Social Support in PTSD: An Analysis of Gender, Race, and Trauma Type

Methods

Participants: Participants for this study included 200 men (24.5%, n=49) and women (75.5%, n=151) that were recruited from a PTSD treatment-outcome study at two sites. Participants were recruited via referrals and advertising around the community. Exclusion criteria for this study included: (a) current psychosis, unstable bipolar disorder, substance dependence, or high suicide risk and, (b) in assault cases, an ongoing relationship with the perpetrator. Thirty-five percent of participants who were evaluated for this study did not have a primary diagnosis of PTSD, and therefore were excluded. The average age of participants in this study was 37.1 years (SD=11.3); average time since trauma was 11.9 years (SD=11.0). Trauma varied within this sample, including adult sexual assault (30.9%), childhood sexual assault (17.8%), adult non-sexual assault (22.0%), accident (motor vehicle, or natural disaster; 14.1%), childhood non-sexual assault (6.8%), death of or violence towards a loved one (5.8%), and military combat (2.6%). The sample also included 21.5% African Americans, 65% Caucasians, and 13.5% other.

Measures: The Inventory of Socially Supportive Behaviors (ISSB; Barrera, Sandler & Ramsey, 1981) is a 40-measure assessment used to measure the participants’ objective levels of social support. Questions include, how often someone in their life gave them money, assisted them in setting goals, expressed respect, or looked after a family member while they were away, etc., within 2 weeks prior to the time of the survey. Higher scores on this scale indicate higher levels of social support. This measure has been established as showing good reliability and validity (Barrera et al., 1981). The Social Reactions Questionnaire (SRQ; Ullman, 2000) is a 48-item measure that assesses objective trauma-related support on a Likert Scale from 1-4. Questions are intended to determine the frequency of positive social support (i.e., how often someone comforted the participant or told him or her that “it would be all right”) as well as negative social support (or how often someone focused on his/ her own needs and neglected the participant). Two scores are identified on the SRQ, higher scores indicating either higher levels of positive or negative social support. The SRQ has been established as having demonstrated adequate reliability (Ullman, 2000).

The Social Support Questionnaire (SSQ; Sarason, Levine, Basham & Sarason, 1983) is a 27-item measure that evaluates the number of perceived social supports in a person’s life. The scale consists of questions that ask the participant to list the people involved in a certain socially supportive task (i.e., “Whom can you really count on to listen when you need to talk?” or “Who do you feel really appreciates you as a person?”). The participant is then required to report how satisfied they are with the level of support they received, within a certain category, on a scale of 1 to 6, with 1 being “very dissatisfied” and 6 being “very satisfied.” The SSQ was established as being a stable measure and also had high internal consistency among items.

The PTSD Symptom Scale Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) was used to establish a primary diagnosis of PTSD in all participants. The PSS-I is a 17-item semi-structured interview that requires the participant to focus on one specific traumatic event, and the scale then evaluates the symptom severity and presence of PTSD symptoms according to the DSM-IV-TR. Symptoms are measured on a four-point scale where 0 indicates “not at all” and 3 indicates “5 or more times per week/very much.” Only symptoms occurring within the two weeks prior to the interview are assessed. The PSS-I has been established as a reliable and valid measure used to assess diagnostic criteria for PTSD.

Procedure: Participants were required to sign forms that indicated that they consented to the policies and procedures of the study. Once informed consent was obtained, participants were required to answer a series of assessments (including the ISSB, SSQ, and SRQ). Participants were also administered the PSS-I in order to determine their eligibility for the study (a primary diagnosis of PTSD). Once results were obtained, we analyzed the data using SPSS, utilizing standard ANOVA tests, a descriptive analysis, and a means comparison of all variables.

Results

After performing standard ANOVAs and means comparisons for all three dependent variables (gender, minority status, and trauma type) against the independent variables (the ISSB, SRQ, and SSQ scores), it was found that there were several significant relationships between the variables.

Gender: ISSB scores were significantly lower (p= .017) for women (x Ì„=86.46) than for men (x Ì„=89.87), indicating that women had lower levels of objective social support. Women also had significantly less positive support (SRQ; p=.001; men x Ì„=39.14; women x Ì„=36.97); had significantly less available social support (SSQ; p=.015; men x Ì„=13.49; women x Ì„=12.42), and were less satisfied with the support they did have than men (SSQ; p=.079; men x Ì„=22.33; women x Ì„=21.54). (See Table 1).

CSA vs. non-CSA: Interestingly enough, those who experienced trauma, who did not have a history of childhood sexual assault, had significantly higher levels of negative social support than that of trauma survivors who did experience childhood sexual assault (SRQ; p=.015; Non-CSA x Ì„=35.23; CSA x Ì„=30.99). No data was found to support the hypothesis that survivors of childhood sexual assault had significantly different levels of social support than that of survivors of other trauma. (See Table 2).

Minority Status: Finally, there was no evidence that supported the hypothesis that minorities had significantly less social support than Caucasians. In fact, minorities scored slightly higher (though not statistically significant) in both social availability (SSQ; minority x Ì„=13.15; Caucasian x Ì„=12.42) and satisfaction (SSQ; minority x Ì„=21.65; Caucasian x Ì„=21.54), and also slightly higher in positive support (SRQ; minority μ=; Caucasian μ=36.97). Implications for this finding will be evaluated in the discussion. (See Table 3).Continued on Next Page »