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November 25, 2008 — A strong sense of purpose may be the single most important factor in determining mental health outcomes following serious trauma, new research suggests.

Investigators from Howard University, in Washington, DC, found that, among 259 individuals exposed to at least 1 severe traumatic event, purpose in life was the key predictor of a trauma-exposed individual's ability to maintain a baseline mental health status or recover from a psychiatric illness.

"We found that the most important psychosocial factor associated with resilience or recovered status was a sense of higher purpose in life. We also found that mastery, or having a strong sense of control over one's life, was significantly associated with recovered status," said Adriana Feder, MD, Mount Sinai School of Medicine, New York, who, along with Tanya N. Alim, MD, is a principal investigator.
The study is published online November 17 in the American Journal of Psychiatry.
High Rate of Unreported Trauma, Mental Health Complaints

Trauma can increase the risk for a range of psychiatric disorders. However, many individuals are able to adapt with minimal disruption to their lives (resilience) and others are able to return to their baseline level of functioning (recovery).

Previous research has tended to focus on identifying risk factors for posttraumatic stress disorder (PTSD) and depression after trauma, and little attention is paid to potentially protective factors, Dr. Feder told Medscape Psychiatry.

To better understand the psychological characteristics associated with resistance to severe stress, researchers examined specific psychosocial factors among 259 African American patients exposed to at least 1 severe traumatic event in their lifetime and recruited from primary-care offices at a single center in an urban setting.

Subjects who had experienced a serious traumatic event, such as physical or sexual assault, then underwent a structured face-to-face interview conducted by trained clinical interviewers to assess lifetime psychiatric disorders.

Patients were then categorized accordingly:
Resilient group (n = 47) — Those who had no history of psychiatric disorders.
Recovered group (n = 85) — Those who had at least 1 past psychiatric disorder but no current disorder.
Currently ill group (n = 127) — Those who met the criteria for at least 1 current psychiatric disorder.
It is notable, say the authors, that of those in the currently ill group, only 9% (12/127) reported receiving any specialized mental health treatment, and that, among a subset of 123 individuals from all 3 diagnostic groups, only 37% reported discussing their trauma or any mental health problem with their primary-care provider.

PTSD Most Common Diagnosis

The participants also completed self-report tests to measure their optimism, purpose in life, and sense of control over their life, attendance at religious services, sense of spirituality, and coping skills.
Psychiatric diagnoses in the study sample consisted primarily of depression, anxiety, and substance-use disorders. PTSD was the most common diagnosis.

Among the resilient group, there was a significantly lower lifetime trauma load, and female sex was predictive of currently ill status. A higher burden of trauma types, as well as physical or sexual assault, was also linked to currently ill status.

Researchers also found that a higher frequency of religious-service attendance was associated with resilient status, but this did not reach statistical significance in the final model. It is possible, said Dr. Feder, that attending a religious service is, in part, a proxy for increased social support.

Although more research is needed, said Dr. Feder, these results could help guide future intervention studies in traumatized individuals to help prevent or treat mental illness.

"An intervention guided by these principles of maintaining or instilling a sense of purpose and control over one's life may protect against posttraumatic stress disorders and/or aid in recovery," she said.