Emotional Dysregulation and Worry as Mediators between Stressful Life Events and Posttraumatic Stress Symptoms in Adult Mexican Women: A Cross-Sectional Study
##plugins.themes.bootstrap3.article.main##
Abstract
Introduction. Women experience numerous episodes of adverse events, often linked to violence, which create emotional difficulties that contribute to the development of post-traumatic stress disorder. However, more research is required to understand the nature of post-traumatic reactions and the underlying psycho-emotional processes.
Objective. To determine whether emotional dysregulation and worry mediate the relationship between the experience of stressful events and post-traumatic stress symptoms in a sample of adult Mexican women seeking online psychological treatment.
Method. A cross-sectional study was conducted with a non-probabilistic sample of 687 women ages 18 to 76.
Results. The data show that emotional dysregulation mediated the relationship between the type of trauma and post-traumatic stress symptoms for illness- and death-related events, but not for other types of stressors, whereas worry mediated the association between sexual and physical assault and post-traumatic stress symptoms.
Discussion and conclusion. This study contributes to current psychopathology models focused on the transdiagnostic perspective. The findings may guide interventions targeting emotion regulation and worry as modifiable risk factors for the development of post-traumatic stress.
References
Akel, M., Berro, J., Rahme, C., Haddad, C., Obeid, S., & Hallit, S. (2021). Violencia contra las mujeres durante la pandemia de COVID-19. Revista de Violencia Interpersonal, 37, 13-14. https://doi.org/10.1177/0886260521997953
Al-Jbouri, N., Mashkury, Z., & Al-Ameri, R. (2021). Salud mental durante la pandemia de COVID-19 / Bagdad Al-Karkh. Revista Internacional de Psiquiatría Social, 68, 4. https://doi.org/10.1177/00207640211004987
Almeida, M., Shrestha, A. D., Stojanac, D., & Miller, L. J. (2020). The impact of the COVID-19 pandemic on women’s mental health. Archives of Women's Mental Health, 23(6), 741-748. https://doi.org/10.1007/s00737-020-01092-2
Ardino, V., Milani, L., & Di Blasio, P. (2013). PTSD and re-offending risk: the mediating role of worry and a negative perception of other people’s support. European Journal of Psychotraumatology, 4. https://doi.org/10.3402/ejpt.v4i0.21382
Bardeen, J. R., Kumpula, M. J., & Orcutt, H. K. (2013). Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following a mass shooting. Journal of Anxiety Disorders, 27(2), 188-196. https://doi.org/10.1016/j.janxdis.2013.01.003
Berking, M., & Whitley, B. (2014). Emotion regulation: Definition and relevance for mental health. En M. Berking & B. Whitley (Eds.), Affect regulation training: A practitioners’ manual (pp. 5-17). New York, NY: Springer. https://doi.org/10.1007/978-1-4939-1022-9_2
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 395(10227), 912-920. https://doi.org/10.1016/S0140-6736(20)30460-8
Cabras, C., Mondo, M. Diana, A., & Sechi, C. (2020). Relationships between Trait Emotional Intelligence, mood states, and future orientation among female Italian victims of Intimate Partner Violence. Heliyon, 6(11), e05538. https://doi.org/10.1016/j.heliyon.2020.e05538
Campos, J., Campos, L., Martins, B., Valadão, F., Ruano, R., & Maroco, J. (2021). El impacto psicológico del COVID-19 en personas con y sin trastornos de salud mental. Informes Psicológicos, 125(5), 2435-2455. https://doi.org/10.1177/00332941211026850
Chávez-Valdez, S. M., Domínguez Rodríguez, A., Esparza-Del Villar, O. A., Hernández Jiménez, M. J., de la Rosa-Gómez, A., Arenas-Landgrave, P., Martínez-Luna, S. C., Ramírez-Martínez, F. R., & Salinas-Saldívar, J. T. (2021). Coping strategies associated to widespread fear and post-traumatic stress criteria in a Mexican sample during COVID-19 pandemic: A cross-sectional study. Salud Mental, 44(4), 159-166. https://doi.org/10.17711/sm.0185-3325.2021.021
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidencia para el PTSD propuesto por la CIE-11 y el PTSD complejo: un análisis de perfil latente. Revista Europea de Psicotraumatología, 4. https://doi.org/10.3402/ejpt.v4i0.20706
Coker, A. L., Weston, R., Creson, D. L., Justice, B., & Blakeney, P. (2005). PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors. Violence and Victims, 20(6), 625-643.
Connor, J., Madhavan, S., Mokashi, M., Amanuel, H., Johnson, N., Pace, L., & Bartz, D. (2020). Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Social Science & Medicine, 266(1):113364. https://doi.org/10.1016/j.socscimed.2020.113364
Czeisler, M. É., Howard, M. E., & Rajaratnam, S. M. W. (2021). Mental Health During the COVID-19 Pandemic: Challenges, Populations at Risk, Implications, and Opportunities. American Journal of Health Promotion, 35(2), 301-311. https://doi.org/10.1177/0890117120983982b
Davey, G. C. L. (1994). Worrying, social problem-solving abilities, and social problem-solving confidence. Behaviour Research and Therapy, 32(3), 327-330. https://doi.org/10.1016/0005-7967(94)90130-9
De la Rosa-Gómez, A., Hernández-Posadas, A., Valencia, P. D., & Guajardo-Garcini, D. A. (2021). Análisis dimensional de la Escala de Dificultades en la Regulación Emocional (DERS-15) en universitarios mexicanos. Revista Evaluar, 21(2), 80-97. https://doi.org/10.35670/1667-4545.v21.n2.34401
Demissie, D. B., & Bitew, Z. W. (2021). Efecto en la salud mental de la pandemia de COVID-19 entre mujeres embarazadas y / o lactantes: una revisión sistemática y un metanálisis. Medicina Abierta SAGE, 9. https://doi.org/10.1177/20503121211026195
Dlamini, N. J. (2021). Violencia de género, pandemia gemela a COVID-19. Sociología Crítica, 47(4-5), 583-590. https://doi.org/10.1177/0896920520975465
Dominguez-Rodriguez, A., Herdoiza-Arroyo, P. E., Martínez-Arriaga, R. J., Bautista-Valerio, E., Mateu-Mollá, J., de la Rosa-Gómez, A., Farfallini, L., Hernández-Jiménez, M. J., Esquivel-Santoveña, E. E., Ramírez-Martínez, F. R., Castellanos-Vargas, R. O., Arzola-Sánchez, C. A., Arenas-Landgrave, P., & Martínez-Luna, S. C. (2022). Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study. Frontiers in Psychiatry, 13, 749236. https://doi.org/10.3389/fpsyt.2022.749236
Durón-Figueroa, R., Cárdenas-López, G., Castro-Calvo, J., & De la Rosa-Gómez, A. (2019). Adaptación de la Lista Checable de Trastorno por Estrés Postraumático para DSM-5 en Población Mexicana. Acta de Investigación Psicológica, 9(1), 26-36. https://doi.org/10.22201/fpsi.20074719e.2019.1.03
Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity. Behavior Therapy, 41(4), 587-598. https://doi.org/10.1016/j.beth.2010.04.004
Feeny, N., Zoellner, L., Fitzgibbons, L., & Foa E. (2000). Exploring the Roles of Emotional Numbing, Depression, and Dissociation in PTSD. Journal of Traumatic Stress, 13, 489-498. https://doi.org/10.1023/A:1007789409330
Forbes, C. N., Tull, M. T., Rapport, D., Xie, H., Kaminski, B., & Wang, X. (2020). Emotion dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure. Journal of Traumatic Stress, 33(6), 1007-1016. https://doi.org/10.1002/jts.22551
Freyd, J., Deprince, A., & Zurbriggen, E. (2001) Self-Reported Memory for Abuse Depends Upon Victim-Perpetrator Relationship. Journal of Trauma & Dissociation, 2(3), 5-15. https://doi.org/10.1300/J229v02n03_02
Galindo-Vázquez, O., Ramírez-Orozco, M., Costas-Muñiz, R., Mendoza-Contreras, L. A., Calderillo-Ruíz, G., & Meneses-García, A. (2020). Symptoms of anxiety, depression and self-care behaviors during the COVID-19 pandemic in the general population. [Síntomas de ansiedad, depresión y conductas de autocuidado durante la pandemia de COVID-19 en la población general]. Gaceta Médica de México, 156(4), 298-305. https://doi.org/10.24875/GMM.20000266
Gilmore, A., Lopez, C., Muzzy, W., Brown, W., Grubaugh, A., Oesterle, D., & Acierno, R. (2020). Emotion dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder. Women’s Health Issues, 30(6), 462-469. https://doi.org/10.1016/j.whi.2020.07.004
Gratz, K., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Hilko, T., & Chalder, T. (2018). Childhood adversity as a transdiagnostic risk factor for affective disorders in adulthood: A systematic review focusing on biopsychosocial moderating and mediating variables. Clinical Psychology Review, 65, 81-151. https://doi.org/10.1016/j.cpr.2018.08.002
Holladay, K. R., Hagedorn, W. B., Boote, D. N., & Ladier, D. T. (2021). The Trauma of Cyber-Sexual Assault: Heightened Dimensions of Emotional Dysregulation Among Survivors. The Practitioner Scholar: Journal of the International Trauma Training Institute, 3, 60-77.
Huerta Rosales, R., Miljánovich, M., Pequeña, J., Campos, E., Santivañez, R., & Aliaga, J. (2014). Estrés post traumático e inadaptación en mujeres víctimas de violencia doméstica en la relación de pareja en función de la edad. Revista de Investigación en Psicología, 17(2), 59-75. https://doi.org/10.15381/rinvp.v17i2.11258
Irizarry, W., & Rivero, M. (2018). Post-traumatic stress disorder in women victim of domestic violence: An Integrative Review of Literature. Nure Investigación, 15(95), 1-17.
Karakurt, G., Smith, D., & Whiting, J. (2014). Impact of Intimate Partner Violence on Women’s Mental Health. Journal of Family Violence, 29(7), 693-702. https://doi.org/10.1007/s10896-014-9633-2
Lilly, M., London, M., & Bridgett, D. (2014). Using SEM to examine emotion regulation and revictimization in predicting PTSD symptoms among childhood abuse survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 6(6), 644-651. https://doi.org/10.1037/a0036460
Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., Wu, L., Sun, Z., Zhou, Y., Wang, Y., & Liu, W. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research, 287, 112921. https://doi.org/10.1016/j.psychres.2020.112921
McEvoy, P., Watson, H., Watkins, E., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313-320. https://doi.org/10.1016/j.jad.2013.06.014
McLean, C., & Foa, E. (2017). Emotions and emotion regulation in posttraumatic stress disorder. Current Opinion in Psychology, 14, 72-77. https://doi.org/10.1016/j.copsyc.2016.10.006
Messman-Moore, T. L., Walsh, K. L., & DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse & Neglect, 34(12), 967-976. https://doi.org/10.1016/j.chiabu.2010.06.004
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487-495. https://doi.org/10.1016/0005-7967(90)90135-6
Muñoz-Rivas, M., Bellot, A., Montorio, I., Ronzón-Tirado, R., & Redondo, N. (2021). Profiles of Emotion Regulation and Post-Traumatic Stress Severity among Female Victims of Intimate Partner Violence. International Journal of Environmental Research and Public Health, 18(13), 6865. http://dx.doi.org/10.3390/ijerph18136865
Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine, 38(4), 467-480. https://doi.org/10.1017/S0033291707001353
Olatunji, B. O., Wolitzky-Taylor, K. B., Sawchuk, C. N., & Ciesielski, B. G. (2010). Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD, Applied and Preventive Psychology, 14(1-4), 1-24. https://doi.org/10.1016/j.appsy.2011.03.001
Padros-Blazquez, F., Gonzalez-Betanzos, F., Martinez-Medina, M. P., & Wagner, F. (2018). Psychometric characteristics of the original and brief version of the Penn State Worry Questionnaire (PSWQ) in Mexican samples. Actas Españolas de Psiquiatría, 46(4), 117-124.
Paulus, D. J., Gallagher, M. W., Bartlett, B. A., Tran, J., & Vujanovic, A. A. (2018). The unique and interactive effects of anxiety sensitivity and emotional dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters. Comprehensive Psychiatry, 84, 54-61. https://doi.org/10.1016/j.comppsych.2018.03.012
Pencea, I., Munoz, A. P., Maples-Keller, J. L., Fiorillo, D., Schultebraucks, K., Galatzer-Levy, I., Rothbaum, B. O., Ressler, K. J., Stevens, J. S., Michopoulos, V., & Powers, A. (2020). Emotion dysregulation is associated with increased prospective risk for chronic PTSD development. Journal of Psychiatric Research, 121, 222-228. https://doi.org/10.1016/j.jpsychires.2019.12.008
Pérez-Cano, H. J., Moreno-Murguía, M. B., Morales-López, O., Crow-Buchanan, O., English, J. A., Lozano-Alcázar, J., & Somilleda-Ventura, S. A. (2020). Anxiety, depression, and stress in response to the coronavirus disease-19 pandemic. Cirugía y Cirujanos, 88(5), 562-568. https://doi.org/10.24875/CIRU.20000561
Piquero, A. R., Jennings, W. G., Jemison, E., Kaukinen, C., & Knaul, F. M. (2021). Domestic violence during the COVID-19 pandemic - Evidence from a systematic review and meta-analysis. Journal of Criminal Justice, 74, 101806. https://doi.org/10.1016/j.jcrimjus.2021.101806
Raudales, A., Short, N. A., & Schmidt, N. B. (2019). Emotion dysregulation mediates the relationship between trauma type and PTSD symptoms in a diverse trauma-exposed clinical sample. Personality and Individual Differences, 139(8), 28-33. https://doi.org/10.1016/j.paid.2018.10.033
Rodríguez-Quiroga, A., Buiza, C., de Mon, M. A. A., & Quintero, J. (2020). Update on COVID-19 and mental health. Medicine - Programa de Formación Médica Continuada Acreditado, 13(23), 1285-1296. https://doi.org/10.1016/j.med.2020.12.010
Rosenthal, M. Z., Cheavens, J. S., Lynch, T. R., & Follette, V. (2006). Thought suppression mediates the relationship between negative mood and PTSD in sexually assaulted women. Journal of Traumatic Stress, 19(5), 741-745. https://doi.org/10.1002/jts.20162
Ruork, A. K., McLean, C. L., & Fruzzetti, A. E. (2021). It Happened Matters More Than What Happened: Associations Between Intimate Partner Violence Abuse Type, Emotion Regulation, and Post-Traumatic Stress Symptoms. Violence Against Women, 28(5), 1158-1170. https://doi.org/10.1177/10778012211013895
Sandín, B., Chorot, P., Valiente, R. M., & Lostao, L. (2009). Validación española del cuestionario de preocupación PSWQ: estructura factorial y propiedades psicométricas. Revista de Psicopatología y Psicología Clínica, 14(2). https://doi.org/10.5944/rppc.vol.14.num.2.2009.4070
Santomauro, D., Mantilla, A., Shadid, J., Zheng, P., Ashbaugh, C., Pigorr, D., Abbafati, C., Adolph, C., Amlag, J. O., Aravkin, A. Y., Bang-Jensen, B. L., Bertolacci, G. J., Bloom, S. S., Castellano, R., Castro, E., Chakrabarti, S., Chattopadhyay, J., Cogen, R. M., Collins, J. K., … Ferrari, A. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398(10312), 1700-1712. https://doi.org/10.1016/S0140-6736(21)02143-7
Sardinha, L., Maheu-Giroux, M., Stöckl, H., Meyer, S. R., & García-Moreno, C. (2022). Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet, 399(10327), 803-813. https://doi.org/10.1016/S0140-6736(21)02664-7
Secretaría de Seguridad y Protección Ciudadana [SSPC]. (2020). Información sobre violencia contra las mujeres e incidencia delictiva y llamadas de emergencia al 911. Retrieved from https://www.gob.mx/sesnsp/acciones-y-programas/incidencia-delictiva-299891?state=published
Sediri, S., Zgueb, Y., Ouanes, S., Ouali, U., Bourgou, S., Jomli, R., & Nacef, F. (2020). Women’s mental health: acute impact of COVID-19 pandemic on domestic violence. Archives of Women's Mental Health, 23(6), 749-756. https://doi.org/10.1007/s00737-020-01082-4
Seligowski, A. V., Lee, D. J., Bardeen, J. R., & Orcutt, H. K. (2015). Emotion regulation and posttraumatic stress symptoms: a meta-analysis. Cognitive Behaviour Therapy, 44(2), 87-102. https://doi.org/10.1080/16506073.2014.980753
Siegel, A., Mor, I., & Lahav, Y. (2021). Profiles in COVID-19: peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and emotion dysregulation. European Journal of Psychotraumatology, 12(1), 1968597. https://doi.org/10.1080/20008198.2021.1968597
Thibaut, F., & van Wijngaarden-Cremers, P. J. M. (2020). Women’s Mental Health in the Time of Covid-19 Pandemic. Frontiers in Global Women’s Health, 1, 588372. https://doi.org/10.3389/fgwh.2020.588372
Tull, M. T., Hahn, K. S., Evans, S. D., Salters-Pedneault, K., & Gratz, K. L. (2011). Examining the Role of Emotional Avoidance in the Relationship Between Posttraumatic Stress Disorder Symptom Severity and Worry. Cognitive Behaviour Therapy, 40(1), 5-14. https://doi.org/10.1080/16506073.2010.515187
Tyra, A. T., Ginty, A. T., & John-Henderson, N. A. (2021). Emotion Regulation Strategies Predict PTSS During the COVID-19 Pandemic in an American Indian Population. International Journal of Behavioral Medicine, 28(6), 808-812. https://doi.org/10.1007/s12529-021-09964-2
United Nations Entity Dedicated to Gender Equality and the Empowerment of Women [UN Women]. (2020). Violence Against Women and Girls: the Shadow Pandemic. Retrieved from https://www.unwomen.org/es/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic
United Nations Entity Dedicated to Gender Equality and the Empowerment of Women [UN Women]. (2021). Una de cada tres mujeres en el mundo sufre violencia física o sexual desde que es muy joven. Retrieved from https://news.un.org/es/story/2021/03/1489292#:~:text=La%20violencia%20de%20g%C3%A9nero%20es,pareja%20o%20de%20otras%20personas
Velotti, P., Civilla, C., Rogier, G., & Beomonte Zobel, S. (2021). A Fear of COVID-19 and PTSD Symptoms in Pathological Personality: The Mediating Effect of Dissociation and Emotion dysregulation. Frontiers in Psychiatry, 12, 590021. https://doi.org/10.3389/fpsyt.2021.590021
Villalta, L., Khadr, S., Chua, K.-C., Kramer, T., Clarke, V., Viner, R. M., Stringaris, A., & Smith, P. (2020) Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault. European Journal of Psychotraumatology, 11(1). https://doi.org/10.1080/20008198.2019.1710400
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729
Weathers, F., Litz, B., Keane, T., Palmieri, P., Marx, B., & Schnurr, P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Retrieved from https://www.ptsd.va.gov/
World Health Organization [WHO]. (2021). Violencia contra la mujer. Retrieved from https://www.who.int/es/news-room/fact-sheets/detail/violence-against-women
Yiğit, I., & Guzey-Yiğit, M. (2019). Psychometric properties of Turkish version of Difficulties in Emotion Regulation Scale-Brief Form (DERS-16). Current Psychology, 36, 1503-1511. https://doi.org/10.1007/s12144-017-9712
