title: In the shadow of terror: posttraumatic stress and psychiatric co-morbidity following bombing in Iraq: the role of shattered world assumptions and altered self-capacities.
abstract: Whilst research has looked at posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among civilians exposed to bombing, there is a lack of longitudinal data on the development of these outcomes and the psychological factors associated with them, particularly among Iraqi civilians. This study aimed to: investigate 1) the trajectory of PTSD and psychiatric co-morbidity following bombing among civilians in Iraq and 2) the link between shattered world assumptions, altered self-capacities and identified health outcomes. One hundred and eighty (F = 90, M = 90) Iraqi civilians exposed to first time bombing were recruited approximately one month (time 1) after the bombing and five months (time 2) after the baseline assessment. A control group data (178, F = 91, M = 87) from people who were not exposed to bombing was also collected. They completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the World Assumptions Questionnaire and the Inventory of Altered Self-Capacities. The results showed that there was a significant decline in the proportion of people meeting the screening criteria for PTSD and psychiatric co-morbidity symptoms over time. For the cross-sectional analysis, controlling for demographic variables, regression analysis showed that severity of the bombing (β = .16), controllability of events (β = -.21), safety and vulnerability (β=.31) and affect dysregulation (β = .37) significantly predicted PTSD time 1. Controllability of events (β = -.20) and affect dysregulation (β = .37) also predicted psychiatric co-morbidity at time 1. For the prospective analysis, controlling for PTSD and psychiatric co-morbidity at time 1, none of these dimensions predicted PTSD and psychiatric co-morbidity at time 2. Findings are discussed in terms of individual resilience. It can be concluded that following bombing, civilians developed PTSD and psychiatric co-morbidity which declined over time. Civilians' perceptions of their ability to control events in the world and regulate their affect had a short term impact on the severity of these symptoms.
authors.affiliation: Faculty of Health, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom. Fuaad.Freh@plymouth.ac.uk
authors.forename: Fuaad Mohammed
authors.initials: FM
authors.lastname: Freh
authors.forename: Man Cheung
authors.initials: MC
authors.lastname: Chung
authors.forename: Rudi
authors.initials: R
authors.lastname: Dallos
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005107:Explosions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D023481:Terrorism / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult