in the review.…”