Abstract
Background: One 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. Methods: We 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. Results: After 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). Conclusion: While 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.
Original language | English (US) |
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Article number | 81 |
Journal | BMC Medical Research Methodology |
Volume | 17 |
Issue number | 1 |
DOIs | |
State | Published - May 10 2017 |
Bibliographical note
Funding Information:The Center for Chronic Disease Outcomes Research is a VA Health Services Research and Development (HSR&D) Service Center of Excellence (Center grant #HFP 98–001). This study was supported by grants #GWI 04–352 and #IIR-09-359 from VA HSR&D service. Dr. Kehle-Forbes was supported by a VA HSR&D Career Development Award (#09-020). Dr. Partin was supported by a VA HSR&D Research Career Scientist Award (#RCS 10–185). The funding agency had no role in the design, data collection, analysis, data interpretation, manuscript writing, or decision to submit the manuscript.
Publisher Copyright:
© 2017 The Author(s).
Keywords
- Affect
- Ethics
- Iatrogenic
- Patient surveys
- Posttraumatic stress disorder
- Pre-post test observation
- Psychological distress
- Research participation
- Research subjects/psychology
- Trauma