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موسوی, سیده مهسا, نریمانی, محمد, عسگری, سیده سحر. (1401). مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی. هنرهای کاربردی, 14(4), 39-51. doi: 10.22075/jcp.2022.26298.2394
سیده مهسا موسوی; محمد نریمانی; سیده سحر عسگری. "مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی". هنرهای کاربردی, 14, 4, 1401, 39-51. doi: 10.22075/jcp.2022.26298.2394
موسوی, سیده مهسا, نریمانی, محمد, عسگری, سیده سحر. (1401). 'مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی', هنرهای کاربردی, 14(4), pp. 39-51. doi: 10.22075/jcp.2022.26298.2394
موسوی, سیده مهسا, نریمانی, محمد, عسگری, سیده سحر. مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی. هنرهای کاربردی, 1401; 14(4): 39-51. doi: 10.22075/jcp.2022.26298.2394

مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی

روان‌شناسی بالینی: نوآوری‌ها در پژوهش و عمل
مقاله 4، دوره 14، شماره 4 - شماره پیاپی 56، دی 1401، صفحه 39-51    اصل مقاله (581.58 K)
نوع مقاله: مقاله پژوهشی
شناسه دیجیتال (DOI): 10.22075/jcp.2022.26298.2394
نویسندگان
سیده مهسا موسوی* 1؛ محمد نریمانی2؛ سیده سحر عسگری3
1دانشجوی دکتری روانشناسی، دانشکدۀ علوم‌تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران
2استاد، گروه روانشناسی، دانشکدۀ علوم-تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران
3دانشجوی دکتری روانشناسی، دانشکدۀ علوم-تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران
تاریخ دریافت: 25 بهمن 1400،  تاریخ بازنگری: 23 شهریور 1401،  تاریخ پذیرش: 09 آبان 1401 
چکیده
مقدمه: هدف این پژوهش مدل‌یابی افکار خودکشی بر اساس تصویر بدنی و نشخوار فکری با میانجی‌گری هراس اجتماعی در افراد با اختلال ملال جنسیتی است.
روش: در پژوهش حاضر که از نوع توصیفی همبستگی بود از میان افراد دارای اختلال ملال جنسیتی و عضو ترنس سکشوال‌های قبل و بعد از جراحی تغییر جنسیت که به انجمن حمایت از بیماران ملال جنسیتی ایران در سال 1400مراجعه می کردند با روش نمونه‌گیری در دسترس،تعداد  200 نفر انتخاب شدند. سپس همه افراد نمونه پرسشنامه‌های افکار خودکشی (BSSI)، نگرانی از تصویر بدنی (BICI)، نشخوار فکری (RRS) و هراس اجتماعی (SPS) را تکمیل کردند. داده‌ها با روش مدل‌یابی معادلات ساختاری و نرم‌افزارهای SPSS-26 و Lisrel-8.8 تحلیل شدند.
یافته­ ها: نتایج نشان داد متغیرهای نشخوار فکری (96/3 =T)، نگرانی از تصویر بدنی (50/5 =T) و هراس اجتماعی (83/3 =T) بر افکار خودکشی اثر مستقیم مثبت و معنادار دارند. همچنین، هراس اجتماعی میانجی روابط بین نشخوار فکری و نگرانی از تصویر بدنی با افکار خودکشی بود.
نتیجه ­گیری: با توجه به یافته‌های پژوهش، می‌توان نتیجه گرفت نشخوار فکری، نگرانی از تصویر بدنی و هراس اجتماعی می‌توانند بر افکار خودکشی تأثیرگذار باشند.
کلیدواژه‌ها
هراس اجتماعی؛ افکار خودکشی؛ تصویر بدنی؛ ملال جنسیتی؛ نشخوار فکری
عنوان مقاله [English]
Suicidal Ideation Modeling based on Body Image and Rumination with the Mediation of Social Phobia in Individuals with Gender Dysphoric Disorder
نویسندگان [English]
Seyyedeh Mahsa Mousavi1؛ Mohammad Narimani2؛ Seyyedeh Sahar Asgari3
1PhD student in psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran
2Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran
3PhD student in psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran
چکیده [English]
Introduction: The aim of this study was to model suicidal ideation based on body image and rumination with the mediation of social phobia in individuals with gender dysphoric disorder.
Method: In a  descriptive correlational study among individuals with gender dysphoric disorder and members of transsexuals before and after gender reassignment surgery of the Iranian association for the support of patients with gender dysphoria in 2021 using available sampling, 200 people were selected. Then all subjects completed the beck suicide scale ideation (BSSI), body image concern inventory (BICI), rumination response scale (RRS), and social phobia scale (SPS). Data were analyzed by structural equation modeling and SPSS26 and Lisrel8.8 software.
Results: The results showed that the variables of rumination (T= 3.96), body image concern (T= 5.50), and social anxiety (T= 3.83) have a direct positive and significant effect on suicidal ideation. Social phobia could mediate the relationship between rumination and body image concern with suicidal ideation as welln.
Conclusion: According to the research findings, it can be concluded that rumination, body image concern, and social phobia can affect suicidal ideation.
کلیدواژه‌ها [English]
Social Phobia, Suicidal Ideation, Body Image, Gender Dysphoria, Rumination
مراجع
منابع

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  2. Bos H, Sandfort T. Gender nonconformity, sexual orientation, and Dutch adolescents’ relationship with peers. Archives of sexual behavior. 2015 Jul;44(5):1269-79.
  3. Bergero-Miguel T, García-Encinas MA, Villena-Jimena A, Pérez-Costillas L, Sánchez-Álvarez N, de Diego-Otero Y, Guzman-Parra J. Gender dysphoria and social anxiety: an exploratory study in Spain. The journal of sexual medicine. 2016 Aug 1;13(8):1270-8.
  4. Griffin L, Clyde K, Byng R, Bewley S. Sex, gender and gender identity: A re-evaluation of the evidence. BJPsych Bulletin. 2021 Oct;45(5):291-9.
  5. Zucker KJ. Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues. Archives of Sexual Behavior. 2019 Oct;48(7):1983-92.
  6. Mantashloo S, Shairi MR, Heydarinasab L, Izadi Dehnavi S. Comparison of depression, anxiety and body image in patients with gender dysphoric disorder and non patients. Quarterly Journal of Health Breeze. 2016 Feb 20;4(3):42-50. [Persian] 
  7. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolescent Health, Medicine and Therapeutics. 2018;9:31.
  8. Jobes DA, Joiner TE. Reflections on suicidal ideation. 2019.
  9. Babaee Z, Sabet M, Mansoobifar M, Borjali M, Mashayekh M. Comparison of the effectiveness of cognitive-behavioral therapy and mindfulness therapy on anxiety tolerance and suicidal ideation in adolescents with suicidal ideation. Journal of Clinical Psychology. 2022 Feb 20;13(4):41-52. [Persian] 
  10. dDadashian P, Rajabi M, Jafari H. Suicidal ideation in patients with multiple sclerosis: a systematic review. Clinical Excellence. 2021 Mar 10;10(4):1-1. [Persian] 
  11. García Vega E, Camero García A, Fernández Rodríguez M, Villaverde González A. Suicidal ideation and suicide attempts in persons with gender dysphoria. Psicothema. 2018.
  12. Biggs M. Puberty blockers and suicidality in adolescents suffering from gender dysphoria. Archives of Sexual Behavior. 2020 Oct;49(7):2227-9.
  13. Mahmoodi H, Mohammad Bagheri F, Sufi S. Comparison of depression, suicidal ideation and social support between transsexual people with and without gender change. Scientific Journal of Forensic Medicine. 2019 Sep 10;25(3):131-8.[Persian] 
  14. Milano W, Ambrosio P, Carizzone F, De Biasio V, Foggia G, Capasso A. Gender dysphoria, eating disorders and body image: An overview. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2020 May 1;20(4):518-24.
  15. Tylka TL. Overview of the field of positive body image. Body positive: Understanding and improving body image in science and practice. 2018 Jul 19:6-33.
  16. Grogan S. Body image: Understanding body dissatisfaction in men, women, and children. Routledge; 2021 Nov 11.
  17. Becker I, Auer M, Barkmann C, Fuss J, Möller B, Nieder TO, Fahrenkrug S, Hildebrandt T, Richter-Appelt H. A cross-sectional multicenter study of multidimensional body image in adolescents and adults with gender dysphoria before and after transition-related medical interventions. Archives of Sexual Behavior. 2018 Nov;47(8):2335-47.
  18. Simbar M, Nazarpour S, Mirzababaie M, Emam Hadi MA, Ramezani Tehrani F, Alavi Majd H. Quality of life and body image of individuals with gender dysphoria. Journal of Sex & Marital Therapy. 2018 Aug 18;44(6):523-32.
  19. Angelakis I, Gooding PA, Panagioti M. Suicidality in body dysmorphic disorder (BDD): A systematic review with meta-analysis. Clinical psychology review. 2016 Nov 1;49:55-66.
  20. Rufino KA, Viswanath H, Wagner R, Patriquin MA. Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders. Comprehensive psychiatry. 2018 Jul 1;84:22-5.
  21. Orbach I, Stein D, Shani-Sela M, Har-Even D. Body attitudes and body experiences in suicidal adolescents. Suicide and Life-Threatening Behavior. 2001 Sep 1;31(3):237-49.
  22. Akram U, Allen S, Stevenson JC, Lazarus L, Ypsilanti A, Ackroyd M, Chester J, Longden J, Peters C, Irvine KR. Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours. Journal of affective disorders. 2022 Jan 15;297:634-40.
  23. Silva DC, Salati LR, Villas-Bôas AP, Schwarz K, Fontanari AM, Soll B, Costa AB, Hirakata V, Schneider M, Lobato MI. Factors associated with ruminative thinking in individuals with gender dysphoria. Frontiers in Psychiatry. 2021 May 25;12:799.
  24. Scaini S, Palmieri S, Caselli G, Nobile M. Rumination thinking in childhood and adolescence: a brief review of candidate genes. Journal of Affective Disorders. 2021 Feb 1;280:197-202.
  25. Bowman SJ, Casey LJ, McAloon J, Wootton BM. Assessing gender dysphoria: A systematic review of patient-reported outcome measures. Psychology of Sexual Orientation and Gender Diversity. 2021 Jul 1.
  26. Timmins L, Rimes KA, Rahman Q. Minority stressors, rumination, and psychological distress in lesbian, gay, and bisexual individuals. Archives of Sexual Behavior. 2020 Feb;49(2):661-80.
  27. Smith JM, Alloy LB, Abramson LY. Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: Multiple pathways to self-injurious thinking. Suicide and Life-threatening behavior. 2006 Aug;36(4):443-54.
  28. Chan S, Miranda R, Surrence K. Subtypes of rumination in the relationship between negative life events and suicidal ideation. Archives of Suicide Research. 2009 Apr 15;13(2):123-35.
  29. Eshun S. Role of gender and rumination in suicide ideation: A comparison of college samples from Ghana and the United States. Cross-cultural research. 2000 Aug;34(3):250-63.
  30. Miranda R, Nolen-Hoeksema S. Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behaviour research and therapy. 2007 Dec 1;45(12):3088-95.
  31. Wang S, Jing H, Chen L, Li Y. The influence of negative life events on suicidal ideation in college students: the role of rumination. International journal of environmental research and public health. 2020 Jan;17(8):2646.
  32. Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A. Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research. 2005 Mar 1;58(3):259-61.
  33. Connor KM, Davidson JR, Churchill LE, Sherwood A, Weisler RH, Foa E. Psychometric properties of the social phobia inventory (SPIN): New self-rating scale. The British Journal of Psychiatry. 2000 Apr;176(4):379-86.
  34. Stein MB, Stein DJ. Social anxiety disorder. The Lancet. 2008 Mar 29;371(9618):1115-25.
  35. Bergero-Miguel T, García-Encinas MA, Villena-Jimena A, Pérez-Costillas L, Sánchez-Álvarez N, de Diego-Otero Y, Guzman-Parra J. Gender dysphoria and social anxiety: An exploratory study in Spain. The Journal of Sexual Medicine. 2016 Aug 1;13(8):1270-8.
  36. Fang A, Hofmann SG. Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review. 2010 Dec 1;30(8):1040-8.
  37. Jose PE, Wilkins H, Spendelow JS. Does social anxiety predict rumination and co-rumination among adolescents?. Journal of Clinical Child & Adolescent Psychology. 2012 Jan 1;41(1):86-91.
  38. Akram U, Ypsilanti A, Drabble J, Lazuras L. The role of physical and behavioral self-disgust in relation to insomnia and suicidal ideation. Journal of clinical sleep medicine. 2019 Mar 15;15(3):525-7.
  39. Ypsilanti A, Lazuras L, Powell P, Overton P. Self-disgust as a potential mechanism explaining the association between loneliness and depression. Journal of affective disorders. 2019 Jan 15;243:108-15.
  40. Beck AT, Steer RA. Manual for the Beck scale for suicide ideation. San Antonio, TX: Psychological Corporation. 1991;63.
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منابع

  1. Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: disparities in adolescent bullying and substance use by gender identity. The Journal of Sex Research. 2015 Mar 24;52(3):243-56.
  2. Bos H, Sandfort T. Gender nonconformity, sexual orientation, and Dutch adolescents’ relationship with peers. Archives of sexual behavior. 2015 Jul;44(5):1269-79.
  3. Bergero-Miguel T, García-Encinas MA, Villena-Jimena A, Pérez-Costillas L, Sánchez-Álvarez N, de Diego-Otero Y, Guzman-Parra J. Gender dysphoria and social anxiety: an exploratory study in Spain. The journal of sexual medicine. 2016 Aug 1;13(8):1270-8.
  4. Griffin L, Clyde K, Byng R, Bewley S. Sex, gender and gender identity: A re-evaluation of the evidence. BJPsych Bulletin. 2021 Oct;45(5):291-9.
  5. Zucker KJ. Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues. Archives of Sexual Behavior. 2019 Oct;48(7):1983-92.
  6. Mantashloo S, Shairi MR, Heydarinasab L, Izadi Dehnavi S. Comparison of depression, anxiety and body image in patients with gender dysphoric disorder and non patients. Quarterly Journal of Health Breeze. 2016 Feb 20;4(3):42-50. [Persian] 
  7. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolescent Health, Medicine and Therapeutics. 2018;9:31.
  8. Jobes DA, Joiner TE. Reflections on suicidal ideation. 2019.
  9. Babaee Z, Sabet M, Mansoobifar M, Borjali M, Mashayekh M. Comparison of the effectiveness of cognitive-behavioral therapy and mindfulness therapy on anxiety tolerance and suicidal ideation in adolescents with suicidal ideation. Journal of Clinical Psychology. 2022 Feb 20;13(4):41-52. [Persian] 
  10. dDadashian P, Rajabi M, Jafari H. Suicidal ideation in patients with multiple sclerosis: a systematic review. Clinical Excellence. 2021 Mar 10;10(4):1-1. [Persian] 
  11. García Vega E, Camero García A, Fernández Rodríguez M, Villaverde González A. Suicidal ideation and suicide attempts in persons with gender dysphoria. Psicothema. 2018.
  12. Biggs M. Puberty blockers and suicidality in adolescents suffering from gender dysphoria. Archives of Sexual Behavior. 2020 Oct;49(7):2227-9.
  13. Mahmoodi H, Mohammad Bagheri F, Sufi S. Comparison of depression, suicidal ideation and social support between transsexual people with and without gender change. Scientific Journal of Forensic Medicine. 2019 Sep 10;25(3):131-8.[Persian] 
  14. Milano W, Ambrosio P, Carizzone F, De Biasio V, Foggia G, Capasso A. Gender dysphoria, eating disorders and body image: An overview. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2020 May 1;20(4):518-24.
  15. Tylka TL. Overview of the field of positive body image. Body positive: Understanding and improving body image in science and practice. 2018 Jul 19:6-33.
  16. Grogan S. Body image: Understanding body dissatisfaction in men, women, and children. Routledge; 2021 Nov 11.
  17. Becker I, Auer M, Barkmann C, Fuss J, Möller B, Nieder TO, Fahrenkrug S, Hildebrandt T, Richter-Appelt H. A cross-sectional multicenter study of multidimensional body image in adolescents and adults with gender dysphoria before and after transition-related medical interventions. Archives of Sexual Behavior. 2018 Nov;47(8):2335-47.
  18. Simbar M, Nazarpour S, Mirzababaie M, Emam Hadi MA, Ramezani Tehrani F, Alavi Majd H. Quality of life and body image of individuals with gender dysphoria. Journal of Sex & Marital Therapy. 2018 Aug 18;44(6):523-32.
  19. Angelakis I, Gooding PA, Panagioti M. Suicidality in body dysmorphic disorder (BDD): A systematic review with meta-analysis. Clinical psychology review. 2016 Nov 1;49:55-66.
  20. Rufino KA, Viswanath H, Wagner R, Patriquin MA. Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders. Comprehensive psychiatry. 2018 Jul 1;84:22-5.
  21. Orbach I, Stein D, Shani-Sela M, Har-Even D. Body attitudes and body experiences in suicidal adolescents. Suicide and Life-Threatening Behavior. 2001 Sep 1;31(3):237-49.
  22. Akram U, Allen S, Stevenson JC, Lazarus L, Ypsilanti A, Ackroyd M, Chester J, Longden J, Peters C, Irvine KR. Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours. Journal of affective disorders. 2022 Jan 15;297:634-40.
  23. Silva DC, Salati LR, Villas-Bôas AP, Schwarz K, Fontanari AM, Soll B, Costa AB, Hirakata V, Schneider M, Lobato MI. Factors associated with ruminative thinking in individuals with gender dysphoria. Frontiers in Psychiatry. 2021 May 25;12:799.
  24. Scaini S, Palmieri S, Caselli G, Nobile M. Rumination thinking in childhood and adolescence: a brief review of candidate genes. Journal of Affective Disorders. 2021 Feb 1;280:197-202.
  25. Bowman SJ, Casey LJ, McAloon J, Wootton BM. Assessing gender dysphoria: A systematic review of patient-reported outcome measures. Psychology of Sexual Orientation and Gender Diversity. 2021 Jul 1.
  26. Timmins L, Rimes KA, Rahman Q. Minority stressors, rumination, and psychological distress in lesbian, gay, and bisexual individuals. Archives of Sexual Behavior. 2020 Feb;49(2):661-80.
  27. Smith JM, Alloy LB, Abramson LY. Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: Multiple pathways to self-injurious thinking. Suicide and Life-threatening behavior. 2006 Aug;36(4):443-54.
  28. Chan S, Miranda R, Surrence K. Subtypes of rumination in the relationship between negative life events and suicidal ideation. Archives of Suicide Research. 2009 Apr 15;13(2):123-35.
  29. Eshun S. Role of gender and rumination in suicide ideation: A comparison of college samples from Ghana and the United States. Cross-cultural research. 2000 Aug;34(3):250-63.
  30. Miranda R, Nolen-Hoeksema S. Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample. Behaviour research and therapy. 2007 Dec 1;45(12):3088-95.
  31. Wang S, Jing H, Chen L, Li Y. The influence of negative life events on suicidal ideation in college students: the role of rumination. International journal of environmental research and public health. 2020 Jan;17(8):2646.
  32. Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A. Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research. 2005 Mar 1;58(3):259-61.
  33. Connor KM, Davidson JR, Churchill LE, Sherwood A, Weisler RH, Foa E. Psychometric properties of the social phobia inventory (SPIN): New self-rating scale. The British Journal of Psychiatry. 2000 Apr;176(4):379-86.
  34. Stein MB, Stein DJ. Social anxiety disorder. The Lancet. 2008 Mar 29;371(9618):1115-25.
  35. Bergero-Miguel T, García-Encinas MA, Villena-Jimena A, Pérez-Costillas L, Sánchez-Álvarez N, de Diego-Otero Y, Guzman-Parra J. Gender dysphoria and social anxiety: An exploratory study in Spain. The Journal of Sexual Medicine. 2016 Aug 1;13(8):1270-8.
  36. Fang A, Hofmann SG. Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review. 2010 Dec 1;30(8):1040-8.
  37. Jose PE, Wilkins H, Spendelow JS. Does social anxiety predict rumination and co-rumination among adolescents?. Journal of Clinical Child & Adolescent Psychology. 2012 Jan 1;41(1):86-91.
  38. Akram U, Ypsilanti A, Drabble J, Lazuras L. The role of physical and behavioral self-disgust in relation to insomnia and suicidal ideation. Journal of clinical sleep medicine. 2019 Mar 15;15(3):525-7.
  39. Ypsilanti A, Lazuras L, Powell P, Overton P. Self-disgust as a potential mechanism explaining the association between loneliness and depression. Journal of affective disorders. 2019 Jan 15;243:108-15.
  40. Beck AT, Steer RA. Manual for the Beck scale for suicide ideation. San Antonio, TX: Psychological Corporation. 1991;63.
  41. Anisi J, Fathi AA, Salimi S, Ahmadi NK. Validity and reliability of Beck suicide scale ideation among soldiers. 2005; 33-7. [Persian] 
  42. Littleton HL, Axsom D, Pury CL. Development of the body image concern inventory. Behaviour Research and therapy. 2005 Feb 1;43(2):229-41.
  43. Mohammadi NE, Sajadinezhad MA. The Evaluation of psychometric properties of body image concern inventory and examination of a model about the relationship between body mass index, body image dissatisfaction and self-esteem in adolescent girls. 2007;3(1):85-101. [Persian] 
  44. Pooravari M, Habibi M, Parija HA, Tabar SH. Psychometric properties of body image concern inventory in adolescent. Pajoohandeh Journal. 2014 Oct 10;19(4):189-99.
  45. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology. 1991 Jul;61(1):115.
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