Changes in affect after completing a mailed survey about trauma: two pre- and post-test studies in former disability applicants for posttraumatic stress disorderReport as inadecuate

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BMC Medical Research Methodology

, 17:81

Data analysis, statistics and modelling


BackgroundOne potential concern with using mailed surveys containing trauma-related content is the possibility of re-traumatizing survivors without a trained mental health professional present. Prior research provides insufficient guidance regarding the prevalence and magnitude of this risk because the psychological harms of trauma-related surveys have typically been estimated using single post-test observations. Post-test observations cannot quantify magnitude of change in participants’ emotional states and may over or under estimate associations between participants’ characteristics risk factors and post-survey upset.

MethodsWe conducted two pre- and post-test studies in samples of former applicants for posttraumatic stress disorder disability benefits: 191 males who served during Gulf War I plus 639 male and 921 female Veterans who served sometime between 1955 and 1998. We used two 9-point items from the Self-Assessment Manikins to measure participants’ valence sadness-happiness and arousal tenseness-calmness before and after they completed mailed surveys asking about trauma-related symptoms or experiences. We examined the following potential predictors for post-survey sadness and tenseness: screening positive for posttraumatic stress disorder, having a serious mental illness, and history of military sexual assault or combat.

ResultsAfter the survey, across the groups, 29.3–41.8% were sadder, 45.3–52.2% had no change in valence, and 12.9–22.5% were happier; 31.7–40.2% were tenser, 40.6–48.2% had no change in arousal, and 17.3–24.0% were calmer. The mean increase in sadness or tenseness post-survey was less than one point in all groups SD’s < 1.7. Cohen’s d ranged from 0.07 to 0.30. Most hypothesized predictors were associated with greater baseline sadness or tenseness, but not necessarily with larger post-survey changes. Women with a history of military sexual assault had the largest net post-survey changes in sadness mean = 0.7, SD = 1.4 and tenseness mean = 0.6, SD = 1.6.

ConclusionWhile a substantial minority of Veterans reported more sadness or tenseness post-survey, the net change in affect was small. Most hypothesized risk factors were actually associated with higher baseline sadness or tenseness scores. When receiving unsolicited, trauma-related surveys by mail, separate protections for Veterans with the risk factors studied here do not seem necessary.

KeywordsPre-post test observation Patient surveys Posttraumatic stress disorder Ethics Trauma Research participation Iatrogenic Psychological distress Affect Research subjects-psychology AbbreviationsGWEStGulf War 1 Era Veterans study

IMPROVeInterviews to Measure PTSD Recovery of Veterans study

IRBInstitutional review board

PTSDPosttraumatic stress disorder

RRPQReactions to Research Participation Questionnaire

SAMSelf-Assessment Manikin

SDStandard deviations

VAUnited States Department of Veterans Affairs

Electronic supplementary materialThe online version of this article doi:10.1186-s12874-017-0357-x contains supplementary material, which is available to authorized users.

Author: Maureen Murdoch - Shannon Marie Kehle-Forbes - Melissa Ruth Partin


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