Posttraumatic Stress and Alcohol Use Among Hispanic/Latinx University Students: A Moderated Indirect Effect Model of Coping-Related Drinking and Anxiety Sensitivity

Objective: Posttraumatic stress symptoms (PTSS) and anxiety sensitivity (AS) are associated with increased alcohol use and coping-motivated drinking among university students. This study among trauma-exposed Hispanic/Latinx university students sought to examine the indirect effect of PTSS on alcohol use severity through coping-motivated drinking and test the moderating role of AS and AS subfacets. Methods: University students who identified as Hispanic/Latinx (N = 830) were recruited from a large, urban, southern university and completed online, self-report questionnaires. Results: A significant interactive effect of PTSS and AS on coping-motivated drinking emerged. PTSS exerted a significant indirect effect on alcohol use severity, through coping-motivated drinking. Simple slope analyses revealed that PTSS was associated with coping-motivated drinking across all levels of AS. Post hoc results revealed unique biological sex differences in probable diagnosis odds ratios. Conclusions: These findings indicate that PTSS and AS are associated with coping-motivated drinking and alcohol use severity in trauma-exposed, Hispanic/Latinx university students.

The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC)

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms and alcohol use commonly co-occur and present a prevalent clinical comorbidity. The self-medication/coping model has been applied most consistently to understand the PTSD-alcohol use association. However, there is a relative paucity of self-report measures designed to assess motivations for alcohol use, specifically for coping with PTSD symptoms. The goals of the present study were to develop and validate a measure that assesses the use of alcohol to cope with specific facets of PTSD symptomatology across two independent samples.

METHOD

Two samples were evaluated: a university-based sample (N = 617; 77.0% women; Mage = 22.3; SD = 5.20) composed of racially diverse trauma-exposed students and a nationally representative sample (N = 510; 52.5% women; Mage = 39.5; SD = 10.9) of trauma-exposed adults who endorsed PTSD symptoms and past-year hazardous drinking. Both samples completed identical online questionnaire batteries. A Trauma-Related Alcohol Use Coping (TRAC) measure was developed and validated across both samples.

RESULTS

Confirmatory factor analysis was used to support the latent, hierarchical structure of the TRAC measure (total score; coping with intrusion, avoidance, negative alterations in cognitions and mood, and arousal/reactivity symptoms) and supported an 18-item version of the TRAC measure (university-based sample [N = 617]: RMSEA = 0.047, 90% CI [.04, .05]; SRMR = 0.043; CFI = 0.95; TLI = 0.95; nationally representative sample [N = 510]: RMSEA = 0.045, 90% CI [.04, .05]; SRMR = 0.021; CFI = 0.98; TLI = 0.97). The TRAC measure demonstrated excellent internal consistency, convergent, and discriminant validity with well-established measures of mental health, known-groups validity, and incremental validity relative to non-PTSD coping-motivated drinking.

CONCLUSIONS

Overall, the TRAC measure can be used to assess the extent to which alcohol use is related to coping with PTSD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PTSD Symptom Severity and Alcohol Use among Firefighters: The Role of Emotion Regulation Difficulties

OBJECTIVE

Heightened rates of posttraumatic stress disorder (PTSD) symptoms and alcohol use have been documented among firefighters. Emotion regulation difficulties (ERD) are clinically relevant to both PTSD and alcohol use. Few studies have examined the role of ERD in the association of PTSD symptoms with alcohol use severity and alcohol use motives among firefighters. Thus, the present investigation examined the indirect effect of PTSD symptom severity on alcohol use severity and alcohol use motives through ERD.

METHODS

The sample was comprised of 685 firefighters (Mage = 38.65, SD = 8.57, 93.6% male) recruited from an urban fire department in the southern U.S. to complete an online survey. Indirect effects were calculated using 10,000 bootstrapped samples. Effects were examined after accounting for years of fire service, occupational stress, trauma load (i.e., number of traumatic event types experienced); in models evaluating alcohol use motives as outcomes, other alcohol use motives (i.e., alternate motives subscales) were included as additional covariates.

RESULTS

First, ERD explained the association of PTSD symptom severity with alcohol use coping motives (β = .01, SE = .003, 95% CI [.004-.01]). Furthermore, ERD did not significantly account for the association of PTSD symptom severity with alcohol use severity (β = .02, SE = .01, 95% CI [-.004-.04]), alcohol use enhancement motives (β = -.003, SE = .002, 95%CI [-.007-.000]), alcohol use social motives (β = .004, SE = .002, 95% CI [-.000-.01]), or alcohol use conformity motives (β = -.002, SE = .002, 95% CI [-.006-.02]).

CONCLUSIONS

Results demonstrated that, among firefighters, PTSD symptom severity is positively related to alcohol use coping motives through heightened ERD. Clinical implications and future directions are discussed.

Distress overtolerance among firefighters: Associations with posttraumatic stress

OBJECTIVE

Firefighters experience heightened rates of posttraumatic stress disorder (PTSD) symptoms compared to the general population. Nascent literature has identified distress overtolerance (DO; i.e., the tendency to persist through extremely high levels of distress despite harmful consequences) as a construct of potential relevance to PTSD symptomatology, though empirical research is lacking. The present study examined incremental associations between DO subscales (Capacity for Harm: persevering through distress despite its effect on 1's wellbeing; Fear of Negative Evaluation: persisting through distress due to a fear of being negatively evaluated by others should they quit) and PTSD symptom severity and symptom cluster severity (i.e., intrusion, avoidance, negative alterations in cognitions and mood [NACM], arousal and reactivity) among firefighters.

METHOD

Participants included 282 trauma-exposed firefighters (91.8% male, Mage = 40.4, SD = 9.6). Covariates included years in the fire service, trauma load (i.e., number of trauma exposure types), and negative affect.

RESULTS

Results indicated that Capacity for Harm was a significant incremental correlate of total PTSD symptom severity (ΔR² = .045, p = .004), NACM symptoms (ΔR² = .061, p < .001), and arousal/reactivity symptoms (ΔR² = .047, p = .005). Fear of Negative Evaluation was not significantly related to any criterion variables.

CONCLUSION

Further work examining DO-PTSD relations is necessary to inform intervention and policy for the fire service. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Firearm ownership and storage practices among United States firefighters and emergency medical services personnel

Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and storage practices among U.S. FF + EMS personnel. A total of 141 U.S. FF + EMS personnel completed a structured, web-based self-report questionnaire. Overall, 76.6% (n = 108) of FF + EMS personnel in our sample reported owning a personal firearm, among whom 85.2% (n = 92) reported owning more than one firearm. Among firearm owners, 42.6% (n = 46) reported secure firearm storage (i.e., unloaded and locked) and 57.4% (n = 62) reported nonsecure firearm storage (i.e., loaded and/or unlocked). FF + EMS personnel who cited personal safety as the only reason for firearm ownership, as opposed to reporting other or multiple reasons for ownership (e.g., hunting), were at increased odds of reporting nonsecure storage practices (69.4% vs. 47.5%; OR = 2.51, 95% CI [1.14, 5.55], p = .023). Most FF + EMS personnel in our sample reported firearm ownership, and approximately half of the firearm owners reported nonsecure firearm storage practices. Promoting secure firearm storage practices among FF + EMS personnel might decrease risk of firearm suicide and other forms of firearm-related injuries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluation of an integrated personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity and PTSD symptoms: Protocol for a randomized controlled trial

Background

Hazardous drinking and posttraumatic stress disorder (PTSD) are commonly co-occurring conditions among adults. Motivational enhancement interventions, such as personalized feedback interventions (PFI), have demonstrated efficacy for reducing hazardous drinking. Emerging though scant literature has evaluated PFI for co-occurring PTSD and hazardous alcohol use. A transdiagnostic risk factor that may underlie this co-occurrence and inform novel PFI development is anxiety sensitivity (AS).

Objective

To use a randomized controlled trial to evaluate the efficacy of a novel, computer-based PFI for hazardous drinkers with at least subclinical PTSD and elevated AS (AP-PFI), against a time-matched comparison condition (C-PFI).

Methods

Participants (N = 100) will be recruited and enrolled from the Houston, TX community. The study includes: an in-person visit (baseline diagnostic assessment, a brief intervention, and a post-intervention assessment) and two follow-up assessments (1-week and 1-month). Participants who meet study inclusion criteria will be randomized to one of two conditions at baseline: AP-PFI or C-PFI. AP-PFI will consist of a brief, single-session, computer-delivered, PFI-based intervention that provides integrative and normative feedback about alcohol use, AS, and PTSD symptoms. C-PFI will be time-matched but will only include alcohol-related feedback.

Conclusions

AP-PFI is designed to provide feedback about alcohol use, PTSD symptoms, and AS and their interplay and deliver psychoeducation on harm-reduction techniques, interoceptive exposure exercises, and stress management strategies. The intervention may address extant gaps in treatment for these co-occurring conditions by providing a brief, evidence-based, motivational enhancement intervention that is cost-effective with potential to be disseminated across a variety of healthcare settings.

Mental Health Correlates of Probable Posttraumatic Stress Disorder, Probable Alcohol Use Disorder, and Their Co-Occurrence among Firefighters

Firefighters demonstrate high rates of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Research has yet to compare how these diagnoses and their co-occurrence relate to firefighter mental health. This study evaluated trauma load, PTSD, alcohol use, depression, sleep, suicide risk, anger, and occupational stress across four discrete groups of firefighters (N = 660): (1) trauma-exposed only (n = 471), (2) probable PTSD-only (n = 36), (3) probable AUD-only (n = 125), and (4) probable PTSD-AUD (n = 28). Firefighters completed an online survey. Firefighters with probable PTSD-AUD demonstrated higher scores on all criterion variables, except trauma load, compared to firefighters with probable AUD-only or trauma-only. Firefighters with probable PTSD-AUD and probable PTSD-only reported similar levels of all indices, except alcohol use severity and suicide risk, which were higher among the probable PTSD-AUD group. Results provide preliminary empirical evidence of the deleterious impact of PTSD-AUD comorbidity among firefighters.

Anxiety sensitivity and suicide risk: Mindfulness as a psychological buffer for Black adults

BACKGROUND

Anxiety sensitivity (AS), defined as the fear of anxiety-related sensations, is associated with increased risk for suicide and related behavior. However, investigations of AS have centered on primarily non-Hispanic White men and women and with limited attention to clinically relevant underlying factors.

METHODS

The purpose of this preliminary study was to examine the indirect effect of AS on suicide ideation and elevated suicide risk through mindfulness in a sample of 307 Black adults (79.2% female; M_age = 22.4, SD = 5.6). Participants completed an online questionnaire battery that included measures of AS, mindfulness, suicide ideation, and elevated suicide risk.

RESULTS

After controlling for age and gender, results indicated that AS was directly and indirectly associated with suicide ideation and elevated suicide risk via lower levels of mindfulness.

LIMITATIONS

Limitations include using a cross-sectional methodological design and exclusive reliance on self-report measures.

CONCLUSIONS

These findings provide preliminary insight into novel risk and protective factors that influence suicide ideation and elevated suicide risk among Black Americans.

Associations between Lower-Order Anxiety Sensitivity Facets and PTSD Symptomatology among Trauma-Exposed Firefighters

Firefighters are chronically exposed to potentially traumatic events, augmenting their risk of developing posttraumatic stress disorder (PTSD). The current study aimed to examine the incremental associations of lower-order dimensions of anxiety sensitivity (AS), examined concurrently, and PTSD symptom severity among a sample of trauma-exposed firefighters. We hypothesized that AS physical and cognitive concerns would be strongly associated with all PTSD symptom clusters and overall symptom severity, after controlling for theoretically relevant covariates (trauma load; years in fire service; alcohol use severity; depressive symptom severity). Participants were comprised of firefighters (N = 657) who completed an online questionnaire battery and endorsed PTSD Criterion A trauma exposure. Results revealed that the AS cognitive concerns, but not AS physical concerns, was significantly and robustly associated with overall PTSD symptom severity, intrusion symptoms, and negative alterations in cognitions and mood (∆R²'s = .028-.042; p's < .01); AS social concerns was incrementally associated with PTSD avoidance (∆R² = .03, p < .01). Implications for firefighter-informed, evidence-based interventions are discussed.

Exploring the impact of the COVID-19 pandemic on the mental health of first responders

The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (M_age = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.

Examining Transdiagnostic Factors among Firefighters in Relation to Trauma Exposure, Probable PTSD, and Probable Alcohol Use Disorder

Firefighters represent a distinct group of first responders that are at heightened risk of developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Assessing the role of transdiagnostic factors that underlie PTSD-AUD associations can inform specialized interventions among this population. This study included urban firefighters (N = 657) with probable PTSD-AUD (n = 27), probable PTSD-alone (n = 35), probable AUD-alone (n = 125), and trauma-exposure-only (n = 470). Methods: All firefighters completed a self-report, online questionnaire battery. Between group differences in anxiety sensitivity (AS), distress tolerance (DT), mindfulness, and emotional regulation difficulties (ERD) were assessed. It was hypothesized that firefighters with probable PTSD-AUD would endorse elevated AS and ERD, and reduced DT and mindfulness in comparison to all other diagnostic groups. Relationship status was included as a covariate in all comparisons. Results: Firefighters with probable PTSD-AUD endorsed elevated AS and ERD, and reduced DT and mindfulness in comparison to firefighters with trauma-exposure-only and probable AUD-alone. Firefighters with probable PTSD-AUD and probable PTSD-alone did not significantly differ. Conclusions: Given these findings, this line of inquiry has great potential to inform specialized, evidence-based mental health programming among firefighter populations, who represent a unique population susceptible to trauma-exposure, PTSD symptomology, and problematic alcohol use.

Childhood maltreatment severity and suicidal ideation among adults receiving acute-care psychiatric inpatient services: The role of distress tolerance

Objective: Persons in psychiatric inpatient hospitals represent a unique population with high rates of suicidal ideation and behavior as well as childhood maltreatment. Lower levels of perceived distress tolerance (DT) are associated with a history of childhood maltreatment and suicidal ideation and behavior in adulthood. Our study examined the association of childhood maltreatment severity with self-report and behavioral indices of suicide through perceived DT in a sample of adults in an acute-care psychiatric inpatient unit. We hypothesized that lower levels of perceived DT would account for the association between (a) childhood maltreatment severity and suicidal ideation severity and (b) childhood maltreatment severity and prehospitalization suicidality. Method: The sample was composed of 94 trauma-exposed adults (60% men; M_age = 33.43; SD = 12.06) admitted to a psychiatric acute-care inpatient hospital in a large metropolitan area in the southern United States. Approximately 55% of the sample were hospitalized due to suicidality, with an average number of 1.28 (SD = 2.42) prior suicide attempts; 3% of patients exhibited suicidality during their hospitalization. All patients reported experiencing at least one type of childhood maltreatment, with varying degrees of exposure. We conducted indirect effects analyses using PROCESS Macro for SPSS. Results: Childhood maltreatment severity was indirectly associated with both suicidal ideation severity and prehospitalization suicidality through DT. Conclusions: Findings advance our understanding of the association between childhood maltreatment and increased risk for suicidal ideation and behavior in adulthood, specifically among the psychiatric inpatient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic stress, alcohol use severity, and alcohol use motives among firefighters: The role of anxiety sensitivity

INTRODUCTION

Firefighters are vulnerable to developing posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Anxiety sensitivity (AS) is a cognitive-affective mechanism with clinical relevance to both PTSD and AUD. The current study examined the potential role of AS in the association of PTSD symptomatology with alcohol use severity and alcohol use motives among a large sample of firefighters. Heightened PTSD and high AS were expected to be associated with alcohol use severity and coping-oriented alcohol use motives. Heightened PTSD symptomatology was expected to be indirectly associated with alcohol use severity and coping motives through high AS. Covariates included number of years in the fire service and the number of traumatic event types endorsed.

METHODS

Participants included 652 urban firefighters (93.3% male; M_age = 38.7, SD = 8.57). Firefighters completed an online questionnaire battery.

RESULTS

PTSD symptomatology was positively associated with alcohol use and coping motives. AS was positively associated with alcohol use coping motives but not alcohol use severity. AS partially explained the association between PTSD symptomatology and coping, conformity, and social motives, but did not significantly account for the relationship between PTSD symptom severity and enhancement motives or alcohol use severity.

CONCLUSIONS

Among firefighters, the association between PTSD and alcohol use coping, conformity, and social motives is partially accounted for by AS. Clinical and research implications are discussed.

Moderate inhibitory effect of interleukin-10 on human neutrophil and monocyte chemotaxis in vitro

Neutrophils and monocytes are the major classes of phagocytes that migrate from the blood stream and accumulate in inflamed tissues in response to various chemoattractants. Because IL-10 is a potent anti-inflammatory cytokine, we analyzed its in vitro effect on chemotaxis using an under agarose method. We found that, as compared to prednisolone, IL-10 alone was a modest inhibitor of C5a, fMLP and IL-8-induced neutrophil chemotaxis, and C5a-induced monocyte chemotaxis. However, GM-CSF pretreatment of the cells potentiated this inhibitory effect. Similarly, the IL-10 induced modulation of the beta2 integrin CD11b/CD18 adhesion molecule expression was only observed on GM-CSF-preactivated neutrophils and monocytes. Taken together, these results suggest that the migration and accumulation of phagocytes at infection sites would not be significantly affected by IL-10 given as an immunomodulatory therapy.

Anti-inflammatory effect of interleukin-10 in rabbit immune complex-induced colitis

BACKGROUND

Interleukin-10 (IL-10) is an anti-inflammatory cytokine that downregulates the secretion of pro-inflammatory cytokines and additionally induces the secretion of anti-inflammatory cytokines, thus possibly leading to reduction of chronic inflammation in inflammatory bowel disease. In this study we evaluated the anti-inflammatory effect of IL-10 in a model of acute colitis in rabbits.

METHODS

Colitis was induced by rectal instillation of formalin, 0.65%, followed by intravenous infusion of 0.85 ml heat-aggregated rabbit immunoglobulin. Rabbits were treated with an intravenous bolus of recombinant human IL-10 (SCH52000), 100 microg/kg (n=14) or 500 microg/kg (n=14), 1 h before induction of colitis (control group, n=12).

RESULTS

High-dose IL-10 improved macroscopic scores of inflammation and decreased tissue myeloperoxidase levels and leukotriene B4 levels in dialysate fluid. Thromboxane B2 and prostaglandin E2 levels remained unaffected.

CONCLUSION

IL-10 ameliorates acute colitis in this model. Consequently, this anti-inflammatory cytokine may have a role in the therapy of acute inflammatory bowel disease.

Lack of interleukin 10 expression in monocyte-derived macrophages in response to in vitro infection by HIV type 1 isolates

Interleukin 10 is a pleiotropic cytokine that is overexpressed in HIV-infected patients. Here, we investigated IL-10 expression in primary cultures of monocyte-derived macrophages (MDMs) in response to in vitro infection by HIV-1/Ba-L or two macrophage-tropic HIV-1 primary isolates. Whatever the multiplicity of infection used, and in spite of high replication levels and an increase in HIV-infected cell frequency, neither significant IL-10 secretion nor IL-10 mRNA overexpression was induced in HIV-1-infected MDMs. Moreover, identical results were obtained with HIV-1-infected 1-day monocytes. These results show that MDM infection by HIV is not sufficient by itself for inducing IL-10 synthesis.

Combined chemotherapy including rifabutin for rifampicin and isoniazid resistant pulmonary tuberculosis. G.E.T.I.M. (Group for the Study and Treatment of Resistant Mycobacterial Infection)

A prospective multicentre open study has been conducted in France in order to assess the efficacy and tolerability of an antimycobacterial regimen including rifabutin in the treatment of patients with pulmonary tuberculosis due to rifampicin and isoniazid resistant bacilli. Patients were treated with daily rifabutin (450-600 mg), associated with companion drugs to which the organisms remained susceptible; in most cases the regimen included a fluoroquinolone. The duration of treatment was initially scheduled for a minimum period of 12 months after sputum culture conversion. Thirty nine patients were enrolled, 23 of whom were treated for at least 12 months. Culture conversion was obtained at the end of the twelfth month in 14 out of 23 patients. Twenty one out of 39 patients experienced adverse events. These were, however, serious enough to discontinue treatment in only four patients. These results suggest that an antimycobacterial combination including rifabutin might contribute to the treatment of multi-resistant pulmonary tuberculosis.

Combined chemotherapy including rifabutin for rifampicin and isoniazid resistant pulmonary tuberculosis. G.E.T.I.M. (Group for the Study and Treatment of Resistant Mycobacterial Infection)

A prospective multicentre open study has been conducted in France in order to assess the efficacy and tolerability of an antimycobacterial regimen including rifabutin in the treatment of patients with pulmonary tuberculosis due to rifampicin and isoniazid resistant bacilli. Patients were treated with daily rifabutin (450-600 mg), associated with companion drugs to which the organisms remained susceptible; in most cases the regimen included a fluoroquinolone. The duration of treatment was initially scheduled for a minimum period of 12 months after sputum culture conversion. Thirty nine patients were enrolled, 23 of whom were treated for at least 12 months. Culture conversion was obtained at the end of the twelfth month in 14 out of 23 patients. Twenty one out of 39 patients experienced adverse events. These were, however, serious enough to discontinue treatment in only four patients. These results suggest that an antimycobacterial combination including rifabutin might contribute to the treatment of multi-resistant pulmonary tuberculosis.

[Treatment of acute otitis media in infants using an amoxicillin-clavulanic acid formulation (in the form of an oral suspension for pediatric use)]

In a multicenter study, Augmentin pediatric suspension was given to 1,227 young children (3 months - 3 years) with otitis media seen in private practice. Patterns of otitis included first episodes, recurrences, and forms that had failed to respond to previous antimicrobial therapy. The study medication was given as a first-line treatment, on the basis of epidemiologic data, in a daily dose of 40 mg/kg for 7 to 10 days. In the 3 months to 3 years age group, two micro-organisms are prevalent, ie. Haemophilus influenzae, which is the most common agent and may produce beta-lactamases (10 to 18% of strains), and Streptococcus pneumoniae. Among our patients, the otitis-conjunctivitis syndrome caused by Haemophilus influenzae was fairly frequent (8.7% of cases). Clinical effectiveness as evaluated between D8 and D11 was good or very good in 91.2% of cases. Tolerance was satisfactory in 83% of patients. Side effects were uncommon and consisted primarily in gastrointestinal symptoms. We point out the potentially deleterious effect of concurrent anti-inflammatory treatment. Acceptability of the suspension was judged satisfactory by the parents in 91.6% of cases. Augmentin proved well-suited to epidemiologic data, outstandingly effective, well tolerated, and easy to use because of its presentation as a pediatric suspension; it is therefore an appropriate first-line drug in the common indication addressed in our study.