This study assessed a relatively homogeneous group of poor mothers to determine whether differences in exposure to trauma account for variation in the diagnosis of posttraumatic stress disorder (PTSD). It also explored whether the personality characteristic of cynicism mediates exposure and diagnosis. Pathological sequelae to trauma exposure are typically attributed to individual vulnerability without considering variation in exposure. However, since exposure to both interpersonal and organizational stressors varies according to social location, assessment across a stress continuum is more appropriate. Once cumulative adversity is considered, individual differences can then be examined. Personality characteristics have been shown to mediate the effects of stressors on mental health outcomes, either enhancing resiliency or vulnerability.
The sample of 79 women convicted of a felony drug charge after 1996 was found through court records in one Midwestern County. Most women were interviewed in their homes; the remainder in drug treatment centers, jail and prison. Face to face interviews were conducted using standardized measures to assess trauma (CIDI), employment discrimination, and difficult life circumstances (such as removal of a child, current battering relationship, and housing concerns). PTSD was evaluated using criteria in the DSM IV. Cynical hostility was measured with a modification of the Cook-Medley Hostility scale, as well as open-ended questions. Scale responses were compared to narrative responses to evaluate the construct in this population.
Logistic regression was used to test direct effects and mediational models of the impact of single and multiple predictors on PTSD. The analysis demonstrated that the probability of PTSD increased exponentially for each trauma experienced, and that the addition of chronic stressors into the model increased the probability of PTSD, explaining over one-third of the total variance. No relationship was found between cynicism and trauma or other stressful life events, but the construct of cynicism was validated for use in this population.
These findings support the use of cumulative adversity models in the assessment of PTSD as well as the need for a comprehensive assessment of stressors based on social location. These findings have implications for researchers, clinicians and public policy.