Posttraumatic stress disorder symptoms in Korean conflict and World War II combat veterans seeking outpatient treatment.

Given important differences in the Korean conflict and World War II, samples of treatment-seeking combat veterans from these wars (30 Korea, 83 World War II) were compared on the prevalence and severity of posttraumatic stress disorder (PTSD). With age, ethnicity, and combat exposure taken into account, the Korean veterans reported significantly more severe symptoms on both interview and self-report PTSD measures. Group differences in the prevalence of current PTSD were in a similar direction but not significant. These results are generally consistent with other studies that have found Korean combat veterans to exhibit higher rates of psychosocial maladjustment than World War II combat veterans. Based on related research with Vietnam veterans, one direction for future investigation is to examine what role stressful postmilitary homecoming experiences may have played in influencing the development and course of combat-related PTSD in the aging cohort of "forgotten" Korean conflict veterans.

Modes of long-term coping with trauma memories: relative use and associations with personality among Vietnam veterans with chronic PTSD.

Little is known about how individuals who develop chronic posttraumatic stress disorder (PTSD) cope with recurring trauma memories, or how enduring personality characteristics influence such coping. Focusing on 110 hospitalized Vietnam combat veterans with chronic PTSD, this exploratory study assessed the relative frequency of using eight ways of coping with war memories, and associations between relative use of these strategies and eight dysfunctional personality styles. As a secondary issue, associations between coping strategies, combat exposure, and PTSD severity were also examined. Consistent with prior findings, these veterans predominantly used emotion-focused and avoidant strategies to cope with war memories. Differing personality styles and relative use or nonuse of particular coping strategies were also associated in psychologically coherent ways. These preliminary findings are discussed in relation to methodologic and future research issues.

Self-critical depressive experience in posttraumatic stress disorder.

Consistent with prior research, 73 hospitalized male Vietnam veterans with combat-related Posttraumatic Stress Disorder (PTSD) reported high scores on Self-criticism as measured by the Depressive Experiences Questionnaire. Self-criticism scores predicted greater severity of PTSD (Mississippi scale) after controlling for symptomatic depression (MMPI-D scale), suggesting that the nature of depression in Posttraumatic Stress Disorder differs from that in major depressive disorder.

Negative parenting behavior, combat exposure, and PTSD symptom severity. Test of a person-event interaction model.

The "personal characteristics" and "extreme event" hypotheses have been proposed as alternative explanations for the development of posttraumatic stress disorder (PTSD) among combat veterans. The person-event interaction model attempts to integrate both perspectives by hypothesizing that premilitary individual vulnerability characteristics play a greater role in influencing risk of PTSD or PTSD symptom severity at lower than at higher levels of exposure to traumatic combat stressors. Focusing on a sample of 57 Vietnam veterans undergoing inpatient treatment for diagnosed PTSD, we assessed this model by examining interactions between negative parenting behaviors in childhood (e.g., inconsistent love) and degree of combat exposure in predicting PTSD symptom severity. Hierarchical regression analyses supported the model, indicating that the father's negative parenting behaviors were more predictive of PTSD symptom severity at relatively lower levels of combat exposure. Implications of the findings for further research on multivariate, interactional models of PTSD etiology among Vietnam combat veterans are discussed.

Suicidal behavior among chronic Vietnam theatre veterans with PTSD.

Suicidal behavior among Vietnam veterans with chronic Post-traumatic Stress Disorder (PTSD) was evaluated. Sixty chronic PTSD vets admitted to a Specialized PTSD Unit were divided into two groups based on the presence of suicidal behavior: 29 patients in a Suicide Group and 31 in a Non-suicide Group. Subjects were evaluated on symptoms, psychometric measures, military variables, adjustment factors, and pre-military parental patterns of discipline. Results showed that the Suicide Group possessed problems in paternal child-rearing patterns, current adjustment difficulties, and the PTSD symptoms of survival guilt and crying. In a regression analysis, paternal inconsistency of love, survivor guilt, and tendency to cry, in addition to age and sex, accounted for the significant variance of suicidal behavior.

The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample.

This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.

Personality antecedents of burnout among middle-aged physicians.

Utilizing a prospective design, this study addressed the question of whether vulnerability to burnout among physicians is associated with certain longstanding, maladaptive personality tendencies that predate entrance into medical training and subsequent exposure to the intrinsic stresses of medical practice. Subjects were 440 practicing physicians whose personality traits and psychological adjustment had been assessed with the Minnesota Multiphasic Personality Inventory (MMPI) shortly before entering medical school who were followed up by mail questionnaire an average of 25 years later to evaluate current symptoms of burnout with the Tedium scale. Results revealed that higher burnout scores were significantly correlated with a number of standard and special MMPI scales measuring low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others. In contrast, burnout scores exhibited no significant associations with demographic or practice characteristics, including sex, age, medical specialty, practice arrangement, hours worked per week, or percentage of work time spent in direct contact with patients. Alternative interpretations of these findings and their potential implications for reducing the risk of burnout among physicians are discussed.

Work stress, hardiness, and burnout among hospital staff nurses.

The question of whether personality hardiness moderates the impact of job stressors on burnout was studied in 107 registered staff nurses from an urban, community hospital who responded to a self-administered questionnaire. Consistent with previous research, burnout was significantly associated with higher levels of perceived job stress and lower levels of personality hardiness. Hierarchical multiple regression analyses further indicated that work stressors (particularly stress due to workload) and hardiness were significant additive rather than interactive predictors of burnout. That is, hardiness had beneficial main effects in reducing burnout, but did not appear to prevent high levels of job stress from leading to high levels of burnout.

Hostility, coronary heart disease (CHD) incidence, and total mortality: lack of association in a 25-year follow-up study of 478 physicians.

Higher levels of hostility, assessed by a Minnesota Multiphasic Personality Inventory (MMPI) scale (Ho), have been associated with the incidence of coronary disease and mortality from coronary disease and other causes in two prospective studies. In this study we examined the relationship between hostility and health status 25 years later in 478 physicians who completed the MMPI at the time of their medical-school admission interview. In contrast to earlier studies, higher Ho scores were not predictive of coronary disease incidence or total mortality. The implications of this finding for current research on the hostility component of the Type A behavior pattern are discussed.

Personality and multiple divorce. A prospective study.

A review of cross-sectional and prospective research in both normal and clinical samples suggests that increased risk of divorce is associated with socially nonconforming, impulsive, and stimulus-seeking personality traits. This exploratory study addresses the question of whether individuals who divorce more than once are especially likely to exhibit such general personality dispositions. Subjects were male physicians (N = 431) who had completed the MMPI before entering medical school and who were followed up more than two decades later by a mail questionnaire that inquired about their health status, health practices, subjective well-being, and marital history. As indicated by higher scores on the MMPI Psychopathic Deviate (Pd) scale and greater likelihood of concurrently reporting several negative health practices (e.g., cigarette smoking), multiply divorced physicians did tend to exhibit greater nonconforming, impulsive, and risk-taking tendencies than both never-divorced and once-divorced physicians. Possible social-psychological processes linking such personality dispositions to the risk of multiple divorce are discussed, along with suggestions for further research.

Practice and career satisfaction among residency trained family physicians: a national survey.

This paper reports the results of a national survey of perceptions of practice and career satisfaction among the first cohorts of residency-trained family physicians. The findings indicate that a large majority of the respondents (n = 876), most of whom had been in practice for only three years or less at the time of the survey in 1979, were well satisfied with their careers and work in general as well as with their residency training, practice arrangements and facilities, colleague relationships, and hospital privileges. Several sources of relative dissatisfaction and difficulty were reported by the physicians, however, including practice time pressures, the necessity of treating emotional problems beyond their training, financial costs associated with operating their practice, paperwork, and perceived interference of external regulations and/or agencies in the physician-patient relationship.

Type A behavior, field dependence, and serum lipids.

Given evidence that individual differences on the cognitive style dimension of field dependence/independence are significantly related to sympathetically mediated cardiovascular functioning and lipid metabolism, a correlational study was designed to examine associations between Type A behavior, field dependence, and serum lipids. It was hypothesized that field dependent Type A individuals would exhibit higher levels of total cholesterol and triglycerides than would field independent Type A individuals. Using 82 medical students as subjects, the hypothesis was supported among both males and females for total cholesterol, with a trend in the predicted direction for triglycerides. Field dependent Type A individuals of both sexes were also found to have a higher level of low-density lipoprotein to total cholesterol, when compared to their field independent Type A counterparts. The overall pattern of findings provides suggestive evidence that field dependence is an important mediating personality factor influencing levels of autonomic arousal and coronary risk among Type A individuals. Alternative explanations as to why field dependent Type A individuals may be more chronically aroused in response to environmental stimuli are discussed.

Aftercare for psychiatric patients: does it prevent rehospitalization?

Focusing on a sample of 421 patients who made from one to 65 visits to an aftercare clinic, the authors replicated and extended and investigation of the effectiveness of psychiatric aftercare for patients discharged from hospital settings. A total of 167 of the patients were rehospitalized at least once during the follow-up period. The findings of both studies suggest that there is a significant relationship between an increasing number of aftercare visits and a reduced liklihood of rehospitalization, especially among the more chronic patients. The authors emphasize the need for further studies in which patients are interviewed directly about their perceptions of aftercare.