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

  • Monica M. Gerber
  • Sheila B. Frankfurt
  • Ateka A. Contractor
  • Kelsey Oudshoorn
  • Paula Dranger
  • Lily A. Brown


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.


Lifetime traumatic experiences PTSD Depression Distress tolerance Dose-response theory Stress-inoculation theory 



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.

Compliance with Ethical Standards

Conflict of Interest

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Monica M. Gerber
    • 1
  • Sheila B. Frankfurt
    • 2
    • 3
  • Ateka A. Contractor
    • 1
  • Kelsey Oudshoorn
    • 1
  • Paula Dranger
    • 4
    • 5
  • Lily A. Brown
    • 6
  1. 1.Department of PsychologyUniversity of North TexasDentonUSA
  2. 2.VISN 17 Center of Excellence for Research on Returning War VeteransWacoUSA
  3. 3.Texas A&M UniversityCollege StationUSA
  4. 4.Choices! Counseling ServicesNorthwestUSA
  5. 5.Valparaiso University Graduate School and Counseling CenterValparaisoUSA
  6. 6.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA

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