Murdoch Maureen, Kehle-Forbes Shannon Marie, Partin Melissa Ruth
Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.
Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
BMC Med Res Methodol. 2017 May 10;17(1):81. doi: 10.1186/s12874-017-0357-x.
One potential concern with using mailed surveys containing trauma-related content is the possibility of re-traumatizing survivors without a trained mental health professional present. Prior research provides insufficient guidance regarding the prevalence and magnitude of this risk because the psychological harms of trauma-related surveys have typically been estimated using single post-test observations. Post-test observations cannot quantify magnitude of change in participants' emotional states and may over or under estimate associations between participants' characteristics (risk factors) and post-survey upset.
We conducted two pre- and post-test studies in samples of former applicants for posttraumatic stress disorder disability benefits: 191 males who served during Gulf War I plus 639 male and 921 female Veterans who served sometime between 1955 and 1998. We used two 9-point items from the Self-Assessment Manikins to measure participants' valence (sadness/happiness) and arousal (tenseness/calmness) before and after they completed mailed surveys asking about trauma-related symptoms or experiences. We examined the following potential predictors for post-survey sadness and tenseness: screening positive for posttraumatic stress disorder, having a serious mental illness, and history of military sexual assault or combat.
After the survey, across the groups, 29.3-41.8% were sadder, 45.3-52.2% had no change in valence, and 12.9-22.5% were happier; 31.7-40.2% were tenser, 40.6-48.2% had no change in arousal, and 17.3-24.0% were calmer. The mean increase in sadness or tenseness post-survey was less than one point in all groups (SD's < 1.7). Cohen's d ranged from 0.07 to 0.30. Most hypothesized predictors were associated with greater baseline sadness or tenseness, but not necessarily with larger post-survey changes. Women with a history of military sexual assault had the largest net post-survey changes in sadness (mean = 0.7, SD = 1.4) and tenseness (mean = 0.6, SD = 1.6).
While a substantial minority of Veterans reported more sadness or tenseness post-survey, the net change in affect was small. Most hypothesized risk factors were actually associated with higher baseline sadness or tenseness scores. When receiving unsolicited, trauma-related surveys by mail, separate protections for Veterans with the risk factors studied here do not seem necessary.
使用包含创伤相关内容的邮寄调查问卷存在一个潜在问题，即可能在没有专业心理健康人员在场的情况下再次伤害幸存者。先前的研究对于这种风险的发生率和严重程度提供的指导不足，因为创伤相关调查问卷对心理造成的伤害通常是通过单一的测试后观察来估计的。测试后观察无法量化参与者情绪状态的变化程度，可能高估或低估参与者特征（风险因素）与调查后情绪困扰之间的关联。
我们对创伤后应激障碍残疾福利的前申请人样本进行了两项测试前和测试后研究：191名在第一次海湾战争期间服役的男性，以及639名男性和921名女性退伍军人，他们在1955年至1998年之间的某个时间服役。我们使用自评估人体模型中的两个9分项目，在参与者完成询问创伤相关症状或经历的邮寄调查问卷之前和之后，测量他们的效价（悲伤/快乐）和唤醒水平（紧张/平静）。我们研究了以下调查后悲伤和紧张情绪的潜在预测因素：创伤后应激障碍筛查呈阳性、患有严重精神疾病以及军事性侵犯或战斗史。
调查后，在所有组中，29.3% - 41.8%的人更悲伤，45.3% - 52.2%的人效价没有变化，12.9% - 22.5%的人更快乐；31.7% - 40.2%的人更紧张，40.6% - 48.2%的人唤醒水平没有变化，17.3% - 24.0%的人更平静。所有组中调查后悲伤或紧张情绪的平均增加量均小于1分（标准差 < 1.7）。科恩d值范围为0.07至0.30。大多数假设的预测因素与更高的基线悲伤或紧张情绪相关，但不一定与调查后的更大变化相关。有军事性侵犯史的女性在调查后悲伤（平均 = 0.7，标准差 = 1.4）和紧张（平均 = 0.6，标准差 = 1.6）方面的净变化最大。
虽然相当一部分退伍军人报告调查后更悲伤或更紧张，但情绪的净变化很小。大多数假设的风险因素实际上与更高的基线悲伤或紧张分数相关。当通过邮件收到未经请求的、与创伤相关的调查问卷时，对于此处研究的有风险因素的退伍军人，似乎没有必要进行单独保护。
