LIST OF TABLES
Table: Summary of multiple regression analysis result showing the relationship between resilience, social support, self-efficacy and PTSD Symptoms
ABSTRACT
Exposure to intense psychological trauma is associated with significant emotional burden and stress. Trauma victims suffer from myriads of adverse psychological consequences, particularly Post -traumatic stress disorder (PTSD) symptoms. This study examined resilience, social support and self-efficacy as predictors of PTSD symptoms among adult trauma victims. A cross-sectional design was adopted in the study. Two hundred and eighty-one (281) adults consisting of 131(46.6%) males and 150 (53.4%) females with age range of 18 to 64 years (M=29.62, SD=7.05) participated in the study. Samples were drawn from Odi and Biseni Communities in BayelsaState and Okobe Community in RiversState of the Niger Delta Region of Nigeria. Resilience Scale (RS-14), Social Support Scale (SPS), Self-Efficacy Scale (SES) and Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) were used to collect data from the participants. Multiple regression analysis indicated no significant relationship between resilience and PTSD symptoms, whereas significant relationship was shown between social support and PTSD symptoms, as well as between self-efficacy and PTSD symptoms. This implies that resilience does not significantly predict PTSD symptoms, whereas social support and self-efficacy play significant predictive roles in the occurrence of PTSD symptoms. It is therefore recommended that elements of social support and self-efficacy should be considered and integrated into psychological intervention strategies for victims of trauma.
CHAPTER ONE
INTRODUCTION
Traumatic events such as natural disasters, being victims of crimes and other adversities are fast assuming global phenomena. Although, not much of natural disasters have been experienced in Nigeria compared with other parts of the world, disasters such as flooding, erosion, land slide, building collapse and accidents (fire, plane crashes, auto-crashes, petrol tanker explosion, gas/petrol/pipeline explosion) are becoming common occurrences. There has also been an upsurge in the wave of crime and insecurity such as election crises, militancy, inter-ethnic clashes, kidnapping, Boko Haram insurgence, bomb blast and extra-judicial killings in the country (Onwe, 2010; Umeagbalasi, 2010; Ogundele, 2009; Iyayi, 2008; Oshun, 1999).
It has been observed that not everyone copes successfully with these potentially disturbing events in the same way; some people experience acute distress from which they are unable to recover. Some other individuals suffer less intensely and for a shorter period of time, while others seem to recover quickly, but thereafter begin to experience unexpected health problems. However, a large number of people who are exposed to traumatic events manage to survive the temporary upheaval of loss or potentially traumatic events significantly well, with no obvious disruption in their ability to function and appear to move on with ease (Bonano, 2004). The manner in which individuals react to traumatic events, including the experience of post-traumatic stress disorder symptoms appear to depend on a number of psychological factors such as resilience, social support and self-efficacy (Solomon & Davidson, 1997).
Posttraumatic Stress Disorder (PTSD)
Posttraumatic stress disorder is an anxiety disorder characterized by intense anxiety-related experiences, behaviours and physiological responses that develop after direct or indirect exposure to a psychologically traumatic event (American Psychiatric Association, 2000). Post-traumatic Stress Disorder was recognized as a diagnostic entity in 1980 when it was associated with combat or war experiences. However, prevalence studies have since proven that the disorder exists in any population that is exposed to traumatic experiences (Ahmed, 2007).
In terms of conceptualization, International Classification of Diseases (ICD-10) (WHO, 1992) considers an event or situation of exceptionally threatening or catastrophic nature likely to cause pervasive psychological strain or distress as the main cause of Post-traumatic stress disorder (PTSD).
The first and second versions (DSM-I & II) of the DSM only described the trauma reaction symptoms (stress response syndromes) as transient reactive processes (APA, 1952; 1958) and used other diagnosis in chronic cases. The fourth version of Diagnostic and Statistical Manual of Mental Disorders (DSM – IV (APA, 1994: p.248) further incorporated individuals’ emotional reactions to the traumatic experience, such as intense fear, helplessness or horror , in the diagnostic criteria. The current version which is the DSM-IV – TR (APA, 2000) additionally provides that, for a diagnosis of PTSD to be made, the individual must have been directly or indirectly exposed to a traumatic event. He/she must have persistent re-experiencing of the traumatic event, persistent avoidance of the stimuli associated with the trauma/emotional numbing and persistent symptoms of increased arousal absent prior to the trauma. Furthermore, it requires that the reported symptoms must be confirmed to have had significant impairment of major domains of his/her life. Regarding duration, the DSM-IV stipulates that the symptoms under the diagnostic criteria must be present and be confirmed to have persisted for more than 30 days after the traumatic event. Although, onset of symptoms of PTSD is usually within the first three (3) months after exposure to traumatic event, it may be delayed for more months and even years. Symptoms of PTSD can affect any age and is said to be acute when the duration of the symptoms is less than three (3) months and chronic, when duration is three (3) months or more. It is described as delayed, if onset of symptoms is at least six (6) months after the event (APA, 2000; Satcher, 1999). Some individuals do experience an “incubation period” during which for days, weeks and months after the traumatic event, the person is without symptoms, then suddenly the traumatic reaction begins to appear (Op den Velde, Hovens, Aarts, Frey-Wouters, Falger, van Duijn, & De Groen, 1996).
The relationship between the experience of traumatic events (either directly or indirectly) and the development of posttraumatic stress disorder has been established by various researchers and therefore not in doubt (Ayala &Ochotorena, 2005). For example, Jimoh (2010), in a study of Niger Delta youths’ exposure to community violence and Post-traumatic stress disorder reactions reported that the high rate of crime and violence has actually rendered the youths vulnerable to post-traumatic stress disorder symptoms. Other studies have corroborated the assertion that exposure to traumatic events and violence is a strong predictor of PTSD in victims, including on-lookers and even those who heard about the events (Jimoh, 2010; Salami, 2010; Zahrandnik, Stewart, O’Connor, Stevens, Ungar&Wekerle, 2010; Slovak & Singer, 2001; Ahern, Galea&Resnick, 2002; Sungur& Kaya, 2001; Abenhaim, Dab & Salami, 1992). Additionally, Fitzpatrick and Boldizer (1993) examined the relationship between chronic exposure to community violence and Post-Traumatic Stress Disorder symptoms among low income African-American Youths and indicated that their reporting of PTSD symptoms was markedly influenced by exposure to various forms of violence and traumatic experiences.
Posttraumatic stress disorder is relatively common with an increasing prevalence rate in both western and non-western societies (Keane, Scott, Chavoya, Lamparski& Fairbank, 2000). Breslau, Kessler, Chilcoat, Schultz, Davis and Andreski (1998), using the DSM-IV criteria examined trauma exposure and diagnosis of post-traumatic stress disorder in a telephoned community sample of 2,181 individuals in the Detroit area and posited that the lifetime prevalence of trauma exposure among them was 89.6%. Consistent with this, another research found that by the age of 18 years, more than two-fifth of young adults in a community sample had been exposed to an event that was severe enough to qualify for a diagnosis of post-traumatic stress disorder. Resnick, Kilpatrick, Dansky, Saunders and Best (1993) also indicated 69% lifetime rate of exposure to any type of traumatic event. Similarly, studies in non-western population (Africa) have a suggested high prevalence of PTSD in the general (non-veteran) population. For example, Seedat, Nyamai, Vythilingum, and Stein (2004) reported 14.8% prevalence rate in the general population for South Africa and Kenya. The World Health Organization in a report on International PTSD rate published in 2004 estimated that 53 out of 100,000 Nigerians suffer from PTSD (WHO, 2004). Furthermore, Onyeizugbo (2009) in a more recent prevalence study conducted in the South- East and South-South regions of Nigeriareported that 41.8% of people exposed to traumatic events met DSM IV (TR) criteria for diagnosis of PTSD, surpassing other known international epidemiological data. In another study conducted in Lagos-Nigeria, Busari (2010) reported that about 82.4% of the sample had experienced one or more traumatic events.
Observation has also shown that the myriads of challenges being faced globally, including Nigeria appear to expose people directly or indirectly to one form of potentially traumatic experience (Onyeizugbo, 2009) and subsequent adverse psychological consequences, including PTSD. This calls for concerted research efforts aimed at examining the psychological impacts of the trauma experiences, particularly in relation to occurrence of PTSD symptoms. In this regard, an understanding of the roles played by psychological factors such as resilience, social support, self-efficacy in predicting PTSD symptoms on trauma victims is essential. Findings from such studies will guide the development of interventions to promote psychological re-adjustment after trauma experiences.
A few studies have so far been carried out in Nigeria on child and adolescents’ maltreatment and exposure to violence (e.g. Ugoji, 2009; Oni, 2009; Jegede, 2008; Oladeji, 2003). The literature is replete with mostly western studies examining the relationship between PTSD and a number of mediator variables such as resilience (Salami, 2010; Zahradnik et al., 2010; Taylor, 2007), social support (Wu, Chen, Weng& Wu, 2009), self-esteem (Salami, 2010; Bradley, Schwartz &Kaslow, 2005) and locus of control (North, Spitznagel& Smith , 2001). Despite the phenomenal rise in traumatic events such as crimes, violence, accidents and natural disasters occurrences in Nigeria, the critical psychological factors which predict maladaptive or psychopathology remain largely unexplored by researchers.
Resilience
The ability of individuals to thrive in the presence of adversity is referred to as resilience (Masten& Powel, 2003). Resilience behaviour might either result in the individual regaining normal functioning after a brief period of time or not showing symptoms of mal-adaptation after exposure to adversity. Resilience is sometimes conceptualized as positive attributes of individuals and cognitive features of people who are resistant to stress. However, this conceptualization has been observed to be too simplistic and incapable of capturing the dynamic nature and the processes involved in human adaptation(Kaplan, 1999).
In order to capture the individual characteristics and environmental factors, researchers have shifted emphasis in the conceptualization and definition of resilience (Lerner & Benson, 2003; Ungar, 2001). Accordingly, some researchers have argued that the positive outcome of individuals mainly depend on a combination of the individual factors and resources in the community (Zahradnik et al., 2010; Luther, Cicchetti& Becker, 2000). The community (society or environment), in this regard, is expected to negotiate for (or provide) the resources needed (e.g. healthcare, education, security, infrastructure, employment, etc.) by it’s members, while the members, on the other hand, are expected to navigate their way to (or access) the resources provided by the community (Ungar, 2008). Based on this postulation, therefore, resilience has been regarded as a dual process of negotiation and navigation (Zahradnik et al., 2010; Luther, 2003; Lerner & Benson, 2003), and a two-dimensional construct involving the exposure to adversity and the positive adjustment outcome and not a fixed trait or characteristics. Resilience essentially implies the absence of symptoms of psychopathology/maladjustment following trauma, sustained functioning during an intense physical or psychological challenge or maintenance of positive outlook despite having experienced significant adversity (Luther, et al ., 2007; Bonnano, Galea, Bucciarelli&Vlahor, 2006).
Resilience behaviour is expressed in form of achieving good outcomes, maintaining competence under stress, recovery from trauma and making use of challenges for growth and ability to handle the challenges of human existence. Various factors such as beliefs, attitudes, coping strategies, behaviours and psychological cohesion have been suggested as boosters to resilience in the face of trauma.
There is substantial body of literature that have examined and shown evidences of significant negative relationship between exposure to violence and posttraumatic stress disorder symptoms (Salami, 2010; Zahradnik et al, 2010; Onyeizugbo, 2009; Ahmed, 2007; Salami, 2010; Ahmed, 2007; Haglund, Cooper, Southwick &Charney , 2007). Therefore, it is a known fact that exposure to traumatic events including violence may result to adverse psychological consequences, including PTSD symptoms.
Resilience in the context of this study pertains to the ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as flooding, extra-judicial killings, mass killings, mass death resulting from petrol tanker explosion or other life –threatening situations, to maintain relatively stable, healthy level of psychological and physical functioning. It is, therefore, more than the simple absence of psychopathology (Bonano, 2004).
The main theoretical perspective to resilience as a construct is anchored on the sympathetic nervous system and hypothalamic-pituitary-adrenocortical (HPA) system. The psycho-social perspective is formed on the basis that factors such as social support, self-efficacy, self esteem, and other psycho-social variables have the ability to optimize the neuro-chemical response to increase resilience (Charney, 2004).
Social Support
Social support may be described as a network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical and financial help. It can also be conceptualized as the extent to which individuals perceive that provisions of social relationships exist and are available to them, or they are being cared for, particularly in times of adversity.
Social support may be in the form of tangible (or material/financial assistance) support, informational support (e.g. advice) and emotional support (e.g. nurturance) from friends, family members, romantic partners, professional colleagues/co-workers, support groups and significant others (Taylor, 2011; Hogan&Narajian, 2002). According to Stice (2004), the optimal source of social support largely depends on the developmental stage of the recipient. For instance, research has shown that the perception of social support in the elderly is related to the extent of their social interaction, while in younger adults it is associated to instrumental support (Lynch, Mendelson& Robins, 1999). Furthermore, it has been shown that the form of social support received by individuals is important in the conferment of resilience to stress (Hyman, Gold &Cott, 2003).
The relationship between social support and general well –being has been established by various researchers. For instance, studies have shown that social support was negatively related to Posttraumatic stress disorder among victimized and maltreated youths (Wu, Chen & Wu, 2009; Bradley, Schwatz&Kaslow, 2005; Ozer, Best Lipsey& Weiss, 2003). Similarly, it has been reported that social support mediates or moderates the relationship between exposure to violence, victimization and maltreatment and Posttraumatic Stress Disorder (Wu, Chen, Weng& Wu, 2009). People with lower social support have been reported to have higher rates of major mental disorder (including posttraumatic stress disorder) than those with higher social support (Brewin, Andrews & Valentine, 2000).
Theories of social support include the Stress and Coping theory (Cohen, 1985), Relational Regulatory theory (Lakey&Orehek, 2011) and the Life-Span Theory (Uchino, 2009). In addition, current research evidence has shown biopsychosocial pathways, indicating a link between social support and health (Taylor, 2007).
Self-Efficacy
Self–Efficacy refers to the belief that one has the power or capacity to produce an outcome by completing a task related to the outcome. As a construct, self efficacy is defined as the measure of an individual’s perception of his/her own competence to complete tasks or reach set goals (Omrod, 2006)), a person’s belief that he or she is capable of the specific behavior required to produce a desired outcome in a given situation (Brehm, Kassin& Fein, 2002) or people’s perception of their ability to plan and take actions to reach a particular goal (Bandura, 1977). Although, some people may believe that they are in control of some future events, they may not believe in their ability or capability of enacting appropriate behaviors that will bring about the desired goals. People who believe that they have some degree of control over what happens to them also feel that they can effectively cope with stressful or threatening events and often express feelings of self-efficacy (Ifeagwazi&Oguizu, 2006). According to Luszczynska and Schwarzer (2005), self-efficacy plays a major role in how one approaches tasks, goals and challenges. Bandura (1977) has shown how self-efficacy helps people to cope effectively with adversity or stressful situations.
Self efficacy beliefs regulate human functioning through cognitive, motivational, affective and decisional processes and these in turn among others influence their resilience to adversity and vulnerability to stressful situations. In the present study, self-efficacy refers to the perceived capability to manage one’s personal functioning and the various environmental demands of the aftermath (chronic/disabling forms of stress) arising from a traumatic event, as against common adverse life events.
A few researches have indicated that people with high self efficacy show less psychological and physiological symptoms than those with low self-efficacy, when exposed to stressful experiences (Bandura, et al., 1985) and that self-efficacy moderates the stress hormones (Bandura, 1988). The theory of self-efficacy is underpinned by Bandura’s Social Cognition theory (1986), which places emphasis on observational learning and social experiences in the development of individuals’ personality.
Statement of Problem
The high rate of crime, violence, disaster (natural and human-made) and the myriads of adversities being experienced by people world-wide, including Nigeria, have been observed to be taking its toll on the psychological well-being of individuals. In Nigeria, in particular, inhabitants of the Niger Delta Region who had experienced frequent incidences of oil and gas related explosions, kidnapping, militancy, mass killings by security forces, communal clashes, extra-judicial killings appear to be highly affected (Onyeizugbo, 2009; Jimoh, 2010). As a consequence of their exposure, inhabitants of that region appear to be prone to experiencing various psychological disturbances, especially Post-traumatic Stress Disorder (PTSD) symptoms. It has been suggested that majority of the residents of Nigerian communities have experienced one or more traumatic events that meet the stressor criterion for Post-traumatic Stress Disorder diagnosis as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This is in line with the various empirical findings that most people are exposed to at least one violent or life threatening situations during their life circle (Ozer, Best, Lipsey& Weiss, 2003). However, it has been observed that people continue to have positive emotional experiences and show only minor and transient (short-lived) disruption on their ability to function without experiencing symptoms of Post-Traumatic Stress Disorder (PTSD). A number of psychological factors such as self esteem, locus of control, social support, beliefs and attitudes appear to influence the stress -response process as suggested by various research studies.
While Post-traumatic stress Disorder, as a psychological consequence of exposure to traumatic events has been documented by some studies, little attention has so far been paid to the predictor role of resilience, social support and self-efficacy, particularly among adult trauma victims in Nigerian population. Most of previous studies in this area and their findings were based on western populations with different socio-economic and cultural backgrounds with limited scope of generalization. The present study, therefore, aims to investigate the predictor roles of resilience, social support and self-efficacy in Post-Traumatic Stress Disorder (PTSD) symptoms among adults who had been exposed to traumatic events (trauma victims) in Nigerian population. The researcher intends to use findings derived from this study to contribute to existing literature.
Specifically, the study will attempt to address the following questions:
- Will resilience play a predictor role in Post-Traumatic Stress Disorder (PTSD) symptoms among adult trauma victims?
- Will social support play a predictor role in Post-traumatic Stress Disorder (PTSD) symptoms among adult trauma victims?
- Will self-efficacy play a predictor role in Post-traumatic Stress Disorder (PTSD) symptoms among adult trauma victims?
Purpose of the Study
The main purpose of this study is to investigate the role of resilience, social support and self efficacy as predictors in Posttraumatic Stress Disorder (PTSD) symptoms among adult trauma victims. This study, therefore, aims to:
- Investigate whether resilience predicts Post-traumatic Stress Disorder (PTSD) symptoms among adult trauma victims.
- Investigate whether social support predicts Post-traumatic Stress Disorder (PTSD) symptoms among adult trauma victims.
- Investigate whether self efficacy predicts Post-traumatic Stress Disorder (PTSD) symptoms among adult trauma victims.
Operational Definition
Resilience: This is the ability to maintain a state of normal equilibrium in the face of traumatic experiences and unfavourable circumstances in individuals’ environment. Resilience will be measured by the 14-item version of the Resilience Scale (RS-14) developed by Wagnild& Young (1993) and validated in Nigeria by Abiola and Udofia (2011).
Social Support: This is the available social networks which provide psychological and material resources intended to enable an individual cope with stress as measured by Social Provision Scale. This is to be measured by Social Provision Scale developed by Cutrona and Russel (1987) and validated by Kpenu (2009) for use in Nigeria.
Self Efficacy: This is an individual’s sense of ability and capacity to deal with challenges as measured by Self Efficacy Scale (SES) developed by Sherer, Maddox, Mercandante, Prentice-Dunn, Jacobs and Rogers (1982) and validated for use in NigeriabyAyodele (1998).
Post-Traumatic Stress Disorder: This is an anxiety disorder characterized by intense anxiety-related experiences, behaviours and physiological responses that develop after direct or indirect exposure to a psychologically traumatic event as measured by the Post-traumatic Stress Disorder Checklist developed by Weathers, Litz, Herman, Huska& Keane (1993) and validated by Tamunomiete (2006) for use in Nigeria.
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