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Posttraumatic Stress Disorder: Diagnosis and Assessment
Just as risk factors likely increase a person’s chances of developing PTSD, protective factors might reduce the risk. Researchers have found that protective factors include coping with the traumatic event in positive and active ways rather than by avoiding it (Benotsch et al. 2000; Norris et al. 2002; North et al. 2001), better training and preparation to respond to a traumatic event (Alvarez and Hunt 2005; Basoglu et al. 1997), higher education and income, a sense of mastery or self-esteem, and male sex (Brewin et al. 2000; Kulka et al. 1990; Orcutt et al. 2004); (Coker et al. 2005; Norris et al. 2002).
Beginning in the 1980s, research has shown that after a traumatic event, social support is associated with reduced likelihood of PTSD (e.g., Cohen and Wills 1985; Kaniasty and Norris 1997; Koenen et al. 2003; Ozer et al. 2003). The research involved largely civilians exposed to community or domestic violence. Social support is often defined as help with physical activities, emotional support, and having someone to talk with about traumatic experiences or to turn to for advice. Such social support might be provided by a network of health care and mental health care professionals as well as by family and community members (Flannery 1990).
Studies of veterans have shown that social support, particularly after homecoming, is also associated with reduced likelihood and severity of PTSD (Fontana and Rosenheck 1994; Fontana et al. 1997b; King et al. 1998). It was found that the protective effects of homecoming were greatest among those veterans who had the greatest war-zone exposures (Fontana et al. 1997a). Interestingly, Fontana et al. (1997a) also showed that having been part of a cohesive military unit did not have the protective effect of postwar social support.
One study (King et al. 1998), conducted in a sample of 1,632 Vietnam veterans from the National Vietnam Veterans Readjustment Study, found that hardiness as a personality trait was protective. Hardiness was a construct defined as having a sense of control over life, feeling that life is meaningful, and being open to change.