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Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing

Published online by Cambridge University Press:  09 September 2016

Ø. Solberg ,
M. S. Birkeland ,
I. Blix ,
M. B. Hansen  and
T. Heir
Ø. Solberg*
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
M. S. Birkeland
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
I. Blix
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
M. B. Hansen
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
T. Heir
Affiliation:
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
*
*Address for correspondence: Ø. Solberg, Ph.D., Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 5 etg, 0484 Oslo, Norway. (Email: [email protected])
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Abstract

Background

Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited.

Method

Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model.

Results

Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups.

Conclusions

For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.

Keywords

Exposurefunctional impairmentpost-traumatic stress
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 15 , November 2016 , pp. 3241 - 3254
Copyright
Copyright © Cambridge University Press 2016 

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