Social Support Networks, Coping Mechanisms, and Mental Health Outcomes in Post-Traumatic Stress Disorder (PTSD) Patients in Yogyakarta

ABSTRACT


INTRODUCTION
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that often arises after exposure to traumatic events.It is characterized by symptoms such as recurrent distressing dreams or flashbacks, internal or external avoidance, and hypervigilance or exaggerated startle response [1].PTSD can have a significant impact on an individual's interpersonal relationships and social cognition [2].It is common among various populations, including military servicemembers, veterans, and refugees [3].
Several factors have been found to be associated with PTSD.For example, a study on resettled Afghan refugees in Australia found that communication difficulties, separation from family, and self-recognition of a mental health problem were strongly and independently associated with a probable PTSD diagnosis [3].Another study on violently injured patients in urban trauma centers found that PTSD was highly prevalent in this population, and understanding the root causes of PTSD could help direct interventions to support individuals with services that meet their individual needs [4].
Treatment options for PTSD include psychotherapy, which is often considered the first line of treatment, and pharmacological interventions.Among the psychotherapy options, cognitive processing therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR) are some of the most common and effective approaches [5].Ketamine-assisted therapy has also shown promise in treating PTSD and depression, particularly among healthcare providers [6].The incidence of PTSD may be noteworthy in the context of Yogyakarta, Indonesia, a region known for its history of natural disasters and socio-political turmoil.Such events can have long-lasting psychological effects on the impacted people, making a careful investigation of the variables affecting their mental health outcomes necessary.
Yogyakarta offers a distinctive location for our study because of its hardy people and rich cultural heritage.The chance to examine the intricacies of PTSD in a culturally unique setting is provided by the contrast between its historical background and current difficulties.Given the possible effects of trauma in Yogyakarta, it is critical to examine the coping strategies and support networks that people with PTSD may utilize.
It is important to comprehend how coping strategies and social support interact in the mental health context of PTSD patients for a number of reasons [7], [8].First of all, Yogyakarta's vulnerability to traumatizing incidents calls for a focused investigation of the elements affecting the mental health of its citizens.Second, by figuring out these patterns, it will be easier to create and carry out mental health interventions that are more suited to the particular requirements of the community [9].Using a quantitative methodology, this project aims to produce empirical data that will improve the debate on PTSD among academics and give useful information for Yogyakarta community stakeholders, mental health professionals, and policymakers.

PTSD and Mental Health
Post-Traumatic Stress Disorder (PTSD) is a severe and persistent mental health condition that arises from exposure to traumatic events.It affects an individual's emotional well-being, cognitive functioning, and overall quality of life.PTSD symptoms often include intrusive memories, hypervigilance, avoidance behaviors, and alterations in mood and cognition [3], [10], [11].Research has shown that PTSD is common among various populations, such as resettled refugees [3], and violently injured patients [4].A study on core symptoms of PTSD in a veteran sample identified recurrent distressing dreams or flashbacks, internal or external avoidance, and hypervigilance or exaggerated startle as the main criteria [1].These core symptoms were found to accurately identify 79% of veterans with PTSD [1].
PTSD has been linked to increased inflammation in the body and brain.Patients with PTSD have been found to have higher levels of inflammatory cytokine biomarkers, such as interleukin-1, interleukin-6, tumor necrosis factor-α, nuclear factor-KB, and C-reactive protein, compared to healthy controls [12].Animal model experiments have also suggested the role of inflammation in the pathogenesis and pathophysiology of PTSD [12].The impact of PTSD on quality of life and subjective well-being has been studied in various populations, such as those affected by natural disasters like tsunamis [13], and victims of bullying at work [14].In both cases, PTSD was found to have a significant negative impact on the individuals' mental health and quality of life.The chronic and pervasive nature of PTSD underscores the importance of investigating factors that may mitigate or exacerbate its impact, particularly within distinct cultural contexts like Yogyakarta.

Social Support Networks
Social support is indeed a crucial factor in influencing mental health outcomes, particularly in the context of trauma and PTSD [15]- [18].Various dimensions of social support include emotional, instrumental, informational, and appraisal support.Primary sources of social support are family, friends, and community networks, which provide individuals coping with trauma a sense of belonging, understanding, and assistance in practical matters3.Studies have shown that higher levels of perceived social support are associated with better mental health outcomes in PTSD patients [19], [20].
For instance, in the context of military sexual trauma (MST), social support has been found to be essential for recovery and prevention of PTSD.However, individual differences in seeking or benefiting from social support in trauma survivors are not well understood [19].Interventions like Skills Training in Affective and Interpersonal Regulation (STAIR) have been developed to promote social engagement and skills that support greater role functioning in veterans with PTSD and MST [21].
Moreover, resilience has been found to mediate the relationship between social support and mental health outcomes.In a study on individuals with multiple sclerosis, resilience significantly mediated the relationships between social support from significant others, family members, and friends, and subsequent mental health outcomes [22].However, cultural nuances may influence the nature and effectiveness of social support, necessitating an exploration of how these dynamics manifest in the context of Yogyakarta.

Coping Mechanisms in PTSD
Coping mechanisms are the various approaches people take to deal with the psychological and emotional difficulties brought on by trauma.Numerous coping strategies are highlighted in the research, such as expressing emotions, problem-solving, avoiding situations, and looking for social support.While maladaptive coping methods may exacerbate symptoms, adaptive coping mechanisms are linked to better mental health outcomes.It is essential to comprehend the coping strategies used by PTSD sufferers in order to customize solutions that meet the particular requirements of Yogyakarta's community.The literature highlights the necessity for context-specific research by speculating that cultural influences may influence the choice of coping mechanisms [23]- [26].

Gaps in the Literature
There are still certain gaps in the literature, despite the fact that it offers insightful information about coping strategies, social support, and PTSD.Few studies have explicitly examined the relationships between these variables, especially in Yogyakarta's cultural environment.Moreover, most research has mostly concentrated on populations in the West, therefore a more comprehensive and diverse approach is needed to take into account the distinct socio-cultural aspects that are common in areas like Yogyakarta.Comprehending these limitations is essential to defending the necessity of a quantitative study that advances a more comprehensive understanding of PTSD in a multicultural and heterogeneous environment.

Design & Sample
This study utilized a quantitative research approach to systematically investigate the relationship between social support networks, coping mechanisms, and mental health outcomes in individuals diagnosed with Post-Traumatic Stress Disorder (PTSD) in Yogyakarta, Indonesia.
Quantitative research provides the advantage of generating empirical data, which allows statistical analysis to draw reliable conclusions and uncover patterns in a large and diverse sample.The target population for this study consisted of individuals diagnosed with PTSD in Yogyakarta.
Given the diversity of age, gender, and trauma experience in this population, a representative sample will be selected.To achieve this, stratified random sampling is conducted to ensure that the sample reflects the demographic characteristics of individuals with PTSD in Yogyakarta.Participants will be recruited from mental health clinics, support groups, and community organizations serving individuals affected by trauma and PTSD with a total of 150 participants involved in the study.

Data Collection
Data collection involves administering a structured survey to the participants.The following standardized measurement tools will be used:

a. Statistics Descriptive
This study involved a diverse sample of individuals diagnosed with Post-Traumatic Stress Disorder (PTSD) in Yogyakarta.Demographic characteristics are summarized as follows: The mean age of participants was calculated at 35.2 years (SD = 8.7).The sample consisted of 45% males and 55% females.Participants reported exposure to a variety of traumatic events, including natural disasters (22%), conflict-related incidents (30%), and personal trauma (48%).

Perceived Social Support
The assessment of perceived social support utilized the Social Support Questionnaire.
The participants rated their perception of support across multiple domains: The mean score for emotional support was 4.8 (SD=1.2).Participants reported an average score of 3.9 (SD = 1.5) for instrumental support.The mean score for informational support was 4.2 (SD = 1.0).The mean score for appraisal support was 4.5 (SD = 1.3).

Coping Mechanisms
Coping mechanisms were evaluated using the Coping Strategies Inventory, which provides insight into the strategies used by participants to manage the challenges associated with PTSD: Problem Solving participants reported a mean score of 3.6 (SD = 1.4).The mean score for emotional expression was 4.1 (SD=1.2).The mean score for avoidance as a coping strategy was 2.8 (SD = 1.6).Seeking Social Support participants reported a mean score of 4.0 (SD = 1.1).

PTSD Symptom Severity
PTSD symptom severity was assessed using the PTSD Checklist (PCL-5).Participants rated the intensity of symptoms experienced.The mean score for overall PTSD symptom severity was 52.7 (SD = 12.3).
These descriptive statistics provided an initial overview of the characteristics of the study sample.The next stage of the study involved more in-depth statistical examinations, including correlation and regression analyses, to uncover the complex relationships between social support, coping mechanisms, and mental health outcomes in individuals with PTSD in Yogyakarta.The diversity in the sample ensures that the findings will reflect the complex and multifaceted nature of PTSD in this unique socio-cultural context.

b. Variable Correlation
The associations between coping strategies, mental health outcomes (such as the intensity of PTSD symptoms), and perceived social support were investigated using bivariate correlation analysis.
The findings demonstrated the connections between social support, coping mechanisms, and mental health outcomes by revealing strong correlations between these variables.
There was a strong positive correlation between emotional support and instrumental support (0.632), informational support (0.481), and appraisal support (0.554).This suggests that individuals who perceive higher emotional support are also likely to experience higher levels of the other forms of support.
The strong positive correlation (0.683) between problem solving and emotional expression suggests that individuals who engage in active problem-solving strategies are also more likely to openly express their emotions.
The strong negative correlation (-0.712) suggests that higher levels of perceived emotional support are associated with lower PTSD symptom severity.This is in line with existing literature that emphasizes the protective role of emotional support in reducing the impact of trauma.
Avoidance: The positive correlation (0.261) between avoidance and PTSD symptom severity suggests that individuals who tend to avoid stressors may experience higher levels of PTSD symptoms.This is in line with the literature highlighting the potentially maladaptive nature of avoidance strategies.Social Support Seeking and PTSD Symptom Severity: A strong negative correlation (-0.627) indicated that actively seeking social support was associated with lower PTSD symptom severity.This underscores the importance of encouraging individuals to seek support.Actively seeking social support also emerged as a key predictor of lower PTSD symptom severity.These findings are in line with the idea that individuals who seek support and engage with their social networks experience better mental health outcomes.Mental health interventions in Yogyakarta should consider emphasizing and normalizing support-seeking as a coping strategy.

b. Coping Mechanisms and their Complexity
The positive correlation between problem solving and emotion expression suggests a dynamic relationship where individuals who actively engage in problem solving are also more likely to openly express their emotions.However, the moderate effect size in the regression analysis implies that problem solving alone may not be sufficient to significantly impact PTSD symptom severity.An integrative approach that includes various coping strategies may be more effective.
The unexpected positive coefficient for avoidance in the regression analysis prompted a reevaluation of the assumptions surrounding this coping mechanism.
Contrary to expectations, higher levels of avoidance were associated with higher PTSD symptom severity.

Implications
The results have applications for Yogyakarta mental health professionals.Interventions may be more effective if they are designed with an emphasis on the value of emotional support, proactive social supportseeking, and a thorough understanding of coping mechanisms.These findings should be included into mental health policies by policymakers in order to support culturally appropriate approaches.

CONCLUSION
To sum up, this study offers important new understandings of the intricate relationships influencing the mental health results of PTSD sufferers in Yogyakarta.The important role those social connections play in reducing the effects of trauma is highlighted by the substantial influence of social support, especially emotional and proactive assistance.The unanticipated contribution of avoidance to symptom intensity necessitates careful investigation and taking into account cultural differences in coping mechanisms.These findings highlight the need for culturally responsive therapies and have practical consequences for Yogyakarta politicians and mental health practitioners.Ongoing research and cooperative efforts are crucial to improving our understanding of the intricacies of PTSD in many cultural contexts and boosting the efficacy of mental health support systems.

Table 1 .
Regression Analysis Results