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Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?

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Abstract

The experience of potentially traumatizing events (PTEs) may be associated with conflicting outcomes: individuals may experience greater psychological distress (dose-response theory), or individuals may become more resilient against repeated PTEs (stress-inoculation theory). With limited empirical data comparing these theories, we examined the relationships between the count of lifetime PTE types and psychological outcomes [posttraumatic stress disorder (PTSD), depression, impaired distress tolerance] using linear and quadratic regressions. A linear relationship would support the dose-response theory, and a quadratic relationship would support the stress-inoculation theory. We also explored whether there was a threshold number of PTE types fostering resiliency before an increase of distressing outcomes. The sample included 123 (68.30% female) treatment-seeking patients at a community mental health center participating in a larger study (Contractor et al. in Psychiatry Research, 252, 252215–252222, 2017). Linear regression results indicated number of PTE types significantly predicted increasing PTSD and depression severity and distress tolerance difficulties. Quadratic regression model results were not significant. ROC analyses indicated exposure to at least 3.5 PTE types predicted PTSD with moderate accuracy. In conclusion, the dose-response theory was supported, with results indicating there may be a threshold count of lifetime PTE types (> 3) influencing traumatic stress outcomes.

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References

  • Agaibi, C. E., & Wilson, J. P. (2005). Trauma, PTSD, and resilience a review of the literature. Trauma, Violence & Abuse, 6(3), 195–216.

    Article  Google Scholar 

  • Agorastos, A., Pittman, J. O., Angkaw, A. C., Nievergelt, C. M., Hansen, C. J., Aversa, L. H., Parisi S.A., Barkauskas D.A., Marine Resiliency Study Team., Baker D.G. (2014). The cumulative effect of different childhood trauma types on self-reported symptoms of adult male depression and PTSD, substance abuse and health-related quality of life in a large active-duty military cohort. Journal of Psychiatric Research, 58, 46–54. https://doi.org/10.1016/j.jpsychires.2014.07.014.

    Article  Google Scholar 

  • Anestis, M. D., Tull, M. T., Bagge, C. L., & Gratz, K. L. (2012). The moderating role of distress tolerance in the relationship between posttraumatic stress disorder symptom clusters and suicidal behavior among trauma exposed substance users in residential treatment. Archives of Suicide Research, 16(3), 198–211. https://doi.org/10.1080/13811118.2012.695269.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ashokan, A., Sivasubramanian, M., & Mitra, R. (2016). Seeding stress resilience through inoculation. Neural Plasticity, 2016, 1–6. https://doi.org/10.1155/2016/4928081.

    Article  Google Scholar 

  • Banyard, V. L., Williams, L. M., & Siegel, J. A. (2001). The long-term mental health consequences of child sexual abuse: An exploratory study of the impact of multiple traumas in a sample of women. Journal of Traumatic Stress, 14(4), 697–715.

    Article  Google Scholar 

  • Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20.

    Article  PubMed  Google Scholar 

  • Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391. https://doi.org/10.1037/pas0000254.

    Article  PubMed  Google Scholar 

  • Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA, US: Sage Publications, Inc..

    Google Scholar 

  • Briere, J., Agee, E., & Dietrich, A. (2016). Cumulative trauma and current posttraumatic stress disorder status in general population and inmate samples. Psychological Trauma Theory Research Practice and Policy, 8, 439–446. https://doi.org/10.1037/tra0000107.

    Article  Google Scholar 

  • Campbell, D. G., Felker, B. L., Liu, C., Yano, E. M., Kirchner, J. E., Chan, D., et al. (2007). Prevalence of depression–PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions. Journal of General Internal Medicine, 22(6), 711–718. https://doi.org/10.1007/s11606-006-0101-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cicerone, K. D., & Fraser, R. T. (1999). Counseling interactions for clients with traumatic brain injury. In R. T. Fraser & D. C. Clemmons (Eds.), Traumatic brain injury rehabilitation: Practical vocational, neuropsychological, and psychotherapy interventions (pp. 95–127). New York: CRC Press.

    Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. https://doi.org/10.1037/0033-2909.112.1.155.

    Article  PubMed  Google Scholar 

  • Contractor, A. A., Weiss, N. H., Dranger, P., Ruggero, C., & Armour, C. (2017). PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology. Psychiatry Research, 252, 252215–252222. https://doi.org/10.1016/j.psychres.2017.03.008.

    Article  Google Scholar 

  • Contractor, A. A., Caldas, S., Fletcher, S., Shea, M. T., & Armour, C. (2018). Empirically-derived lifespan polytraumatization typologies: A systematic review. Journal of Clinical Psychology, 1–23. https://doi.org/10.1002/jclp.22586.

    Article  Google Scholar 

  • Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1(1), 16–29. https://doi.org/10.1037/1082-989X.1.1.16.

    Article  Google Scholar 

  • DePrince, A. P., Chu, A. T., & Pineda, A. S. (2011). Links between specific posttrauma appraisals and three forms of trauma-related distress. Psychological Trauma: Theory, Research, Practice, And Policy, 3(4), 430–441. https://doi.org/10.1037/a0021576.

    Article  Google Scholar 

  • deRoon-Cassini, T. A., Mancini, A. D., Rusch, M. D., & Bonanno, G. A. (2010). Psychopathology and resilience following traumatic injury: A latent growth mixture model analysis. Rehabilitation Psychology, 55(1), 1–11. https://doi.org/10.1037/a0018601.

    Article  PubMed  Google Scholar 

  • Diamond, G. M., Lipsitz, J. D., Fajerman, Z., & Rozenblat, O. (2010). Ongoing traumatic stress response (OTSR) in Sderot, Israel. Professional Psychology: Research And Practice, 41(1), 19–25. https://doi.org/10.1037/a0017098.

    Article  Google Scholar 

  • Ehrensaft, M. K., Cohen, P., Brown, J., Smailes, E., Chen, H., & Johnson, J. G. (2003). Intergenerational transmission of partner violence: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 71(4), 741–753.

    Article  Google Scholar 

  • Elhai, J. D., de Francisco Carvalho, L., Miguel, F. K., Palmieri, P. A., Primi, R., & Christopher Frueh, B. (2011). Testing whether posttraumatic stress disorder and major depressive disorder are similar or unique constructs. Journal of Anxiety Disorders, 25(3), 404–410. https://doi.org/10.1016/j.janxdis.2010.11.003.

    Article  PubMed  Google Scholar 

  • Fetzner, M. G., Peluso, D. L., & Asmundson, G. G. (2014). Tolerating distress after trauma: Differential associations between distress tolerance and posttraumatic stress symptoms. Journal of Psychopathology and Behavioral Assessment, 36(3), 475–484. https://doi.org/10.1007/s10862-014-9413-6.

    Article  Google Scholar 

  • Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423.

    Article  Google Scholar 

  • Fischer, J. E., Bachmann, L. M., & Jaeschke, R. (2003). A readers' guide to the interpretation of diagnostic test properties: Clinical example of sepsis. Intensive Care Medicine, 29(7), 1043–1051.

    Article  Google Scholar 

  • Fossion, P., Leys, C., Kempenaers, C., Braun, S., Verbanck, P., & Linkowski, P. (2014). Disentangling sense of coherence and resilience in case of multiple traumas. Journal of Affective Disorders, 160, 16021–16026. https://doi.org/10.1016/j.jad.2014.02.029.

    Article  Google Scholar 

  • Goodman, L., Corcoran, C., Turner, K., Yuan, N., & Green, B. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the stressful life events screening questionnaire. Journal of Traumatic Stress, 11(3), 521–542.

    Article  Google Scholar 

  • Hains, A. A. (1992). A stress-inoculation training program for adolescents in a high school setting: A multiple baseline approach. Journal of Adolescence, 15(2), 163–175. https://doi.org/10.1016/0140-1971(92)90045-7.

    Article  PubMed  Google Scholar 

  • Heim, C., Newport, D. J., Mletzko, T., Miller, A. H., & Nemeroff, C. B. (2008). The link between childhood trauma and depression: Insights from HPA axis studies in humans. Psychoneuroendocrinology, 33(6), 693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008.

    Article  PubMed  Google Scholar 

  • Herman, J. (2012). CPTSD is a distinct entity: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 256–257. https://doi.org/10.1002/jts.21697.

    Article  PubMed  Google Scholar 

  • Holliday, S. B., Pedersen, E. R., & Leventhal, A. M. (2016). Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance. Drug and Alcohol Dependence, 161, 161348–161355. https://doi.org/10.1016/j.drugalcdep.2016.02.030.

    Article  Google Scholar 

  • Jakob, J. D., Lamp, K., Rauch, S. M., Smith, E. R., & Buchholz, K. R. (2017). The impact of trauma type or number of traumatic events on PTSD diagnosis and symptom severity in treatment seeking veterans. The Journal of Nervous and Mental Disease, 205(2), 83–86. https://doi.org/10.1097/NMD.0000000000000581.

    Article  PubMed  Google Scholar 

  • Karam, E. G., Friedman, M. J., Hill, E. D., Kessler, R. C., McLaughlin, K. A., Petukhova, M., Sampson, L., Shahly, V., Angermeyer, M. C., Bromet, E. J., de Girolamo, G., de Graaf, R., Demyttenaere, K., Ferry, F., Florescu, S. E., Haro, J. M., He, Y., Karam, A. N., Kawakami, N., Kovess-Masfety, V., Medina-Mora, M. E., Browne, M. A. O., Posada-Villa, J. A., Shalev, A. Y., Stein, D. J., Viana, M. C., Zarkov, Z., & Koenen, K. C. (2014). Cumulative traumas and risk thresholds: 12-month PTSD in the world mental health (WMH) surveys. Depression and Anxiety, 31, 130–142. https://doi.org/10.1002/da.22169.

    Article  PubMed  Google Scholar 

  • Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National Estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26(5), 537–547. https://doi.org/10.1002/jts.21848.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kolassa, I.-T., & Elbert, T. (2007). Structural and functional neuroplasticity in relation to traumatic stress. Current Directions in Psychological Science, 16(6), 321–325.

    Article  Google Scholar 

  • Kolassa, I., Ertl, V., Eckart, C., Kolassa, S., Onyut, L. P., & Elbert, T. (2010). Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychological Trauma: Theory, Research, Practice, And Policy, 2(3), 169–174. https://doi.org/10.1037/a0019362.

    Article  Google Scholar 

  • Kraemer, K. M., Luberto, C. M., & McLeish, A. C. (2013). The moderating role of distress tolerance in the association between anxiety sensitivity physical concerns and panic and PTSD-related re-experiencing symptoms. Anxiety, Stress & Coping: An International Journal, 26(3), 330–342. https://doi.org/10.1080/10615806.2012.693604.

    Article  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • LeBouthillier, D. M., McMillan, K. A., Thibodeau, M. A., & Asmundson, G. G. (2015). Types and number of traumas associated with suicidal ideation and suicide attempts in PTSD: Findings from a U.S. nationally representative sample. Journal of Traumatic Stress, 28(3), 183–190. https://doi.org/10.1002/jts.22010.

    Article  PubMed  Google Scholar 

  • Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600. https://doi.org/10.1037/a0019712.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York, NY: Oxford University Press 978-0195395525.

    Google Scholar 

  • Marshall-Berenz, E. C., Vujanovic, A. A., Bonn-Miller, M. O., Bernstein, A., & Zvolensky, M. J. (2010). Multimethod study of distress tolerance and PTSD symptom severity in a trauma-exposed community sample. Journal of Traumatic Stress, 23(5), 623–630. https://doi.org/10.1002/jts.20568.

    Article  PubMed  PubMed Central  Google Scholar 

  • McNally, R. J. (2006). Cognitive abnormalities in posttraumatic stress disorder. Trends in Cognitive Sciences, 10, 271–277.

    Article  Google Scholar 

  • McQuaid, J. R., Pedrelli, P., McCahill, M. E., & Stein, M. B. (2001). Reported trauma, post-traumatic stress disorder and major depression among primary care patients. Psychological Medicine, 31(07), 1249–1257.

    Article  Google Scholar 

  • Meichenbaum, D. (2007). Stress-inoculation training: A preventative and treatment approach. In P. M. Lehrer, R. L. Woolfolk, W. E. Sime, P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed., pp. 497–516). New York, NY, US: Guilford Press.

    Google Scholar 

  • Miranda, J. M., Green, B. L., & Krupnick, J. (1997, December). Mental disorders in disadvantaged gynecology patients. Paper presented at the north American meeting of the Society for Psychotherapy Research. AZ: Tucson.

    Google Scholar 

  • Mollica, R. F., McInnes, K., Poole, C., & Tor, S. (1998). Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. The British Journal of Psychiatry, 173(6), 482–488.

    Article  Google Scholar 

  • Mustanski, B., Andrews, R., & Puckett, J. A. (2016). The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. American Journal of Public Health, 106(3), 527–533. https://doi.org/10.2105/AJPH.2015.302976.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from wave 2 of the National Epidemiologic Survey on alcohol and related conditions. Journal of Anxiety Disorders, 25, 456–465. https://doi.org/10.1016/j.janxdis.2010.11.010.

    Article  PubMed  Google Scholar 

  • Rutter, M. (2012). Resilience as a dynamic concept. Development and Psychopathology, 24(2), 335–344. https://doi.org/10.1017/S0954579412000028.

    Article  PubMed  Google Scholar 

  • Rytwinski, N. K., Scur, M. D., Feeny, N. C., & Youngstrom, E. A. (2013). The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: A meta-analysis. Journal of Traumatic Stress, 26, 299–309. https://doi.org/10.1002/jts.21814.

    Article  PubMed  Google Scholar 

  • Schauer, M., Neuner, F., Karunakara, U., Klaschik, C., Robert, C., & Elbert, T. (2003). PTSD and the “building block” effect of psychological trauma among West Nile Africans. ESTSS (European Society for Traumatic Stress Studies) Bulletin, 10(2), 5–6.

    Google Scholar 

  • Schnurr, P. P., Rosenberg, S. D., & Friedman, M. J. (1993). Change in MMPI scores from college to adulthood as a function of military service. Journal of Abnormal Psychology, 102(2), 288–296.

    Article  Google Scholar 

  • Seery, M. D. (2011). Resilience a silver lining to experiencing adverse life events? Current Directions in Psychological Science, 20(6), 390–394.

    Article  Google Scholar 

  • Seery, M. D., Leo, R. J., Holman, E. A., & Silver, R. C. (2010). Lifetime exposure to adversity predicts functional impairment and healthcare utilization among individuals with chronic back pain. Pain, 150, 507–515.

    Article  Google Scholar 

  • Seery, M. D., Leo, R. J., Lupien, S. P., Kondrak, C. L., & Almonte, J. L. (2013). An upside to adversity?: Moderate cumulative lifetime adversity is associated with resilient responses in the face of controlled stressors. Psychological Science (0956–7976), 24(7), 1181–1189.

    Article  Google Scholar 

  • Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102.

    Article  Google Scholar 

  • Stein, J. Y., Wilmot, D. V., & Solomon, Z. (2016). Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD criterion a. Journal of Anxiety Disorders, 43, 43106–43117. https://doi.org/10.1016/j.janxdis.2016.07.001.

    Article  Google Scholar 

  • Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed, R., Stein, D. J., & Seedat, S. (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50(2), 121–127. https://doi.org/10.1016/j.comppsych.2008.06.006.

    Article  PubMed  Google Scholar 

  • Sullivan, E., Contractor, A. A., Gerber, M. M., & Neumann, C. (2017). Examination of polytrauma typologies: A latent class analysis approach. Psychiatry Research, 255, 255111–255118. https://doi.org/10.1016/j.psychres.2017.05.026.

    Article  Google Scholar 

  • Thibodeau, M. A., Welch, P. G., Sareen, J., & Asmundson, G. G. (2013). Anxiety disorders are independently associated with suicide ideation and attempts: Propensity score matching in two epidemiological samples. Depression and Anxiety, 30(10), 947–954. https://doi.org/10.1002/da.22203.

    Article  PubMed  Google Scholar 

  • Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36(4), 360–376. https://doi.org/10.2307/2137325.

    Article  PubMed  Google Scholar 

  • van Minnen, A., Hendriks, L., & Olff, M. (2010). When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behaviour Research and Therapy, 48(4), 312–320. https://doi.org/10.1016/j.brat.2009.12.003.

    Article  PubMed  Google Scholar 

  • Vujanovic, A. A., Bonn-Miller, M. O., Potter, C. M., Marshall, E. C., & Zvolensky, M. J. (2011a). An evaluation of the relation between distress tolerance and posttraumatic stress within a trauma-exposed sample. Journal of Psychopathology and Behavioral Assessment, 33(1), 129–135.

    Article  Google Scholar 

  • Vujanovic, A. A., Marshall-Berenz, E. C., & Zvolensky, M. J. (2011b). Posttraumatic stress and alcohol use motives: A test of the incremental and mediating role of distress tolerance. Journal of Cognitive Psychotherapy, 25(2), 130–141. https://doi.org/10.1891/0889-8391.25.2.130.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vujanovic, A. A., Hart, A. S., Potter, C. M., Berenz, E. C., Niles, B., & Bernstein, A. (2013). Main and interactive effects of distress tolerance and negative affect intensity in relation to PTSD symptoms among trauma-exposed adults. Journal of Psychopathology and Behavioral Assessment, 35(2), 235–243. https://doi.org/10.1007/s10862-012-9325-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In Annual convention of the international society for traumatic stress studies. San Antonio: International Society for Traumatic Stress Studies.

  • Whiting, D., & Bryant, R. A. (2007). Role of appraisals in expressed anger after trauma. Clinical Psychologist, 11(1), 33–36. https://doi.org/10.1080/13284200601178136.

    Article  Google Scholar 

  • Wiederhold, B. K., & Wiederhold, M. D. (2008). Virtual reality for posttraumatic stress disorder and stress-inoculation training. Journal Of Cybertherapy And Rehabilitation, 1(1), 23–35.

    Google Scholar 

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Funding

Dr. Frankfurt’s work is supported by the Department of Veterans Affairs Office of Research and Development Rehabilitation Research and Development Service Career Development Award - 1 (#IK1RX00304-01-A1). Since Dr. Frankfurt is an employee of the U.S. Government and contributed to this manuscript as part of her official duties, the work is not subject to US copyright.

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Authors and Affiliations

  1. Department of Psychology, University of North Texas, 369 Terrill Hall, Denton, TX, 76203, USA

    Monica M. Gerber, Ateka A. Contractor & Kelsey Oudshoorn

  2. VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA

    Sheila B. Frankfurt

  3. Texas A&M University, College Station, TX, USA

    Sheila B. Frankfurt

  4. Choices! Counseling Services, Valparaiso, Northwest, IN, USA

    Paula Dranger

  5. Valparaiso University Graduate School and Counseling Center, Valparaiso, IN, USA

    Paula Dranger

  6. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

    Lily A. Brown

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  1. Monica M. Gerber
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Correspondence to Ateka A. Contractor.

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Monica Gerber, Sheila B. Frankfurt, Ateka A. Contractor, Kelsey Oudshoorn, Paula Dranger, and Lily Brown declare that they have no conflict of interest.

Experiment Participant

This study was approved by a Midwestern university’s Institutional Review Board. The present study is a secondary analysis of this larger dataset (see Contractor et al. 2017 for full study details). Participants were recruited from waiting rooms at a Midwest community mental health center. All paricipants completed informed consent and compensation for participation was not offered.

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Gerber, M., Frankfurt, S.B., Contractor, A.A. et al. Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?. J Psychopathol Behav Assess 40, 645–654 (2018). https://doi.org/10.1007/s10862-018-9682-6

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