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)     

The impact of killing on mental health symptoms in Gulf War veterans.

This study examined the impact of killing on posttraumatic stress symptomatology (PTSS), depression, and alcohol use among 317 U.S. Gulf War veterans. Participants were obtained via a national registry of Gulf War veterans and were mailed a survey assessing deployment experiences and postdeployment mental health. Overall, 11% of veterans reported killing during their deployment. Those who reported killing were more likely to be younger and male than those who did not kill. After controlling for perceived danger, exposure to death and dying, and witnessing killing of fellow soldiers, killing was a significant predictor of PTSS, frequency and quantity of alcohol use, and problem alcohol use. Military personnel returning from modern deployments are at risk of adverse mental health symptoms related to killing in war. Postdeployment mental health assessment and treatment should address reactions to killing in order to optimize readjustment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Underdiagnosing and nontreatment of posttraumatic stress disorder in community mental health: A case study.

Research indicates that trauma is extremely prevalent among populations seeking community-based services. However, underdiagnosis and nontreatment of trauma-related disorders is widespread. This study explored how one urban community mental health center (CMHC), serving a severely mentally ill (SMI) population, assessed, diagnosed, and treated reported trauma histories. Results indicate that of the 72 consumers in this sample who reported trauma histories (51%), only 2 were diagnosed with posttraumatic stress disorder (PTSD). Instead, those with a reported trauma history were likely to be diagnosed with affective disorders and were almost seven times as likely to be recommended therapy as were those without a trauma history. However, even those recommended therapy were not likely to receive it. Findings indicate significant barriers to PTSD diagnoses and the receipt of therapy services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reestablishing mental health services in St. Bernard Parish, Louisiana, following Hurricane Katrina.

In August 2005, Hurricane Katrina struck the Gulf Coast causing widespread residential displacement, unemployment, and compromised social networks for the residents of St. Bernard Parish, Louisiana. Symptoms of grief, depression, anxiety, posttraumatic stress, adjustment disorders, and psychosis were anecdotally reported among clinic patients during the authors' deployment to the parish in December 2005 (4 months post-Katrina). These anecdotal reports were confirmed through the analysis of survey data that were collected during the authors' follow-up visit in August 2006 (11 months post-Katrina). In collaboration with the United States Public Health Service, the parish has prioritized restoring medical and mental health services to the parish in its efforts to rebuild and repopulate. Implications for mental health practice and public policy are summarized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy in the veterans health administration: Missed opportunities?

Informed by data on the dose-response effect, the authors assessed use of psychotherapy in the Veterans Health Administration (VA). The authors identified 410,923 patients with newly diagnosed depression, anxiety, or posttraumatic stress disorder using VA databases (October 2003 through September 2004). Psychotherapy encounters were identified by Current Procedural Terminology codes for the 12 months following patients' initial diagnosis. Psychotherapy was examined for session exposure received within the 12-month follow-up period and time (in days) between diagnosis and treatment. Of the cohort, 22% received at least one session of psychotherapy; 7.9% received four or more sessions; 4.2% received eight or more sessions; and 2.4% received 13 or more sessions. Delays between initial mental health diagnosis and initiation of care averaged 57 days. Patient variables including age, marital status, income, travel distance, psychiatric diagnosis, and medical-illness burden were significantly related to receipt of psychotherapy. Treatment delays and general underuse of psychotherapy services are potential missed opportunities for higher-quality psychotherapeutic care in integrated health care settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Components measurable in manifestations of mental conflict.

3 operational approaches to conflict measurement, emanating from the dynamic calculus theory, are described. Conflict measurement, as investigated here, intercorrelates 24 varied behavioral manifestations commonly considered signs of conflict. To check on generalizability, this is done for 3 distinct foci of conflict. The intercorrelations among the conflict manifestations are subjected to simple structure factor resolution, and it is shown that there is a high degree of similarity of loading pattern among the 8 factors which proved to be present in each of the 3 experiments. The interpretations offered for these factors fit some definitions of ego defenses as given by psychoanalysts, but, additionally, there are systematic modes of response to conflict transcending psychoanalytic concepts. Relations to social-psychological criteria will follow. (32 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of a cognitive restructuring program for treating posttraumatic disorders in adolescents.

The study explored the feasibility and efficacy of a manualized cognitive restructuring program for treating adolescents suffering from posttraumatic stress disorder (PTSD). Nine girls and 3 boys (mean age 16 years; range = 14–18), with PTSD, were recruited from a community mental health center and a tertiary health care center and enrolled in a pilot study. The adolescents were seen weekly for 12–16 weeks of individual treatment. Variables assessed included: trauma history, PTSD diagnosis and severity, depression, substance abuse, and client satisfaction. Twelve adolescents consented to treatment; 9 completed the program. The number of types of traumas reported averaged 6.5 (range = 1–13). Paired t tests were used to test prepost change for PTSD symptoms and depression, in completers. From baseline to posttreatment, there were statistically significant improvements in PTSD and depression. Treatment gains were maintained at 3 month follow-up. Preliminary results suggest the feasibility of implementing a manualized cognitive restructuring program to treat PTSD in adolescents. Completers rated themselves as improved and satisfied at posttreatment and 3-month follow-up. Feedback from referring clinicians also indicated high satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Timing of postcombat mental health assessments.

When soldiers return from combat and peacekeeping operations, the United States and many NATO and Partnership for Peace countries conduct some form of postdeployment mental health assessment. To date, however, no research has been published examining changes in prevalence rates of mental health problems in the first several months after returning from combat duty. In this study, the authors examined the degree to which timing was related to reported prevalence rates of mental health problems in a matched sample of 509 US Army soldiers returning from combat in Iraq. Results showed significant increases in mental health problems at 120 days postdeployment relative to immediate reintegration. The findings are discussed in terms of providing mental health services to soldiers returning from combat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of cognitive processing to adjustment in the 1st year following amputation.

Objective: To describe depressive symptoms, posttraumatic stress disorder (PTSD), and posttraumatic growth at 6 and 12 months following amputation and to explore differences by demographic variables and cognitive processing of trauma. Participants: 83 adults with newly acquired limb loss. Setting: Two large metropolitan hospitals. Main Outcome Measures: The Patient Health Questionnaire depression module, PTSD Checklist, and Posttraumatic Growth Inventory. Results: Significant depressive and PTSD symptoms were reported by 15%-25% of participants. Relatively low levels of posttraumatic growth were reported. Negative cognitive processing predicted depressive and PTSD symptoms at 6 months. Positive cognitive processing predicted posttraumatic growth at 12 months. Conclusion: Cognitive processing appears to be integral to positive and negative psychosocial outcomes following amputation and should be targeted by clinical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and major depression in veterans with spinal cord injury.

Objective: To explore the relationship between posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in veterans with spinal cord injury and to compare those results with results found in veterans who had sustained other traumatic injuries. Method: To investigate the relationship between PTSD and MDD in persons with spinal cord injury, the authors examined whether individuals endorsed overlapping items on measures of both disorders, evaluated the contribution of overlapping items to comorbid diagnosis, and conducted an exploratory factor analysis. Results: The overlapping symptoms between the 2 disorders did not fully explain the high rate of comorbidity, although participants who endorsed a symptom common to MDD and PTSD on 1 measure were likely to endorse the corresponding item on another measure. In both samples, items loaded on separate PTSD and MDD factors. Conclusion: MDD and PTSD appear to represent independent reactions to trauma in those individuals who had experienced either a nonspinal cord injury or a spinal cord injury. This research also provides an initial investigation of some of the possible ways that MDD and PTSD are related by addressing psychometric issues inherent in their measurement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of mental and physical health service utilization among Vietnam veterans.

This study investigated predictors of mental and physical health care service utilization among 1,632 male (n = 1,200) and female (n = 432) Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Using Anderson's theory as a model (Anderson & Bartkus, 1973), the authors examined both direct and mediated relationships among predisposing factors (i.e., age, marital status, and combat exposure), enabling factors (e.g., household income and insurance), and need factors (e.g., medical and psychological symptomatology) and physical and mental health care utilization outcomes. Need factors were the most consistent and strongest mediators of predisposing variables for both physical and mental health care service utilization, although there were differences between male and female veterans. For men, combat exposure indirectly predicted mental health care utilization through the need variables (with the effects of posttraumatic stress disorder being greatest). For women, physical health problems mediated the relationship between combat exposure and physical health outpatient care utilization. These findings have implications for screening and outreach efforts. (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)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Countertransference in the treatment of PTSD.

Reviews the book, Countertransference in the treatment of PTSD, edited by John P. Wilson and Jacob D. Lindy (see record 1994-98036-000). This book purports to be the first to examine systematically the unique role of countertransference in working with victims of trauma. To help systematize clinical work with trauma victims, the contributors produced a theoretical model that attempts "to identify the core elements and dimensions of countertransference and their relationship to PSTD." The unique status of this book claimed by the editors is predicated on an assumption unexamined by the editors; namely, that the contributors have uncovered a new clinical phenomenon—countertransference to PSTD. This assumption rests on a second important and unquestioned assumption that the victims of PSTD suffer differently and more horribly than do other sufferers of the human condition. Haven't clinicians learned by now that suffering is suffering regardless of the external event that may have precipitated the hurt? If suffering is suffering, regardless of its provocation, then countertransference is countertransference regardless of the external events to which the clinician is responding. While this volume, by carefully delineating and systematizing a host of therapist responses to patient inductions, contributes to a better understanding of countertransference, it hasn't discovered a new clinical phenomenon. The value of this book resides in the thoughtful ways the contributors discuss monitoring one's countertransference and their compassionate and efficacious responses to the suffering of their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a brief mental health intervention for primary care patients.

This randomized trial is a first evaluation of a brief psychotherapeutic intervention for primary care patients. Sixty-two participants were randomly assigned to the intervention or to treatment as usual. As compared with treatment as usual, the intervention led to significant reductions in symptoms of anxiety and depression. The reduction was maintained for 3 months after the end of treatment, but some return of symptoms occurred by 6 months after treatment. The treatment was well accepted by patients. This study provides good preliminary evidence for the effectiveness of this intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Posttraumatic Cognitions Inventory (PTCI) in a German sample of individuals with a history of trauma.

In this study, we examined the psychometric properties of the 33-item Posttraumatic Cognitions Inventory (Foa, Ehlers, Clark, Tolin, & Orsillo, 1999) in 213 individuals with accident-related trauma and 190 individuals with interpersonal trauma. Confirmatory factor analyses generally supported the scale's original three-factor structure—Negative Cognitions About Self (SELF), Negative Cognitions About World (WORLD), and Self-Blame (BLAME)—after four redundant items were excluded. However, in line with previous findings, results for BLAME remained inconclusive because the scale performed poorly with the individuals with accident-related trauma, whereas its fit with those with interpersonal trauma was acceptable. BLAME might possibly relate to trauma type. Our results indicate that the proposed 29-item version shows acceptable psychometric properties and that the role of BLAME should be further investigated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infants' meaning-making and the development of mental health problems.

We argue that infant meaning-making processes are a central mechanism governing both typical and pathological outcomes. Infants, as open dynamic systems, must constantly garner information to increase their complexity and coherence. They fulfill this demand by making nonverbal “meaning”—affects, movements, representations—about themselves in relation to the world and themselves into a “biopsychosocial state of consciousness,” which shapes their ongoing engagement with the world. We focus on the operation of the infant–adult communication system, a dyadic, mutually regulated system that scaffolds infants' engagement with the world of people, things, and themselves, and consequently their meaning-making. We argue that infant mental health problems emerge when the meanings infants make in the moment, which increase their complexity and coherence and may be adaptive in the short run, selectively limit their subsequent engagement with the world and, in turn, the growth of their state of consciousness in the long run. When chronic and iterative, these altered meanings can interfere with infants' successful development and heighten their vulnerability to pathological outcomes. Cultural variations in meaning-making and implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life transitions and mental health in a national cohort of young Australian women.

Young adulthood, a time of major life transitions and risk of poor mental health, may affect emotional well-being throughout adult life. This article uses longitudinal survey data to examine young Australian women's transitions across 4 domains: residential independence, relationships, work and study, and motherhood. Changes over 3 years in health-related quality of life, optimism, depressive symptoms, stress, and life satisfaction, were examined in relation to these transitions among 7,619 young adult participants in the nationally representative Australian Longitudinal Study on Women's Health. Positive changes in mental health occurred for women moving into cohabitation and marriage, whereas reductions were observed among those experiencing marital separation or divorce and those taking on or remaining in traditionally "feminine" roles (out of the workforce, motherhood). The data suggest that women cope well with major life changes at this life stage, but reductions in psychological well-being are associated with some transitions. The findings suggest that preventive interventions to improve women's resilience and coping might target women undergoing these transitions and that social structures may not be providing sufficient support for women making traditional life choices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)