Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire

Effects of trauma and PTSD on self-reported physical functioning in sexual minority women

OBJECTIVE

Sexual minority women (lesbians, bisexual women, and women who partner with women) experience high rates of trauma exposure, are more likely to develop posttraumatic stress disorder (PTSD), and have high rates of physical health problems compared with heterosexual women. The present study tested whether PTSD may be the mechanism through which trauma exposure affects self-reported physical functioning in this population.

METHOD

In a sample of 857 sexual minority women, we examined the association between trauma exposure and worsening physical functioning (measured using the 12-item Short Form Health Survey) 2 years later, whether PTSD mediated this relationship, and if so, which PTSD symptom clusters best accounted for this mediation.

RESULTS

Results showed that more Criterion A traumatic events experienced (based on DSM-IV) predicted greater decline in physical functioning 2 years later, and PTSD symptoms mediated this relationship, explaining 73% of the total effect. The arousal/reactivity symptom cluster was the only significant mediator, explaining 68% of the total effect.

CONCLUSIONS

Results show that PTSD, and arousal/reactivity symptoms in particular, may be the mechanism through which traumatic events negatively impact self-reported physical functioning. These findings provide further evidence that, for this at risk population, treating PTSD as soon as possible after onset may improve long term physical functioning. (PsycINFO Database Record

Peer alcohol behavior moderates within-level associations between posttraumatic stress disorder symptoms and alcohol use in college students

Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one's peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers. (PsycINFO Database Record

Risk factors for concurrent suicidal ideation and violent impulses in military veterans

Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N = 2,543 Iraq/Afghanistan-era U.S. veterans. Compared with veterans denying suicidal ideation or violent impulses (n = 1,927), veterans endorsing both (n = 171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n = 186) and had lower odds of endorsing self-direction/life purpose compared with veterans reporting violent impulses only (n = 259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans. (PsycINFO Database Record

A Dyadic Perspective on PTSD Symptoms' Associations with Couple Functioning and Parenting Stress in First-Time Parents

Posttraumatic stress disorder (PTSD) symptoms are associated with disruptions in both couple functioning and parenting, and limited research suggests that, among military couples, perceptions of couple functioning and parenting stress are a function of both one's own and one's partner's mental health symptoms. However, this work has not been generalized to civilian couples, and little is known about the associations between PTSD symptoms and family adjustment in specific family developmental contexts. We examined PTSD symptoms' associations with perceived couple functioning and parenting stress within a dyadic context in civilian couples who had participated in a randomized controlled trial of a universal, couple-based transition to parenthood program and at least one member of the couple reported having experienced a Criterion A1 traumatic event. Results of actor-partner interdependence models revealed that parents' own and partners' PTSD symptoms were negatively associated with perceived couple functioning; contrary to expectation, the association of partners' PTSD symptoms with perceived couple functioning was strongest among men who received the intervention. A parent's own PTSD symptoms were positively associated with parenting stress for both men and women and were unexpectedly strongest for men who received the intervention. Partner PTSD symptoms were also positively associated with increased parenting stress for both men and women. Findings support a dyadic conceptualization of the associations between spouses' PTSD symptoms and family outcomes during the transition to parenthood and suggest that participating in a couple-based, psychoeducational program during this phase in the family life cycle may be particularly salient for men.

Posttraumatic Stress and Problem Drinking at the Transition Out of College

The objective of the present study was to examine how symptoms of posttraumatic stress disorder (PTSD) may confer drinking risk as students with trauma histories complete college and move toward independent adulthood. Students (N = 283) completed assessments of trauma, posttraumatic stress, and alcohol use and consequences at four time points during the year following their fourth year of college. Some students had transitioned out of the college environment, whereas others had not. We examined how transition status moderated within-person associations between changes in PTSD and corresponding changes in alcohol outcomes over time. Using multilevel modeling, we examined differences in within-person PTSD-alcohol associations comparing students who were (1) continuing as fifth-year seniors, (2) graduated and pursuing graduate education, and (3) graduated and left the university setting. Alcohol use and consequences tended to decline on average from the fourth to fifth year post-matriculation. Yet, within-person increases in posttraumatic stress symptomatology across the fifth year were associated with greater alcohol consequences, but only for those students who had left the university setting. These data suggest that the transition out of college may be an important developmental context that is associated with increased vulnerability for negative consequences from stress-related drinking. Findings may have important implications for campus-based prevention efforts geared toward the facilitation of a successful transition into independent adulthood.

Posttraumatic Symptom Reporting and Reported Cigarette Smoking During Pregnancy

INTRODUCTION

Increased prevalence of nicotine dependence among individuals suffering from posttraumatic stress disorder (PTSD) is well established. However, there are limited studies on the prevalence of smoking during pregnancy in relation to prepregnancy history of trauma exposures and active PTSD symptoms during pregnancy. Prenatal smoking has been implicated in a host of negative outcomes for mother and baby. Given maternal and fetal risk, it is critical to define predictors of continued cigarette smoking during pregnancy.

METHODS

Pregnant women from an urban perinatal clinic completed an anonymous survey of trauma history using a modified Traumatic Life Events Questionnaire (TLEQ), PTSD symptoms using the PTSD Symptom Checklist-Civilian Version (PCL-C) and current and past smoking behavior. Those who smoked any number of cigarettes per day after pregnancy confirmation were considered to be "pregnant smokers."

RESULTS

Of 218 women who completed the survey, 34 (15.6%) reported smoking cigarettes after confirmation of pregnancy. In unadjusted models, trauma exposure that resulted in fear, helplessness, or horror (FHH), as well as current PTSD symptom severity and probable PTSD diagnosis showed statistical significance as predictors of smoking during pregnancy. After adjusting for age only, PTSD symptoms retained their significant association with smoking during pregnancy. When history of smoking at least five cigarettes per day was added to our models, none of the associations remained significant.

CONCLUSIONS

These findings emphasize the importance of the behavioral response to past traumatic exposures in influencing cigarette smoking behavior before pregnancy. Given such behaviors enhance risk for continued tobacco use during pregnancy, a trauma-informed approach to smoking cessation in preconception care may ultimately reduce the likelihood of smoking during pregnancy and requires further study.

Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders

PURPOSE

Traumatic events and adverse stressful experiences are major etiological factors in a wide variety of physical and mental disorders. Developing psychological instruments that can be easily administered and that have good psychometric properties have become an integral part for research and practice. This study investigated the reliability and validity of the Korean version of the Lifetime Stressor Checklist-Revised (LSC-R) in a consecutive sample of psychiatric outpatients. The LSC-R is a 30-item self-reporting questionnaire examining lifetime traumatic and non-traumatic stressors.

MATERIALS AND METHODS

A final sample of 258 outpatients with anxiety or depressive disorders was recruited at the psychiatric department of a university-affiliated teaching hospital. Self-reported data included the Life Events Checklist (LEC), the Zung Self-Rating Depression and Anxiety Scales, and the Impact of Events Scale-Revised, in addition to the LSC-R. A convenience sample of 50 college students completed the LSC-R on two occasions separated by a three week-interval for test-retest reliability.

RESULTS

Mean kappa for temporal stability was high (κ=0.651) and Cronbach alpha was moderate (α=0.724). Convergent validity was excellent with corresponding items on the LEC. Concurrent validity was good for symptoms of post-traumatic stress disorder, depression, and anxiety. An exploratory factor analysis revealed that 11 factors explained 64.3 % of the total variance.

CONCLUSION

This study demonstrated good psychometric properties of the Korean version of the LSC-R, further supporting its use in clinical research and practice with a Korean speaking population.

Posttraumatic Reactions to Psychosis: A Qualitative Analysis

The current study aimed to evaluate the potentially traumatic aspects of psychotic symptoms and psychiatric treatment of psychosis using qualitative methods. Participants included 63 people with first episode psychosis or multiple psychotic episodes recruited from an inpatient psychiatric unit and an urban state psychiatric hospital in the North East region of the United States. Quasi-structured interviews were used to explore those aspects of symptoms and treatment that were perceived as traumatic Emotional reactions to the most traumatic aspect of symptoms and treatment, during and after the event, were also examined. Participants described a number of traumatogenic aspects of psychotic symptoms, including frightening hallucinations; suicidal thought/attempts, thoughts/attempts to hurt others; paranoia/delusions and bizarre/disorganized behavior or catatonia. Traumatic aspects of psychosis elicited emotions including anger, sadness and confusion, anxiety, and numbness at the time of event. Furthermore, many participants found aspects of treatment to be traumatic, including: being forced to stay in the hospital for a long time; experiencing upsetting side-effects; coercive treatments, including involuntary hospitalization, use of restraints, and forced medication; being exposed to aggressive patients; and mistreatment by professionals. These experiences elicited emotions of anger, sadness, distrust, and a sense of helplessness. Study findings suggest that the experiences both of psychotic symptoms and psychiatric treatment, potentially traumatic, can be a powerful barrier to engaging people in mental health services and facilitating recovery. Clinical implications were discussed.

Social Surrogate use in those Exposed to Trauma: I Get by with a Little Help from my (Fictional) Friends

Traumatic events bring an increased need for social connection but paradoxically can make relationships more difficult. The current research examines the unique role social surrogates such as favorite TV shows, books, and celebrities may play in fulfilling the social needs of people who have experienced trauma. Across two studies we predicted and found that experiencing traumatic events is associated with higher interest in using social surrogates. Furthermore, individuals who have experienced trauma without developing PTSD are able to effectively use social surrogates to combat social isolation. However, perhaps because PTSD symptoms often are associated with impaired social functioning, those with PTSD actually feel worse after social surrogate use. Implications for trauma, PTSD, social surrogates, and social self research are discussed.

Posttraumatic stress disorder symptoms, anxiety sensitivity, and alcohol-use motives in college students with a history of interpersonal trauma

Posttraumatic stress disorder (PTSD) symptoms are associated with coping-motivated alcohol use in trauma-exposed samples. However, it is unclear which individuals experiencing PTSD symptoms are at greatest risk for alcohol-use problems following trauma exposure. Individuals endorsing high anxiety sensitivity, which is the fear of anxiety and related sensations, may be particularly motivated to use alcohol to cope with PTSD symptoms. In the current study, we examined the moderating role of anxiety sensitivity in the association between PTSD symptoms and coping motives in a sample of 295 young adults with a history of interpersonal trauma and current alcohol use. Participants completed measures of past 30-day alcohol consumption, trauma history, current PTSD symptoms, anxiety sensitivity, and alcohol-use motives. Results of hierarchical multiple regression analyses indicated that greater anxiety sensitivity was significantly associated with greater coping (β = .219) and conformity (β = .156) alcohol-use motives, and greater PTSD symptoms were associated with greater coping motives (β = .247), above and beyond the covariates of sex, alcohol consumption, trauma load, and noncriterion alcohol-use motives. The interaction of anxiety sensitivity and PTSD symptoms accounted for additional variance in coping motives above and beyond the main effects (β = .117), with greater PTSD symptoms being associated with greater coping motives among those high but not low in anxiety sensitivity. Assessment and treatment of PTSD symptoms and anxiety sensitivity in young adults with interpersonal trauma may be warranted as a means of decreasing alcohol-related risk in trauma-exposed young adults. (PsycINFO Database Record

Neuroticism Increases PTSD Symptom Severity by Amplifying the Emotionality, Rehearsal, and Centrality of Trauma Memories

OBJECTIVE

Although it is well established that neuroticism increases the risk of posttraumatic stress disorder (PTSD), little is known about the mechanisms that promote PTSD in individuals with elevated levels of neuroticism. Across two studies, we examined the cognitive-affective processes through which neuroticism leads to greater PTSD symptom severity.

METHOD

Community-dwelling adults with trauma histories varying widely in severity (Study 1) and clinically diagnosed individuals exposed to DSM-IV-TR A1 criterion traumas (Study 2) completed measures of neuroticism, negative affectivity, trauma memory characteristics, and PTSD symptom severity.

RESULTS

Longitudinal data in Study 1 showed that individuals with higher scores on two measures of neuroticism assessed approximately three decades apart in young adulthood and midlife reported trauma memories accompanied by more intense physiological reactions, more frequent involuntary rehearsal, and greater perceived centrality to identity in older adulthood. These properties of trauma memories were in turn associated with more severe PTSD symptoms. Study 2 replicated these findings using cross-sectional data from individuals with severe trauma histories and three additional measures of neuroticism.

CONCLUSIONS

Results suggest that neuroticism leads to PTSD symptoms by magnifying the emotionality, availability, and centrality of trauma memories as proposed in mnemonic models of PTSD.

Methodology of AA CRASH: a prospective observational study evaluating the incidence and pathogenesis of adverse post-traumatic sequelae in African-Americans experiencing motor vehicle collision

INTRODUCTION

A motor vehicle collision (MVC) is one of the most common life-threatening events experienced by individuals living in the USA. While most individuals recover following MVC, a significant proportion of individuals develop adverse post-traumatic sequelae such as post-traumatic stress disorder or persistent musculoskeletal pain. Adverse post-traumatic sequelae are common, morbid and costly public health problems in the USA and other industrialised countries. The pathogenesis of these disorders following MVC remains poorly understood. In the USA, available data suggest that African-Americans experience an increased burden of adverse post-traumatic sequelae after MVC compared to European Americans, but to date no studies examining the pathogenesis of these disorders among African-Americans experiencing MVC have been performed.

METHODS AND ANALYSIS

The African-American CRASH (AA CRASH) study is an NIH-funded, multicentre, prospective study that enrols African-Americans (n=900) who present to the emergency department (ED) within 24 hours of MVC. Participants are enrolled at 13 ED sites in the USA. Individuals who are admitted to the hospital or who report a fracture or tissue injury are excluded. Participants complete a detailed ED interview that includes an assessment of crash history, current post-traumatic symptoms and health status prior to the MVC. Blood samples are also collected in the ED using PAXgene DNA and PAXgene RNA tubes. Serial mixed-mode assessments 6 weeks, 6 months and 1 year after MVC include an assessment of adverse sequelae, general health status and health service utilisation. The results from this study will provide insights into the incidence and pathogenesis of persistent pain and other post-traumatic sequelae in African-Americans experiencing MVC.

ETHICS AND DISSEMINATION

AA CRASH has ethics approval in the USA, and the results will be published in a peer-reviewed journal.

Oxytocin and Social Sensitivity: Gene Polymorphisms in Relation to Depressive Symptoms and Suicidal Ideation

Although the neuropeptide oxytocin has been associated with enhanced prosocial behaviors, it has also been linked to aggression and mental health disorders. Thus, it was suggested that oxytocin might act by increasing the salience of social stimuli, irrespective of whether these are positive or negative, thus increasing vulnerability to negative mental health outcomes. The current study (N = 243), conducted among white university students, examined the relation of trauma, depressive symptoms including suicidal ideation in relation to a single nucleotide polymorphism (SNP) within the oxytocin receptor gene (OXTR), rs53576, and a SNP on the CD38 gene that controls oxytocin release, rs3796863. Individuals with the polymorphism on both alleles (AA genotype) of the CD38 SNP had previously been linked to elevated plasma oxytocin levels. Consistent with the social sensitivity perspective, however, in the current study, individuals carrying the AA genotype displayed elevated feelings of alienation from parents and peers as well as increased levels of suicidal ideation. Moreover, they tended to report elevated depressive symptoms compared to CC homozygotes. It was also observed that the CD38 genotype moderated the relation between trauma and suicidal ideation scores, such that high levels of trauma were associated with elevated suicidal ideation among all CD38 genotypes, but this relationship was stronger among individuals with the AA genotype. In contrast, there was no relationship between the OXTR SNP, rs53576, depression or suicidal ideation. These findings support a social sensitivity hypothesis of oxytocin, wherein the AA genotype of the CD38 SNP, which has been considered the "protective allele" was associated with increased sensitivity and susceptibility to disturbed social relations and suicidal ideation.

Risk and Protective Factors for Suicidal Ideation in African American Women With a History of Sexual Violence as a Minor

Compared with other ethnic groups, African Americans have the highest rate of childhood victimization. The literature is sparse with regard to suicidal ideation among African American women with a history of sexual violence as a minor. Using survey data, this study utilized logistic regression to investigate the roles of a risk factor, criminal justice involvement, and protective factors, ethnic identity, and spiritual well-being, in experiencing suicidal ideation. Findings suggest that criminal justice involvement and the interaction of ethnic identity and spiritual well-being are important factors in understanding which African American women may be at a greater risk of experiencing suicidal ideation.

A Pilot Psychometric Study on the Validation of the Older Women's Non-Medical Stress Scale (OWN-MSS) on an Ethnically Diverse Sample

INTRODUCTION

Older women often experience various types of stressors, including the death of a spouse and associated financial stress (often with a lack of social support), emotional stress due to factors such as caregiving and being single, and the challenges of the aging process. These circumstances could produce or aggravate anxious symptomatology that can in turn compound the negative effects of aging. A brief scale of perceived stress that is not confounded with health status and covers multiple culturally relevant potential stressors is needed for quick use in busy medical settings.

AIM

To assess the reliability and the validity of an original stress scale designed to measure perceptions of stress beyond health status in a non-clinical convenience sample of community-dwelling older women.

METHOD

In this cross-sectional pilot investigation, via conducting item-total correlations and correlational tests of validity, we studied the psychometric properties of our measure using data from volunteer older subjects (mainly low-income and from non-Caucasian backgrounds). The domains covered by the nine items of the tool were selected based on a literature review of common stressors experienced by older adults, especially by older women. Data were collected face-to-face using a demographic list, a well-established depression measure, a brief posttraumatic stress disorder (PTSD) screener, and our 9-item stress tool. Primary outcomes: reliability and validity of the scale of older women's non-medical stress. Secondary outcomes: demographic characteristics of the sample and correlations between stress items.

RESULTS

Based on our sample of older women (N=40, mean age 71 years), good internal consistency between the items of the stress scale was found (Cronbach's a=.66). The findings of the data analyses also revealed that our psychometric tool has good convergent validity with the PTSD screener (r=.53). Moreover, in contrast with most other stress tools, it has strong discriminant validity (r=.11) with a well-validated depression scale.

CONCLUSION

Our results suggest that this new measure is psychometrically strong. Future research directions encompass using larger samples, ideally including older men with the modification of the scale's name, as well as validating this tool against more measures. Clinical implications of our findings are briefly discussed.

Maladaptive trauma appraisals mediate the relation between attachment anxiety and PTSD symptom severity

OBJECTIVE

In a large sample of community-dwelling older adults with histories of exposure to a broad range of traumatic events, we examined the extent to which appraisals of traumatic events mediate the relations between insecure attachment styles and posttraumatic stress disorder (PTSD) symptom severity.

METHOD

Participants completed an assessment of adult attachment, in addition to measures of PTSD symptom severity, event centrality, event severity, and ratings of the A1 PTSD diagnostic criterion for the potentially traumatic life event that bothered them most at the time of the study.

RESULTS

Consistent with theoretical proposals and empirical studies indicating that individual differences in adult attachment systematically influence how individuals evaluate distressing events, individuals with higher attachment anxiety perceived their traumatic life events to be more central to their identity and more severe. Greater event centrality and event severity were each in turn related to higher PTSD symptom severity. In contrast, the relation between attachment avoidance and PTSD symptoms was not mediated by appraisals of event centrality or event severity. Furthermore, neither attachment anxiety nor attachment avoidance was related to participants' ratings of the A1 PTSD diagnostic criterion.

CONCLUSION

Our findings suggest that attachment anxiety contributes to greater PTSD symptom severity through heightened perceptions of traumatic events as central to identity and severe. (PsycINFO Database Record

Polygenic Risk for Externalizing Psychopathology and Executive Dysfunction in Trauma-Exposed Veterans

The frequent co-occurrence of antisocial behavior and other disinhibited phenotypes reflects a highly heritable externalizing spectrum. We examined the molecular genetic basis of this spectrum by testing polygenic associations with psychopathology symptoms, impulsive traits, and cognitive functions in two samples of primarily military veterans (n =537, n =194). We also investigated whether polygenic risk for externalizing moderated the effects of trauma on these phenotypes. As hypothesized, polygenic risk positively predicted externalizing psychopathology and negatively predicted performance on inhibitory control tasks. Gene-by-environment effects were also evident, with trauma exposure predicting greater impulsivity and less working memory capacity, but only at high levels of genetic liability. As expected, polygenic risk was not associated with internalizing psychopathology or episodic memory performance. This is the first independent replication of the polygenic score as a measure of genetic predispositions for externalizing and provides preliminary evidence that executive dysfunction is a heritable vulnerability for externalizing psychopathology.

Longitudinal Study of Mental Health and Pain-Related Functioning Following a Motor Vehicle Collision

OBJECTIVE

Relations between mental and physical health symptoms are well-established in the literature on recovery following motor vehicle collisions (MVCs). To understand the temporal sequencing and evolution of these relations, we examined the bidirectional association between mental and physical health symptoms at 4 and 16 weeks following a MVC.

METHODS

The sample consisted of 103 participants recruited through public MVC police reports. The study included self-report assessments for posttraumatic stress symptoms, depressive symptoms, bodily pain, and role limitations attributable to physical health. A series of multivariable linear regression analyses were conducted to estimate the associations between these mental and physical health outcomes.

RESULTS

The analysis revealed that mental health symptoms at 4 weeks post-MVC were associated with higher bodily pain at 16 weeks post-MVC (PTSD symptoms: β = -0.74, 95% CI: -1.06, -0.42; depressive symptoms: β = -1.34, 95% CI: -1.90, -0.78), but not higher health-related role limitations. Physical health symptoms at 4 weeks post-MVC were not associated with PTSD or depressive symptoms at 16 weeks post-MVC.

CONCLUSIONS

The results indicate the predictive strength of mental health symptoms at 4 weeks post-MVC in identifying individuals at risk for bodily pain at 16 weeks and shed light on the temporal sequencing of how relations between physical and mental health symptoms emerge over time. This suggests that early assessment of mental health symptoms may have significant implications for the treatment of these patients. (PsycINFO Database Record

Participant, rater, and computer measures of coherence in posttraumatic stress disorder

We examined the coherence of trauma memories in a trauma-exposed community sample of 30 adults with and 30 without posttraumatic stress disorder. The groups had similar categories of traumas and were matched on multiple factors that could affect the coherence of memories. We compared the transcribed oral trauma memories of participants with their most important and most positive memories. A comprehensive set of 28 measures of coherence including 3 ratings by the participants, 7 ratings by outside raters, and 18 computer-scored measures, provided a variety of approaches to defining and measuring coherence. A multivariate analysis of variance indicated differences in coherence among the trauma, important, and positive memories, but not between the diagnostic groups or their interaction with these memory types. Most differences were small in magnitude; in some cases, the trauma memories were more, rather than less, coherent than the control memories. Where differences existed, the results agreed with the existing literature, suggesting that factors other than the incoherence of trauma memories are most likely to be central to the maintenance of posttraumatic stress disorder and thus its treatment.

BDNF Methylation and Maternal Brain Activity in a Violence-Related Sample

It is known that increased circulating glucocorticoids in the wake of excessive, chronic, repetitive stress increases anxiety and impairs Brain-Derived Neurotrophic Factor (BDNF) signaling. Recent studies of BDNF gene methylation in relation to maternal care have linked high BDNF methylation levels in the blood of adults to lower quality of received maternal care measured via self-report. Yet the specific mechanisms by which these phenomena occur remain to be established. The present study examines the link between methylation of the BDNF gene promoter region and patterns of neural activity that are associated with maternal response to stressful versus non-stressful child stimuli within a sample that includes mothers with interpersonal violence-related PTSD (IPV-PTSD). 46 mothers underwent fMRI. The contrast of neural activity when watching children—including their own—was then correlated to BDNF methylation. Consistent with the existing literature, the present study found that maternal BDNF methylation was associated with higher levels of maternal anxiety and greater childhood exposure to domestic violence. fMRI results showed a positive correlation of BDNF methylation with maternal brain activity in the anterior cingulate (ACC), and ventromedial prefrontal cortex (vmPFC), regions generally credited with a regulatory function toward brain areas that are generating emotions. Furthermore we found a negative correlation of BDNF methylation with the activity of the right hippocampus. Since our stimuli focus on stressful parenting conditions, these data suggest that the correlation between vmPFC/ACC activity and BDNF methylation may be linked to mothers who are at a disadvantage with respect to emotion regulation when facing stressful parenting situations. Overall, this study provides evidence that epigenetic signatures of stress-related genes can be linked to functional brain regions regulating parenting stress, thus advancing our understanding of mothers at risk for stress-related psychopathology.

Assessing post-traumatic stress symptoms in a Latino prison population

PURPOSE

The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates.

DESIGN/METHODOLOGY/APPROACH

Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression. The reliability, factor structure, and convergent validity of the DTS-S were assessed. Cross-validation was employed to confirm the results of the factor analyses.

FINDINGS

Using the cut-offs adopted by the scale's author, 136 (13.4 percent) of the inmates are likely to have current PTSD and 117 (11.6 percent) reach the cut-off for sub-threshold PTSD. Confirmatory factor analysis generated two factors explaining 53 percent of the variance. High reliabilities were obtained for the total scale (α=0.95) and for the frequency and severity scales (α=0.90 and 0.91). Significantly higher DTS-S scores were found for females (t=2.26, p<0.025), for inmates diagnosed with depression or anxiety (t=2.02, p<0.05), and those reporting suicide attempts (t=4.47, p<0.0001).

ORIGINALITY/VALUE

Findings support that the DTS-S is a reliable and valid measure to assess PTSD symptoms in Latino inmate populations and to identify individuals at risk for the disorder that require confirmatory diagnosis and clinical interventions.

Latent Factor Structure of DSM-5 Posttraumatic Stress Disorder

The current study examined the latent factor structure of posttraumatic stress disorder (PTSD) based on DSM-5 criteria in a sample of participants (N = 374) recruited for studies on trauma and health. Confirmatory factor analyses (CFA) were used to compare the fit of the previous 3-factor DSM-IV model of PTSD to the 4-factor model specified in DSM-5 as well as to a competing 4-factor "dysphoria" model (Simms, Watson, & Doebbeling, 2002) and a 5-factor (Elhai et al., 2011) model of PTSD. Results indicated that the Elhai 5-factor model (re-experiencing, active avoidance, emotional numbing, dysphoric arousal, anxious arousal) provided the best fit to the data, although substantial support was demonstrated for the DSM-5 4-factor model. Low factor loadings were noted for two of the symptoms in the DSM-5 model (psychogenic amnesia and reckless/self-destructive behavior), which raises questions regarding the adequacy of fit of these symptoms with other core features of the disorder. Overall, the findings from the present research suggest the DSM-5 model of PTSD is a significant improvement over the previous DSM-IV model of PTSD.

Accounting for Posttraumatic Stress Disorder Symptom Severity With Pre- and Posttrauma Measures: A Longitudinal Study of Older Adults

Using data from a longitudinal study of community-dwelling older adults, we analyzed the most extensive set of known correlates of PTSD symptoms obtained from a single sample to examine the measures' independent and combined utility in accounting for PTSD symptom severity. Fifteen measures identified as PTSD risk factors in published meta-analyses and 12 theoretically and empirically supported individual difference and health-related measures were included. Individual difference measures assessed after the trauma, including insecure attachment and factors related to the current trauma memory, such as self-rated severity, event centrality, frequency of involuntary recall, and physical reactions to the memory, accounted for symptom severity better than measures of pre-trauma factors. In an analysis restricted to prospective measures assessed before the trauma, the total variance explained decreased from 56% to 16%. Results support a model of PTSD in which characteristics of the current trauma memory promote the development and maintenance of PTSD symptoms.

A biological measure of stress levels in patients with functional movement disorders

INTRODUCTION

While the presence of co-existing psychological stressors has historically been used as a supportive factor in the diagnosis of functional neurological disorders, many patients with functional neurological disorders deny the presence of these stressors. The stress response circuitry in these patients remains largely unexplored.

METHODS

We performed an observational study examining biological stress levels in patients with functional movement disorders as compared with matched healthy controls. Specifically, we compared levels of circulating cortisol, the end-product of the hypothalamic-pituitary-adrenal axis. Salivary cortisol samples were collected from patients with "clinically definite" functional movement disorders (n = 33) and their age- and sex-matched controls (n = 33). Collections were performed at five standardized time points, reflecting participants' diurnal cortisol cycles. To rule out confounders, participants also underwent extensive psychological assessment including Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Hamilton Anxiety Rating Scale, and Hamilton Rating Scale for Depression.

RESULTS

Patients with functional movement disorders did not differ from matched controls with respect to levels of circulating cortisol.

CONCLUSION

We demonstrate that current stress levels are not altered in patients with functional movement disorders. Our results warrant careful review of current management of patients with functional neurological symptoms, and suggest that the insistence on heightened stress levels in these patients is unjustified.

Self-reported physical health associations of traumatic events in medical and dental outpatients: a cross-sectional study

The purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample.Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center.Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care.Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.

The relative impact of socioeconomic status and childhood trauma on Black-White differences in paranoid personality disorder symptoms

The current study examines mechanisms of racial differences in symptoms of paranoid personality disorder (PPD) in a sample of adults ages 55-64 from the St. Louis, MO area. Socioeconomic status (SES) and childhood trauma were tested as intervening variables in the association between race and PPD symptoms using structural equation modeling. PPD symptoms were modeled as a latent variable composed of items from the PPD scales of the Multi-Source Assessment of Personality Pathology self and informant reports and the Structured Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Personality. Childhood trauma was measured using the Traumatic Life Events Questionnaire, and SES was a composite of parent education, participant education, and annual household income. Blacks exhibited higher levels of PPD symptoms across the 3 personality measures, reported significantly lower SES, and reported greater childhood trauma. The proposed model was a good fit to the data, and the effect of race on PPD symptoms operated mainly through SES. The indirect effect through SES was stronger for males. Findings suggest that racial differences in PPD symptoms are partly explained by problems more commonly experienced by Black individuals.

An examination of the association between 5-HTTLPR, combat exposure, and PTSD diagnosis among U.S. veterans

Objective

To examine the association between the 5-HTTLPR polymorphism of the serotonin transporter (SLC6A4) gene, combat exposure, and posttraumatic stress disorder (PTSD) diagnosis and among two samples of combat-exposed veterans.

Method

The first sample included 550 non-Hispanic Black (NHB) combat-exposed veterans. The second sample included 555 non-Hispanic White (NHW) combat-exposed veterans. Participants were genotyped for the 5-HTTLPR/rs25531 variants of the SLC6A4 gene. A structured clinical interview was used to diagnose PTSD. Combat and civilian trauma exposure were assessed with validated self-report instruments. Logistic regression was used to test for main effects of 5-HTTLPR on PTSD diagnosis as well as gene x environment (GxE) interactions after adjusting for sex, ancestry proportion scores, civilian trauma exposure, and combat exposure.

Results

Within the NHB sample, a significant additive effect was observed for 5-HTTLPR (OR = 1.502, p = .0025), such that the odds of having a current diagnosis of PTSD increased by 1.502 for each additional S’ allele. No evidence for an association between 5-HTTLPR and PTSD was observed in the NHW sample. In addition, no evidence for combat x 5-HTTLPR effects were observed in either sample.

Conclusion

The present study suggests that there may be an association between 5-HTTLPR genotype and PTSD diagnosis among NHB veterans; however, no evidence for the hypothesized 5-HTTLPR x combat interaction was found.

Free, brief, and validated: Standardized instruments for low-resource mental health settings

Evidence-based assessment has received little attention despite its critical importance to the evidence-based practice movement. Given the limited resources in the public sector, it is necessary for evidence-based assessment to utilize tools with established reliability and validity metrics that are free, easily accessible, and brief. We review tools that meet these criteria for youth and adult mental health for the most prevalent mental health disorders to provide a clinical guide and reference for the selection of assessment tools for public sector settings. We also discuss recommendations for how to move forward the evidence-based assessment agenda.

Comparative effectiveness of cognitive and dynamic therapies for major depressive disorder in a community mental health setting: study protocol for a randomized non-inferiority trial

BACKGROUND

There is substantial evidence that cognitive therapy is an effective intervention for the treatment of major depressive disorder. Although dynamic psychotherapies have been widely studied and are commonly practiced worldwide, there are few randomized comparisons of cognitive therapy and dynamic therapy for major depressive disorder.

METHODS

We are completing data collection on a randomized non-inferiority trial comparing the effectiveness of cognitive therapy and short-term dynamic psychotherapy in the treatment of major depressive disorder in the community mental health setting. Therapists employed in the community setting have been recruited for training in either short-term dynamic psychotherapy or cognitive therapy. Patients seeking services at the community site who meet criteria for major depressive disorder based on a blind independent diagnostic interview are randomized to 16 sessions of treatment. All patients are assessed at baseline and months 1, 2, 4, and 5 utilizing a comprehensive battery.

DISCUSSION

This study adds to the growing literature evaluating the effectiveness of short-term dynamic psychotherapy for specific diagnostic groups. These results will have implications for the dissemination of effective interventions for major depressive disorder in community mental health settings.

TRIAL REGISTRATION

This trial is registered at ClinicalTrials.gov, a service of the United States National Institute of Health. NIH Identifier: NCT01207271. Registered 21 September 2010.

A controlled examination of two coping skills for daily alcohol use and PTSD symptom severity among dually diagnosed individuals

Investigations of targeted coping skills could help guide initial treatment decisions for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who often endorse worse coping skills than those with AD but not PTSD. Although improvement in coping skills is associated with enhanced alcohol use outcomes, no study has evaluated the utility of teaching specific coping skills in the context of comorbid PTSD/AD. We compared the effects of teaching two coping skills (cognitive restructuring [CR] and experiential acceptance [EA]) or an attention control condition on drinking and PTSD symptoms among 78 men and women with comorbid PTSD/AD during a 5-week daily follow-up assessment. Both CR and EA skills were associated with decreased drinking compared to control, and that change in drinking over time did not significantly differ between those who received CR and EA. Individuals who received CR skills, however, consumed less alcohol on a given day than those who received EA skills. Neither CR nor EA was associated with a decrease in PTSD symptom severity. These results provide preliminary support for clinicians to prioritize CR and EA skills during initial treatment sessions when working with individuals with PTSD/AD, and offer ideas for continued investigation and intervention refinement.

Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition

OBJECTIVE

This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives.

METHODS

This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar.

RESULTS

Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control group (effect size=.69, p<.05), reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up. Benefits counseling was associated with increased use of mental health services, but this correlation did not mediate the effect of benefits counseling on working.

CONCLUSIONS

Barriers to employment associated with disability payments are remediable with basic counseling. More research is needed to understand the active ingredient of this counseling and to strengthen the intervention.

Coping, PTSD symptoms, and alcohol involvement in trauma-exposed college students in the first three years of college

The objective of the present study was to examine prospective, bidirectional associations among posttraumatic stress disorder (PTSD) symptoms, coping style, and alcohol involvement (use, consequences) in a sample of trauma-exposed students just entering college. We also sought to test the mechanistic role that coping may play in associations between PTSD symptoms and problem alcohol involvement over time. Participants (N = 734) completed measures of trauma exposure, PTSD symptoms, coping, and alcohol use and consequences in September of their first college year and again each September for the next 2 years. We observed reciprocal associations between PTSD and negative coping strategies. In our examination of a mediated pathway through coping, we found an indirect association from alcohol consequences and PTSD symptoms via negative coping, suggesting that alcohol consequences may exacerbate posttraumatic stress over time by promoting negative coping strategies. Trauma characteristics such as type (interpersonal vs. noninterpersonal) and trauma reexposure did not moderate these pathways. Models were also invariant across gender. Findings from the present study point to risk that is conferred by both PTSD and alcohol consequences for using negative coping approaches, and through this, for posttraumatic stress. Interventions designed to decrease negative coping may help to offset this risk, leading to more positive outcomes for those students who enter college with trauma exposure.

Pretraumatic Stress Reactions in Soldiers Deployed to Afghanistan

Posttraumatic Stress Disorder is a diagnosis related to the past. Pre-traumatic stress reactions, as measured by intrusive involuntary images of possible future stressful events and their associated avoidance and increased arousal, have been overlooked in the PTSD literature. Here we introduce a scale that measures pre-traumatic stress reactions providing a clear future-oriented parallel to the posttraumatic stress reactions described in the diagnostic criteria for PTSD. We apply this pre-traumatic stress reactions checklist (PreCL) to Danish soldiers before, during, and after deployment to Afghanistan. The PreCL has good internal consistency and is highly correlated with a standard measure of PTSD symptoms. The PreCL as answered before the soldiers' deployment significantly predicted level of PTSD symptoms during and after their deployment, while controlling for baseline PTSD symptoms and combat exposure measured during and after deployment. The findings have implications for the conceptualization of PTSD, screening, and treatment.

The relation between insecure attachment and posttraumatic stress: Early life versus adulthood traumas

The present study examined the relations between insecure attachment and posttraumatic stress disorder (PTSD) symptoms among community-dwelling older adults with exposure to a broad range of traumatic events. Attachment anxiety and attachment avoidance predicted more severe symptoms of PTSD and explained unique variance in symptom severity when compared to other individual difference measures associated with an elevated risk of PTSD, including NEO neuroticism and event centrality. A significant interaction between the developmental timing of the trauma and attachment anxiety revealed that the relation between PTSD symptoms and attachment anxiety was stronger for individuals with current PTSD symptoms associated with early life traumas compared to individuals with PTSD symptoms linked to adulthood traumas. Analyses examining factors that account for the relation between insecure attachment and PTSD symptoms indicated that individuals with greater attachment anxiety reported stronger physical reactions to memories of their trauma and more frequent voluntary and involuntary rehearsal of their trauma memories. These phenomenological properties of trauma memories were in turn associated with greater PTSD symptom severity. Among older adults with early life traumas, only the frequency of involuntary recall partially accounted for the relation between attachment anxiety and PTSD symptoms. Our differential findings concerning early life versus adulthood trauma suggest that factors underlying the relation between attachment anxiety and PTSD symptoms vary according to the developmental timing of the traumatic exposure. Overall our results are consistent with attachment theory and with theoretical models of PTSD according to which PTSD symptoms are promoted by phenomenological properties of trauma memories.

Reciprocal associations between PTSD symptoms and alcohol involvement in college: a three-year trait-state-error analysis

Bidirectional associations between posttraumatic stress disorder (PTSD) symptoms and alcohol involvement have been theorized, but have not been tested empirically. In this study, we examined these relations at the transition into and over the first 3 years of college by using an analytic approach (Trait-State-Error Modeling [TSE]; Kenny & Zautra, 1995) that allowed us to examine prospective, reciprocal associations among these constructs while accounting for intraindividual stability. Young adults (N = 486) were recruited at matriculation into college and assessed by Web survey in September of the first college year (T1) and 11 additional time points over 3 years. Findings showed evidence of prospective associations from alcohol involvement (both use and problems) to PTSD symptoms over the 3-year assessment period. We also observed prospective relations from PTSD symptoms to alcohol involvement over time. Patterns of covariation in trait vulnerability for alcohol involvement and PTSD symptoms differed from crossed-lagged associations among state-like variance in these constructs. Results suggest that PTSD symptoms and alcohol involvement each predict the other over the course of college. Findings also highlight the importance of considering both time-varying and stable sources of variation in these associations.

Interstitial Cystitis - Elucidation of Psychophysiologic and Autonomic Characteristics (the ICEPAC Study): design and methods

BACKGROUND AND PURPOSE

Interstitial cystitis/bladder pain syndrome (IC/BPS) is relatively common and associated with severe pain, yet effective treatment remains elusive. Research typically emphasized the bladder's role, but given the high presence of systemic comorbidities, the authors hypothesized a pathophysiologic nervous system role. This paper reports the methodology and approach to study the nervous system in women with IC/BPS. The study compares neurologic, urologic, gynecologic, autonomic, gastrointestinal, and psychological features of women with IC/BPS, their female relatives, women with myofascial pelvic pain (MPP), and healthy controls to elucidate the role of central and peripheral processing.

METHODS AND RESULTS

In total, 228 women (76 IC/BPS, 76 MPP, 38 family members, and 38 healthy controls) will be recruited. Subjects undergo detailed screening, structured neurologic examination of limbs and pelvis, tender point examination, autonomic testing, electrogastrography, and assessment of comorbid functional dysautonomias. Interpreters are blinded to subject classification. Psychological and stress response characteristics are examined with assessments of stress, trauma history, general psychological function, and stress response quantification. As of December 2012, data collection is completed for 25 healthy controls, 33 IC/BPS ± MPP, eight MPP, and three family members. Recruitment rate is accelerating and strategies emphasize maintaining and encouraging investigator participation in study science, internet advertising, and presentations to pelvic pain support groups.

CONCLUSION

The study represents a comprehensive, interdisciplinary approach to sampling autonomic and psychophysiologic characteristics of women with IC/BPS. Despite divergent opinions on study methodologies based on specialty experiences, the study has proven feasible to date and different perspectives have proved to be one of the greatest study strengths.

Posttraumatic stress symptoms and alcohol problems: self-medication or trait vulnerability?

BACKGROUND AND OBJECTIVES

Posttraumatic stress symptoms (PTSD) and problem alcohol use (ALC) commonly co-occur, but the nature of this co-occurrence is unclear. Self-medication explanations have been forwarded, yet traits such as tendency toward negative emotionality and behavioral disconstraint also have been implicated. In this study we test three competing models (Self-Medication, Trait Vulnerability, Combined Dual Pathway) of PTSD-ALC prospectively in a college sample.

METHOD

Participants (N=659; 73% female, M age=18) provided data at college matriculation (Time 1) and 1 year later (Time 2).

RESULTS

Structural equation models showed disconstraint to meditate the path from PTSD symptoms to alcohol problems, supporting a trait vulnerability conceptualization. Findings regarding negative emotionality and self-medication were more mixed. Negative emotionality played a stronger role in cross-sectional than in prospective analyses, suggesting the importance of temporal proximity.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Self-regulation skills may be an important focus for clinicians treating PTSD symptoms and alcohol misuse disorders concurrently.

Epigenetic analysis of neurocognitive development at 1 year of age in a community-based pregnancy cohort

Multiple studies show that molecular genetic changes and epigenetic modifications affect the risk of cognitive disability or impairment. However, the role of epigenetic variation in cognitive development of neurotypical young children remains largely unknown. Using data from a prospective, community-based study of mother-infant pairs, we investigated the association of DNA methylation patterns in neonatal umbilical cord blood with cognitive and language development at 1 year of age. No CpG loci achieved genome-wide significance, although a small number of weakly suggestive associations with Bayley-III Receptive Communication scales were noted. While umbilical cord blood is a convenient resource for genetic analyses of birth outcomes, our results do not provide conclusive evidence that its use for DNA methylation profiling yields epigenetic markers that are directly related to postnatal neurocognitive outcomes at 1 year of age.

Anxiety Sensitivity as a Moderator of the Association Between Premenstrual Symptoms and Posttraumatic Stress Disorder Symptom Severity

Experience of premenstrual symptoms may be an important factor involved in understanding posttraumatic stress disorder (PTSD) symptom vulnerability. Correlations between PTSD and premenstrual dysphoric disorder (PMDD) have been identified in epidemiological studies, however, the nature of this relation is not clear. The current study examined the incremental validity of premenstrual symptoms, as well as their interaction with anxiety sensitivity, in the prediction of PTSD symptom severity above and beyond other theoretically relevant covariates. A community sample of trauma-exposed women (N = 63) completed questionnaires assessing premenstrual symptoms, anxiety sensitivity, and neuroticism and were administered the Clinician-Administered PTSD Scale to assess PTSD symptom severity. A series of hierarchical linear regressions revealed that premenstrual symptoms uniquely predicted PTSD total, reexperiencing, avoidance, and hyperarousal symptoms above and beyond other theoretically relevant covariates (i.e., number of potentially traumatic events, neuroticism, panic attack history, and anxiety sensitivity). Additionally, anxiety sensitivity emerged as a moderator of the association between premenstrual symptoms and PTSD symptom severity such that greater premenstrual symptoms were associated with greater PTSD total, reexperiencing, and numbing symptom severity for individuals high, but not low, in anxiety sensitivity. Experience of premenstrual symptoms may be an important sex-specific mechanism involved in increasing vulnerability for PTSD symptoms, particularly among women high in anxiety sensitivity.

The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state

This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.

Reduced Specificity in Episodic Future Thinking in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD), one of the most common disorders following trauma, has been associated with a tendency to remember past personal memories in a nonspecific, overgeneral way. The present study investigated whether such a bias also applies to projections of future personal events. Trauma survivors (N = 50) generated brief descriptions of imagined future experiences in response to positive and negative cues in a future-based Autobiographical Memory Test. Survivors with PTSD imagined fewer specific future events in response to positive, but not to negative, cues, compared to those without PTSD. This effect was independent of comorbid major depression. Reduced memory specificity in response to positive cues was related to appraisals of foreshortened future and permanent change. Training to enhance specificity of future projections may be helpful in PTSD and protect against potentially toxic effects of autobiographical memory overgenerality.

Sexual victimization, health status, and VA healthcare utilization among lesbian and bisexual OEF/OIF veterans

BACKGROUND

Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA.

OBJECTIVE

The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving.

DESIGN

Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities.

PARTICIPANTS

Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %).

MAIN MEASURES

Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction.

KEY RESULTS

LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001).

CONCLUSIONS

Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

Changes in neuroticism following trauma exposure

Using longitudinal data, the present study examined change in midlife neuroticism following trauma exposure. Our primary analyses included 670 participants (M(age) = 60.55; 65.22% male, 99.70% Caucasian) who completed the NEO Personality Inventory at ages 42 and 50 and reported their lifetime exposure to traumatic events approximately 10 years later. No differences in pre- and post-trauma neuroticism scores were found among individuals who experienced all of their lifetime traumas in the interval between the personality assessments. Results were instead consistent with normative age-related declines in neuroticism throughout adulthood. Furthermore, longitudinal changes in neuroticism scores did not differ between individuals with and without histories of midlife trauma exposure. Examination of change in neuroticism following life-threatening traumas yielded a comparable pattern of results. Analysis of facet-level scores largely replicated findings from the domain scores. Overall, our findings suggest that neuroticism does not reliably change following exposure to traumatic events in middle adulthood. Supplemental analyses indicated that individuals exposed to life-threatening traumas in childhood or adolescence reported higher midlife neuroticism than individuals who experienced severe traumas in adulthood. Life-threatening traumatic events encountered early in life may have a more pronounced impact on adulthood personality than recent traumatic events.

Measuring the Severity of Negative and Traumatic Events

We devised three measures of the general severity of events, which raters applied to participants' narrative descriptions: 1) placing events on a standard normed scale of stressful events, 2) placing events into five bins based on their severity relative to all other events in the sample, and 3) an average of ratings of the events' effects on six distinct areas of the participants' lives. Protocols of negative events were obtained from two non-diagnosed undergraduate samples (n = 688 and 328), a clinically diagnosed undergraduate sample all of whom had traumas and half of whom met PTSD criteria (n = 30), and a clinically diagnosed community sample who met PTSD criteria (n = 75). The three measures of severity correlated highly in all four samples but failed to correlate with PTSD symptom severity in any sample. Theoretical implications for the role of trauma severity in PTSD are discussed.

Posttraumatic stress disorder and partner-specific social cognition: a pilot study of sex differences in the impact of arginine vasopressin

Posttraumatic stress disorder (PTSD) is associated with problems in intimate relationships, partly due to deficits in social cognition. In this study, the role of arginine vasopressin (AVP) in the link between PTSD and partner-specific social cognition was examined. Participants were 24 individuals from 12 heterosexual couples in which at least one partner exhibited clinically significant PTSD symptoms. Attention to partner expressions of anger was examined as an indicator of distress and need for affiliative behaviors to repair the relationship bond. AVP administration improved the speed of men's attentional engagement with their partners' expressions of anger and alleviated the negative impact of PTSD on this social cognitive process. Further, men's morning urinary AVP levels were negatively correlated with their PTSD severity. No such effects were found among women or for attention to unfamiliar men's or women's anger expressions. Thus, the AVP system may function in the relationship problems associated with PTSD.

Exploration of the influence of childhood trauma, combat exposure, and the resilience construct on depression and suicidal ideation among U.S. Iraq/Afghanistan era military personnel and veterans

This study evaluated the effect of childhood trauma exposure and the role of resilience on both depressive symptoms and suicidal ideation. The study evaluated 1,488 military personnel and veterans, who served after September 2001, for depressive, suicidal, and PTSD symptoms, combat exposure, childhood trauma exposure, and resiliency. Participants were enrolled as part of an ongoing multicenter study. Outcome measures were depressive symptoms and suicidal ideation. After controlling for the effects of combat exposure and PTSD, results revealed that childhood trauma exposures were significantly associated with depressive symptoms and suicidal ideation. In addition, resilience was negatively associated with depressive symptoms and suicidal ideation, suggesting a potential protective effect. These findings suggest that evaluation of childhood trauma is important in the clinical assessment and treatment of depressive symptoms and suicidal ideation among military personnel and veterans.

How Disorder-Specific are Depressive Attributions? A Comparison of Individuals with Depression, Post-Traumatic Stress Disorder and Healthy Controls

Depressed individuals tend to assign internal, stable, and global causes to negative events. The present study investigated the specificity of this effect to depression and compared depressive attributional styles of individuals with major depression (MD), post-traumatic stress disorder (PTSD), and healthy controls. We indexed attributional style using the depressive attributions questionnaire in 164 participants. Additionally, we assessed appraisals characteristic of PTSD using the post-traumatic cognitions inventory (PTCI), depressive rumination, trauma history, and depression and PTSD symptom severity. Individuals with MD endorsed a depressive attributional style to a greater extent than both individuals with PTSD, who were not depressed, and healthy controls. Depressive attributional style was associated with the severity of depressive and PTSD symptoms, number and distress of traumatic experiences, frequency of rumination, and post-traumatic cognitions. Depressive attributions and PTCI appraisals independently predicted MD and PTSD symptom severity. They may thus be useful in predicting MD and PTSD, and should be targeted in psychological treatments of these conditions.

Investigating Cognitive Pathways to Psychopathology: Predicting Depression and Posttraumatic Stress Disorder From Early Responses After Assault

Depression and posttraumatic stress disorder (PTSD) are common after trauma, but it remains unclear what factors determine which disorder a trauma survivor will develop. A prospective longitudinal study of 222 assault survivors assessed candidate predictors derived from cognitive models of depression and PTSD at 2 weeks posttrauma (N = 222), and depression and PTSD symptom severities (N = 183, 82%) and diagnoses at 6 months (N = 205, 92%). Structural equation modeling showed that the depression and PTSD models predicted both depression and PTSD symptom severity, but that the disorder-specific models predicted the respective outcome best (43% for depression, 59% for PTSD symptom severity). Maintaining cognitive variables (hopelessness and self-devaluative thoughts in depression; cognitive responses to intrusive memories and persistent dissociation in PTSD) showed the clearest specific relationships with outcome. Model-derived variables predicted depression and PTSD diagnoses at 6 months over and above what could be predicted from initial diagnoses. Results support the role of cognitive factors in the development of depression and PTSD after trauma, and provide preliminary evidence for some specificity in maintaining cognitive mechanisms.

Use of fidelity assessments to train clinicians in the CBT for PTSD program for clients with serious mental illness

OBJECTIVE

One barrier to disseminating evidence-based practices for persons with serious mental illness is the difficulty of training frontline clinicians. This study evaluated whether frontline clinicians could be trained to implement an empirically supported cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) among persons with serious mental illness when a standardized fidelity measure was used to provide clinicians with feedback on practice cases.

METHODS

Twenty-five clinicians (23 master's level) at five agency sites were trained in the CBT for PTSD program and delivered it to 35 clients (practice cases) over six months. Supervisors or consultants used the fidelity measure to rate audio-recorded sessions and provide feedback. A criterion of competence was established to designate program certification. Clients' PTSD and depression symptoms were monitored. Clinicians' satisfaction with training was also assessed.

RESULTS

Two clinicians dropped out, and 21 of the remaining 23 clinicians (91%) achieved program certification with their first case; the remaining two (9%) achieved it with their second case. Clients' symptoms, measured by the PTSD Checklist and the Beck Depression Inventory, decreased significantly during treatment, suggesting clinical benefits of the program. Clinicians reported that group supervision was very helpful and written feedback was helpful or very helpful. All rated the training as excellent.

CONCLUSIONS

Results support the feasibility of training frontline clinicians in the CBT for PTSD program by using regular feedback based on the fidelity measure and indicate that most clinicians can achieve competence in the model with a single practice case.

Traumatic event re-exposure in injecting drug users

Drug users have very high rates of lifetime exposure to traumatic events, leading to significant psychiatric complications. In spite of the high rate of lifetime exposure, very little is known about the rate of ongoing re-exposure to new traumatic events in drug users. We investigated the rate of traumatic event re-exposure in male and female injecting drug users using syringe exchange services in Baltimore (N = 197). Participants were assessed monthly for traumatic event re-exposure for 16 months. Averaged over the entire follow-up period, 27% of participants were re-exposed to a traumatic event each month and 72% were re-exposed over the 16-month study period. Women were over twice as likely to report any traumatic event re-exposure as men (adjusted odds ratio [AOR] = 2.48; 95% CI = 1.54-3.99), with the specific events of life-threatening illness, death of a loved one, and injury or illness of a loved one being more common in women than men. Traumatic event re-exposure occurs far more often than previously reported, with women injecting drug users at the highest risk. Reassessment of traumatic events may help to identify people most in need and encourage entry into treatment.