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Cited by 222Posttraumatic Stress Disorder ResearchTraumatic Brain Injury ResearchMigration, Health and Trauma

Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis.

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Zalta, Alyson K., Tirone, Vanessa, Orlowska, Daria, Blais, Rebecca K., Lofgreen, Ashton, Klassen, Brian, Held, Philip, Stevens, Natalie R. +2 more·2021·Psychological Bulletin
DOI 10.1037/bul0000316PMC PMC8101258
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Abstract

Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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  • Negative responses to disclosure of trauma were associated with more severe PTSD symptoms among survivors of betrayal trauma.

    “Negative responses to disclosure of trauma (e.g. blame, treating someone differently after disclosure) were associated with more severe PTSD symptoms, consistent with previous research (Dworkin et al., 2019; Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Zalta et al., 2021

    The Discussion reports that negative social reactions had the strongest association with PTSD severity, and that many measures assessed negative responses to trauma disclosure. The Introduction gives blame and treating a survivor differently as examples. The paper does not establish this association specifically among survivors of betrayal trauma, as the claim states. No page numbers were available in our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Social support has most commonly been assessed using global measures of perceived availability and satisfaction with social support.

    “Although one body of the trauma literature has focused on the types of supportive responses survivors receive after disclosing their trauma, particularly among interpersonal trauma survivors (Dworkin et al., 2019), social support has most commonly been assessed using global measures of perceived availability and satisfaction with social support (Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Zalta et al., 2021

  • Harmful effects of negative social reactions on psychopathology, including PTSD symptoms, are more impactful than the salubrious effects of positive forms of social support.

    “Several meta-analyses have shown that harmful effects of negative social reactions (e.g. blame, treating the person differently, social constraint, making demands) on psychopathology, including PTSD symptoms, are more impactful than the salubrious effects of positive forms of social support (Blais et al., 2021; Dworkin et al., 2019; Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Zalta et al., 2021

  • The overall effect was consistent with previous meta-analyses examining the relationship between social support and PTSD symptoms across all trauma types, which found an overall weighted cross-sectional effect size of −.27.

    “This overall effect was consistent with previous meta-analyses examining the relationship between social support and PTSD symptoms across all trauma types (overall weighted cross-sectional effect size of −.27 in Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Zalta et al., 2021

  • General positive support was associated with fewer PTSD symptoms among survivors of betrayal trauma.

    “General positive support was associated with fewer PTSD symptoms, consistent with previous meta-analytic findings that perceived social support, enacted support, and structural support were associated with fewer PTSD symptoms among a broad range of trauma survivors (Zalta et al., 2021).”

    From The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis (2021) · cites this paper as Zalta et al., 2021

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Authors
Zalta, A. K., Tirone, V., Orlowska, D., Blais, R. K., Lofgreen, A., Klassen, B., Held, P., Stevens, N. R., Adkins, E., & Dent, A. L.
Affiliations
  • University of California, Irvine (US)
  • Rush University Medical Center (US)
  • Western Michigan University (US)
  • Northwestern University (US)
ORCID
Venue
Psychological Bulletin
Publisher
American Psychological Association (APA)
Published
2021-01
Volume
147
Issue
1
Pages
33-54
ISSN
  • 0033-2909 (ISSN-L)
  • 1939-1455
DOI
10.1037/bul0000316
PMC
PMC8101258
OpenAlex
W3109357377
Cited by
222
References
182
Citations by year
2026: 43 · 2025: 55 · 2024: 43 · 2023: 40 · 2022: 28 · 2021: 12 · 2019: 1
FWCI
8.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Bulletin (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
National Institute of Mental Health ((K23 MH103394)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
social support, post-traumatic stress disorder, PTSD symptom severity, moderators, natural disasters, war injuries, interpersonal violence, veterans, trauma exposure, social support interventions
MeSH terms
Adult, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Severity of Illness Index, Social Support, Stress Disorders, Post-Traumatic, Wounds and Injuries, Effect Modifier, Epidemiologic, Self Report

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