POSTTRAUMATIC STRESS SYMPTOMS IN COLLEGE STUDENTS WITH A CHRONIC ILLNESS

Social Behavior and Personality, 2006 by Barakat, Lamia P, Wodka, Ericka L

To examine posttraumatic stress symptoms in college students with a chronic illness, volunteers who endorsed having a chronic illness (N=61) were administered the Posttraumatic Diagnostic Scale (FTDS: Foa, Cashman, Jaycox, & Perry, 1997). Over 50% met criteria for reexperiencing symptoms and interference with functioning; however, few participants met criteria for Posttraumatic Stress Disorder (PTSD). Higher threat appraisals (endorsement of A criteria, general appraisal/level of pessimism) explained a significant portion of the variance in total PTSD symptoms beyond the significant contributions of anxiety, life events, and illness interference with daily functioning. Findings document the presence of posttraumatic stress symptoms among college students with chronic illness and highlight the role of anxiety and perceived threat in the development of symptoms. College students face a number of demands from chronic illness and stressors not related to their health indicating the need for services targeted at responses to stress.

Keywords: chronic illness, college students, posttraumatic stress responses, appraisals

Posttraumatic stress responses may be present among college students as many college-age youth have experienced traumatic life events, including the diagnosis and ongoing demands of chronic illness (Compas, Wagner, Slavin, & Vannatta, 1986; Gortmaker & Sappenfield, 1984). Improvements in medical treatments in recent decades have resulted in greater numbers of youth with chronic illness surviving into adulthood. This is reflected in significantly increased numbers of youth with disabilities entering college (Sawin et al., 1999). In 1995, it was reported that 9.2% of college freshmen had a disability with 2.4% specifically identifying a health-related or orthopedic disability (Henderson, 1995).

Examination of posttraumatic stress responses in youth who experience moderate to severe health-related traumatic stressors is focused on lifethreatening, chronic diseases (i.e., cancer), acute events (i.e., accidents), and treatments (i.e., transplantation) (Aaron, Zaglul, & Emery, 1999; Robbie et al., 2000; Landolt, VoUrath, Ribi, Gnehm, & Sennhauser, 2003; Levi, Drotar, Yeates, & Taylor, 1999). Findings generally support the presence of posttraumatic stress symptoms in a significant subsample of youth with health-related traumas with a smaller but still sizeable percentage meeting full criteria for Posttraumatic Stress Disorder (PTSD) particularly as they become young adults (Aaron et al., 1999; Hobbie et al., 2000). Reexperiencing and arousal are typically endorsed; avoidance/numbing is less commonly reported. Furthermore, Oswalt and Silberg (1995) reported that 36% of 179 randomly sampled college students endorsed having experienced a traumatic event (e.g., accidents, deaths, harassment, and medical illnesses) during college with accompanying posttraumatic stress symptoms; however, only 6% in their sample met criteria for a diagnosis of PTSD.

Considerable effort has been made to uncover factors that increase risk for, or protect from, the development of posttraumatic stress symptoms in chronically ill and healthy samples. Consistent with assertions made in cognitive processing models of PTSD (Creamer, Burgess, & Pattison, 1992), subjective variables that reflect variation in perceptions of the severity of the traumatic event, in this case chronic illness, are among the most studied. For youth with chronic illness, perceived life threat and treatment intensity have been associated with symptoms of PTSD, but more objective disease characteristics are less consistently associated (Barakat et al., 1997; Stewart & Mishel, 2001; Stuber, Meeske, Gonzalez, Houskamp, & Pynoos, 1994). The literature also suggests that trait anxiety and other life stressors may put one at risk for posttraumatic stress responses to chronic illness (Stuber et al., 1997).

The aim of this study was to describe posttraumatic stress symptoms among college students with chronic health conditions and to understand the relative contribution of illness factors and perceived threat (endorsement of A criteria for PTSD; perceived threat from chronic illness; generalized appraisal/pessimism) to posttraumatic stress symptoms.

METHOD

PARTICIPANTS AND PROCEDURES

This study is part of a larger study examining the adaptation of college students with chronic illness. Participants comprised students enrolled in psychology courses at a private university located in an east coast city in USA. All students who gave written informed consent completed the measures for which they were eligible. Measures were given in two parts: eligibility for part 1 included being at least 18 years of age or older, and eligibility for part 2 required that the participant endorsed having experienced a major life event or chronic illness in part 1. Those who reported a learning disability or mental illness were also excluded. Nine students met exclusion criteria resulting in a total of 195 participants. Procedures were approved by the appropriate Institutional Review Board.