Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms.

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.

Objective: This study investigated the association between mindfulness, other resilience resources, and several measures of health in 124 urban firefighters. Method: Participants completed health measures of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, physical symptoms, and alcohol problems and measures of resilience resources including mindfulness, optimism, personal mastery, and social support. The Mindful Awareness and Attention Scale (MAAS; Brown & Ryan, 2003) was used to assess mindfulness. Participants also completed measures of firefighter stress, number of calls, and years as a firefighter as control variables. Hierarchical multiple regressions were conducted with the health measures as the dependent variables with 3 levels of independent variables: (a) demographic characteristics, (b) firefighter variables, and (c) resilience resources. Results: The results showed that mindfulness was associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems when controlling for the other study variables. Personal mastery and social support were also related to fewer depressive symptoms, firefighter stress was related to more PTSD symptoms and alcohol problems, and years as a firefighter were related to fewer alcohol problems. Conclusions: Mindfulness may be important to consider and include in models of stress, coping, and resilience in firefighters. Future studies should examine the prospective relationship between mindfulness and health in firefighters and others in high-stress occupations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relationship between posttraumatic stress symptoms and sexual risk: Examining potential mechanisms.

Little is known about behavioral and psychological mechanisms that may explain relationships between posttraumatic stress and sexual risks. As rates of HIV infection among African American women remain significantly higher than for other female subgroups, research on sexual risk among African American women is needed. The present study examines the relationships of posttraumatic stress symptoms as measured by the Posttraumatic Stress Disorder Checklist-Civilian Version with sexual risk behaviors, sexual sensation-seeking, and sexual compulsivity in 30 undergraduate African American women with any reported history of sexual intercourse. Higher posttraumatic stress symptoms were associated with more sexual partners, greater frequency of vaginal sex without a condom, and endorsement of sex while under the influence of a substance. Posttraumatic stress symptoms were negatively correlated with perceived sexual control, but were not significantly correlated with sexual compulsivity or sensation-seeking. Perceived sexual control was negatively associated with frequency of unprotected sex and sex under the influence. The preliminary evidence from this small sample suggests sexual control may mediate the relationship of the posttraumatic stress symptoms with unprotected sex. These results are generally consistent with previous findings suggesting posttraumatic stress is associated with sexual risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorder symptoms, drinking motives, and alcohol use and consequences: Cross-sectional and prospective mediation.

Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women.

Objective: Posttraumatic stress disorder (PTSD) reflects a prolonged stress reaction and dysregulation of the stress response system and is hypothesized to increase risk of developing coronary heart disease (CHD). No study has tested this hypothesis in women even though PTSD is more prevalent among women than men. This study aims to examine whether higher levels of PTSD symptoms are associated with increased risk of incident CHD among women. Design: A prospective study using data from women participating in the Baltimore cohort of the Epidemiologic Catchment Area study (n = 1059). Past year trauma and associated PTSD symptoms were assessed using the NIMH Diagnostic Interview Schedule. Main Outcome Measures: Incident CHD occurring during the 14-year follow-up through 1996. Results: Women with five or more symptoms were at over three times the risk of incident CHD compared with those with no symptoms (age-adjusted OR = 3.21, 95% CI: 1.29-7.98). Findings were maintained after controlling for standard coronary risk factors as well as depression or trait anxiety. Conclusion: PTSD symptoms may have damaging effects on physical health for civilian community-dwelling women, with high levels of PTSD symptoms associated with increased risk of CHD-related morbidity and mortality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychiatric symptoms of complex posttraumatic stress disorder: A preliminary Minnesota Multiphasic Personality Inventory scale to identify adult survivors of childhood abuse.

This study integrated psychological and neuroscience research regarding the effects of childhood trauma in order to advance assessment with this population. Recently, researchers proposed new criteria for complex posttraumatic stress disorder (PTSD) on the basis of years of interdisciplinary research, identifying symptoms that have an empirical association with survivors of childhood trauma. The criteria reflect alterations in regulating affect, dissociation, executive functioning, somatization, and chronic characterological changes. These content areas are compatible with recent neuroscience research with this population and illustrate the interplay between mind–brain interactions, chronic stress, and neurodevelopment. Prior research suggested that Scale 8 of the Minnesota Multiphasic Personality Inventory (MMPI) was most sensitive to neurological dysfunction. Therefore, can complex PTSD be detected by the MMPI? Item analyses were performed comparing abused and nonabused participants. Stage 1 of the analysis identified 11 items that differentiated groups. In Stage 2, the study attempted to construct a preliminary scale that correctly classified 81% of participants and 89% of those with a history of abuse. The content of identified items reflects problems with impulsivity, affect regulation, and disrupted cognitive processes. A theoretical explanation is provided in the Discussion section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Holographic reprocessing: Empirical evidence to reduce posttraumatic cognitions in women veterans with PTSD from sexual trauma and abuse.

Holographic reprocessing (HR) facilitates holistic reappraisal of attributions regarding interpersonal violence and maltreatment. The authors tested the feasibility to train therapists to run a protocol using HR to reduce negative thoughts associated with posttraumatic stress disorder (PTSD) in women veterans who have had sexual trauma or abuse. The study assessed pre- and postscores on the Posttraumatic Cognitions Inventory (PTCI) in a naturalistic clinical setting with 5 therapists. The protocol consisted of screening for PTSD, followed by an average of 9 HR treatment sessions. Twenty-two women were referred to the study; 17 enrolled and completed treatment (0% dropout rate). Significant decreases were found on all scales of the PTCI, with large effect sizes: total negative thoughts, t(16) = 4.42, p     

The impact of posttraumatic symptoms on women's commitment to a hypothetical violent relationship: A path analytic test of posttraumatic stress, depression, shame, and self-efficacy on investment model factors.

Recent evidence shows that female victims of intimate partner violence utilize a rational-decision making framework for deciding whether to remain involved with or leave an abusive partner. This framework, known as the Investment Model, does not take into consideration intraindividual factors that may affect commitment and stay or leave decisions, as the model is predominately based on relational dynamics between partners. However, it is well-known that many victims of intimate partner violence suffer ill psychological consequences stemming from abuse, such as posttraumatic stress, depression, increased shame, and reduced self-efficacy. These posttraumatic symptoms may potentially interfere with relationship termination as defined by the Investment Model. Using a sample of female undergraduate students and a hypothetical abusive dating relationship vignette, results from path analyses indicated that posttraumatic symptoms predicted commitment through model factors. Posttraumatic stress symptoms impacted the model in expected and unexpected ways. Self-efficacy emerged as a particularly important factor predicting commitment. Directions for future research and clinical implications aimed at increasing women's empowerment are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.

A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r=.17) and peritraumatic dissociation the largest (weighted r=.35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking to cope and alcohol use and abuse in unipolar depression: A 10-year model.

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4, and 10-year follow-ups and for more drinking problems at 1- and 4-year follow-ups. Findings elucidate a key mechanism in this process by showing that drinking to cope strengthened the link between depressive symptoms and drinking behavior. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger connection between depressive symptoms and both alcohol consumption and drinking problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse patients with posttraumatic stress disorder (PTSD): Identifying specific triggers of substance use and their associations with PTSD symptoms.

Although individuals with comorbid posttraumatic stress disorder (PTSD) and substance use diagnoses are at heightened risk for relapse after substance abuse treatment, little is known about the specific situations in which these individuals are likely to relapse. The present study was designed to test whether a PTSD diagnosis related to substance use in specific situations in which PTSD symptoms were likely to be present. Data were gathered from inpatients (n?=?86) in a substance-abuse treatment program, and relationships between PTSD diagnosis and frequency of substance use in high-risk situations were examined. As predicted, PTSD diagnosis was related to substance use in situations involving unpleasant emotions, physical discomfort, and interpersonal conflict, but not to substance use in other situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in the sensitivity to posttraumatic stress disorder: An epidemiological study of urban young adults.

The authors examine the relationship between 2 separate but interrelated findings in the epidemiology of posttraumatic stress disorder (PTSD): women's greater PTSD risk following traumatic events and the sensitizing effects of a prior trauma on the PTSD response to a subsequent trauma. Data come from a representative sample of 1,698 young adults from a large U.S. city. Analysis was conducted on the subset exposed to traumatic events. Women's risk for PTSD following assaultive violence was higher than men's. When assaultive violence preceded a later nonassaultive trauma in women, there was an increased risk (relative risk = 4.9) for PTSD, which was not observed in men. The relative risk estimate in women was significantly higher than in men. These findings suggest that assaultive violence elicits women's PTSD response directly and by sensitizing them to the effects of subsequent traumatic events of lesser magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory in posttraumatic stress disorder: Properties of voluntary and involuntary, traumatic and nontraumatic autobiographical memories in people with and without posttraumatic stress disorder symptoms.

One hundred fifteen undergraduates rated 15 word-cued memories and their 3 most negatively stressful, 3 most positive, and 7 most important events and completed tests of personality and depression. Eighty-nine also recorded involuntary memories online for 1 week. In the first 3-way comparisons needed to test existing theories, comparisons were made of memories of stressful events versus control events and involuntary versus voluntary memories in people high versus low in posttraumatic stress disorder (PTSD) symptom severity. For all participants, stressful memories had more emotional intensity, more frequent voluntary and involuntary retrieval, but not more fragmentation. For all memories, participants with greater PTSD symptom severity showed the same differences. Involuntary memories had more emotional intensity and less centrality to the life story than voluntary memories. Meeting the diagnostic criteria for traumatic events had no effect, but the emotional responses to events did. In 533 undergraduates, correlations among measures were replicated and the Negative Intensity factor of the Affect Intensity Measure correlated with PTSD symptom severity. No special trauma mechanisms were needed to account for the results, which are summarized by the autobiographical memory theory of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory for emotionally neutral information in posttraumatic stress disorder: A meta-analytic investigation.

Studies have come to conflicting conclusions about whether posttraumatic stress disorder (PTSD) is associated with poorer memory for emotionally neutral information. The authors report a meta-analysis of 27 studies that investigated verbal and/or visual memory in samples with PTSD and healthy controls. The results indicated that the association between PTSD and memory impairment appears to be robust, small to moderate in size, and stronger for verbal than for visual memory. Effect sizes did not vary according to whether recall was immediate or delayed. The association is found in both civilian and military samples and cannot be readily explained as being due to the use of nontraumatized healthy control groups or concurrent head injury. The findings are placed in the context of recent neurobiological and experimental cognitive research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples.

Using a sample of 434 couples consisting of active duty Army husbands married to civilian wives, relationships between recent deployment, current posttraumatic stress disorder (PTSD) symptoms, and a range of marital outcomes were investigated. Self-reports from both husbands and wives regarding relationship functioning did not differ between couples who were and were not separated due to deployment in the prior year. However, deployment in the past year was related to higher levels of current PTSD symptoms for husbands, and husbands' current PTSD symptoms were associated with lower marital satisfaction, confidence in the relationship, positive bonding between the spouses, parenting alliance, and dedication to the relationship for both husbands and wives. In addition, husbands' current PTSD symptoms were associated with higher levels of negative communication for both husbands and wives, and lower satisfaction with sacrifice for the relationship for husbands. Once positive bonding, negative communication, and parenting alliance were controlled, husband PTSD symptoms no longer significantly predicted marital satisfaction for wives. Husband PTSD symptoms continued to exert a significant, but reduced, unique effect on husband marital satisfaction once these variables were accounted for. The results provide greater understanding of the relationship of deployment/PTSD symptoms and marital functioning and suggest areas for intervention with military couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for trauma histories, posttraumatic stress disorders (PTSD) and subthreshold PTSD in psychiatric outpatients.

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couple adjustment and posttraumatic stress disorder symptoms in National Guard veterans of the Iraq war.

Relationship adjustment and posttraumatic stress disorder (PTSD) symptoms were assessed across two time points in a sample of 313 married or partnered National Guard soldiers recently returned from combat duty in Iraq. Structural equation modeling using a four-factor model for PTSD found the latent variable dysphoria (reflecting generalized distress including aspects of emotional numbing and arousal) had the strongest independent contribution to predicting relationship adjustment at Time 1 and indirectly predicted poorer relationship adjustment at Time 2. Exploratory analysis of gender differences (n = 33 women; n = 280 men) suggested a different pattern of relations between PTSD factors and relationship adjustment among female soldiers at Time 1, with a trend toward trauma specific avoidance being more highly related to relationship adjustment. Clinical and research implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder (PTSD), actual pathology, and the question of representability: A reply to Attachment deficits, personality structure, and PTSD (J. Mills).

Replies to commentary by J. Mills (see record 2008-03991-014) on the current authors' original article (see record 2006-00627-003) regarding posttraumatic stress disorder and the question of representability. In the first part of our answer, we will clarify certain of our ideas in the light of Mills's critical remarks. In the second part, we want to address what we consider to be the main problem in matters of posttraumatic stress disorder (PTSD), that is, the question of representability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type D personality and the development of PTSD symptoms: A prospective study.

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms. (PsycINFO Database Record (c) 2011 APA, all rights reserved)