Cyr K, Shnaider P, Roth ML, Ketcheson F, Balderson K, Elhai JD. Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans

BACKGROUND

Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663).

METHOD

Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression.

RESULTS

Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances.

CONCLUSIONS

The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.

Problematic smartphone use and relations with negative affect, fear of missing out, and fear of negative and positive evaluation

For many individuals, excessive smartphone use interferes with everyday life. In the present study, we recruited a non-clinical sample of 296 participants for a cross-sectional survey of problematic smartphone use, social and non-social smartphone use, and psychopathology-related constructs including negative affect, fear of negative and positive evaluation, and fear of missing out (FoMO). Results demonstrated that FoMO was most strongly related to both problematic smartphone use and social smartphone use relative to negative affect and fears of negative and positive evaluation, and these relations held when controlling for age and gender. Furthermore, FoMO (cross-sectionally) mediated relations between both fear of negative and positive evaluation with both problematic and social smartphone use. Theoretical implications are considered with regard to developing problematic smartphone use.

Emotion regulation's relationships with depression, anxiety and stress due to imagined smartphone and social media loss

A sample of 359 students participated in a web survey, administered the Emotion Regulation Questionnaire, and Depression Anxiety Stress Scale-21 (DASS-21) as a pre-test. We subsequently randomly assigned subjects to either 1) a smart phone loss group or 2) social media accounts loss group. We asked them to imagine losing two days' access to the technology in their respective group, and rate associated symptoms using the DASS-21. Compared to subjects in the smartphone loss group, social media loss subjects evidenced stronger relations between suppressive emotion regulation with depression, anxiety and stress from imagined loss. Controlling for age and gender, social media loss subjects' increased use of suppression, and decreased use of cognitive reappraisal in emotion regulation, were related to depression, stress and (for suppression only) anxiety due to imagined lost social media. Emotion regulation was not related to psychopathology for subjects in the smartphone loss scenario. Results suggest that emotion dysregulation may be associated with psychopathology from social media loss.

PTSD Latent Classes and Class Transitions Predicted by Distress and Fear Disorders in Disaster-Exposed Adolescents

This study aimed to determine the population-based typologies of posttraumatic stress disorder (PTSD) symptomatology, the longitudinal patterns of transitions across these typologies, and the predictive effects of distress and fear disorder symptoms on these transitions in a frequently referred but scantly studied population of traumatized youth. A sample of 1,278 Chinese adolescents (54.0% girls) with a mean age of 13.4 years (SD = 0.8, range = 12-16) completed 2-wave surveys 2.5 and 3.5 years after a major disaster. Psychopathological symptoms were assessed with the UCLA PTSD Reaction Index for DSM-IV, the Depression Self-Rating Scale for Children, and the Screen for Child Anxiety Related Emotional Disorders. Latent class analyses identified 4 classes characterized by high, reexperiencing/hypervigilance, dysphoria, and low symptoms, respectively at each time point. Latent transition analyses revealed relatively high levels of temporal stability within low symptom and dysphoria classes but relatively high probabilities of migration from re-experiencing/hypervigilance and high symptom classes into lower symptom classes. Multinomial logistic regression analyses found that some of the between-class movements during the year were predicted by baseline distress or fear disorders. This study provides an initial depiction of both quantitative and qualitative changes in youth's long-term PTSD symptom patterns over time and gives a further elucidation of other forms of posttrauma psychopathology's impacts on PTSD course. These findings carry implications for ongoing evaluation and adjustable intervention individually tailored to youth's PTSD manifestations and comorbidities in the long-term disaster aftermath.

DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors

It has been well-documented that posttraumatic stress symptoms cause impairments in health-related quality of life (HRQoL). Until now we have little data on how DSM-5 PTSD symptom dimensions relate to different aspects of HRQoL. Clarifying this question would be informative to improve the quality of life of PTSD patients. This study aimed to investigate the effects of dimensions of a well-supported seven-factor model of DSM-5 PTSD symptoms on physical and psychosocial HRQoL. A total of 1063 adult survivors of the 2008 Wenchuan earthquake took part in this study nine years after the disaster. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). HRQoL was measured by the Medical Outcomes Survey Short Form-36 (SF-36). The associations between PTSD symptom dimensions and HRQoL were examined using structural equation models. Dysphoric arousal symptoms were found to significantly relate to physical HRQoL. Other symptom dimensions were not associated with HRQoL. Our findings contribute to the relationship between DSM-5 PTSD and HRQoL, and carry implications for further clinical practice and research on trauma-exposed individuals.

Relationship of Hippocampal Volumes and Posttraumatic Stress Disorder Symptoms Over Early Posttrauma Periods

BACKGROUND

Smaller hippocampal volume is associated with more severe posttraumatic stress disorder (PTSD) symptoms years after traumatic experiences. Posttraumatic stress symptoms appear early following trauma, but the relationship between hippocampal volume and PTSD symptom severity during early posttrauma periods is not well understood. It is possible that the inverse relationship between hippocampal volume and PTSD symptom severity is already present soon after trauma. To test this possibility, we prospectively examined the association between hippocampal volumes and severity of PTSD symptoms within weeks to months after trauma due to a motor vehicle collision.

METHODS

Structural magnetic resonance imaging scans of 44 survivors were collected about 2 weeks and again at 3 months after a motor vehicle collision to measure hippocampal volumes. The PTSD Checklist was used to evaluate PTSD symptoms at each scan time. Full (n = 5) or partial (n = 6) PTSD was evaluated using the Clinician-Administered PTSD Scale at 3 months.

RESULTS

Left hippocampal volumes at both time points negatively correlated with PTSD Checklist scores, and with subscores for re-experiencing symptoms at 3 months. Left hippocampal volumes at 3 months also negatively correlated with hyperarousal symptoms at 3 months. Finally, neither left nor right hippocampal volumes significantly changed between 2 weeks and 3 months posttrauma.

CONCLUSIONS

The results suggest that small hippocampal volume at early posttrauma weeks is associated with increased risk for PTSD development. Furthermore, the inverse relationship between hippocampal volume and PTSD symptoms at 3 months did not arise from posttrauma shifts in hippocampal volume between 2 weeks and 3 months after trauma.

Compelled to Risk: Does Sexual Compulsivity Explain the Connection Between Borderline Personality Disorder Features and Number of Sexual Partners?

Having more sexual partners increases the likelihood of new HIV infections among women. Women with more borderline personality disorder (BPD) features have been known to have greater numbers of sexual partners. However, the mechanisms linking BPD features with more sexual partners remain to be clarified. Sexual compulsivity (lack of control, increased distress over sexual behavior) may be one such explanatory factor, as it overlaps with BPD features (e.g., impulsivity, negative affectivity). The present study examined whether sexual compulsivity explained the relation of BPD features with number of sexual partners among a diverse sample of college females (N = 1,326). Results demonstrated a significant indirect effect of BPD features via sexual compulsivity on number of sexual partners. These findings support the relation between BPD features and sexual compulsivity and suggest sexual compulsivity as a target in the promotion of the sexual health of women with BPD who demonstrate risky sexual practices.

Factor structure of DSM-5 PTSD symptoms in trauma-exposed adolescents: Examining stability across time

This study investigated the latent structure of DSM-5 PTSD symptoms using two-wave longitudinal data collected from a sample of adolescents exposed to an explosion accident. Two waves of surveys were conducted approximately 3 and 8 months after the accident, respectively. A total of 836 students completed the baseline survey, and 762 students completed the follow-up survey. The results of confirmatory factor analyses(CFA) indicated that a seven-factor hybrid model composed of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal and dysphoric arousal factors yielded significantly better data fit at both waves than the other models including the DSM-5 four-factor model, the six-factor anhedonia and externalizing behaviors models. Furthermore, the results of CFA invariance tests supported the longitudinal invariance of the model. Implications and limitations in terms of these results are discussed.

The 7-factor hybrid model of DSM-5 PTSD symptoms and alcohol consumption and consequences in a national sample of trauma-exposed veterans

The purpose of the present study was to investigate associations between the 7-factor hybrid model of DSM-5 posttraumatic stress disorder (PTSD) symptoms, which includes intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal symptoms, and alcohol consumption and consequences. A nationally representative sample of 916 trauma-exposed U.S. military veterans were administered the Trauma History Screen, PTSD Checklist-5, and Alcohol Use Disorders Identification Test. Confirmatory factor analyses were conducted to determine associations between the 7-factor hybrid model of PTSD symptoms, and alcohol consumption and consequences. Results revealed that lifetime dysphoric arousal (r=0.31), negative affect (r=0.30), and anhedonia (r=0.29) symptom clusters were most strongly associated with past-year alcohol consequences. No significant associations were observed for alcohol consumption. While the cross-sectional study design does not allow one to ascertain causative associations between PTSD factors and alcohol consumption and consequences, results generally align with the self-medication hypothesis, as PTSD factors reflecting internalizing were most strongly related to alcohol-related consequences. These results underscore the importance of assessing for alcohol use problems in veterans who score highly on PTSD symptoms reflecting internalizing symptomatology.

Functions of Nonsuicidal Self-Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, ; Joiner, Sachs-Ericson, Wingate, Brown, Anestis, & Selby, ) wherein painful and provocative experiences (e.g., nonsuicidal self-injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, ; Smith, ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; M_age  = 18.69, range 18-22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI (β = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts (β = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.

General distress is more important than PTSD's cognition and mood alterations factor in accounting for PTSD and depression's comorbidity

BACKGROUND

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are highly comorbid and exhibit strong correlations with each other at both the symptom level and latent factor level. Various theories have attempted to explain this relationship. Results have been inconsistent regarding whether PTSD's negative alterations in cognition and mood factor (NACM) is significantly more related to depression, in contrast to other factors of PTSD.

METHODS

Confirmatory factor analysis was used to attempt to address the relationships between PTSD and MDD in a large sample of trauma-exposed combat veterans from the Ohio National Guard as part of a larger longitudinal study.

RESULTS

Confirmatory factor analysis was used to test a bifactor model of PTSD symptoms, testing relations between PTSD's factors and a latent depressive factor. After partitioning out the common variance into the bifactor, we found that in contrast to other PTSD factors, PTSD's NACM factor was not significantly more related to depression. Instead, only the general bifactor predicted depressive symptoms.

LIMITATIONS

The limitations of the present study include the following: the specific measures of PTSD and MDD used were based on self-report, and the sample consisted of non-clinical, non-treatment seeking veterans.

CONCLUSIONS

The present study suggests that the high rate of comorbidity between posttraumatic stress disorder (PTSD) and major depressive disorder is more related to underlying general distress or negative affectivity than the symptom categories of the PTSD diagnostic criteria.

Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use

Common mental health consequences following the experience of potentially traumatic events include Posttraumatic Stress Disorder (PTSD) and addictive behaviors. Problematic smartphone use is a newer manifestation of addictive behaviors. People with anxiety severity (such as PTSD) may be at risk for problematic smartphone use as a means of coping with their symptoms. Unique to our knowledge, we assessed relations between PTSD symptom clusters and problematic smartphone use. Participants (N = 347), recruited through Amazon's Mechanical Turk (MTurk), completed measures of PTSD and smartphone addiction. Results of the Wald tests of parameter constraints indicated that problematic smartphone use was more related to PTSD's negative alterations in cognitions and mood (NACM) than to PTSD's avoidance factor, Wald χ²(1, N = 347) = 12.51, p = 0.0004; and more to PTSD's arousal compared to PTSD's avoidance factor, Wald χ²(1, N = 347) = 14.89, p = 0.0001. Results indicate that problematic smartphone use is most associated with negative affect and arousal among trauma-exposed individuals. Implications include the need to clinically assess problematic smartphone use among trauma-exposed individuals presenting with higher NACM and arousal severity; and targeting NACM and arousal symptoms to mitigate the effects of problematic smartphone use.

The underlying dimensions of DSM-5 PTSD symptoms and their relations with anxiety and depression in a sample of adolescents exposed to an explosion accident

Background: A large number of empirical studies pertaining to the latent dimensions of DSM-5 PTSD symptoms have accumulated. However, there is still a lack of studies specific to youths. Objective: This study sought to investigate the latent dimensions of DSM-5 PTSD symptoms in a sample of adolescents exposed to an explosion accident. Method: Participants were 836 students (407 females and 428 males). Self-reported measures including the PTSD Checklist for DSM-5 and the anxiety and depression subscales of the 21-item Depression Anxiety Stress Scale were administered to participants. Confirmatory factor analysis (CFA) was implemented to test competing factor models. Results: A seven-factor model composed of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, anxious arousal and dysphoric arousal factors emerged as the best fitting model, and PTSD's factors displayed distinguishable correlations with external measures of anxiety and depression. Conclusions: The findings provide and extend empirical evidence supporting the newly refined seven-factor hybrid model of DSM-5 PTSD symptoms, and have implications for further trauma-related clinical practice and research.

Latent classes of childhood poly-victimization and associations with suicidal behavior among adult trauma victims: Moderating role of anger

The aims of the present study were first to identify discrete patterns of childhood victimization experiences including crime, child maltreatment, peer/sibling victimization, sexual violence, and witnessing violence among adult trauma victims using latent class analysis; second, to examine the association between class-membership and suicidal behavior, and third to investigate the differential role of dispositional anger on the association between class-membership and suicidal behavior. We hypothesized that those classes with accumulating exposure to different types of childhood victimization (e.g., poly-victimization) would endorse higher suicidal behavior, than the other less severe classes, and those in the most severe class with higher anger trait would have stronger association with suicidal behavior. Respondents were 346 adults (N=346; M_age=35.0years; 55.9% female) who had experienced a lifetime traumatic event. Sixty four percent had experienced poly-victimization (four or more victimization experiences) and 38.8% met the cut-off score for suicidal behavior. Three distinct classes emerged namely, the Least victimization (Class 1), the Predominantly crime and sibling/peer victimization (Class 2), and the Poly-victimization (Class 3) classes. Regression analysis controlling for age and gender indicated that only the main effect of anger was significantly associated with suicidal behavior. The interaction term suggested that those in the Poly-victimization class were higher on suicidal behavior as a result of a stronger association between anger and suicidal behavior in contrast to the association found in Class 2. Clinical implications of findings entail imparting anger management skills to facilitate wellbeing among adult with childhood poly-victimization experiences.

Do gender and directness of trauma exposure moderate PTSD's latent structure?

The PTSD diagnosis and latent structure were substantially revised in the transition from DSM-IV to DSM-5. However, three alternative models (i.e., anhedonia model, externalizing behavior model, and hybrid model) of PTSD fit the DSM-5 symptom criteria better than the DSM-5 factor model. Thus, the psychometric performance of the DSM-5 and alternative models' PTSD factor structure needs to be critically evaluated. The current study examined whether gender or trauma directness (i.e., direct or indirect trauma exposure) moderates the PTSD latent structure when using the DSM-5 or alternative models. Model performance was evaluated with measurement invariance testing procedures on a large undergraduate sample (n=455). Gender and trauma directness moderated the DSM-5 PTSD and externalizing behavior model and did not moderate the anhedonia and hybrid models' latent structure. Clinical implications and directions for future research are discussed.

Relations between anger and DSM-5 posttraumatic stress disorder symptoms

The present study investigated the relationship between posttraumatic stress disorder (PTSD) and anger. Anger co-occurring with PTSD is found to have a severe effect across a wide range of traumatic experiences, making this an important relationship to examine. The present study utilized data regarding dimensions of PTSD symptoms and anger collected from a non-clinical sample of 247 trauma-exposed participants. Confirmatory factor analysis (CFA) was used to determine the underlying factor structure of both PTSD and anger by examining anger in the context of three models of PTSD. Results indicate that a five-factor representation of PTSD and one-factor representation of anger fit the data best. Additionally, anger demonstrated a strong relationship with the dysphoric arousal and negative alterations in cognitions and mood (NACM) factors; and dysphoric arousal was differentially related to anger. Clinical implications include potential need to reevaluate PTSD's diagnostic symptom structure and highlight the potential need to target and treat comorbid anger in individuals with PTSD. In regard to research, these results support the heterogeneity of PTSD.