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Title: Post-traumatic stress disorder (PTSD) symptoms in later life
Author: Suchorab, Klaudia Anna
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2020
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Objectives: Around three in four older adults report exposure to at least one traumatic event, however, only a small proportion develop PTSD. Making a PTSD diagnosis in later life can be challenging for a number of reasons, including underreporting of trauma history and misattribution of symptoms to a physical illness. Research on PTSD in older adults remains scarce and little is known about complex factors involved in the experiences of PTSD. The primary objective of this thesis was to investigate factors relevant to the development and maintenance of PTSD in later life. A systematic review was conducted with the aim of summarising and critically appraising literature on the relationship between delirium, a hypothesised risk factor for PTSD, and subsequent PTSD symptoms in older hospital inpatients. The systematic review also explored the relationship between age and PTSD following hospital discharge. An empirical study was designed to examine the predictive utility of emotion regulation strategies, cumulative trauma exposure, group identifications and socioeconomic deprivation on current PTSD symptoms in older adults. These factors were hypothesised to influence the experience of PTSD in later life based on findings from younger adult populations. Method: A systematic search strategy across five electronic databases identified eight studies which met the eligibility criteria. A cross-sectional study recruited an opportunistic sample of 88 older adults in receipt of psychological treatment for common mental health disorders. Study participants provided basic demographic information and completed self-report measures of traumatic events, emotion regulation difficulties, PTSD symptoms and group identifications. Socioeconomic deprivation was determined with the Scottish Index of Multiple Deprivation (SIMD). Results: Five of the eight studies included in the systematic review found that delirium was associated with PTSD symptoms, either at follow-up or during hospital stay. Three of the eight studies additionally investigated the relationship between age and PTSD symptoms in patients with and without delirium. Two of the three studies found that older age was associated with less PTSD symptoms after hospital discharge. The empirical study found that limited access to emotion regulation strategies and cumulative trauma exposure significantly contributed to PTSD symptoms in older adults, explaining a high proportion of variance (58%) in PTSD scores. Contrary to expectations, group identifications and socioeconomic deprivation did not add further predictive value to the model. Conclusion: The systematic review suggested that the prevalence of PTSD after hospital discharge is higher than in general population and appears to be associated with in-hospital delirium. Older age was indicated as a protective factor for PTSD following a hospital stay. However, the available literature is considerably heterogenous, with a small number of studies and significant limitations. Findings from the empirical paper suggest that limited access to emotion regulation strategies may be a vulnerability factor in the development and maintenance of PTSD symptoms in older adults. There also appears to be a dose-response relationship between cumulative trauma exposure and severity of PTSD symptoms in later life. Clinical implications of these findings for working with older adults are discussed. These include the importance of designing prevention and early interventions services for older adults at risk of PTSD, comprehensive screening for PTSD symptoms and further development of psychological interventions specifically targeting emotion regulation strategies.
Supervisor: Guzman, Azucena Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
Keywords: post-traumatic stress disorder ; psychological therapies ; emotion regulation ; older adults ; socioeconomic deprivation