Revista de tratamiento y trastornos del estrés traumático

Post-traumatic Stress, Physical Health and Chronic Pain: The Role of Hyperarousal and Depressive Symptoms

Gómez-Pérez L, Wessa M, and Flor H

Background: This cross-sectional study aimed to examine the association of posttraumatic stress symptoms (PTSS; i.e., re- experiencing, avoidance/numbing, and hyperarousal) and depressive symptoms with: (a) physical health symptoms, (b) pain symptoms, (c) and the presence of chronic pain among trauma-exposed individuals. The mediational role of depressive symptoms in the relationship between each PTSS cluster and physical health symptoms, pain symptoms, or presence of chronic pain was also tested.

Method: Individuals who reported to have suffered a traumatic experience (N = 100) participated in the study. They were recruited through organizations offering services for victims of violence, self- help groups, newspaper announcements, and the outpatient clinic. Participants were interviewed with the Diagnostic and Statistical Manual for DSM-IV and the German versions of the Clinician- Administered PTSD Scale, the Beck Depression Inventory, and the Freiburg Complaints Scale.

Results: Regression analysis showed that both hyperarousal and depressive symptoms accounted for unique variances of physical health symptoms (partial r2 were .03 and .11, respectively). Bootstrap analysis indicated that whereas hyperarousal was both directly and indirectly (through depressive symptoms) related to physical health symptoms, avoidance/numbing and re-experience were only indirectly related with physical health symptoms via depressive symptoms. For pain symptoms, only depressive symptoms were uniquely related with this variable (partial r2 was .05). Depressive symptoms mediated the relationship between the three PTSS clusters and pain symptoms, but not the relationship between the clusters and the presence of chronic pain. Hyperarousal was the only variable uniquely and directly related with the presence of chronic pain (OR = 3.01; p <.05).

Conclusions: These data highlight the importance of treating depressive and hyperarousal symptoms in order to improve physical health and pain in trauma-exposed individuals.