TABLE 1.
Description of coping styles and defense mechanisms.
| Coping styles | Description | Example |
|---|---|---|
| Emotion-focused | Attempt to escape from the emotional distress associated with the stressor |
|
| Problem-focused or rational | Deliberate and rational approach, in which individuals make conscious efforts to cope with stressful circumstances |
|
| Engagement | Confrontation of the stressor and/or related emotions/thoughts |
|
| Disengagement | Seeking to avoid the threat and/or related emotions/thoughts |
|
| Defense mechanisms | Description | Example |
|---|---|---|
| Mature | Complex cognitive processes enabling the maximization of gratification while maintaining more conscious awareness of psychosocial stressors |
|
| Neurotic | Prevent the acknowledgment of specific feelings, ideas, or memories by keeping them out of awareness |
|
| Immature | Cognitive simple processes aiming to prevent the awareness of unacceptable ideas and/or feelings that result in marked distortion of the significance and source of stress |
|
TABLE 2.
Sample demographic characteristics
| Female (n= 353) | Male (n = 334) | Total (N = 687) | |
|---|---|---|---|
| Age | |||
| 13 years | 7 (2.0%) | 13 (3.9%) | 20 (2.9%) |
| 14 years | 177 (50.1%) | 179 (53.6%) | 356 (51.8%) |
| 15 years | 167 (47.3%) | 137 (41.0%) | 304 (44.3%) |
| 16 years | 2 (0.6%) | 5 (1.5%) | 7 (1.0%) |
| Mean (SD) | 14.5 (SD=0.5) | 14.4 (SD=0.6) | 14.4 (SD=0.6) |
| Living with | |||
| Both parents | 290 (82.2%) | 272 (81.4%) | 562 (81.8%) |
| One of their parents | 58 (16.4%) | 53 (15.9%) | 111 (16.2%) |
| Other arrangements* | 5 (1.4%) | 9 (2.7%) | 14 (2.0%) |
| Father education | |||
| Did not report | 34 (9.6%) | 46 (13.8%) | 80 (11.6%) |
| Primary school | 86 (24.4%) | 59 (17.7%) | 145 (32.8%) |
| High school | 42 (11.9%) | 62 (18.6%) | 104 (15.1%) |
| College | 112 (31.7%) | 80 (24.0%) | 192 (27.9%) |
| University | 79 (22.4%) | 87 (26.0%) | 166 (24.2%) |
| Mother education | |||
| Did not report | 32 (9.1%) | 46 (13.8%) | 78 (11.4%) |
| Primary school | 74 (21.0%) | 68 (20.4%) | 142 (20.7%) |
| High school | 121 (34.3%) | 112 (33.5%) | 233 (33.9%) |
| College | 81 (22.9%) | 64 (19.2%) | 145 (21.1%) |
| University | 45 (12.7%) | 44 (3.2%) | 89 (13.0%) |
TABLE 3.
Items representing PTSD and DSO symptoms.
| Cluster | Test items |
|---|---|
| PTSD symptoms | HTQ 2. Feeling as though the event is happening again |
| HTQ 3. Recurrent nightmares | |
| HTQ 6. Being jumpy or easily startled | |
| HTQ 9. Feeling on guard | |
| HTQ 11. Avoiding activities that remind you of the traumatic or hurtful event | |
| HTQ 15. Avoiding thought or feelings associated with the traumatic or hurtful events | |
| DSO symptoms | TSC 16. Temper outburst that you could not control |
| TSC 14. Crying easily | |
| TSC 28. Feelings of inferiority or insecurity | |
| TSC 29. Blaming yourself | |
| TSC 6. Feeling isolated from other people | |
| HTQ 27. Feeling that you have no one to rely upon |
TABLE 4.
Adverse childhood events according to exposure.
| Event | Count (%) |
|---|---|
| Traffic accident | 115 (16.7) |
| Other serious accidents | 80 (11.6) |
| Physical assault | 66 (9.6) |
| Rape | 28 (4.1) |
| Witnessed other people injured or killed | 66 (9.6) |
| Came close to being injured or killed | 87 (12.7) |
| Threats of violence | 217 (31.6) |
| Near-drowning | 150 (21.8) |
| Attempted suicide | 68 (9.9) |
| Robbery/theft | 94 (13.7) |
| Pregnancy /abortion | 21 (3.1) |
| Serious illness | 88 (12.8) |
| Death of someone close | 362 (52.7) |
| Divorce | 90 (13.1) |
| Sexual abuse | 35 (5.1) |
| Physical abuse | 50 (7.3) |
| Severe childhood neglect | 34 (4.9) |
| Bullying | 207 (30.1) |
| Absence of a parent | 101 (14.7) |
| Other events | 48 (7.0) |
TABLE 5.
Correlation matrix of study variables-
| Variables | 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. | 9. | 10. |
|---|---|---|---|---|---|---|---|---|---|---|
| 1. Exposure to ACE | - | –.03 | –.04 | .22*** | .12** | .28*** | .08 | .08 | .36*** | .37*** |
| 2. MDM | - | .48*** | .49*** | .44*** | .08* | .35*** | .36*** | .13** | .08* | |
| 3. NDM | - | .41*** | .36*** | .18*** | .20*** | .34*** | .20*** | .20*** | ||
| 4. IDM | - | .35*** | .42*** | .19*** | .37*** | .33*** | .41*** | |||
| 5. Rational coping | - | .35*** | .55*** | .48*** | .28*** | .26*** | ||||
| 6. Emotional coping | - | .09* | .42*** | .45*** | .65*** | |||||
| 7. Detachment coping | - | .39*** | .06 | .05 | ||||||
| 8. Avoidance coping | - | .28*** | .29*** | |||||||
| 9. PTSS | - | .54*** | ||||||||
| 10. DSOS | - |
FIGURE 1.
A multiple mediational model for PTSD symptoms by defense styles and coping styles. Rectangles indicate measured variables. Standardized maximum likelihood parameters are used. Unidirectional arrows depict hypothesized directional links. Bold estimates are statistically significant and dashed lines are nonsignificant. Unstandardized regression coefficients are presented. *p <.05, ***p <.01, ***p <.001.
TABLE 6.
Bootstrapped point estimate for direct and indirect effects and 95% confidence intervals for predicting PTSD and DSO symptoms by sums of exposure to adverse childhood experiences through defense mechanisms levels and coping styles dimensions.
| Estimates of standardized regression weights | Estimates of unstandardized regression weights | BCa 95% CI (lower, upper) | p | |
|---|---|---|---|---|
| PTSD symptoms | ||||
| Direct effect of exposure to ACEs | .30 | .44 | (.34, .54) | .001 |
| Indirect effect via mature defense mechanisms | .04 | .02 | (−.26, .30) | .28 |
| Indirect effect via neurotic defense mechanisms | .04 | .02 | (−.02, .06) | .26 |
| Indirect effect via immature defense mechanisms | .06 | .24 | (−.09, .57) | .16 |
| Indirect effect via rational coping | .17 | .33 | (.19, .47) | .001 |
| Indirect effect via emotional coping | .31 | .55 | (.42, .68) | .001 |
| Indirect effect via detachment coping | −.13 | −.17 | (−.27, −.07) | .01 |
| Indirect effect via avoidance coping | .07 | .05 | (−.02, .12) | .14 |
| DSO symptoms | ||||
| Direct effect of exposure to ACEs | .24 | .33 | (.25, .41) | .001 |
| Indirect effect via mature defense mechanisms | −.02 | −.04 | (−.26, .18) | .70 |
| Indirect effect via neurotic defense mechanisms | .04 | .02 | (−.02, .06) | .26 |
| Indirect effect via immature defense mechanisms | .26 | .44 | (.17, .71) | .001 |
| Indirect effect via rational coping | .04 | .03 | (−.03, .09) | .39 |
| Indirect effect via emotional coping | ,45 | .35 | (.30, .40) | .001 |
| Indirect effect via detachment coping | −.08 | −.10 | (−.19, −.01) | .04 |
| Indirect effect via avoidance coping | .02 | .02 | (−.03, .07) | .57 |
FIGURE 2.
A multiple mediational model for DSO symptoms by defense styles and coping styles. Rectangles indicate measured variables. Standardized maximum likelihood parameters are used. Unidirectional arrows depict hypothesized directional links. Bold estimates are statistically significant and dashed lines are nonsignificant. Unstandardized regression coefficients are presented. *p <.05, ***p <.01, ***p <.001.
FIGURE 3.
A serial mediational integrated model for PTSD symptoms and DSO symptoms by defense styles and coping styles. Rectangles indicate measured variables. Standardized maximum likelihood parameters are used. Unidirectional arrows depict hypothesized directional links. Bold estimates are statistically significant and dashed lines are nonsignificant. Unstandardized regression coefficients are presented. *p <.05, ***p <.01, ***p <.001.
TABLE 7.
Bootstrapped point estimate for direct and indirect effects and 95% confidence intervals for predicting PTSD and DSO symptoms by sums of exposure to adverse childhood experiences through immature defense mechanisms levels and coping styles
| Estimates of standardized regression weights | Estimates of unstandardized regression weights | BCa 95% CI (lower, upper) | p | |
|---|---|---|---|---|
| PTSD symptoms | ||||
| Direct effect of exposure to ACEs | .29 | .43 | (.20, .66) | .02 |
| Indirect effect via IDM | .10 | .35 | (.07, .63) | .02 |
| Indirect effect via rational coping | .06 | ,12 | (−.01, .25) | .08 |
| Indirect effect via emotional coping | .26 | .21 | (.14, .28) | .001 |
| Indirect effect via detachment coping | −.04 | −.04 | (−.12, .04) | .31 |
| Indirect effect via avoidance coping | .02 | .04 | (−.09, .17) | .50 |
| Indirect effect via IDM and rational coping | .43 | 2.10 | (1.76, 2.44) | .001 |
| Indirect effect via IDM and emotional coping | .41 | 1.97 | (1.67, 2.27) | .001 |
| Indirect effect via IDM and detachment coping | −.13 | −.18 | (−.29, −.07) | .01 |
| Indirect effect via IDM and avoidance coping | .08 | .06 | (−.01, .13) | .07 |
| DSO symptoms | ||||
| Direct effect of exposure to ACEs | .23 | .32 | (.24, .40) | .001 |
| Indirect effect via IDM | .17 | ,58 | (.34, .82) | .001 |
| Indirect effect via rational coping | .04 | .04 | (−.01, .09) | .13 |
| Indirect effect via emotional coping | .23 | .34 | (.29, .39) | .001 |
| Indirect effect via detachment coping | .04 | .04 | (−.08, .16) | .18 |
| Indirect effect via avoidance coping | .04 | .03 | (−.02, .08) | .25 |
| Indirect effect via IDM and rational coping | .37 | 1.34 | (1.11, 1.57) | .001 |
| Indirect effect via IDM and emotional coping | .42 | 2.07 | (1.77, 2.37) | .001 |
| Indirect effect via IDM and detachment coping | −.10 | −.10 | (−.19, −.01) | .04 |
| Indirect effect via IDM and avoidance coping | .02 | .04 | (−.02, .08) | .50 |
[i] Note. ACEs = Adverse childhood experiences; PTSD = Post-traumatic stress disorder; DSO = Disturbances in self-organization; IDM = Immature defense mechanisms; BCa = bias corrected and accelerated; CI = confidence intervals; Confidence intervals that do not include 0 (null association) are significant.