Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity.

There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N = 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N = 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both cross-sectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure and posttraumatic stress disorder predictors of mental health treatment use in college students.

The authors examined trauma exposure and posttraumatic stress disorder (PTSD) associations with previous mental health (MH) treatment use in college students while statistically controlling for gender and treatment attitudes. A total of 300 students were recruited for an Internet survey and were administered a modified version of the demographic survey, the Stressful Life Events Screening Questionnaire (L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), PTSD Symptom Scale-Self-Report (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH; E. H. Fischer & A. Farina, 1995), and a MH treatment use survey. Univariate analyses demonstrated that previous MH treatment use was associated with violent crime and noncrime trauma frequency, and treatment attitudes. Controlling for gender and MH treatment attitudes, regression analyses including violent and noncrime trauma and PTSD significantly predicted previous MH service use and recent visit counts; only noncrime trauma and treatment attitudes were significant for service use, and only treatment attitudes was significant for visit counts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of posttraumatic stress disorder: Illness perceptions among traumatic injury survivors.

More than 1.5 million persons in the United States sustain traumatic physical injuries each year. A significant proportion of traumatic injury survivors develop serious mental health problems, such as posttraumatic stress disorder (PTSD), yet few obtain professional mental health care. According to the commonsense model of self-regulation (Leventhal, Diefenbach, & Leventhal, 1992), illness-related perceptions can influence coping responses, including the use of professional treatment. Using the commonsense model as a guiding framework, we conducted semistructured interviews with nontreatment-seeking trauma injury survivors with PTSD (N = 23). Illness perceptions regarding the following key conceptual dimensions were examined: PTSD symptoms (identity), experienced or perceived consequences of PTSD symptoms, and beliefs about the causes, controllability, and course of PTSD symptoms. Results revealed that no respondents identified their symptoms as indicative of PTSD. Common illness perceptions included believing that symptoms would be short-lived, that symptoms were reflective of poor physical health or were a natural reaction to life in a violent community, and that symptoms were functionally adaptive. Respondents also reported exerting some limited control over symptoms by relying on religious forms of coping. None of the respondents perceived professional treatment as being able to completely control symptoms. Findings indicated that respondents' conceptualizations of PTSD symptoms might have inhibited the recognition of symptoms as a serious mental health condition that warrants professional treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: Evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of posttraumatic stress disorder symptom structure models in Hispanic and White college students.

This study tested measurement invariance between Hispanic (n = 226) and White (n = 278) college students’ responses to a well-validated measure of posttraumatic stress disorder (PTSD) symptoms. Participants completed the PTSD Checklist—Civilian Version (PCL–C; Weathers, Litz, Herman, Juska, & Keane, 1993); however, trauma histories were not assessed, nor were responses to the PCL–C indexed to a specific traumatic event. Eight models were tested using within-groups confirmatory factor analysis (CFA); 3 models (D. King, Leskin, King, & Weathers, 1998; Simms, Watson, & Doebbeling, 2002; Smith, Redd, DuHamel, Vickberg, & Ricketts, 1999) showed good fit for both ethnic groups, although differences in the degree of fit were observed between the 2 ethnic groups. Models that demonstrated good fit were then compared for equivalence using multiple group CFA. Factor loadings were equivalent between groups, but intercepts differed between groups in all 3 models. Mean item score differences between Hispanic and White groups were observed on items assessing emotional upset with reminders (Item B4) and emotional distancing (Item C5). D. King and colleagues (1998) model resulted in the best measurement invariance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minority status stress and coping processes among African American college students.

The current study tested coping efforts as moderators of the effects of minority status stress on general levels of perceived stress and academic performance for African American students at a predominantly White college and university (PWCU) and a historically Black college and university (HBCU). Multivariate analyses revealed that African American students at the PWCU experienced significantly higher levels of minority status stress than their counterparts at the HBCU. Students did not differ in overall levels of perceived stress and in most coping efforts assessed. HBCU students reported higher mean use of problem-oriented strategies and spiritual efforts than students at the PWCU. Moderated regression analyses revealed an increase in the effects of minority status stress on perceived stress at high levels of problem-oriented efforts. The effects of minority status stress on perceived stress decreased at higher levels of disengagement. In predicting academic performance, type of institution was the strongest predictor. Implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

Perfectionism, perceived stress, drinking to cope, and alcohol-related problems among college students.

This study investigated the association between perfectionism (categorized by adaptive perfectionistic, maladaptive perfectionistic, or nonperfectionistic groups), perceived stress, drinking alcohol to cope, and alcohol-related problems in a large sample of college students (N = 354). Maladaptive perfectionists reported significantly higher levels of stress and drinking to cope than adaptive perfectionists and nonperfectionists. Adaptive perfectionists reported the fewest alcohol-related problems, suggesting that healthy levels of high standards may protect against drinking to cope with stress. Across all participants, a significant indirect effect for drinking to cope supported its role as a mediator between stress and alcohol-related problems. Structural equation modeling analyses supported the moderating role of perfectionism in this mediation model, such that maladaptive perfectionists were more likely to drink to cope under stress and report alcohol-related problems, whereas higher stress was associated with fewer alcohol-related problems among nonperfectionists. Additional analyses revealed higher stress levels for women and a stronger link between stress and drinking to cope for women compared to men. Future research directions as well as clinical implications regarding perfectionism, stress, drinking to cope, and alcohol-related problems are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and posttraumatic stress: Sexual violence as an explanation for women's increased risk.

Women are approximately twice as likely as men to develop posttraumatic stress disorder (PTSD), but the cause of this disparity remains unclear. This study evaluated 2 alternative explanations of gender differences in PTSD, one pointing to an intrinsic vulnerability in women and the other emphasizing sexual violence across the life span. To test these competing theories, the authors analyzed National Violence Against Women Survey data from 591 victims of partner aggression. Results suggested that gender, when considered alone, has a small but significant effect on PTSD symptom severity. However, once models factor in sexual victimization history, the latter replaces gender as a key determinant of PTSD symptoms. These findings argue against theories of "feminine vulnerability," instead linking PTSD risk to sexually violent situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdisaster stress in the United States and Mexico: A cross-cultural test of the multicriterion conceptual model of posttraumatic stress disorder.

Data on symptoms of posttraumatic stress disorder (PTSD) were collected 6 months after Hurricanes Paulina (N/&=/&200; Mexico) and Andrew (non-Hispanic n/&=/&270; United States) using the Revised Civilian Mississippi Scale. A 4-factor measurement model that represented the accepted multicriterion conceptualization of PTSD fit the data of the U.S. and Mexican samples equally well. The 4 factors of Intrusion, Avoidance, Numbing, and Arousal correlated significantly and equivalently with severity of trauma in each sample. A single construct explained much of the covariance of the symptom factors in each sample. However, modeling PTSD as a unidimensional construct masked differences between samples in symptom severity. With severity of trauma controlled, the Mexican sample was higher in Intrusion and Avoidance, whereas the U.S. sample was higher in Arousal. The results suggest that PTSD is a meaningful construct to study in Latin American societies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minority stress, perceived bicultural competence, and depressive symptoms among ethnic minority college students.

Based on biculturalism theory (LaFromboise, Coleman, & Gerton, 1993), the present study examined the direct effect of perceived bicultural competence (PBC) on depressive symptoms, and PBC as a potential coping resource to moderate the association between minority stress and depressive symptoms. Participants were 167 Asian American, African American, and Latino/a American students at a predominantly White Midwest university. Results from a hierarchical regression analysis suggested that (a) minority stress was positively associated with depressive symptoms after controlling for perceived general stress, (b) PBC was negatively associated with depressive symptoms after controlling for perceived general stress and minority stress, and (c) the interaction between minority stress and PBC was significant in predicting depressive symptoms. Results from a simple effect analysis supported the hypothesis that a higher level of PBC buffers the association between minority stress and depressive symptoms. Furthermore, post hoc exploratory analyses of the components of PBC suggested that 2 components, Social Groundedness and Cultural Knowledge, may be especially important coping resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders.

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-, 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety sensitivity and PTSD symptom severity are reciprocally related: Evidence from a longitudinal study of physical trauma survivors.

Cross-lagged panel analysis of interview data collected from survivors of traumatic physical injury (N = 677) was used to examine the temporal relationship between anxiety sensitivity and posttraumatic stress disorder (PTSD) symptom severity. The 2 constructs were assessed at 3 time points: within days of physical injury, at 6-month follow-up, and at 12-month follow-up. Results indicated that anxiety sensitivity and PTSD symptom severity were reciprocally related such that anxiety sensitivity predicted subsequent PTSD symptom severity, and symptom severity predicted later anxiety sensitivity. Findings have both theoretical and clinical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: Examining differences in factor structure.

The authors examined the effects of a methodological manipulation on the Posttraumatic Stress Disorder (PTSD) Checklist’s factor structure: specifically, whether respondents were instructed to reference a single worst traumatic event when rating PTSD symptoms. Nonclinical, trauma-exposed participants were randomly assigned to 1 of 2 PTSD assessment conditions: referencing PTSD symptoms to their worst trauma (trauma-specific group, n = 218) or to their overall trauma history in general (trauma-general group, n = 234). A 3rd group of non-trauma-exposed participants (n = 464) rated PTSD symptoms globally from any stressful event. Using confirmatory factor analysis, the authors show that the 4-factor PTSD model proposed by D. W. King, G. A. Leskin, L. A. King, and F. W. Weathers (1998; separating effortful avoidance and emotional numbing) demonstrated the best model fit for trauma-general and non-trauma-exposed participants. The 4-factor PTSD model proposed by L. J. Simms, D. Watson, and B. N. Doebbeling (2002; emphasizing a general dysphoria factor) demonstrated the best model fit for trauma-specific participants. Measurement invariance testing revealed that non-trauma-exposed participants were different from both trauma-exposed groups on factor structure parameters, but trauma groups were not substantially different from each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis.

Objective/Method: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. Implications: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acculturative stress, depression, and anxiety in migrant farmwork college students of Mexican heritage.

Migrant status (migrant, nonmigrant) and sex (female, male) differences were examined in a sample of 168 college students of Mexican heritage on measures of college stress, acculturative stress, depression, anxiety, and academic achievement. Migrant farmwork students reported higher levels of acculturative stress than nonmigrants, and men reported higher levels of acculturative stress than women. When language preference was held constant, there were no differences in depression and anxiety. However, migrant students reported higher levels of depression and anxiety than nonmigrants when language preference was not held constant. The overall sample reported high levels of depression: 55% versus the expected 20% of the general population shown in other research. Depression and anxiety were highly correlated, and women reported a higher grade point average than male students. Implications include the importance of integrating cultural factors in stress research with this population and accounting for acculturative stress, depression, and anxiety in clinical treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal violence and mental health outcomes among Asian American and Native Hawaiian/other Pacific Islander college students.

In a cross-sectional survey of college students (N = 614), we studied interpersonal violence victimization, perpetration, and mental health outcomes in an ethnoracially diverse rural-based sample of Asian Americans (27%) and Native Hawaiian/Other Pacific Islanders (25%), two groups vastly underrepresented in trauma research. High rates of interpersonal violence (34%), violence perpetration (13%), and probable psychiatric diagnoses (77%), including posttraumatic stress disorder, were found. Exposure to physical violence, sexual violence, and life stress all were predictive of psychopathology. Female participants were associated with higher likelihood of sexual violence victimization compared to male participants, and Asian American status (especially among males) was associated with lower likelihood of physical and sexual violence compared with European Americans. These data enhance our understanding of interpersonal violence and mental health outcomes among previously understudied minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face.

The present study attempted to examine the influence of culture-bound barriers such as acculturation status, loss of face, and conception of mental health on the attitudes of Asian American college students (n = 134) toward seeking professional psychological help. An adapted Acculturation Attitude Scale (AAS; U. Kim, 1988), Zane's (1991) Loss of Face Scale (LOFS), a 10-factor Conception of Mental Health Scale (CMHS; Nunnally, 1961), and a modified version of the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS) with four subscales (Fischer & Turner, 1970) were used in this study. Results support the hypothesis that acculturation and conceptions of mental health were significantly correlated with attitudes toward mental health services. Loss of face was also significantly correlated with attitudes of being open to professional counseling. Implications for mental health professionals working with Asian Americans are highlighted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)