title: Post-traumatic stress symptoms and adult attachment: a 24-year longitudinal study.
abstract: OBJECTIVE
  Attachment theory has become a key framework for understanding responses to and consequences of trauma across the life course. We predicted that more severe post-traumatic stress (PTS) symptoms at age 37 years would be associated with insecure attachment at age 55 and with worse PTS symptoms 24 years later at age 61, and that age 55 attachment would mediate the influence of earlier PTS symptoms on later symptoms.
  
  
  METHODS
  Data on PTS self-reported symptoms were available for 975 community-dwelling participants from the longitudinal Vietnam Era Twin Study of Aging at ages 37 and 61 years. At age 55, participants completed the Experiences in Close Relationships Inventory, a measure of adult attachment.
  
  
  RESULTS
  PTS symptoms at ages 37 and 61 correlated (r = 0.43; p <0.0001). Multiple mediation models found significant direct effects of age 37 PTS symptoms on age 61 PTS symptoms (β = 0.26; 95% confidence interval: 0.19-0.33). Anxious and avoidant attachment at age 55 predicted PTS symptoms at age 61 (r = 0.34 and 0.25; ps <0.0001, respectively) and also significantly mediated PTS symptoms over time, showing that insecure attachment increased PTS severity. Participants with higher age 37 PTS symptoms were more likely to have a history of divorce; marital status did not mediate PTS.
  
  
  CONCLUSIONS
  Analyses demonstrate the persistence of PTS symptoms from early midlife into early old age. Mediation analyses revealed that one path through which PTS symptoms persisted was indirect: through their influence on attachment insecurity. This study provides insight into ongoing interconnections between psychological and interpersonal responses to stress.
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA. Electronic address: cfranz@ucsd.edu.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Franz
authors.affiliation: Department of Psychology, Boston University, Boston, MA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyons
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Spoon
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hauger
authors.affiliation: University of Chicago, Chicago, IL.
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Jacobson
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA.
authors.forename: James B
authors.initials: JB
authors.lastname: Lohr
authors.affiliation: Department of Psychology, Boston University, Boston, MA.
authors.forename: Ruth
authors.initials: R
authors.lastname: McKenzie
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Panizzon
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA.
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Thompson
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA.
authors.forename: Ming T
authors.initials: MT
authors.lastname: Tsuang
authors.affiliation: University of Chicago, Chicago, IL.
authors.forename: Terrie
authors.initials: T
authors.lastname: Vasilopoulos
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Vuoksimaa
authors.affiliation: Department of Statistics, St. Louis University, St. Louis, MO; Research Service, VA St. Louis Healthcare System, St. Louis, MO.
authors.forename: Hong
authors.initials: H
authors.lastname: Xian
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA.
authors.forename: William S
authors.initials: WS
authors.lastname: Kremen
mesh_terms: D000328:Adult; D000375:Aging / Q000523:psychology; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013997:Time Factors; D014728:Veterans / Q000523:psychology; D047829:Vietnam Conflict
keywords: PTSD; Post-traumatic stress symptoms; VETSA; attachment; stress; veterans