Self-Reported Trauma Symptoms by Women in Churches of Christ – Part 2

Author’s note: I received a lot of feedback regarding my last post. I want to briefly address that before presenting the next part of my findings.

I set out to discover if my experiences in Churches of Christ are unique. I have learned that I am not alone. I want to reiterate that regardless of one’s particular beliefs, theology, hermeneutics, or ecclesiology we cannot deny the experiences of women who self-report pain. Their story is their story, and it cannot be ignored, rewritten, or taken from them.

I was not sponsored, endorsed, or in any way compensated to do this work. I have embarked on this journey without the support of a congregation or an academic institution. I have used my own time and resources. This research was not intended to be published or peer-reviewed, I simply wanted to gather information and see what I found. I have held this research for a year because of the intense pain it causes me to evaluate it, write about it, and share it. But after a year of reflection and prayer I share it now. As I have repeatedly worked through comments of hundreds of women who answered this survey, I sense their sorrow and pain and my own pain bubbles to the surface – this is deeply troubling work for me.

One thing that I want to make clear (that I had hoped was clear in the first article) is what these findings are verses what they are not. 

What This Is:

– This is a survey I sent out in order to gather more information to “take the temperature” of other women in our community.
– This is research that was initially borne out of my own experiences and feelings of solitude as a woman within the Church of Christ.
– This is a summary of findings that point to a need for professional, academic studies—something that has not been done before at the scope and scale of what I am proposing here.
– This is data-gathering that asks previously unasked questions.

What This Is Not:
– This is not a peer-reviewed article or a methodological approach to the statistics.
– This is not intended to prove causation, as much as it is to present findings and say, “What do we do with this? What are our next steps? Where do we go from here?”

I know this study has gaps and holes. Nevertheless, in spite of the flawed methods, embedded in this imperfect research are stories of hundreds of women and their voices should be heard. I embarked on this research out of shear curiosity and to offer other women the opportunity to be heard. I hope that a more robust methodology will come with future research. I hope that future research will be based on the quotes, experiences, and findings I share below and in my next post. The implications of this survey (which measures symptoms of trauma experienced by women in the Churches of Christ) are great. More research is unequivocally needed. I also recommend an in-depth study of the self-reported trauma symptoms in men who have served as ministers and preachers in Churches of Christ to determine if gender differentiates a self-reported trauma level.

My prayer now is that you, my dearest brothers and sisters, read on with curiosity, empathy, and openness to the stories of others. I also pray that the hard questions asked here will continue to be asked and that further research will be undertaken by someone more skilled than me. May we all have the courage to ask brave questions – and then listen. Soli Deo Gloria – Heather

Summary

In September 2018, I launched an online snowball sampling survey through the social media venue, Facebook. This snowball survey used the self-reporting assessment PTSD Checklist – Civilian Version (PCL-C) and was used to screen for the presence and severity of self-reported trauma symptoms in women in Churches of Christ. The eligibility criteria for survey participants was they must be a current or former member of a Church of Christ. The goal was to collect between 50-75 responses but within one day the survey had grown to over 500 completed responses. The results show that 50% of respondents reported none to mild self-reported trauma symptoms as a result of their experience in Churches of Christ, 22% reported moderate symptoms, and 28% reported severe to extremely severe trauma symptoms.

Measure

The PCL-C is a standardized self-report rating scale for PTSD comprised of 17 items that correspond to the key symptoms of PTSD from the DSM-IV. The PCL-C was derived from the PCL-Military Version (PCL-M; Weathers et al., 1993). The civilian version is identical to the military version, except that it inquires about a “stressful experience from the past” as opposed to military trauma. The PCL-C demonstrates good retest reliability and internal consistency, as well as adequate convergent and discriminant validities (Adkins, Weather, McDevitt-Murphy, & Daniels, 2008). In other words, experts in the research and psychology communities view it is a reliable assessment to screen for self-reported trauma symptoms. In fact, one study found that the PCL-C may be superior compared with other assessments in discriminating between trauma symptoms and symptoms of social anxiety disorder, panic disorder, OCD, and depression (Conybeare et al., 2012).

The PCL-C is self-administered and takes about 10 minutes to complete. Each respondent indicates how much they have been “bothered” by a symptom over the past month using a 5-point scale; 1 – “Not at all” to 5 – “Extremely.” The PCL-C is scored by tallying all items for a total severity score (17-85). The scale used by this research to rank the presence and severity of symptoms is below:

  • 0—17 = No symptoms
  • 18—29 = Mild 
  • 30—44 = Moderate
  • 45—57 = Severe
  • 58+ = Extremely severe 

Each respondent was asked to consider her own experience(s) of being part of Churches of Christ and answer the survey questions through that lens. While each respondent’s definition of trauma was different, this survey explored the self-reported symptoms of their experiences. Five of the items measure re-experiencing symptoms, seven measure avoidance symptoms, and five measure hyperarousal symptoms. The following DSM-IV criteria are used by the PCL-5 for assessing symptoms (note that the PCL-5 does not include a Criterion “A” component):

  • – Symptomatic response to at least 1 “B” item (Questions 1–5),
  • – Symptomatic response to at least 3 “C” items (Questions 6–12), and
  • – Symptomatic response to at least 2 “D” items (Questions 13–17)

Please see the expanded symptomatic criteria for PTSD in the DSM-IV here

Please note: The PCL-5 should not be used as a diagnostic tool. Only licensed and qualified clinicians can diagnose PTSD. This assessment was used to screen for the presence and severity of self-reported trauma symptoms and was not intended to diagnose or treat any symptoms. The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician Administered PTSD Scale (CAPS).

Findings

This data includes the 5 women who did not fully complete their surveys. While they did not complete the 17 question PCL-C portion of the survey, they did provide relevant comments which will be included in Part 3 of this series. Since these incomplete survey scores did not exceed 17, their answers have been added to the “No Symptoms” category. Thus, the survey sample size was 521 women who are now or have been part of Churches of Christ.

The 521 respondents were from 41 States and 10 countries.

Of these 521 women, 95% answered yes to, “I have served as an unpaid lay leader in Churches of Christ (i.e. Bible class teacher, ministry leader, nursery, meals, benevolence, hospital visits, hosted showers, youth group volunteer, office administration, missions, building care and maintenance.)” One hundred and thirty-three (133) have served as a paid minister or ministry leader in Churches of Christ, and 111 answered yes to, “I am now or have been married to a Church of Christ minister.”

While the survey did not ask the ages of the respondents it did inquire as to how many years they have been part of Churches of Christ. The majority of respondents, 370 or 71%, have been part of Churches of Christ between 21 and 50 years.

Of the entire sample group 50% reported none to mild symptoms, 22% reported moderate symptoms, and 28% reported severe to extremely severe symptoms.

The following chart shows the number of years spent in Churches of Christ and the presence and severity of self-reported trauma symptoms. There is a correlation between the number of years the respondents spent in Churches of Christ and the absence of self-reported trauma symptoms. The longer a respondent has been part of Churches of Christ the fewer symptoms reported. Likewise, those respondents who have spent fewer years in Churches of Christ report more symptoms and a higher degree of severity.

Of the 494 respondents who have served as an unpaid lay leader in Churches of Christ, 51.5% reported none to mild symptoms, 21% reported moderate symptoms, and 27.5% reported severe to extremely severe symptoms. Of the women who are or have been married to a Church of Christ minister 36% reported none to mild symptoms, 23% reported moderate symptoms, and 42% reported severe to extremely severe symptoms. Similarly, of the 133 women who have served as a paid minister or ministry leader in Churches of Christ 42% reported none to mild symptoms, 23% reported moderate symptoms, and 36% reported severe to extremely severe symptoms. Of those women who have both served as a paid minister or a ministry leader and also married to a Church of Christ minister only 31% report none to mild symptoms while 18% report moderate symptoms, and 51% reported severe to extremely severe symptoms.

Discussion

According to the National Center for PTSD there is not an absolute method for determining the correct cut-off point on the PCL. However, a cut-off score of 45 or higher is appropriate to use as the threshold to aid in the prediction of PTSD and was selected for this study to yield optimal sensitivity. Freedy et al. (2010) used a cut-off score of 43 or higher as the cutoff for PTSD. Gore et al. (2013) used 48 as a cut-off for PTSD and 22 for those without PTSD. Gelaye et al. (2017) used the cut-off score of 26 in pregnant women in Peru to determine the presence of PTSD. Alaqeel et al. (2019) used the cut-off of 30-35 to determine the PTSD status among emergency medical personnel. Bown et al. (2019) used three cut-off thresholds of 36, 44, and 50 to determine the presence of PTSD in patients with traumatic brain injury. Bressler et al (2018) used the cutoff of 35 to 38 as a positive predictive value of PTSD.

The prevalence of PTSD in the general public of the United States has been estimated at 6–8% (Kessler et al., 2005; Kessler et al., 1995; Kilpatrick et al., 2013; Pietrzak et al., 2011). The global prevalence of PTSD has not been well characterized, but the World Mental Health (WMH) surveys have identified prevalence in a number of countries ranging from 1 to 10% (Atwoli et al., 2015; Koenen et al., 2017). In civilian primary care samples, rates of current PTSD of 6%–20% are typically reported (Freedy et al., 2010). Recent large-scale studies indicate that PTSD among U.S. service men and women returning from current military deployments, are as high as 14 –16% (Gates et al., 2012). In a review of the prevalence of combat-related PTSD among Iraq and Afghanistan veterans, one study reported estimates for current PTSD ranging from 4% to 17% (Richardson et al., 2010).

This study shows that 28% of the entire sample group meet the screening criteria for further PTSD assessment and possible diagnosis. With 28% of respondents reporting 45 or higher this survey reveals that the prevalence of possible PTSD in these women is two to three times higher than the general public. Additionally, all three of the subgroups, women who have served as a paid minister (36% scored 45 or higher), women married to a minister (42% scored 45 or higher), and women who have both served as a paid minister and also married to a minister in Churches of Christ (53% scored 45 or higher) all exceed the cut-off threshold for a predictive diagnosis of PTSD.

Clinical Implications

PTSD is associated with health issues: health risk behaviors (e.g. smoking, sedentary lifestyle, medical nonadherence), vague physical complaints, chronic medical problems (e.g. diabetes mellitus, COPD), mental health comorbidity (e.g. depression, alcohol abuse) and functional impairment (e.g. relationship instability, underachievement) (Freedy et al., 2010).  Research shows that women are exposed to higher levels of sexual victimization, a form of trauma that is particularly associated with PTSD risk. Also, women in general are more willing to report symptoms than men (Freedy et al., 2010). One study showed that a PTSD diagnosis is higher among women than among men, and the prevalence increased with greater traumatic event exposure (Kirkpatrick et al., 2013).

Conclusion

Twenty-eight percent (28%) of the 521 women who answered the survey scored 45 or higher which exceeds the cut-off threshold to aid in the predictive diagnosis of PTSD. Respondents who served as a paid minister or ministry leader in Churches of Christ were more likely to report severe to extremely severe symptoms of trauma over the general reporting group. Those respondents who were or have been married to a Church of Christ minister reported very similar results. However, those respondents who were both a paid minister or ministry leader and married to a Church of Christ minister were the most likely to self-report symptoms of trauma. In fact, 51% of this demographic self-reported severe to extremely severe symptoms of trauma.

The number of years spent in Churches of Christ also seems to have a connection to the presence and severity of self-reported trauma symptoms. The more years the respondents spent in Churches of Christ, the less likely they were to report symptoms. The reverse was true as well, respondents who have spent fewer years in Churches of Christ reported more severe symptoms.

The two groups who were most likely to report severe to extremely severe symptoms were women who have both served as a paid minister and also married to a Church of Christ minister, and those who have been part of Churches of Christ for 10 years or less.

Future Research

This study is not definitive and requires replication. Nevertheless, the results are important. More research is needed to accurately assess the severity of self-reported trauma symptoms in women as a result of being part of Churches of Christ. Future research should also explore the reason behind the self-reported trauma symptoms (i.e. is the trauma tied to issues such as patriarchy, complementarianism, sexism, internalized sexism, physical or sexual trauma, or something else entirely?).

For more robust conclusions, future research could include the study of self-reported trauma symptoms in women from other denominations as well as women in the general public who do not attend a church. Another area of study could include the correlation between whether a woman in Churches of Christ feels that her particular spiritual gifts were fully utilized or not.

In addition, future studies should also include men in Churches of Christ and men who have served as a minister in Churches of Christ. I suspect that the presence and severity of self-reported trauma symptoms in men who have served as ministers and preachers in Churches of Christ is also quite high. Similarly, research should be done to assess whether there are any mental, emotional, or spiritual effects on boys and men as a result of being part of Churches of Christ, particularly related to the church’s view of women. Also, more research could help determine whether there is any correlation to the experiences of women and the decline of Churches of Christ.

Part 3

In the third part of this series I will share direct quotes and comments from the survey respondents.

Resources

Adkins, J.W., Weathers, F.W., McDevitt-Murphy, M., & Daniels, J.B. (2008). Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure. Journal of Anxiety Disorders, 22, 1393–1402.

Alaqeel, Meshal K., Nawfal A. Aljerian, Muhannad A. AlNahdi, and Raiyan Y. Almaini. 2019. “Post-Traumatic Stress Disorder among Emergency Medical Services Personnel: A Cross Sectional Study.” Asian Journal of Medical Sciences 10 (4): 28–31.            

Atwoli L, Stein DJ, Koenen KC, McLaughlin KA (2015) Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Curr Opin Psychiatry 28(4):307–311.           

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behavioral Research & Therapy, 34, 669-673.

Bressler, Rachel, Bradley T. Erford, and Stephanie Dean. 2018. “A Systematic Review of the Posttraumatic Stress Disorder Checklist (PCL).” Journal of Counseling & Development 96 (2): 167–86.

Bown, Dominic, Antonio Belli, Kasim Qureshi, David Davies, Emma Toman, and Rachel Upthegrove. 2019. “Post-Traumatic Stress Disorder and Self-Reported Outcomes after Traumatic Brain Injury in Victims of Assault.” PLoS ONE 14 (2): 1–14.           

Conybeare, Daniel, Evelyn Behar, Ari Solomon, Michelle G. Newman, and T. D. Borkovec. 2012. “The PTSD Checklist-Civilian Version: Reliability, Validity, and Factor Structure in a Nonclinical Sample.” Journal of Clinical Psychology 68 (6): 699–713.         

Freedy, John R., Maria M. Steenkamp, Kathryn M. Magruder, Derik E. Yeager, James S. Zoller, William J. Hueston, and Peter J. Carek. 2010. “Post-Traumatic Stress Disorder Screening Test Performance in Civilian Primary Care.” Family Practice 27 (6): 615–24.

Gates, Margaret A., Darren W. Holowka, Jennifer J. Vasterling, Terence M. Keane, Brian P. Marx, and Raymond C. Rosen. 2012. “Posttraumatic Stress Disorder in Veterans and Military Personnel: Epidemiology, Screening, and Case Recognition.” Psychological Services, Health Services Research in the Veterans Administration, 9 (4): 361–82.      

Gelaye, Bizu, Yinnan Zheng, Maria Elena Medina-Mora, Marta B. Rondon, Sixto E. Sánchez, and Michelle A. Williams. 2017. “Validity of the Posttraumatic Stress Disorders (PTSD) Checklist in Pregnant Women.” BMC Psychiatry 17 (May): 1–10.

Gore, Kristie L., Phoebe K. McCutchan, Annabel Prins, Michael C. Freed, Xian Liu, Jennifer M. Weil, and Charles C. Engel. 2013. “Operating Characteristics of the PTSD Checklist in a Military Primary Care Setting.” Psychological Assessment 25 (3): 1032–36.            

Kessler, Ronald C., Patricia Berglund, Olga Demler, Robert Jin, and Ellen E. Walters. 2005. “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication.” Archives of General Psychiatry 62 (6): 593.

Kessler, R C, A Sonnega, E Bromet, M Hughes, and C B Nelson. 1995. “Posttraumatic Stress Disorder in the National Comorbidity Survey.” Archives Of General Psychiatry 52 (12): 1048–60. 

Kilpatrick, Dean G., Heidi S. Resnick, Melissa E. Milanak, Mark W. Miller, Katherine M. Keyes, and Matthew J. Friedman. 2013. “National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV and DSM-5 Criteria.” Journal of Traumatic Stress 26 (5): 537–47.

Koenen, K C, A Ratanatharathorn, L Ng, K A McLaughlin, E J Bromet, D J Stein, E G Karam, et al. 2017. “Posttraumatic Stress Disorder in the World Mental Health Surveys.” Psychological Medicine 47 (13): 2260–74. 

Levey, Elizabeth J., Bizu Gelaye, Karestan Koenen, Qiu-Yue Zhong, Archana Basu, Marta B. Rondon, Sixto Sanchez, David C. Henderson, and Michelle A. Williams. 2018. “Trauma Exposure and Post-Traumatic Stress Disorder in a Cohort of Pregnant Peruvian Women.”Archives of Women’s Mental Health 21 (2): 193–202.

Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disorder 25(3):456–465.

Richardson, L. K., Frueh, B. C., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: Critical review. Australian and New Zealand Journal of Psychiatry, 44, 4 –19.

Weathers, F.W., Litz, B.T., Herman, D.S., Huska, J.A., & Keane, T.M. (1993). The PTSD            checklist: Reliability, validity, and diagnostic utility. Paper presented at the Annual Meeting of International Society for Traumatic Stress Studies, San Antonio, TX, October.

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  1. Wow, this “unscientific” study is far more convicting of present practice and convincing of what our sisters in Christ are going through than anything I have seen in 20 years of being involved in this movement. It is something that every Christian in the Churches of Christ should read and take very seriously, especially considering what our female children are facing and may have to endure if we don’t change! Keep up the research because we need to know in order to affect change. I would love to see the survey given to an 800 member congregation like mine and then the results published and discussed to the whole congregation. I could be a game changer.

  2. I grew up in the Church of Christ. My grandfather and father were elders. My mother was an educator and wrote lessons to be used in Bible camp. She also taught women’s groups – she wasn’t allowed to teach a group if there was a male there. This made me angry. My older brother was a minister for the Church of Christ until he left and joined the Disciples of Christ primarily because of issues with the Churches of Christ treatment of women. When I left around the age of 35 I was the education coordinator.

    This is why I left the Church of Christ. It was not the issues related to women. It was because I was trying to do as much as I could for God and the church. I was exhausted because my husband was very ill and was frequently in the hospital and, besides caring for him, we had three daughters. I did not feel though that I could cut back on what I was doding at church because I wanted God not to condemn me. The pressure was such that I became depressed and suicidal. One Sunday I was in church and the minister was pressing how we all needed to do more. I got up and ran out of the church and started to walk home. My husband and kids left also when I didn’t come back into the auditorium. He picked me up and took me home.

    The next Sunday, I went to First Christian Church. I wasn’t going to stay there. I just needed to hear that God loved me until such time that I could believe God loved me. I grew in the knowledge that God loved me and was surrounding me with love. Eventually, I decided though that I would not go back because of it’s treatment of women – I didn’t want my daughters to have to deal with the issue of women in leadership positions. I joined the church and so did my husband. It has taken me a long time and a lot of work to dump the garbage I was taught by the Church of Christ and embrace God’s love. I no longer do things because I’m afraid of displeasing God – I do them because God loves me.

    After my husband died, I went to seminary and was ordained as a minister. I served two churches as a minister and another church as the Director of Spirituality. I am currently retired and am a volunteer Mental Health Minister.

    I was not physically abused by the Church of Christ but I was spiritually, emotionally and mentally abused. I am thankful I escaped from the Church of Christ and found healing and love.