Posttraumatic-stress during later life : a cross-sectional and longitudinal investigation : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
Older people may not only fall victim to traumatic events, but will inevitably encounter a host of late-life stressors that threaten psychological and physical well-being. In addition to current distressing occurrences, many older people will have past unresolved traumatic memories that have the capacity to generate trauma-related symptoms and impinge on present-day functioning. Much of the existing literature and research on late-life traumatisation concerns the impact of prior war- or Holocaust-experiences. Empirical investigations into the traumatizing effects of lifetime trauma exposure and late-life stressors within community-based samples of older people are scarce. The present study explored the manifestation of trauma-related symptoms in a sample of New Zealand's older (60+ years) citizens. The goal was to discover the extent that lifetime trauma, recent trauma and recent stressors impact on posttraumatic stress disorder (PTSD), trauma-related perceptions and physical health during later life. Additionally, a new theoretical framework of traumatisation, Trauma-Schema Theory, was introduced and given some preliminary testing. Trauma-Schema Theory maintains that trauma-schemata, cognitive-emotional frameworks that guide information processing, are responsible for traumatic-stress by eliciting beliefs and perceptions that confirm an overwhelming sense of threat, vulnerability and powerlessness. This theory provides viable explanations for occurrences specific to later life, including delayed PTSD reactions in older people, and the triggering of PTSD symptoms in response to late-life stressors. The present study used a cross-sectional/longitudinal design with two data collection points, each one year apart. Questionnaires measuring PTSD, anxiety, depression, dissociation, self-rated physical health, control beliefs, posttraumatic vulnerability perceptions, trauma history and past-year stressors were mailed out to 2000 older adults who had responded to community based advertising. Of these 1489 adults returned questionnaire one (Q1). One year later consenting participants were sent questionnaire two (Q2), which was similar, but contained a measure of past-year trauma exposure in place of lifetime trauma exposure. Altogether, 1050 respondents returned Q2. Mean ages for Time 1 and Time 2 were 72.1 years and 71.7 years, respectively. Each sample consisted of around one-third males and two-third females and most were of New Zealand European descent. Lifetime trauma exposure and past-year stressors were reported at high rates among the samples. Nearly half of the longitudinal sample also reported at least one past-year traumatic event. Of the psychological measures, PTSD was most strongly associated with lifetime trauma, lifetime abuse, multiple lifetime trauma, past-year abuse and past-year multiple trauma. Depression was most strongly associated with past-year trauma. Due to the limited scope of the study, PTSD was the only symptom type further assessed in relation to the other variables. A series of hierarchical multiple regressions were performed and a number of mediational models were tested. Cross-sectional data analyses showed that both lifetime trauma and lifetime abuse predicted PTSD symptoms. Distress from late-life stressors mediated the trauma-PTSD associations. Longitudinal data analyses indicated that late-life stressors establish the pathway from recent trauma to PTSD escalation over one year. Posttraumatic vulnerability perceptions and control beliefs mediated a large proportion of all associations between event variables (i.e., lifetime trauma, lifetime abuse, recent trauma, recent stressors) and PTSD, providing preliminary verification of Trauma-Schema Theory. Additional analyses also indicated that PTSD, not trauma per se, is responsible for late-life physical health decline. Limitations of the study and practical implications of the findings are reported. An emphasis on the importance of future research is portrayed, and ideas for future empirical work on traumatic-stress in New Zealand's older population are provided. Finally, practical implications of the findings are reported with the hope that older traumatised adults will, one day, receive the appropriate clinical care necessary to enhance the quality of their lives.