Social Support and PTSD – A Step Toward Understanding the Association

Posttraumatic Stress Disorder (PTSD), unlike physical injuries, is a condition that may not be visible to the eye. It does, however, have a massive impact on veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. The US Department of Veterans Affairs reports that approximately 11 to 20 percent of veterans of the Iraq and Afghanistan wars have PTSD.

Although extensive research and clinical work has been dedicated to help diagnose, treat, and provide support for people suffering with PTSD, there are still unresolved issues in how to approach this problem. One of these issues is how social support helps to alleviate symptoms and contributes to recovery.

In “Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans,”Duax et al. provide substantial evidence on the association between a lack of social support and the odds of having PTSD. Although they discuss several studies that highlight this association, social environment has not yet been sufficiently taken into account in early interventions. The paper poses a thought-provoking question: Does this lack of social support impede the recovery process, or do symptoms of PTSD, in particular emotional hiding, make access to social support difficult? The answer to this question could be important in regard to the design of interventions targeting PTSD among veterans, who form the high-risk group for this disorder.

Duax et al. explore this association between PTSD and social support through a sample of 536 OEF/OIF veterans. First, the rate of PTSD in the group is high—almost 29.29 percent screened positive for this condition (notably, non-white and separated/divorced veterans had a higher percentage of PTSD diagnosis). Second, higher self-rated support by family, friends, coworkers, and the community was on average associated with 8 to 9 percent lower odds of having PTSD.

In attempting to explain the connection between PTSD and social support, findings preceding this research suggest that either the lack of social support results in an aggravation of symptoms or that PTSD symptoms themselves do not allow a person to seek support.

Duax et al. clarify that these models “may be bidirectional and temporally related. For example, if a person receives inadequate or problematic social support in the aftermath of trauma, he or she may be more likely to withdraw and avoid. This, in turn, may confer risk for developing PTSD.”

In this research, higher levels of self-rated emotional hiding (withholding or avoiding discussions of emotions and problems) from family, friends, coworkers, and community were associated with significantly increased odds of having PTSD.

In fact, both emotional hiding and lack of social support were associated with higher chances of screening positive for PTSD, independent of each other. Alternatively, holding either of them constant, researchers found that they still strongly correlated with the odds of screening positive for PTSD.

The authors point out that the evidence regarding the association cannot provide a causal explanation of the process. “It cannot be determined whether veterans who screened positive for PTSD rated available social support as less helpful due to symptoms reflective of the diagnosis…or whether lower levels of social support conferred risk for PTSD. Similar questions remain regarding emotional hiding.”

Nevertheless, the connection between these three factors seems to provide substantial evidence that the problem should be targeted, not only on the individual level of each affected veteran, but also on the level of his or her social environment. While some believe that having symptoms of PTSD is the cause of lack of support, this paper instead frames the phenomenon as a possible “vicious cycle.” Working from different angles will most likely yield the best result.

Article Source: Duax JM, Bohnert KM, Rauch SA, Defever AM. “Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans.” J Rehabil Res Dev. 2014; 51(4): 571–78.

Feature Photo: cc/(The National Guard)