title: Social relationship satisfaction and PTSD: which is the chicken and which is the egg?
abstract: BACKGROUND
  Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD.
  
  
  OBJECTIVE
  This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two.
  
  
  METHODS
  Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n=501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms.
  
  
  RESULTS
  The cross-lagged effect of SRS on PTSD was statistically significant (β=-0.12, p=0.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (β=-0.02, p=0.67). Both relationships were non-significant among survivors who received CBT.
  
  
  CONCLUSIONS
  SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.
authors.affiliation: Center for Traumatic Stress Studies, Hadassah University Hospital, Jerusalem, Israel; sarafreedman@gmail.com.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Freedman
authors.affiliation: Center for Traumatic Stress Studies, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Gilad
authors.affiliation: Center for Traumatic Stress Studies, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Ankri
authors.forename: Ilan
authors.initials: I
authors.lastname: Roziner
authors.forename: Arieh Y
authors.initials: AY
authors.lastname: Shalev
keywords: PTSD; Social relationship satisfaction; natural recovery