Coping, Peritraumatic Reactions, Negative Life Events, and Posttraumatic Stress Disorder Symptoms: A Prospective Study of Adolescent Girls

The purpose of this study was to identify the prevalence of Highand Lowmagnitude Negative Life Events (NLEs) among adolescent girls, and to investigate the role of coping and Peritraumatic Reactions (PTRs) in relation to PTSD symptoms. Participants (N = 211) completed self report scales at five intervals over a period of two years (grades 9 through 11). Trait coping was assessed both at the beginning and end of the 2-year data collection period. At the end of this period, history of negative life events was assessed; participants then selected the event that they perceived as the most negative (MN-NLE) during this period and completed questionnaires about PTRs, coping with the event (state coping), and post-event symptomology (PTSD symptoms). It was hypothesized that: (1) that the relationship between PTRs, post-event state coping, and PTSD symptoms would be moderated by whether the event was a Highor a Low-magnitude stressor; (2) that PTSD symptoms would be related to PTRs and post-event state coping, and that these relationships would be moderated by pre-event or trait coping styles; (3) that post-NLE state coping would mediate the relationship between PTRs and PTSD symptoms; and (4) that exposure to high levels of adversity during the high school years (Adolescent Adversity) would have a negative effect on trait coping (i.e., decreased use of positive coping and increased use of negative coping). Findings of the present study offered support for each hypothesis: (1) event magnitude moderated the relationship between PTRs and PTSD; (2) baseline trait coping (Positive coping; Externalizing coping) moderated the relationship between PTRs and PTSD; (3) State coping (Internalizing coping, Externalizing coping, and Distancing coping) mediated the relationship RUNNING head: COPING AND POSTTRAUMATIC STRESS 3 between PTRs and PTSD; and (4) Adolescent Adversity predicted changes in Trait Externalizing scoping between baseline at the 2-year follow-up. Results are discussed in terms of PTSD theoretical and clinical issues. RUNNING head: COPING AND POSTTRAUMATIC STRESS 4 Coping, Peritraumatic Reactions, Negative Life Events, and Posttraumatic Stress Disorder Symptoms: A Prospective Study of Adolescent Girls Although traumatic events were once considered rare for children and adolescents, recent research has highlighted that serious negative life events are not uncommon, including those events identified by the Diagnostic and Statistical Manual – Fourth Edition, Text Revision (DSMIV-TR; American Psychiatric Association, 2000) Criterion A for Posttraumatic Stress Disorder (PTSD) as having the potential to trigger the disorder (Keane, 1996; Lewis & Frydenberg, 2002; Perry & Azad, 1999; Saigh 1996). Based upon a large representative epidemiological survey, Costello, Erkanli, Fairbank, and Angold (2002) found that by the age of 16, one-quarter of youth had experienced a minimum of one high magnitude Negative Life Event (NLE). High magnitude NLEs were defined as those stressors acknowledged by DSM-IV-TR as potential antecedents to the development of PTSD. An even greater number of youth, one third, had experienced a low magnitude event (e.g., moving house, changing schools, break-up with significant other) within the preceding three months (Costello et al., 2002). Another study using a modified version of the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-C; Nader, Kriegler, Blake, Pynoos, Newman, & Weathers, 1996) found that 42% of adolescents experienced at least one stressful event (i.e., those traumatic events presented in the modified Clinician-Administered PTSD Scale for Children) before the age of 21 (Bal, Crombez, Van Oost, & Debourdeaudhuij, 2003). The most commonly reported events included a serious accident, sexual abuse, the death of a loved one, and a serious disease (Bal et al., 2003). Given the prevalence of both high and low RUNNING head: COPING AND POSTTRAUMATIC STRESS 5 magnitude NLEs during adolescence, it is important to study how these events affect youth and identify factors that may mediate or moderate the impact of these events. This study involves a prospective investigation of the role of coping and Peritraumatic Reactions (PTRs) in relation to PTSD symptoms. The purpose of this study was to identify the prevalence of high and low magnitude NLEs among adolescent girls, and to investigate the role of coping and PTRs in relation to PTSD symptoms. Research has found that coping is an important link between adolescent stress and psychological symptoms (Compas et al., 1993; Kraaij et al., 2003). Due to the unpredictability of traumatic events, the vast majority of research in the area of PTSD symptoms following NLEs is retrospective. What has not been examined is a possible link between Pre-Event Trait coping style and Post-Event State coping in relation to PTSD symptoms. The prospective nature of this data enabled us to examine the potential moderating role of preevent Trait Coping style, in addition to the mediating role of post-NLE State Coping in the relationship between NLEs and PTSD symptoms. It was anticipated that one’s general coping style (Trait Coping) would affect how one copes with a NLE. In turn, State Coping (coping with the stressor) would mediate the relationship between event-related stress and event-related symptoms. Though there is an increasing amount of research examining the links between PTRs and PTSD symptoms (Bernat et al., 1998; Frieze & Bookwala, 1996; Maercker, Bauducel, & Schützwohl, 2000), this area is still relatively unexplored. PTRs are an individual’s immediate cognitive, physical, and emotional responses to a NLE. PTRs can be thought of as the individual’s immediate coping to trauma, or how they cope in the moment. This study examined the potential RUNNING head: COPING AND POSTTRAUMATIC STRESS 6 mediating role of PTRs in the relationship between NLEs and PTSD symptoms anticipating that PTRs would significantly predict post NLE symptomology.