Western Kentucky University.
The University of Texas at San Antonio.
Behav Ther. 2018 Sep;49(5):796-808. doi: 10.1016/j.beth.2018.01.004. Epub 2018 Jan 31.
Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans' trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.
尽管社会支持与创伤后应激障碍（PTSD）之间存在着强烈而一致的关联，但这种关联的方向性一直存在争议，一些研究表明社会支持可以预防 PTSD 症状，而其他研究则表明 PTSD 症状会侵蚀社会支持。文献中的大多数研究都是横断面研究，因此无法确定其方向性。交叉滞后面板模型克服了许多先前的局限性；然而，采用这些设计的少数研究的结果却不一致，这可能是由于方法学上的差异，包括自我报告与临床医生评估。本研究采用交叉滞后面板结构方程模型，在创伤暴露后数年对 264 名伊拉克和阿富汗退伍军人进行评估，探讨了社会支持与慢性 PTSD 症状在 1 年内的关系。约有三分之一的样本在基线评估时符合 PTSD 标准，退伍军人的创伤平均发生在基线前 6 年。进行了两个单独的模型，一个使用自我报告评估 PTSD 症状，另一个使用临床医生评估 PTSD 症状。两个模型的拟合度都很好。结果表明，社会支持和 PTSD 症状之间的关系受到评估方式的影响。自我报告模型表明，社会支持和 PTSD 症状之间存在双向关系，而临床医生评估模型则表明，只有基线 PTSD 症状可以预测 1 年后的社会支持。研究结果突出表明，评估方式是影响以往研究结果不一致的一个因素。讨论了这些发现的理论和临床意义，并对越来越多利用这些设计来分解这种复杂关联的文献提出了建议。
