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PTSD in Paramedics: Resilience and Sense of Coherence

Published online by Cambridge University Press:  29 May 2013

Markus Streb ,
Pascal Häller  and
Tanja Michael
Markus Streb
Affiliation:
Saarland University, Saarbrücken, Germany
Pascal Häller
Affiliation:
Saarland University, Saarbrücken, Germany
Tanja Michael*
Affiliation:
Saarland University, Saarbrücken, Germany
*
Reprint requests to Tanja Michael, Saarland University, Campus, D-66123 Saarbrücken, Germany. E-mail: [email protected]
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Abstract

Background: Paramedics are frequently subjected to traumatic experiences and have higher PTSD prevalence rates than people in the general population. However, the vast majority of paramedics do not develop PTSD. While several risk factors for PTSD have been established, little is known about protective factors. It has been suggested that a good sense of coherence (SOC) and high resilience lower the risk for developing PTSD. Aims: To examine whether SOC and resilience are associated with PTSD severity in paramedics. Method: A cross-sectional study investigated SOC, resilience and PTSD in paramedics (N = 668). PTSD was assessed with the Posttraumatic Stress Diagnostic Scale (PDS); resilience and SOC were measured with the Resilience Scale (RS-11) and the Sense of Coherence Scale (SOC-L9). Further measures included preparation of dealing with traumatic events and availability of psychological help. Results: As expected, both resilience and SOC were negatively correlated with PTSD symptoms. The regression analysis showed that 19.2% of the total variance in symptom severity was explained by these variables. However, SOC was a better predictor than resilience for PTSD severity, as it accounted for more unique variance. Paramedics who were prepared for dealing with work-related traumatic events and who received psychological help had less severe PTSD symptoms and higher SOC scores than paramedics for whom these services were not available. Conclusions: Enhancing resilience, and especially SOC, seems a promising approach to reduce PTSD symptom severity in high risk groups like paramedics.

Keywords

Posttraumatic stress disorder (PTSD)paramedicsresiliencesense of coherencepsychological resistance
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 4 , July 2014 , pp. 452 - 463
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Abel, T., Kohlmann, T. and Noack, H. (1995). Eine deutsche Übersetzung des SOC. Bern, Switzerland: Universität Bern, Institut für Sozial- und Präventivmedizin.Google Scholar
Agaibi, C. E. and Wilson, J. P. (2005). Trauma, PTSD, and resilience: a review of the literature. Trauma, Violence, and Abuse, 6, 195–216. doi: 10.1177/1524838005277438 CrossRefGoogle ScholarPubMed
Ahmed, A. S. (2007). Post-traumatic stress disorder, resilience and vulnerability. Advances in Psychiatric Treatment, 13, 369–375. doi: 10.1192/apt.bp.106.003236 CrossRefGoogle Scholar
Alim, T. N., Feder, A., Graves, R. E., Wang, Y., Weaver, J., Westphal, M., et al. (2008). Trauma, resilience, and recovery in a high-risk African-American population. American Journal of Psychiatry, 165, 1566–1575.CrossRefGoogle Scholar
American Psychiatric Association (2003). Diagnostische Kriterien des Diagnostischen und Statistischen Manuals Psychischer Störungen. Textrevision. DSM-IV-TR (4th ed.). (Sass, H., Wittchen, H.-U., Zaudig, M. and Trans, I. Houben.). Göttingen: Hogrefe.Google Scholar
Anthony, E. J. and Cohler, B. J. (Eds.) (1987). The Invulnerable Child. New York: Guilford Press.Google Scholar
Antonovsky, A. (1987). Unraveling the Mystery of Health. San Francisco, CA: Jossey-Bass.Google Scholar
Antonovsky, H. and Sagy, S. (1986). The development of a sense of coherence and its impact on responses to stress situations. Journal of Social Psychology, 126, 213–225.Google ScholarPubMed
Başoğlu, M., Mineka, S., Paker, M., Aker, T., Livanou, M. and Gök, Ş. (1997). Psychological preparedness for trauma as a protective factor in survivors of torture. Psychological Medicine, 27, 1421–1433. doi: 10.1017/S0033291797005679 CrossRefGoogle ScholarPubMed
Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., et al. (2012). Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47, 1001–1011. doi: 10.1007/s00127–011–0408–2 CrossRefGoogle Scholar
Blanchard, E. B., Hickling, E. J., Taylor, A. E., Forneris, C. A., Loos, W. and Jaccard, J. (1995). Effects of varying scoring rules of the clinician-administered PTSD scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims. Behaviour Research and Therapy, 33, 471–475.CrossRefGoogle ScholarPubMed
Bonanno, G. A. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events. American Psychologist, 59, 20–28. doi: 10.1037/0003–066X.59.1.20 CrossRefGoogle ScholarPubMed
Bonanno, G. A. (2005). Resilience in the face of potential trauma. American Psychological Society, 14, 135–138.Google Scholar
Bonanno, G. A., Galea, S., Bucciarelli, A. and Vlahov, D. (2006). Psychological resilience after disaster. New York City in the aftermath of the September 11th terrorist attack. Psychological Science, 17, 181–186.CrossRefGoogle ScholarPubMed
Bonanno, G. A., Galea, S., Bucciarelli, A. and Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology, 75, 671–682. doi: 10.1037/0022-006X.75.5.671 CrossRefGoogle ScholarPubMed
Brewin, C. R., Andrews, B. and Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–66.CrossRefGoogle ScholarPubMed
Connor, K. M. and Davidson, J. R. T. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82. doi: 10.1002/da.10113 CrossRefGoogle ScholarPubMed
Connor, K. M., Davidson, J. R. T. and Lee, L.-Ch. (2003). Spirituality, resilience, and anger in survivors of violent trauma: a community survey. Journal of Traumatic Stress, 16, 487–494.CrossRefGoogle ScholarPubMed
Ekblad, S. and Wennström, C. (1997). Relationships between traumatic life events, symptoms and sense of coherence subscale meaningfulness in a group of refugee and immigrant patients referred to a psychiatric outpatient clinic in Stockholm. Scandinavian Journal of Social Welfare, 6, 279–285.CrossRefGoogle Scholar
Ehlers, A., Steil, R., Winter, H. and Foa, E. B. (1996). Deutsche Übersetzung der Posttraumatic Stress Diagnostic Scale (PDS). Unpublished manuscript, Warneford Hospital, Department of Psychiatry, University of Oxford, UK.Google Scholar
Eriksson, M. and Lindström, B. (2005). Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59, 460–466. doi: 10.1136/jech.2003.018085 CrossRefGoogle ScholarPubMed
Eriksson, M. and Lindström, B. (2006). Antonovsky's sense of coherence scale and the relation with health: a systematic review. Journal of Epidemiology and Community Health, 60, 376–381. doi: 10.1136/jech.2005.041616 CrossRefGoogle ScholarPubMed
Eriksson, N.-G. and Lundin, T. (1996). Early traumatic stress reactions among Swedish survivors of the m/s Estonia disaster. British Journal of Psychiatry, 169, 713–716.CrossRefGoogle Scholar
Franke, A. and Witte, M. (2009). Das HEDE-Training – Manual zur Gesundheitsförderung auf Basis der Salutogenese. Bern: Huber.Google Scholar
Frommberger, U., Stieglitz, R.-D., Straub, S., Nyberg, E., Schlickewei, W., Kuner, E., et al. (1999). The concept of sense of coherence and the development of posttraumatic stress disorder in traffic accident victims. Journal of Psychosomatic Research, 46, 343–348.CrossRefGoogle ScholarPubMed
Fuglsang, A. K., Moergeli, H., Hepp-Beg, S. and Schnyder, U. (2002). Who develops acute stress disorder after accidental injuries? Psychotherapy and Psychosomatics, 71, 214–222.CrossRefGoogle ScholarPubMed
Garmezy, N. (1993). Children in poverty: resilience despite risk. Psychiatry, 56, 127–136.CrossRefGoogle ScholarPubMed
Garmezy, N., Masten, A. S. and Tellegen, A. (1984). The study of stress and competence in children: a building block for developmental psychopathology. Child Development, 55, 97–111.CrossRefGoogle Scholar
Gold, P. B., Engdahl, B. E., Eberly, R. E., Blake, R. J., Page, W. F. and Frueh, B. C. (2000). Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war. Social Psychiatry and Psychiatric Epidemiology, 35, 36–42.CrossRefGoogle ScholarPubMed
Häller, P., Michael, T. and Balmer Köchlin, K. (2009). PTBS und komorbide Beschwerden bei Rettungssanitätern. Verhaltenstherapie and Verhaltensmedizin, 30, 403–417.Google Scholar
Hannöver, W., Michael, A., Meyer, Ch., Rumpf, H.-J., Hapke, U. and John, U. (2003). Die Sense of Coherence Scale von Antonovsky und das Vorliegen einer psychiatrischen Diagnose. Ergänzungen zu den deutschen Normwerten aus einer bevölkerungsrepräsentativen Stichprobe. Psychotherapie, Psychosomatik, Medizinische Psychologie, 54, 179–186. doi: 10.1055/s-2003–814787 Google Scholar
Hobfoll, S. E., Canetti-Nisim, D., Johnson, R. J., Palmieri, P. A., Varley, J. D. and Galea, S. (2008). The association of exposure, risk, and resiliency factors with PTSD among Jews and Arabs exposed to repeated acts of terrorism in Israel. Journal of Traumatic Stress, 21, 9–21. doi: 10.1002/jts.20307 CrossRefGoogle ScholarPubMed
Jonsson, A., Segesten, K. and Mattsson, B. (2003). Post-traumatic stress among Swedish ambulance personnel. Emergency Medicine Journal, 20, 79–84.CrossRefGoogle ScholarPubMed
King, L. A., King, D. W., Fairbank, J. A., Keane, T. M. and Adams, G. A. (1998). Resilience-recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: hardiness, postwar social support, and additional stressful life events. Journal of Personality and Social Psychology, 74, 420–434.CrossRefGoogle ScholarPubMed
Langeland, E., Wahl, A. K., Kristoffersen, K., Nortvedt, M. W. and Hanestad, B. R. (2007). Sense of coherence predicts change in life satisfaction among home-living residents in the community with mental health problems: a 1-year follow-up study. Quality of Life Research, 16, 939–946. doi: 10.1007/s11136–007–9199-z CrossRefGoogle ScholarPubMed
Lundin, T. and Jansson, L. (2007). Traumatic impact of a fire disaster on survivors: a 25-year follow-up of the 1978 hotel fire in Boras, Sweden. Nordic Journal of Psychiatry, 61, 479–485. doi: 10.1080/08039480701773329 CrossRefGoogle ScholarPubMed
Newman, R. (2005). APA's resilience initiative. Professional Psychology: Research and Practice, 36, 227–229. doi: 10.1037/0735–7028.36.3.227 CrossRefGoogle Scholar
North, C. S., Tivis, L., McMillen, J. C., Pfefferbaum, B., Spitznagel, E. L., Cox, J., et al. (2002). Psychiatric disorders in rescue workers after the Oklahoma City bombing. American Journal of Psychiatry, 159, 857–859.CrossRefGoogle ScholarPubMed
Nygren, B., Aléx, L., Jonsén, E., Gustafson, Y., Norberg, A. and Lundman, B. (2005). Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old. Aging and Mental Health, 9, 354–362. doi: 10.1080/1360500114415 CrossRefGoogle ScholarPubMed
Ortlepp, K. and Friedman, M. (2002). Prevalence and correlates of secondary traumatic stress in workplace lay trauma counselors. Journal of Traumatic Stress, 15, 213–222.CrossRefGoogle ScholarPubMed
Palmieri, P. A., Canetti-Nisim, D., Galea, S., Johnson, R. J. and Hobfoll, S. E. (2008). The psychological impact of the Israel-Hezbollah war on Jews and Arabs in Israel: the impact of risk and resilience factors. Social Science and Medicine, 67, 1208–1216. doi: 10.1016/j.socscimed.2008.06.030 CrossRefGoogle ScholarPubMed
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., Rivers, A. J., Morgan, C. A., et al. (2010). Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom: the role of resilience, unit support, and postdeployment social support. Journal of Affective Disorders, 120, 188–192. doi: 10.1016/j.jad.2009.04.015 CrossRefGoogle ScholarPubMed
Rutter, M. (1979). Protective factors in children's responses to stress and disadvantage. In Kent, M. W. and Rolf, J. E. (Eds.), Primary Prevention of Psychopathology: III. promoting social competence and coping in children (pp. 49–74). Hanover, NH: University Press of New England.Google Scholar
Rutter, M. (1985). Resilience in the face of adversity: protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598–611.CrossRefGoogle ScholarPubMed
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57, 316–331.CrossRefGoogle ScholarPubMed
Schnyder, U., Büchi, S., Sensky, T. and Klaghofer, R. (2000). Antonovsky's sense of coherence: trait or state? Psychotherapy and Psychosomatics, 69, 296–302.CrossRefGoogle ScholarPubMed
Schnyder, U., Wittmann, L., Friedrich-Perez, J., Hepp, U. and Moergeli, H. (2008). Posttraumatic stress disorder following accidental injury: rule or exception in Switzerland. Psychotherapy and Psychosomatics, 77, 111–118. doi: 10.1159/000112888 CrossRefGoogle ScholarPubMed
Schumacher, J., Leppert, K., Gunzelmann, T., Strauss, B. and Brähler, E. (2005). Die Resilienzskala: ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personmerkmal. Zeitschrift für Klinische Psychologie, Psychiatrie und Psychotherapie, 53, 16–39.Google Scholar
Schumacher, J., Wilz, G., Gunzelmann, T. and Brähler, E. (2000). Die Sense of Coherence Scale von Antonovsky. Teststatistische Überprüfung in einer repräsentativen Bevölkerungsstichprobe und Konstruktion einer Kurzskala. Psychotherapie, Psychosomatik, Medizinische Psychologie, 50, 472–482.CrossRefGoogle Scholar
Surtees, P. G., Wainwright, N. W. J. and Khaw, K.-T. (2006). Resilience, misfortune, and mortality: evidence that sense of coherence is a marker of social stress adaptive capacity. Journal of Psychosomatic Research, 61, 221–227. doi: 10.1016/j.jpsychores.2006.02.014 CrossRefGoogle ScholarPubMed
Tagay, S., Herpertz, S., Langkafel, M. and Senf, W. (2005). Posttraumatic stress disorder in a psychosomatic outpatient clinic: gender effects, psychosocial functioning, sense of coherence, and service utilization. Journal of Psychosomatic Research, 58, 439–446. doi: 10.1016/j.jpsychores.2004.09.007 CrossRefGoogle Scholar
Wagnild, G. M. and Young, H. M. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1, 165–178.Google ScholarPubMed
Werner, E. E. (1993). Risk, resilience, and recovery: perspectives from the Kauai Longitudinal Study. Development and Psychopathology, 5, 503–515.CrossRefGoogle Scholar
White, B., Driver, S. and Warren, A.-M. (2008). Considering resilience in the rehabilitation of people with traumatic disabilities. Rehabilitation Psychology, 53, 9–17. doi: 10.1037/0090–5550.53.1.9 CrossRefGoogle Scholar
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