The impact of anger and self-concealment on post-traumatic stress and psychiatric comorbid symptoms in Chinese prisoners: A longitudinal study

Background: Research reported prevalence of post-traumatic stress disorder (PTSD) among prisoners varies between countries, with most studies based on Western samples. The trajectory of symptoms has also been controversial. Trauma can affect prisoners' emotions and their emotional regulation tends to be maladaptive. Aims: To examine changes in PTSD and psychiatric comorbidity among prisoners in China over time and to determine whether anger and self-concealment predicts later distress. Method: In a longitudinal, prospective study, sentenced men in one prison in China were asked to complete a demographic page and several self-rating scales: the Post-traumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Clinical Anger Scale and the Self-Concealment Scale at baseline and at 6 and 12 months after the initial assessment. Results: More than half of the 496 participating men were diagnosed with PTSD. For those completing the scales at each evaluation, PTSD-DS scores were significantly lower at baseline than at the 6-month and 1-year assessments. No significant differences were found between the two follow-up scores. There was no significant difference in psychiatric comorbidity between the three phases. At the cross-sectional level, after controlling for age and education level, PTSD, anger and self-concealment were associated with psychiatric comorbidity. At the prospective level, anger predicted PTSD 6 months and 1 year later. Self-concealment predicted psychiatric comorbidity over time. Conclusions: Among these prisoners the prevalence of chronic PTSD was far higher than in general population estimates. Early identification of aspects of coping styles is likely to help predict disorder trajectory and inform interventions. Early signs of anger were indicative of the chronic severity of trauma reactions, while the intention to hide distress was related to other later mental health problems.