Abstract
Potentially traumatic events (PTEs) increase risk for psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Social support (SS) is associated with reduced symptoms for each disorder. Each disorder, however, is highly heterogeneous such that they are comprised of clusters of different symptoms. It is unclear if SS is associated with all clusters equally. The current study examined the relation between SS and the symptom clusters of each disorder. Participants completed a battery of self-report assessments for PTSD, MDD, GAD, and SS. All participants experienced a Criterion A traumatic event. Although SS was significantly associated with all symptom clusters, the strength of relations varied. The relation between SS and MDD-affective was significantly stronger than its association with all other factors. The relations between SS and GAD, MDD-somatic, PTSD-AAR, and PTSD-NACM did not significantly differ. These relations were stronger than the relations between SS and the remaining PTSD factors. There was no significant difference in the relations between SS and PTSD-intrusions or PTSD-avoidance. These results suggest that SS is more closely aligned to specific aspects of post-trauma psychopathology.
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American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders, Fifth Edition.: DSM 5. Washington DC: American Psychiatric Association.
Aneshensel, C. S., & Stone, J. D. (1982). Stress and depression: a test of the buffering model of social support. Archives of General Psychiatry, 39(12), 1392–1396. https://doi.org/10.1001/archpsyc.1982.04290120028005.
Armour, C., Műllerová, J., & Elhai, J. D. (2016). A systematic literature review of PTSD’s latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clinical Psychology Review, 44, 60–74. https://doi.org/10.1016/j.cpr.2015.12.003.
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism back to the future. Clinical Psychological Science, 2(3), 344–365. https://doi.org/10.1177/2167702613505532.
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9(1), 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608.
Borsboom, D., Cramer, A. O. J., Schmittmann, V. D., Epskamp, S., & Waldorp, L. J. (2011). The small world of psychopathology. PLoS One, 6(11), e27407. https://doi.org/10.1371/journal.pone.0027407.
Borstelmann, N. A., Rosenberg, S. M., Ruddy, K. J., Tamimi, R. M., Gelber, S., Schapira, L., et al. (2015). Partner support and anxiety in young women with breast cancer. Psycho-Oncology, 24(12), 1679–1685. https://doi.org/10.1002/pon.3780.
Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103(4), 670–686.
Brown, T. A. (2015). Confirmatory factor analysis for applied research. New York: Guilford Publications.
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256–271. https://doi.org/10.1037/a0016608.
Bryant, R. A., O’Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167(3), 312–320. https://doi.org/10.1176/appi.ajp.2009.09050617.
Byllesby, B. M., Charak, R., Durham, T. A., Wang, X., & Elhai, J. D. (2016a). The underlying role of negative affect in the association between PTSD, major depressive disorder, and generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 1–11. https://doi.org/10.1007/s10862-016-9555-9.
Byllesby, B. M., Durham, T. A., Forbes, D., Armour, C., & Elhai, J. D. (2016b). An investigation of PTSD’s core dimensions and relations with anxiety and depression. Psychological Trauma: Theory, Research, Practice, and Policy, 8(2), 214–217. https://doi.org/10.1037/tra0000081.
Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S., Jackson, C. L., et al. (2010). Treatment for PTSD related to childhood abuse: A randomized controlled trial. American Journal of Psychiatry, 167(8), 915–924. https://doi.org/10.1176/appi.ajp.2010.09081247.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310.
Contractor, A. A., Durham, T. A., Brennan, J. A., Armour, C., Wutrick, H. R., Christopher Frueh, B., & Elhai, J. D. (2014). DSM-5 PTSD’s symptom dimensions and relations with major depression’s symptom dimensions in a primary care sample. Psychiatry Research, 215(1), 146–153. https://doi.org/10.1016/j.psychres.2013.10.015.
Contractor, A. A., Elhai, J. D., Fine, T. H., Tamburrino, M. B., Cohen, G., Shirley, E., et al. (2015). Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers. Journal of Psychiatric Research, 68, 19–26. https://doi.org/10.1016/j.jpsychires.2015.05.014.
Dai, W., Chen, L., Tan, H., Wang, J., Lai, Z., Kaminga, A. C., et al. (2016). Association between social support and recovery from post-traumatic stress disorder after flood: a 13–14 year follow-up study in Hunan, China. BMC Public Health, 16, 194. https://doi.org/10.1186/s12889-016-2871-x.
Durham, T. A., Elhai, J. D., Fine, T. H., Tamburrino, M., Cohen, G., Shirley, E., et al. (2015). Posttraumatic stress disorder′s dysphoria dimension and relations with generalized anxiety disorder symptoms. Psychiatry Research, 228(1), 150–155. https://doi.org/10.1016/j.psychres.2015.04.034.
Elhai, J. D., Grubaugh, A. L., Kashdan, T. B., & Christopher, B. (2008). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. Journal of Clinical Psychiatry, 69(4), 597–602. https://doi.org/10.4088/JCP.v69n0411.
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.
Elhai, J. D., Contractor, A. A., Tamburrino, M., Fine, T. H., Cohen, G., Shirley, E., et al. (2015). Structural relations between DSM-5 PTSD and major depression symptoms in military soldiers. Journal of Affective Disorders, 175, 373–378. https://doi.org/10.1016/j.jad.2015.01.034.
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., et al. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy, 43(3), 666–678. https://doi.org/10.1016/j.beth.2012.01.001.
Fields, J. A., Nichols, L. O., Martindale-Adams, J., Zuber, J., & Graney, M. (2012). Anxiety, social support, and physical health in a sample of spouses of OEF/OIF service members. Military Medicine, 177(12), 1492–1497. https://doi.org/10.7205/MILMED-D-12-00036.
Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9(4), 466–491. https://doi.org/10.1037/1082-989X.9.4.466.
Fredman, S. J., Beck, J. G., Shnaider, P., Le, Y., Pukay-Martin, N. D., Pentel, K. Z., et al. (2017). Longitudinal associations between PTSD symptoms and dyadic conflict communication following a severe motor vehicle accident. Behavior Therapy, 48(2), 235–246. https://doi.org/10.1016/j.beth.2016.05.001.
Grant, D. M., Beck, J. G., Marques, L., Palyo, S. A., & Clapp, J. D. (2008). The structure of distress following trauma: posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Journal of Abnormal Psychology, 117(3), 662–672. https://doi.org/10.1037/a0012591.
Gros, D. F. (2014). Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders. Psychiatry Research, 220(1–2), 275–282. https://doi.org/10.1016/j.psychres.2014.08.018.
Gros, D. F., Price, M., Magruder, K. M., & Frueh, B. C. (2012). Symptom overlap in posttraumatic stress disorder and major depression. Psychiatry Research, 196(2–3), 267–270. https://doi.org/10.1016/j.psychres.2011.10.022.
Horowitz, M. J. (2011). Stress response syndromes: PTSD, grief, adjustment, and dissociative disorders (5th ed.). Lanham: Jason Aronson, Inc.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118.
Joiner, T. E. (2000). Depression’s vicious scree: self-propagating and erosive processes in depression chronicity. Clinical Psychology: Science and Practice, 7(2), 203–218. https://doi.org/10.1093/clipsy.7.2.203.
Kass, R. E., & Raftery, A. E. (1995). Bayes factors. Journal of the American Statistical Association, 90(430), 773–795. https://doi.org/10.1080/01621459.1995.10476572.
Kessler, R. C., Price, R. H., & Wortman, C. B. (1985). Social factors in psychopathology: stress, social support, and coping processes. Annual Review of Psychology, 36(1), 531–572. https://doi.org/10.1146/annurev.ps.36.020185.002531.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
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.
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026.
Kwako, L. E., Szanton, S. J., Saligan, L. N., & Gill, J. M. (2011). Major depressive disorder in persons exposed to trauma: relationship between emotional intelligence and social support. Journal of the American Psychiatric Nurses Association, 17(3), 237–245. https://doi.org/10.1177/1078390311402498.
Maheux, A., & Price, M. (2016). The indirect effect of social support on post-trauma psychopathology via self-compassion. Personality and Individual Differences, 88, 102–107. https://doi.org/10.1016/j.paid.2015.08.051.
Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M., & Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 48, 147–155. https://doi.org/10.1016/j.beth.2016.02.011.
McNally, R. J., Robinaugh, D. J., Wu, G. W. Y., Wang, L., Deserno, M. K., & Borsboom, D. (2015). Mental disorders as causal systems: a network approach to posttraumatic stress disorder. Clinical Psychological Science, 3(6), 836–849. https://doi.org/10.1177/2167702614553230.
Miller, M. W., Wolf, E. J., Kilpatrick, D., Resnick, H., Marx, B. P., Holowka, D. W., et al. (2013). The prevalence and latent structure of proposed DSM-5 posttraumatic stress disorder symptoms in U.S. national and veteran samples. Psychological Trauma: Theory, Research, Practice, and Policy, 5(6), 501–512. https://doi.org/10.1037/a0029730.
Muthén, L. K., & Muthén, B. O. (2012). Mplus User's Guide (Seventh Edition). Los Angeles, CA: Muthén & Muthén.
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.
Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social Support and Resilience to Stress. Psychiatry (Edgmont), 4(5), 35–40.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin, 129(1), 52–73. https://doi.org/10.1037/0033-2909.129.1.52.
Paolacci, G., & Chandler, J. (2014). Inside the turk understanding mechanical turk as a participant pool. Current Directions in Psychological Science, 23(3), 184–188. https://doi.org/10.1177/0963721414531598.
Paolacci, G., Chandler, J., & Ipeirotis, P. G. (2010). Running experiments on amazon mechanical turk. Judgment and Decision making, 5(5), 411–419.
Peirce, R. S., Frone, M. R., Russell, M., Lynne, M., & Mudar, P. (2000). A longitudinal model of social contact, social support, depression, and alcohol use. Health Psychology, 19(1), 28–38. https://doi.org/10.1037/0278-6133.19.1.28.
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., & Southwick, S. M. (2009). Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depression and Anxiety, 26(8), 745–751. https://doi.org/10.1002/da.20558.
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., Rivers, A. J., Morgan, C. A., & Southwick, S. M. (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(1–3), 188–192. https://doi.org/10.1016/j.jad.2009.04.015.
Pietrzak, R. H., Tsai, J., Armour, C., Mota, N., Harpaz-Rotem, I., & Southwick, S. M. (2015). Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans Study. Journal of Affective Disorders, 174, 522–526. https://doi.org/10.1016/j.jad.2014.12.007.
Price, M., & van Stolk-Cooke, K. (2015). Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. Journal of Affective Disorders, 186, 149–155. https://doi.org/10.1016/j.jad.2015.06.012.
Price, M., Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (2013). The role of social support in exposure therapy for Operation Iraqi Freedom/Operation Enduring Freedom Veterans: a preliminary investigation. Psychological Trauma: Theory, Research, Practice and Policy, 5(1), 93–100. https://doi.org/10.1037/a0026244.
Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using mechanical Turk to study clinical populations. Clinical Psychological Science, 2167702612469015. https://doi.org/10.1177/2167702612469015.
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-B.
Slade, T., & Watson, D. (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine, null(11), 1593–1600. https://doi.org/10.1017/S0033291706008452.
Spitzer, R. L., Kroenke, K., Williams, J. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the gad-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Thrasher, S., Power, M., Morant, N., Marks, I., & Dalgleish, T. (2010). Social support moderates outcome in a randomized controlled trial of exposure therapy and (or) cognitive restructuring for chronic posttraumatic stress disorder. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 55(3), 187.
Tsai, J., Elhai, J. D., Pietrzak, R. H., Hoff, R. A., & Harpaz-Rotem, I. (2014). Comparing four competing models of depressive symptomatology: a confirmatory factor analytic study of 986,647 U.S. veterans. Journal of Affective Disorders, 165, 166–169. https://doi.org/10.1016/j.jad.2014.04.075.
Ullman, S. E., & Filipas, H. H. (2001). Predictors of PTSD symptom severity and social reactions in sexual assault victims. Journal of Traumatic Stress, 14(2), 369–389. https://doi.org/10.1023/A:1011125220522.
Watson, D. (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology, 5(1), 221–247. https://doi.org/10.1146/annurev.clinpsy.032408.153510.
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013a). The life events checklist for DSM-5 (LEC-5). Retrieved from http://www.ptsd.va.gov/professional/assessment/te-measures/life_events_checklist.asp.
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013b). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov.
Woodward, M. J., Eddinger, J., Henschel, A. V., Dodson, T. S., Tran, H. N., & Beck, J. G. (2015). Social support, posttraumatic cognitions, and PTSD: the influence of family, friends, and a close other in an interpersonal and non-interpersonal trauma group. Journal of Anxiety Disorders, 35, 60–67. https://doi.org/10.1016/j.janxdis.2015.09.002.
Zatzick, D. F., Rivara, F. P., Nathens, A. B., Jurkovich, G. J., Wang, J., Fan, M.-Y., et al. (2007). A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychological Medicine, 37(10), 1469–1480. https://doi.org/10.1017/S0033291707000943.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2.
Acknowledgements
This study was conducted with the support of a University of Vermont APLE Award awarded to Sarah Pallito, Anne Maheux, and Andrew Brown. Dr. Price is supported by K08MH107661-01A1.
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Matthew Price, Sarah Pallito, and Alison Legrand declare that they have no conflict of interest.
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Price, M., Pallito, S. & Legrand, A.C. Heterogeneity in the Strength of the Relation Between Social Support and Post-Trauma Psychopathology. J Psychopathol Behav Assess 40, 334–343 (2018). https://doi.org/10.1007/s10862-017-9629-3
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DOI: https://doi.org/10.1007/s10862-017-9629-3