Attitudes to emotional expression and personality in predicting post-traumatic stress disorder.

OBJECTIVES

To test hypotheses derived from a suggestion of Williams (1989) that negative attitudes towards emotional expression act as a predisposing or maintaining factor for post-traumatic stress reactions following a traumatic event.

DESIGN

The study employed a prospective design in which attitudes to emotional expression, the 'Big Five' personality factors (Costa & McCrae, 1992a) and initial symptoms and injury severity within 1 week of a road traffic accident were used to predict the development of post-traumatic stress disorder 6 weeks post-accident.

METHOD

Sixty victims of road traffic accidents randomly selected from attenders at a large A&E department were assessed by questionnaire and interview. Measures comprised a 4-item scale relating to emotional expression, standardized scales for intrusion and avoidance features of traumatic experiences, and for anxiety and depression and the NEO-FFI Five Factor Personality Inventory. Forty-five of these participants responded to a postal questionnaire follow-up. In this survey the battery was repeated and also included a self-report diagnostic measure of post-traumatic stress disorder (PTSD).

RESULTS

The percentage of the sample meeting DSM-IV diagnostic criteria for PTSD at 6 weeks post-trauma was 30.8%. A small but significant relationship was found for negative attitudes to emotional expression at 1 week to predict intrusive symptoms and diagnosis at 6 weeks, over and above the independent relationships of initial symptoms, initial injury severity, personality and coping. The emotional expression measure was largely stable between the two points of measurement. More negative attitudes to emotional expression were related to less openness, extraversion and agreeableness personality domains.

CONCLUSIONS

Some support for the hypotheses was found in relation to the development of PTSD and for the status of attitudes to emotion as a stable trait related to personality factors. The potential importance of attitudes to emotional expression in therapy and other work is discussed.