The impact of anger and self-concealment on post-traumatic stress and psychiatric comorbid symptoms in Chinese prisoners: A longitudinal study.

BACKGROUND: Research reported prevalence of post-traumatic stress disorder (PTSD) among prisoners varies between countries, with most studies based on Western samples. The trajectory of symptoms has also been controversial. Trauma can affect prisoners' emotions and their emotional regulation tends to be maladaptive. AIMS: To examine changes in PTSD and psychiatric comorbidity among prisoners in China over time and to determine whether anger and self-concealment predicts later distress. METHOD: In a longitudinal, prospective study, sentenced men in one prison in China were asked to complete a demographic page and several self-rating scales: the Post-traumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Clinical Anger Scale and the Self-Concealment Scale at baseline and at 6 and 12 months after the initial assessment. RESULTS: More than half of the 496 participating men were diagnosed with PTSD. For those completing the scales at each evaluation, PTSD-DS scores were significantly lower at baseline than at the 6-month and 1-year assessments. No significant differences were found between the two follow-up scores. There was no significant difference in psychiatric comorbidity between the three phases. At the cross-sectional level, after controlling for age and education level, PTSD, anger and self-concealment were associated with psychiatric comorbidity. At the prospective level, anger predicted PTSD 6 months and 1 year later. Self-concealment predicted psychiatric comorbidity over time. CONCLUSIONS: Among these prisoners the prevalence of chronic PTSD was far higher than in general population estimates. Early identification of aspects of coping styles is likely to help predict disorder trajectory and inform interventions. Early signs of anger were indicative of the chronic severity of trauma reactions, while the intention to hide distress was related to other later mental health problems.

The Impact of Child Abuse and Dissociation on Psychiatric Comorbidity and Self-Concealment Among Prisoners in China.

Child abuse is a common experience among prisoners in China and associated with elevated psychiatric comorbidity. However, the association between child abuse profiles and dissociation is unclear. The extent to which the relationship between these profiles and dissociation might influence psychiatric comorbidity and self-concealment is also unclear. This study examined the impact of this relationship on the preceding outcomes among prisoners in China using Latent Class Analysis. Four hundred and ninety-six male prisoners from China completed questionnaires measuring child abuse, dissociation, self-concealment, and psychiatric comorbidity. A three-class solution was achieved: Class 1 (neglected with moderate dissociation) prisoners had a minimal level of abuse, the highest level of neglect experience, and a medium level of dissociation; Class 2 (low neglect with low dissociation) prisoners also had a minimal level of abuse but lower levels of neglect experience and dissociation; Class 3 (abused and neglected with high dissociation) prisoners had high levels of child abuse, neglect, and dissociation. Controlling for age, Class 3 reported significantly higher psychiatric comorbidity and self-concealment than the other two classes. Class 1 was more depressed than Class 2; Class 2 was more likely to engage in self-concealment than Class 1. To conclude, the kinds of childhood maltreatment experienced by prisoners and their readiness to detach from distressing emotions can influence the severity of current distress symptoms and the tendency to conceal things about themselves.

The Interrelationship Between Child Abuse, Emotional Processing Difficulties, Alexithymia And Psychological Symptoms Among Chinese Adolescents.

This study examined the interrelationship between child abuse, emotional processing difficulties, alexithymia, and psychological symptoms with posttraumatic stress disorder (PTSD) symptoms from past traumas adjusted among Chinese adolescents. Eight hundred adolescents completed questionnaires measuring the preceding psychological constructs. After controlling for PTSD from past trauma, structural equation modeling showed that child abuse correlated with emotional processing difficulty which correlated with alexithymia. In turn, alexithymia correlated with psychological symptom severity. To conclude, child abuse can affect psychological health among Chinese adolescents. This relationship, however, is influenced by the degree to which processing distressing emotions and getting in touch with internal feelings is avoided.

Gender Differences in Child Abuse, Emotional Processing Difficulties, Alexithymia, Psychological Symptoms and Behavioural Problems among Chinese Adolescents.

Child abuse among adolescents in China has been documented and can lead to a whole range of psychological and behavioural problems. This study examined whether male and female adolescents would differ in level of child abuse, emotional processing difficulties, alexithymia, psychological symptoms and behavioural problems, and whether the pattern of association between these variables would vary depending on gender. Eight hundred adolescents were recruited from China and completed the Childhood Trauma Questionnaire, Emotional Processing Scale, Toronto Alexithymia Scale, General Health Questionnaire, and Prediction Test of Problem Children. Male adolescents reported significantly higher levels of emotional and physical neglect, and external oriented thinking style than female adolescents. Females reported significantly more anxiety symptoms and problems with learning than males. For males, child abuse was associated with emotional processing difficulties which were associated with alexithymia. In turn, alexithymia was associated with both psychological and behavioural problems. For females, the same association was established for predicting behavioural problems but not psychological symptoms. Male and female adolescents differed in level of child abuse, alexithymia, psychological symptoms and behavioural problems. These psychological constructs were connected in a specific pattern to trigger psychological and behavioural problems for male adolescents whereas for females, different patterns were involved.

Child Abuse and Psychiatric Co-morbidity Among Chinese Adolescents: Emotional Processing as Mediator and PTSD from Past Trauma as Moderator.

This study investigated whether child abuse was associated with psychiatric co-morbidity in a group of Chinese adolescents, and whether this association would be mediated by emotional processing difficulties and moderated by the severity of PTSD from other traumas in the past. Four hundred seventy-four adolescents participated in the study. They completed the Childhood Trauma Questionnaire-Short Form, General Health Questionnaire-28, the Posttraumatic Stress Diagnostic Scale, and Emotional processing scale-25. The results showed that after adjusting for the total number of traumatic events and how long ago the most traumatic event occurred, child abuse was associated with psychiatric co-morbidity. This association was not moderated by the severity of PTSD from past traumas but mediated by emotion processing difficulties. To conclude, adolescents who experience child abuse can develop emotional processing difficulties which in turn impact on psychiatric symptoms. Experience of past trauma does not influence these psychological processes.

The Relationship Between Gender, Posttraumatic Stress Disorder from Past Trauma, Alexithymia and Psychiatric Co-morbidity in Chinese Adolescents: A Moderated Mediational Analysis.

This study focused on a group of Chinese adolescents and examined whether the degree of alexithymia would mediate the effect of PTSD from past trauma onto psychiatric co-morbidities and whether gender differences would moderate the mediational effects of alexithymia. Three hundred and twenty-six adolescents were recruited from two schools and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28 and Toronto Alexithymia Scale-20. The results showed that 54 % had no trauma in their lives; 10, 21 and 15 % met the criteria for full, partial and no-PTSD respectively. After adjusting the number of traumatic events, difficulty identifying feelings mediated the path between PTSD from past trauma and psychiatric co-morbidity. Gender moderated the mediational effect of difficulty identifying feelings. To conclude, adolescents can develop PTSD symptoms and psychiatric co-morbidity following exposure to a traumatic event. For both males and females, difficulty getting in touch with feelings can influence the impact of PTSD onto psychiatric co-morbidity.