Mental defeat in interpersonal and non-interpersonal traumas
Research type
Research Study
Full title
The role of mental defeat in interpersonal and non-interpersonal traumas
IRAS ID
293056
Contact name
Rachel Ashwick
Contact email
Sponsor organisation
Oxford Health NHS Foundation Trust
Duration of Study in the UK
1 years, 2 months, 30 days
Research summary
Research Summary
Research shows that interpersonal trauma (caused by someone else) poses a significantly higher risk for Posttraumatic Stress Disorder (PTSD) symptoms and more severe presentations than non-interpersonal trauma (e.g. accidents). Moreover, studies demonstrate that this risk is further heightened when an individual has been exposed to multiple interpersonal traumas compared to multiple non-interpersonal traumas. However, the mechanisms by which interpersonal trauma and multiple experiences lead to this increased risk remain unknown. Cognitive models of PTSD suggest that the way in which individuals appraise the trauma and its consequences impact on the development of PTSD. Studies have shown that perceived defeat during and after traumatic experiences increase PTSD symptoms. However, the role of perceived mental defeat following trauma has yet to be explored in interpersonal compared to non-interpersonal traumas. We will conduct a group comparison to address the primary question of whether perceived mental defeat varies between interpersonal and non-interpersonal traumas. We will then address secondary questions of whether there is a dose-response between number of traumas and mental defeat in interpersonal traumas compared to non-interpersonal traumas and whether mental defeat mediates the relationship between type of trauma and PTSD severity. We will be recruiting adults who meet criteria for PTSD as per a standardised measure and who have not yet received treatment. Participants will be asked to complete a range of questionnaires online investigating their type and number of traumas, severity of PTSD symptoms and perceptions of feeling defeated at one time point.
Summary of Research
Why was the study done?
After experiencing a traumatic event, some individuals develop a condition called Post-Traumatic Stress Disorder (PTSD), where they experience unwanted memories of the event, anxiety, avoidance, changes in their mood and thinking, and feeling on edge. Researchers have tried to explain why some people develop PTSD whereas others do not and why some people have worse symptoms.
So far, research shows that factors including the type of trauma and the number of different trauma types experienced may help explain these differences. In particular, traumas that have been purposefully caused by another individual (interpersonal traumas) appear to lead to worse symptoms of PTSD compared to natural or accidental traumas (non-interpersonal traumas). In addition, the more different types of traumas someone experiences, the worse their symptoms are, and it is suggested that the more interpersonal traumas someone experiences, the greater the increase in their PTSD severity compared to non-interpersonal traumas.
We wanted to find out why interpersonal traumas and having experienced more trauma types seem to worsen PTSD. Theories suggest that the way someone thinks about their trauma and its consequences can play an important role, but no studies had yet explored the impact of trauma type and the number of traumas on 'mental defeat'. Mental defeat is a term used to describe thoughts about having lost social status and a sense of identity resulting in feelings of powerlessness and hopelessness.Therefore, this study aimed to look at:
1) Whether mental defeat was higher in individuals who had experienced interpersonal traumas compared to those who had experienced non-interpersonal traumas
2) Whether mental defeat increased more as the number of interpersonal trauma types increased in comparison to non-interpersonal trauma types
3) Whether interpersonal traumas lead to higher mental defeat which then leads to greater PTSD symptoms.How was the study carried out?
The study involved an anonymous online questionnaire advertised to participants through NHS services in Berkshire, Oxfordshire and Buckinghamshire, and via mental health charities, online forums, and social media. Individuals who were over 18-years-old, reported experiencing only interpersonal or non-interpersonal traumas and who scored above 33 on a PTSD screening measure were able to take part. People who scored below 33 or who had experienced both trauma types were excluded. Those who took part completed questionnaires about the number and type of traumas they had experienced, the date of their most recent trauma, their PTSD symptoms, symptoms of mental defeat, age, sex and ethnicity.
What did the study find?
164 individuals took part in the online questionnaire; 62 had experienced only non-interpersonal traumas, and 104 had experienced only interpersonal traumas. We found that those who had experienced interpersonal traumas had higher levels of mental defeat than non-interpersonal traumas, even when we took into account other factors such as their sex, time since trauma and number of traumas. We also found that interpersonal traumas lead to higher levels of mental defeat and subsequently higher levels of PTSD symptoms than non-interpersonal traumas. Therefore, mental defeat could help explain the higher severity of symptoms in people with interpersonal trauma histories.
On the other hand, we found that mental defeat did not increase as the number of trauma types increased for either of the groups. We also found no difference in the rate of increase between interpersonal and non-interpersonal trauma types.What are the limitations of the study?
The study was completed entirely online, which helped to provide anonymity and allow people to answer honestly. However, this meant that we were not able to use a gold-standard measure to confirm that participants met the criteria for a diagnosis of PTSD. The study also excluded a large number of people who had both types of trauma, which means it may not represent people presenting to services. The sample consisted of mainly white (91.6%) females (84.3%) and may not represent males or individuals from other ethnic backgrounds. In addition, the questionnaire was completed at one time point. Therefore, we have to be tentative in saying that interpersonal traumas increase mental defeat and then increase PTSD scores, as we cannot confirm the order in which these factors occurred. Furthermore, as the number of traumas had been reported differently by participants, we had to use the number of trauma types as opposed to the actual number of traumas experienced. Therefore, future research should look at whether mental defeat increases as the number of traumas increases.
Conclusions
People who have experienced traumas that have been purposefully caused by another person appear to experience higher levels of mental defeat than those who have experienced natural or accidental traumas. The higher levels of mental defeat in interpersonal traumas also appear to be linked to higher levels of PTSD symptoms. Mental defeat is an important factor for clinicians to assess for and treat when faced with clients with PTSD, particularly those who have experienced interpersonal traumas.
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
21/NW/0265
Date of REC Opinion
18 Oct 2021
REC opinion
Further Information Favourable Opinion