Date Published: March 21, 2019
Publisher: Public Library of Science
Author(s): Sun Jae Jung, Ashley Winning, Andrea L. Roberts, Kristen Nishimi, Qixuan Chen, Paola Gilsanz, Jennifer A. Sumner, Cristina A. Fernandez, Eric B. Rimm, Laura D. Kubzansky, Karestan C. Koenen, Soraya Seedat.
The relation between TV viewing and posttraumatic stress disorder (PTSD) is controversial; prior work focused exclusively on whether TV viewing of disaster events constitutes a traumatic stressor that causes PTSD. This study evaluates a possible bidirectional relation between PTSD and TV viewing in community-dwelling women.
Data are from the PTSD subsample of the Nurses’ Health II study, an ongoing prospective study of women aged 24–42 years at enrollment and who have been followed biennially (N = 50,020). Trauma exposure and PTSD symptoms (including date of onset) were assessed via the Brief Trauma Questionnaire and the Short Screening Scale for DSM-IV PTSD. Average TV viewing was reported at 5 times over 18 years of follow-up. Linear mixed models assessed differences in TV viewing patterns by trauma/PTSD status. Among women with trauma/PTSD onset during follow-up (N = 14,374), linear spline mixed models assessed differences in TV viewing patterns before and after PTSD onset.
Women with high PTSD symptoms reported more TV viewing (hours/wk) compared to trauma-unexposed women at all follow-up assessments (β = 0.14, SE = 0.01, p < .001). Among the women who experienced trauma during follow-up, significant increases in TV viewing (hours/day) prior to onset of high PTSD symptom levels were evident (β = 0.15, SE = 0.02, p < .001). TV viewing following trauma exposure may be a marker of vulnerability for developing PTSD and also a consequence of having PTSD. High TV viewing levels may be linked with ineffective coping strategies or social isolation, which increase risk of developing PTSD.
The relation between TV viewing and posttraumatic stress disorder (PTSD) has been highly controversial. Following the September 11th terrorist attacks, much literature focused on whether repetitive viewing of disasters on TV constitutes a traumatic stressor that could cause PTSD, with cross-sectional studies reporting positive associations and longitudinal studies reporting mixed findings [1–6]. In 2007, three longitudinal studies[1, 4, 6] assessed the impact of TV viewing on PTSD development, and only one study succeeded in finding a significant result. A study in 2011 among soldiers in the UK did not show any significant result between TV watching and PTSD symptoms. However, in 2012, a longitudinal study of 141 US citizens who were indirectly exposed to both hurricanes Katrina and Gustav through TV viewing reported an increased level of PTSD symptoms. Similar results observed in a longitudinal study of response to Oklahoma City bombing in 2016. Ultimately, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 specifically excluded witnessing traumatic events on TV as a traumatic stressor .
Table 1 summarizes the distribution of covariates by trauma exposure and PTSD symptom categories at study baseline in 1989. At study inception, approximately half of the sample (n = 25,233) had experienced a traumatic event denoted as their worst one. By 2008, 19.9% of women had no history of trauma and 6.6% reported the most severe PTSD symptom level (6–7 symptoms). There was no significant difference in physical activity levels across trauma/PTSD groups. However, the proportion of women reporting lifetime depression increased with severity of PTSD symptoms; compared to 22% of women with no trauma, 60% of women with 6–7 PTSD symptoms reported prior lifetime depression.
This study examined the possibility of a bidirectional relationship between PTSD symptoms and TV viewing trajectories over time in women exposed to a wide range of traumatic events occurring in civilian settings. In longitudinal analyses, TV viewing increased more steeply over time in women with higher PTSD symptom levels in a dose-response fashion compared to women who were not trauma exposed. Although this difference was modest, it was relevant of a population level. Among the subsample of women who developed trauma/PTSD during follow-up, significantly steeper increasing in time spent viewing TV occurred prior to the onset of PTSD symptoms, compared to women who did not go on to develop PTSD symptoms. TV viewing continued to increase after PTSD onset among women with 4–5 PTSD symptoms, but not among women with 6–7 PTSD symptoms. Together, our findings suggest high rates of TV viewing may be a marker of vulnerability to developing PTSD in the event of trauma exposure; moreover these high levels of TV viewing persist after PTSD symptom onset, resulting in individuals with PTSD spending more time watching TV than their less distressed counterparts. Thus, PTSD onset may exacerbate tendencies to watch TV although whether PTSD causally contributes to this form of sedentary behavior remains to be determined. Importantly, all associations were independent of baseline demographic factors as well as depression and initial levels of physical activity.