The longitudinal connections between PTSD symptoms, perceived social support, depression and attachment after exposure to a traumatic event

Background: About 80% of people will be exposed to at least one traumatic event during their lifetime. Of these, approximately 7% will develop Posttraumatic Stress Disorder (PTSD) symptoms. (Sledjeski, Speisman, & Dierker, 2008). Characteristics of posttraumatic symptoms can be divided into three subgroups: intrusions, avoidance and arousal (American Psychiatric Association, 1994).. Relief from posttraumatic symptoms will occur in 40% to 70% of those undergoing treatment (Bradley, Greene, Russ, Dutra, & Westen, 2005).

The aim of the present study is to characterize the different relationships between the study variables: posttraumatic symptoms, social support, attachment style and depression, examining the directions of these relationships, both in the immediate aftermath of the traumatic event and over time, at different time points: three weeks- "Time 1", five months- "Time 2" and nine months - "Time 3", after the traumatic event.

Method: This study is a secondary analysis of data collected as part of a clinical study by the Center for Traumatic Stress at Hadassah Hospital. The study is a quantitative study. The study was conducted among 137 women and 108 men (N = 245) who came to the emergency room after experiencing a traumatic event, such as an accident at work, car accident or other event. After obtaining consent to participate in this study, they were asked to fill in questionnaires: Attachment style classification questionnaire (ECR), perceived social support questionnaire (MSPSS), Beck's Depression Inventory (BDI) and a socio-demographic questionnaire. In addition, they were interviewed using a structured clinical interview to evaluate Posttraumatic Stress Disorder (CAPS).

Results: In the present study, several significant relationships were found between the different study variables. First, there were significant correlations between the variables at the same time period: a significant positive relationship between depression and posttraumatic symptoms, a significant negative relationship between perceived social support and posttraumatic symptoms and a significant negative relationship between depression and perceived social support. Second, there were associations between the same variables over time: (1) Depression at Time 1 contributed significantly to the explanation of the variance of Depression at Time 2, while Depression at Time 2 contributed significantly to explaining the variance of Depression at Time 3. (2) Social Support in Time 1 contributed significantly to explaining the variance of social support at Time 2 and Social Support at Time 2 significant contribution to explain the variance of social support at Time 3.
(3)  Posttraumatic symptoms at Time 1 a significantly contributed to explaining the variance of posttraumatic symptoms in Time 2 and  posttraumatic symptoms at Time 2 significantly contributed  explaining the variance of posttraumatic symptoms at Time 3.

Furthermore, with the help of path analysis, complex relationships were found between study variable: depression at Time 1 and Posttraumatic Symptoms at time 2, posttraumatic symptoms at Time 1 and Depression at Time 2 and posttraumatic symptoms at Time 2 and depression in Time 3 and perceived Social Support at Time 1 and depression at Time 2.

Discussion: The importance of the present study is that it examines the relationship between posttraumatic symptoms, social support, depression, and attachment style. Although posttraumatic symptoms and their consequences leave much to be investigated, academic research is addressing this and investing in the evaluation of their relationship to a real change in human character and behavior. This study aims to raise awareness of the relationship between the variables, and to examine them and their implications. Given the great significance of a person's attachment style to his or her behavior and character, - this study will hopefully expose points so that treatment for people with posttraumatic symptoms in relation to their attachment style can be improved.

Furthermore, the relationships examined over time in this study between posttraumatic symptoms, social support, and depression may shed light on the theoretical and applied framework of people who have experienced a traumatic event. First, it will be possible to undertake further longitudinal studies based on the results found here. and the research findings will teach the therapist how to help victims reduce symptoms, depression, or increase the sense of social support that in turn will help deal with trauma.

This study has several limitations. First, there is no reference in the study to economic factors in one's life. Second, there is no reference in the study to happy events that can happen in one's life. In addition, this study examined only a specific, Hebrew-speaking population that came to the emergency room. Another limitation is the fact that people's trauma is one-off trauma and civilian. Furthermore, 50% of the respondents did not come to the clinical interviews and did not participate in the study at the end.