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Review
. 2021 Mar 30;12(1):1883925.
doi: 10.1080/20008198.2021.1883925.

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis

Vanessa Tirone  1 , Daria Orlowska  2 , Ashton M Lofgreen  1 , Rebecca K Blais  3 , Natalie R Stevens  1 , Brian Klassen  1 , Philip Held  1 , Alyson K Zalta  1   4
Affiliations
Review

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis

Vanessa Tirone et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Betrayal traumas have a particularly deleterious effect on mental health. Although social support is a robust predictor of posttraumatic stress disorder (PTSD) symptom severity, it is not clear what factors may impact this relationship among betrayal trauma survivors. Objective: This study sought to describe the association between social support and PTSD symptom severity among survivors of betrayal trauma and examine whether methodological, sample, trauma, and social support characteristics moderated this association. Method: A comprehensive search identified 29 studies that assessed the cross-sectional association between PTSD symptom severity and social support among 6,510 adult betrayal trauma survivors. Results: The average effect size (r = -.25; 95% CI: -.30, -.20) was small to medium, with significant heterogeneity between studies (I2 = 71.86). The association between PTSD and social support was stronger when the trauma was perpetrated by a romantic partner compared to mixed perpetrators, even after accounting for covariates. There was also a significant effect of support type depending on whether the support was provided in the context of trauma disclosure. Specifically, positive reactions to trauma disclosure were not associated with PTSD symptoms whereas general positive social support (not disclosure focused) was associated with fewer PTSD symptoms. Negative reactions to trauma disclosure were associated with more PTSD symptoms. None of the included studies measured general negative social support outside of trauma disclosure. Conclusions: Our findings suggest that social support may be a particularly important buffer against PTSD symptoms when experiencing traumatic betrayal by an intimate partner. Additionally, our results suggest that social support interventions for those experiencing betrayal trauma should focus on reducing negative responses to disclosure and bolstering general satisfaction with social support.

Antecedentes: Los traumas de traición tienen un efecto particularmente perjudicial sobre la salud mental. Aunque el apoyo social es un fuerte predictor de la severidad de los síntomas del trastorno de estrés postraumático (TEPT), no está claro qué factores pueden afectar esta relación entre los sobrevivientes de traumas de traición.Objetivo: Este estudio buscó describir la asociación entre el apoyo social y la severidad de los síntomas del TEPT entre los sobrevivientes de trauma de traición y examinar si las características metodológicas, muestrales, de trauma y de apoyo social moderaron esta asociación.Método: Una búsqueda exhaustiva identificó 29 estudios que evaluaron la asociación transversal entre la gravedad de los síntomas de TEPT y el apoyo social entre 6.510 adultos sobrevivientes de trauma de traición.Resultados: El tamaño del efecto promedio (r = −.25; IC del 95%: −.30, −.20) fue de pequeño a mediano, con heterogeneidad significativa entre los estudios (I2 = 71.86). La asociación entre el TEPT y el apoyo social fue más fuerte cuando el trauma fue perpetrado por una pareja romántica en comparación con perpetradores mixtos, incluso después de tener en cuenta las covariables. También hubo un efecto significativo del tipo de apoyo dependiendo de si el apoyo se proporcionó en el contexto de la revelación del trauma. Específicamente, las reacciones positivas a la revelación del trauma no se asociaron con síntomas de TEPT, mientras que el apoyo social positivo general (no enfocado en la revelación) se asoció con menos síntomas de TEPT. Las reacciones negativas a la revelación del trauma se asociaron con más síntomas de TEPT. Ninguno de los estudios incluidos midió el apoyo social negativo general fuera de la revelación del trauma.Conclusiones: Nuestros hallazgos sugieren que el apoyo social puede ser un amortiguador particularmente importante contra los síntomas del TEPT cuando se experimenta una traición traumática por un compañero íntimo. Además, nuestros resultados sugieren que las intervenciones de apoyo social para quienes experimentan el trauma de traición deben centrarse en reducir las respuestas negativas a la revelación y reforzar la satisfacción general con el apoyo social.

背景:背叛创伤对心理健康具有特别有害的影响。尽管社会支持是创伤后应激障碍 (PTSD) 症状严重程度的可靠预测指标, 但尚不清楚什么因素可能影响背叛创伤幸存者之间的这种关系。目的:本研究旨在描述背叛创伤幸存者中社会支持与PTSD症状严重程度之间的关联, 并考查方法, 样本, 创伤和社会支持特征是否调节这种关联。方法:全面搜索确定了29项研究, 评估了6,510名背叛创伤成年幸存者中PTSD症状严重程度与社会支持之间的横断面关联。结果:平均效应大小 (r = −.25; 95％CI:-.30, -。20) 从小到中, 研究之间存在显著的异质性 (I2 = 71.86) 。当浪漫伴侣遭受创伤时, 即使控制了协变量, 相较于混合犯罪者, PTSD与社会支持之间的联系也更强。根据是否在创伤性披露背景中提供支持的支持类型也会产生显著影响。具体而言, 对创伤性披露的积极反应与PTSD症状无关, 而总体积极的社会支持 (不针对披露) 与更少的PTSD症状相关。对创伤暴露的负面反应与更多PTSD症状相关。所纳入的研究均未在创伤性披露之外衡量总体的负面社会支持。结论:我们的研究结果表明, 当亲密伴侣遭受背叛创伤时, 社会支持可能是防止PTSD症状的特别重要的缓冲。此外, 我们的结果表明, 针对遭受背叛创伤的人社会支持的干预措施应聚焦于减少对被披露的负面反应, 并提高对社会支持的总体满意度。.

Keywords: Interpersonal trauma; PTSD; assault; child abuse; intimate partner violence; rape; social negativity; social support.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
PRISMA flow chart. Note. In the process of retrieving the full text of the reports from the database searches, several additional reports were identified (i.e., reports with very similar titles or additional reports sent to us by authors when reprints were requested). These reports were included in the total number of records identified through database searches
Figure 2.
Figure 2.
Plot of effect sizes for the association between PTSD and social support
Figure 3.
Figure 3.
Funnel plot of effect sizes for the association between PTSD and social support
Figure A1.
Figure A1.
Scatterplot of percent female by effect size
See this image and copyright information in PMC

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