Lowe Sarah R, Walsh Kate, Uddin Monica, Galea Sandro, Koenen Karestan C
Department of Epidemiology, Columbia University, Mailman School of Public Health.
Center for Molecular Medicine and Genetics, Wayne State University.
J Abnorm Psychol. 2014 Aug;123(3):533-44. doi: 10.1037/a0037046. Epub 2014 Jun 2.
Previous research has documented bidirectional relationships between trauma exposure and posttraumatic stress (PTS), such that individuals who are exposed to more traumatic events are at increased risk of developing PTS, and more severe PTS is associated with more subsequent trauma exposure. However, the empirical literature is limited by a lack of longitudinal studies that include continuous measures of PTS, differentiate between assaultive (e.g., sexual assault, being held up or mugged) and nonassaultive (e.g., serious illness, natural disaster) trauma, and focus on urban contexts. The purpose of this study was to fill these gaps through testing 3-wave cross-lagged panel models of exposure to assaultive and nonassaultive traumatic events and PTS among a large sample of urban-dwelling adults (N = 1,360; 84.4% non-Hispanic Black). In the model including assaultive trauma, more Wave 2 assaultive events were associated with significantly higher Wave 3 PTS. In contrast, in the model including nonassaultive trauma, higher Wave 1 and Wave 2 PTS were associated with more nonassaultive events at Waves 2 and 3, respectively. Taken together, the findings suggest a cycle of adversity wherein urban residents who have experienced assaultive trauma are at risk of more severe PTS, which in turn increases risk for exposure to nonassaultive trauma. This cycle could be tested directly in future studies through models including both types of events. Additional research on the mechanisms that underlie the pathways between PTS and traumatic events could also have implications for policy and practice.
以往的研究记录了创伤暴露与创伤后应激障碍（PTS）之间的双向关系，即遭受更多创伤事件的个体患创伤后应激障碍的风险增加，而更严重的创伤后应激障碍与更多后续创伤暴露相关。然而，实证文献存在局限性，缺乏纵向研究，这些研究应包括对创伤后应激障碍的连续测量、区分攻击性创伤（如性侵犯、被抢劫或打劫）和非攻击性创伤（如重病、自然灾害），并聚焦于城市环境。本研究的目的是通过对大量城市成年居民样本（N = 1360；84.4%为非西班牙裔黑人）中攻击性和非攻击性创伤事件暴露与创伤后应激障碍进行三波交叉滞后面板模型测试来填补这些空白。在包含攻击性创伤的模型中，第二波更多的攻击性事件与第三波显著更高的创伤后应激障碍相关。相比之下，在包含非攻击性创伤的模型中，第一波和第二波较高的创伤后应激障碍分别与第二波和第三波更多的非攻击性事件相关。综合来看，研究结果表明存在一个逆境循环，即经历过攻击性创伤的城市居民面临更严重创伤后应激障碍的风险，这反过来又增加了遭受非攻击性创伤的风险。这个循环可以在未来的研究中通过包含这两种事件类型的模型直接进行测试。对创伤后应激障碍与创伤事件之间途径的潜在机制进行更多研究也可能对政策和实践产生影响。
