A Latent Class Analysis of Adverse Life Events for Kenyan Adolescents

Extant evidence indicates that exposure to adverse childhood experiences (ACE) tend to cluster among children and adolescents. Considering that adolescents from African countries present higher risk of being exposed to multiple ACE compared to other countries, the identification of victimization profiles in this population is clearly warranted. The aim of this study was to determine meaningful clusters of individuals with similar experiences of ACE in a sample of Kenyan adolescents. Latent class analysis (LCA) was conducted to identify latent classes of exposure to ACE. In addition, the relationships between the latent classes and gender, parental education, living arrangements and diagnosis of post-traumatic stress disorder (PTSD) were estimated. A three-class solution was found to be the best description of ACE, and the classes were labelled ''Low Risk'', ''Intermediate Risk'', and ''High Risk''. Compared with the Low-Risk class, the High-Risk class was found to be significantly more likely to have a diagnosis of PTSD and being a female may be an antecedent risk factor for high exposure to ACE. The Intermediate Risk class was significantly less likely to have parents with high school or college education. This paper indicates that Kenyan adolescents present higher risk of being exposed to multiple ACE and that trauma research may turn its focus on the individual as the unit of analysis rather than traumatic events.

Lifetime Polyvictimization and Mental Health Outcomes in Women With vs Without Incarceration Histories: A Population-Based Latent Class Analysis

We use latent class analysis, a life course framework, and information on the type, frequency, and timing of trauma exposure to identify distinct polytrauma groups in a national sample of women (AddHealth). We compare the identified polytrauma groups and their associations with mental health in adulthood in women with and without incarceration histories. A unique group with polyvictimization (neglect, physical, sexual) exposure in childhood by a caregiver in women with incarceration histories was not identified in women without incarceration histories. We find evidence of distinct associations between polytrauma groups and mental health and possibly, criminal justice involvement, in adulthood.

Exploring Independent and Cumulative Effects of Adverse Childhood Experiences on PTSD and CPTSD a Study in Ugandan Adolescents

Exposure to adverse childhood experiences (ACEs) is related to higher morbidity and mortality among adolescents. The present study analyzed the independent and cumulative effects of ACE exposure on the likelihood of PTSD and a CPSTD diagnosis in Ugandan adolescents. A sample of 401 schoolchildren participated in the study. The primary aim was to collect information on ACEs, PTSD, CPTSD, and attachment styles among adolescents living in different countries. It was found that exposure to 2-3 ACEs and exposure to 4-5 ACEs were significantly associated with PTSD diagnosis, while exposure to sexual abuse, bullying, threats of violence, and near-drowning were significantly related to CPTSD diagnosis. Fearful attachment style was significantly associated with PTSD diagnosis. The results propose that biological, psychological, and social issues interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study underscores the importance of addressing childhood-averse and traumatic experiences as a public health priority in Uganda.

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review

Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).

The relationship between patterns of negative life experiences and clinical presentation in a psychiatric sample

BACKGROUND

Attempts have been made to classify the patterns of polytraumatization using a person-centered approach. However, most studies have only focused on maltreatment and interpersonal trauma and have been unable to examine various clinical symptoms.

OBJECTIVES

This study aimed to explore patterns of negative life experiences, including maltreatment, lifetime trauma, and recent stressful life events, and compare diverse dimensions of the clinical manifestations among the subtypes in a clinical sample.

METHOD

We investigated childhood maltreatment, lifetime trauma, and recent stressful events using a self-report method in 1410 psychiatric patients; we classified the patterns of lifelong negative life experiences using latent profile analysis (LPA). We used the rates of psychiatric diagnosis, the Beck Depression Inventory, the Impact of Event Scale-Revised (IES-R-K), and the Multiphasic Minnesota Personality Inventory-2-Restructured Form to compare various symptom dimensions among the derived subtypes.

RESULTS

LPA indicated a four-class solution: mild, recent stress, maltreatment, and multiple adversity group. The multiple adversity group experiencing both lifetime trauma and recent stressful life events, in addition to maltreatment, including sexual abuse, had a high rate of severe mental illness and more symptom dimensions of thought and behavior problems. However, the rates of depressive disorders and emotional/internalizing symptoms were not more than those in the other two groups (recent stress and maltreatment groups) experiencing moderate levels of lifetime trauma. There was no significant difference between the recent stress and maltreatment groups for most symptom dimensions.

CONCLUSIONS

The findings indicate that distinct symptom profiles may be associated with the pattern of negative experiences, suggesting that negative experiences need multidimensional investigation in clinical settings.

The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study

BACKGROUND

The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample.

OBJECTIVE

This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions.

METHODS

We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models.

RESULTS

Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed.

CONCLUSIONS

Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51838.

Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents

Background

The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents.

Aim

The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents.

Method

Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling.

Results

Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping.

Conclusions

The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.

Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents

The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.

Empirically Derived Patterns of Posttraumatic Stress and Growth: A Systematic Review

The relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG) has been extensively studied; however, the nature of the relationship remains unclear. Inconsistencies in the literature could be, in part, due to the use of variable level approaches. Person centered methods may further our understanding of this relationship, as they enable the identification of clinically meaningful subgroups based on PTS/PTG scores. This review aimed to identify commonly found subgroups of PTS and PTG, clinically relevant factors that distinguish the subgroups and to critically appraise the utility of categorizing individuals into subgroups based on PTS/PTG scores. Five databases (Embase, Medline, Web of Science, PILOTS, and PsycINFO) were searched. Seven studies (with a total of eight study samples; n = 6,776) met the eligibility criteria. A narrative synthesis of the findings revealed that the majority of the analyses (n = 6) found three patterns of PTS/PTG. These were categorized as: (1) low PTS/PTG (representing 26.89% of the entire sample), (2) high PTS/PTG (weighted mean percentage = 20.05%), and (3) low PTS/high PTG (weighted mean percentage = 43.1%). The role of social support was examined in five studies and higher social support was consistently found to predict membership in the low PTS/high PTG class. All five studies that examined the role of trauma characteristics found that it was a significant predictor of class membership. These findings could inform the developments of tailored interventions. The utility of person-centered approaches was discussed and recommendations to improve the application and reporting of such methods were made.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BACKGROUND

Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.

METHODS

We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008).

RESULTS

Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.

CONCLUSIONS

Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Latent profiles of posttraumatic stress disorder symptoms and sleep disturbances in relation to drinking to cope motives among college students

BACKGROUND

Posttraumatic stress disorder (PTSD), sleep disturbances, and problematic alcohol use are frequently comorbid. Research shows that individuals with more PTSD symptom severity and poorer sleep are highly susceptible to drinking alcohol to cope with negative affect. The current study examined the number and nature of different subgroups of trauma-exposed college students based on endorsed PTSD symptoms and sleep disturbances; and how such subgroups relate to drinking to cope motives.

METHOD

The sample included 474 trauma-exposed college students (Mage = 20.69 years; 75.50% female) who completed self-report surveys.

RESULTS

Latent profile analyses revealed three subgroups: High PTSD-Sleep Disturbances (n = 71), Moderate PTSD-Sleep Disturbances (n = 135), and Low PTSD-Sleep Disturbances (n = 268). Results indicated that college students in the Low PTSD-Sleep Disturbances group endorsed the lowest amount of coping-related drinking motives; however, college students in the Moderate PTSD-Sleep Disturbances group did not endorse significantly different levels of coping-related drinking motives than college students in the High PTSD-Sleep Disturbances group.

CONCLUSIONS

College students with subclinical presentations of psychopathology are at risk for endorsing risky drinking motives. As they adjust to a stressful environment with a culture of heavy drinking, providing context-relevant intervention efforts such as adaptive coping strategies, relaxation skills designed to facilitate restful sleep, and trauma-informed care may be highly beneficial for college students.

Asian Indians in the United States and Posttraumatic Stress Disorder Interventions: A Narrative Literature Review

Topic. Limited research has examined trauma and posttraumatic stress disorder (PTSD) among Asian Indians in the U.S. Thus, we (1) synthesize literature on trauma, PTSD, disparities in treatment for PTSD, the burden of untreated PTSD, and culturally-adapted (CA) PTSD interventions; and (2) discuss recommendations for clinicians/researchers working with this population.Method. We searched two databases using keywords related to Asian Indians, PTSD, and interventions. Of 238 identified articles, we used content from 26 articles to inform our review.Findings. Asian Indians report traumatic experiences before, during, or after immigration to the U.S. and consequential PTSD symptoms. Further, Asian Indians in the U.S. are disproportionately impacted by socio-cultural and economic determinants of poor mental health (e.g., shame/stigma associated with seeking mental health services, few culturally-responsive services), which may contribute to the under-reporting of PTSD and (interpersonal) traumas and less willingness to seek treatment. Additionally, CA PTSD interventions tailored to Asian Indians in the U.S. have not been developed. Socio-cultural considerations that can inform CA PTSD interventions for Asian Indians include: causal conditions (e.g., culturally-rooted beliefs about trauma/PTSD), intervening conditions/barriers (e.g., emotional inhibition), and mitigating/coping strategies (e.g., religious/spiritual practices, cultural idioms of distress). These considerations influence clinician/treatment preferences (e.g., solution-oriented and structured therapy, less emotional exposure). Lastly, we outline recommendations for clinicians/researchers: (1) need for national studies on trauma, PTSD, treatment utilization, and the burden of untreated PTSD; (2) consideration of immigration-related experiences influencing PTSD; (3) consideration of socio-cultural elements for CA PTSD interventions; and (4) need for culturally-valid PTSD assessments.

The role of affect in associations between sleep disturbances and posttraumatic stress disorder symptoms: A systematic review

Strong evidence supports a bidirectional association between sleep disturbances and posttraumatic stress disorder (PTSD). Affect - temporary internal states experienced as feeling good or bad, energized or enervated - may play a central role in explaining this link. The current systematic review summarizes the literature on associations between sleep, PTSD, and affect among trauma-exposed adults. We systematically searched five electronic databases (PubMed, PsycInfo, PTSDpubs, Web of Science, CINAHL) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Of 2656 screened articles, 6 studies met inclusion criteria. Four findings emerged: (1) greater insomnia symptom severity predicted greater PTSD symptom severity above the influence of negative affect, (2) negative affect mediated the effect of sleep quality on next-day PTSD symptom severity, (3) positive affect mediated the effect of PTSD symptom severity on insomnia symptom severity and sleep disturbances, and (4) greater negative affect (specifically, greater anger) was associated with greater severity of PTSD and sleep disturbances. Findings highlight areas for future research, such as the need to investigate more dimensions, timescales, and methods of studies simultaneously assessing affect, sleep, and PTSD, as well as the need for more longitudinal and experimental work to determine causality across these constructs.

Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Background: Polyvictimization, the experience of multiple types of victimization, is associated with detrimental health outcomes. Despite extensive research on the health consequences of polyvictimization, one challenge in understanding this literature lies in the varied operationalized definitions of polyvictimization and health outcomes. This scoping review provides the volume of the current literature on this topic, documents the varied constructs of polyvictimization and associated health outcomes, identifies knowledge gaps, and guides future research directions. Method: A systematic search of English-language original articles that presented quantitative associations of childhood polyvictimization and health outcomes was performed through six-database searches, a gray literature search, and citation mining from June 2020 to January 2021. The varied constructs of polyvictimization, health outcomes, and other study characteristics were extracted. Results: A total of 96 studies were included. Two ways of creating continuous variables (30.21%) and four ways of constructing categorical variables (72.92%) were identified for operationalizing polyvictimization. The majority of health outcomes were mental, behavioral, or social (96.88%), while slightly more than 10% of studies examined physical health (11.46%) or general health conditions (10.42%), respectively. More than half of studies used U.S. samples (56.25%). Conclusions: The varied constructs of polyvictimization suggests that there is a need to establish a valid polyvictimization construct that is consistently agreed upon in the research community. Findings summarize the specific health outcomes that can be targeted for further investigation and prevention efforts. Findings also suggest that the study of resilience and coping education for childhood polyvictims is sorely needed.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

BACKGROUND AND OBJECTIVES

Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time.

DESIGN AND METHODS

A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys.

RESULTS

Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p  = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days.

CONCLUSIONS

Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Factors Related to Positive Memory Count Among Trauma-Exposed Individuals: A Scoping Review

To examine the existing knowledge base on trauma experiences and positive memories, we conducted a scoping review of trauma and post-trauma factors related to positive memory count. In July 2019, we searched PubMed, Medline, PsycINFO, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Embase, and PTSDpubs for a combination of words related to "positive memories/experiences," "trauma/posttraumatic stress disorder (PTSD)," and "number/retrieval." Twenty-one articles met inclusion criteria (adult samples, original articles in English, peer-reviewed, included trauma-exposed group or variable of trauma exposure, trauma exposure examined with a trauma measure/methodology, assessed positive memory count, empirical experimental/non-experimental study designs). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, two authors reviewed abstracts, completed a secondary search, and independently extracted data. Our review indicated (1) that depression and PTSD were most researched; (2) no conclusive relationships of positive memory count with several psychopathology (depression, acute stress disorder, eating disorder, and anxiety), cognitive/affective, neurobiological, and demographic factors; (3) trends of potential relationships of positive memory count with PTSD and childhood interpersonal traumas (e.g., sexual and physical abuse); and (4) lower positive memory specificity as a potential counterpart to greater overgeneral positive memory bias. Given variations in sample characteristics and methodology as well as the limited longitudinal research, conclusions are tentative and worthy of further investigations.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example

BACKGROUND

Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted).

METHODS

Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes.

RESULTS

On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample.

LIMITATIONS

Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection.

CONCLUSIONS

Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Heterogeneity in patterns of posttraumatic stress disorder symptoms and sleep disturbances among firefighters: Latent profile analyses

Firefighters are at increased risk for posttraumatic stress disorder (PTSD) symptoms and sleep disturbances due to occupational trauma exposure as well as the nature of their job (e.g., shift work, workplace stress). PTSD symptoms co-occur with sleep disturbances, including poor sleep quality, short sleep duration, and low sleep efficiency. No published studies have examined subgroups of firefighters based on PTSD symptoms and sleep disturbances. Thus, we used latent profile analysis to identify the best-fitting class solution to categorize firefighters based on endorsed PTSD symptoms and sleep disturbances and examined relations between the optimal class solution and health covariates (i.e., anger reactions, depression symptoms, emotion regulation difficulties, number of traumatic event types). The sample included 815 trauma-exposed firefighters (M_age = 38.63; 93.20% male). Results indicated three latent subgroups: High PTSD-Sleep Disturbances, Moderate PTSD-Sleep Disturbances, and Low PTSD-Sleep Disturbances. Multinomial logistic regression indicated that endorsing greater anger reactions, depression symptoms, and emotion regulation difficulties increased the chances of being in the more severe classes. Endorsing greater number of traumatic event types increased the chances of being in the Moderate vs. Low PTSD-Sleep Disturbances Classes. Findings improve our understanding of subgroups of firefighters based on PTSD and sleep disturbances and underscore the importance of addressing depression symptoms, anger management, and emotion regulation skills for firefighters reporting more severe PTSD symptoms and sleep disturbances.

The Impact of Child Abuse and Dissociation on Psychiatric Comorbidity and Self-Concealment Among Prisoners in China

Child abuse is a common experience among prisoners in China and associated with elevated psychiatric comorbidity. However, the association between child abuse profiles and dissociation is unclear. The extent to which the relationship between these profiles and dissociation might influence psychiatric comorbidity and self-concealment is also unclear. This study examined the impact of this relationship on the preceding outcomes among prisoners in China using Latent Class Analysis. Four hundred and ninety-six male prisoners from China completed questionnaires measuring child abuse, dissociation, self-concealment, and psychiatric comorbidity. A three-class solution was achieved: Class 1 (neglected with moderate dissociation) prisoners had a minimal level of abuse, the highest level of neglect experience, and a medium level of dissociation; Class 2 (low neglect with low dissociation) prisoners also had a minimal level of abuse but lower levels of neglect experience and dissociation; Class 3 (abused and neglected with high dissociation) prisoners had high levels of child abuse, neglect, and dissociation. Controlling for age, Class 3 reported significantly higher psychiatric comorbidity and self-concealment than the other two classes. Class 1 was more depressed than Class 2; Class 2 was more likely to engage in self-concealment than Class 1. To conclude, the kinds of childhood maltreatment experienced by prisoners and their readiness to detach from distressing emotions can influence the severity of current distress symptoms and the tendency to conceal things about themselves.

The memory-experience gap for PTSD symptoms: The correspondence between experience sampling and past month retrospective reports of traumatic stress symptoms

Posttraumatic stress disorder assessments typically require individuals to provide an aggregate report on the frequency or severity of symptoms they have experienced over a particular time period. Yet retrospective aggregate assessments are susceptible to memory recall and retrieval difficulties. This study examined the correspondence between a month of real-time experience sampling methodology (ESM) reports of traumatic stress symptoms and a retrospective assessment of past-month traumatic stress symptoms for that same period. Participants were a convenience community sample (n=96) from Southern and Central Israel exposed to rocket fire during the Israel-Gaza July-Aug 2014 conflict. Participants provided ESM reports on traumatic stress symptoms twice a day for 30 days via smartphone. Average ESM scores, rather than peak or most recent reports, were most highly correlated with retrospective assessments. For individual symptoms, concentration difficulties had the highest correspondence between ESM and retrospective reports, while amnesia had the lowest correspondence. Regression analysis found that average ESM scores and younger age significantly predicted past-month retrospective assessments of PTSD symptoms. Additionally, previously experiencing more types of trauma predicted PTSD symptoms, but did not moderate the relationship between ESM and retrospective assessments. These findings have implications for assessment.

Patterns of childhood adversity and their associations with internalizing and externalizing problems among at-risk boys and girls

BACKGROUND

Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted.

OBJECTIVE

To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems.

PARTICIPANTS AND SETTING

Participants (N = 2198) were a sample of children ages 1-17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures.

METHOD

Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs.

RESULTS

Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes.

CONCLUSIONS

Exposure to multiple adversities is common among at-risk children. Information on different sex-specific patterns of adversity co-occurrences can guide intervention planning for affected children.

Characterizing Typologies of Polytraumatization: A Replication and Extension Study Examining Internalizing and Externalizing Psychopathology in an Urban Population

A person-centered approach to examining trauma has uncovered typologies of polytraumatization that are differentially associated with psychopathology. However, previous research is limited by narrow conceptualizations of trauma, limited distal outcomes, and underrepresentation of minorities. To address these gaps, we used latent profile analyses to uncover distinct polytraumatization typologies and examine four symptom-based (PTSD, depression, aggression, and substance abuse) and two behavior-based (self-harm, jail counts) outcomes in a sample of low-income adults (n = 7,426, 94% African American). The models were indicated by 19 traumatic experiences (e.g., accident, sexual assault, witnessing/experiencing violence). The best fitting model uncovered five classes: minimal trauma, physical abuse, violence exposure, sexual abuse, and polytrauma. Classes characterized by significant and varied trauma were higher on both internalizing and externalizing psychopathology, while those characterized by specific types of trauma were only higher on one type of psychopathology. Implications for the assessment and treatment of trauma-related disorders are discussed.

Effects of bodily arousal on desire to drink alcohol among trauma-exposed college students

INTRODUCTION

Alcohol consumption on college campuses is a major public health concern. Extant literature has identified trauma exposure as a robust risk factor for problematic alcohol use in this at-risk population. However, the mechanisms underlying this association are less well-studied. Research indicates that bodily arousal is a fundamental feature of trauma exposure, and posits that internal stimuli (e.g., heart pounding) at the time of trauma may manifest into conditioned cues that can trigger posttraumatic responding and related symptomatology, including alcohol use. However, past work supporting these assertions has used paradigms purposefully designed to evoke memories of the trauma, making it difficult to ascertain whether the mechanism driving subsequent alcohol craving is the explicit memory cue or the associated bodily arousal.

METHODS

The current study examined whether an implicit, trauma-relevant cue of bodily arousal (via voluntary hyperventilation) - independent of any explicit memory cue - would elicit increased desire to drink among 104 (M_age = 20.30; 61.5% female) trauma-exposed undergraduates.

RESULTS

Results found no statistically significant difference in change in alcohol craving between the hyperventilation and control tasks. However, secondary analyses indicated that trauma type (i.e., interpersonal/non-interpersonal) may play an influential role in this relationship. More specifically, individuals reporting interpersonal trauma as their most traumatic event evidenced a significantly greater increase in desire to drink following hyperventilation compared to the non-interpersonal index trauma group.

DISCUSSION

Generally, these findings suggest that bodily arousal may only serve as an implicit, trauma-relevant interoceptive cue that increases desire to drink within a specific subset of trauma-exposed college students (i.e., individuals indexing interpersonal trauma). Replication and extension are needed to further understand the influence of bodily arousal on subsequent alcohol use behavior, which will be critical to PTSD-alcohol use modeling and, ultimately, help in informing prevention- and treatment-oriented intervention efforts aimed at reducing problematic alcohol use on college campuses.

The differential relation of trauma types with negative and positive emotion dysregulation

Background and Objectives: Research provides robust support for an association between traumatic exposure and emotion dysregulation. Less understood is the relation of emotion dysregulation stemming from positive emotions to traumatic exposure, or the extent to which negative and positive emotion dysregulation may be uniquely related to specific trauma types.Design and Methods: The present study explored the associations between negative and positive emotion dysregulation and specific trauma types in a community sample of 433 adults (M age = 43.81, 68.4% women).Results: Results highlighted three main findings: (1) negative and positive emotion dysregulation were significantly higher among individuals with vs. without exposure to six and nine specific trauma types, respectively; (2) negative and positive emotion dysregulation were significantly and positively related to total number of specific traumatic events; and (3) negative emotion dysregulation was significantly higher among individuals with Victimization Traumas in the overall sample as well as the no-PTSD and no-MDD subsamples, and positive emotion dysregulation was significantly lower among individuals with Accidental/Injury Traumas and Victimization Traumas in the PTSD subsample.Conclusions: Results underscore the relative and unique roles of negative and positive emotion dysregulation in trauma types; these findings may inform future research.

Critical considerations for the positive memory-posttraumatic stress disorder model

Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.

Factors Associated with Adjustment Disorder - the Different Contribution of Daily Stressors and Traumatic Events and the Mediating Role of Psychological Well-Being

The definition of adjustment disorder (AjD) was recently revised by the 11th version of the International Classification of Diseases. Thus far, only two studies explored stressors associated with symptoms of AjD according to the new definition, revealing that there might be a difference in associations with daily stressors compared to traumatic events. The present study aims at examining the associations of AjD with both types of stressors as well as the mediating role of psychological well-being that was previously suggested as a buffer against mental illness. Four hundred and 19 participants completed questionnaires assessing the prevalence of daily stressors and traumatic events experienced in the last 2 years, psychological well-being and the diagnostic criteria of AjD. Results revealed a direct effect of the prevalence of daily stressors on the diagnosis of AjD as well as the mediating effect of psychological well-being of this association. However, no effect was found for traumatic events on AjD or psychological well-being. Given these findings, psychological well-being should be regarded as a means to reduce the prevalence of AjD among individuals coping with multiple and continuous daily stressors.

The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non-LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health-needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three-class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high-trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past-month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high-trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low-trauma class, ORs = 2.39-23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community.

Examining relations of polytraumatization typologies with positive memory count and phenomenology

Background and Objectives: Most individuals experience multiple potentially traumatizing events (PTEs); hence, it is important to consider count and types of PTEs (polytraumatization) in relation to post-trauma health. Notably, no research has examined polytraumatization typologies in relation to positive memory count and phenomenology. We examined (1) latent subgroupings of individuals based on PTE endorsements; and (2) relation of the optimal latent class solution to positive memory count and phenomenology. Design: Participants were 203 trauma-exposed adults (Mage  = 35.40; 61.10% females); we used PTEs endorsed on the Life Events Checklist for DSM-5 as indicators for analyses. Results: Latent class analyses indicated a three-class solution differing in quantity and quality of PTE types: Low Experience, Predominant Interpersonal PTEs, and Predominant Non-Interpersonal PTEs. Further, more positive memories predicted membership in the Low Experience vs. other classes; greater sensory details of a positive memory predicted membership in the Low Experience vs. the Predominant Interpersonal PTEs Classes; and greater accessibility of a positive memory predicted membership in the Predominant Interpersonal PTEs vs. the Predominant Non-Interpersonal PTEs Classes. Conclusions: Results indicated three meaningful subgroups endorsing differing levels/types of PTEs; count, sensory details, and accessibility of positive memories, pending further investigation, may differentiate these subgroups.

Clusters of Trauma Types as Measured by the Life Events Checklist for DSM-5

Experiences of potentially traumatic events (PTE), commonly assessed with the Life Events Checklist for DSM-5 (LEC-5), can be both varied in pattern and type. An understanding of LEC-assessed PTE type clusters and their relation to psychopathology can enhance research feasibility (e.g., address low base rates for certain PTE types), research communication/comparisons via the use of common terminology, and nuanced trauma assessments/treatments. To this point, the current study examined (1) clusters of PTE types assessed by the LEC-5; and (2) differential relations of these PTE type clusters to mental health correlates (i.e., posttraumatic stress disorder [PTSD] severity, depression severity, emotion dysregulation, reckless and self-destructive behaviors [RSDBs]). A trauma-exposed community sample of 408 participants was recruited via Amazon's Mechanical Turk (M age = 35.90 years; 56.50% female). Network analyses indicated three PTE type clusters: Accidental/Injury Traumas (LEC-5 items 1, 2, 3, 4, 12), Victimization Traumas (LEC-5 items 6, 8, 9), and Predominant Death Threat Traumas (LEC-5 items 5, 7, 10, 11, 13-16). Multiple regression analyses indicated that the Victimization Trauma Cluster significantly predicted PTSD severity (β = .23, p <.001), depression severity (β = .20, p =.001), and negative emotion dysregulation (β = .22, p <.001); and the Predominant Death Threat Trauma Cluster significantly predicted engagement in RSDBs (β = 31, p <.001) and positive emotion dysregulation (β = .26, p <.001), accounting for the influence of other PTE Clusters. Results support three PTE type classifications assessed by the LEC-5, with important clinical and research implications.

Understanding social adversity and stress and mood symptoms: The Bayesian network approach

Social adversity events commonly occur in our daily lives. However, an individual's perception of social adversity experienced may be more important than actual events in impacting an individual's psychological functioning and reactions. In the current study, we examined how individuals' perception of social adversity events they experienced is associated with their traumatic stress symptoms as well as mood and anxiety symptoms using the Bayesian network model. The findings indicated that individuals with a perception of social adversity events as traumatic and frequent showed an increase in the probability of displaying a high level of posttraumatic stress symptoms.

Lifetime Interpersonal Victimization Profiles and Mental Health Problems in a Nationally Representative Panel of Trauma-Exposed Adults From the United Kingdom

Traumatic event exposure has been associated with negative psychological outcomes. There is, however, a dearth of research on revictimization. The current study examined patterns of lifetime interpersonal victimization based on six types of childhood maltreatment, physical and sexual assault, and assault with a weapon during adulthood via latent class analysis (LCA), with gender as covariate. Using a three-step approach, we assessed differences across the latent classes in symptoms and diagnosis of depression, anxiety, and DSM-5 posttraumatic stress disorder (PTSD). A trauma-exposed adult sample representative of the United Kingdom population (N = 1,051) was recruited online through a research panel. The mean participant age 47.18 years (SD = 15.00, range: 18-90 years; 68.4% female). The LCA identified five classes: lifetime polyvictimization (8.3%; 69.5% female), sexual revictimization (13.7%; 96.5% female), physical revictimization (12.5%; 1.5% male), childhood trauma (25.9%; 85.6% female), and limited victimization (39.7%; 40.3% female). Compared to the other classes, the polyvictimization class, followed by the childhood trauma class, demonstrated the highest scores on anxiety, depression, and posttraumatic stress symptoms. The polyvictimization class had nearly a nine- to 33-fold increase in risk of depression, OR = 9.48, 95% CI [3.34, 26.87]; anxiety, OR = 12.10, 95% CI [5.36, 27.36]; and PTSD diagnoses, OR = 33.63, 95% CI [16.35, 69.43], compared to the limited victimization class. The findings facilitate the identification of individuals at risk for revictimization and indicate that evidence-based clinical interventions should be targeted toward those with exposure to revictimization and childhood trauma exposure to alleviate mental health challenges.

The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis

BACKGROUND

Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown.

AIM

To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students.

METHODS

597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality.

RESULTS

28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes.

CONCLUSION

There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.

Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire

BACKGROUND

Exposure to child abuse can lead to lasting mental health problems. Extant research has found that different types of child abuse tend to co-occur and overlap, which merits the investigation of the effects of exposure to multiple types of childhood mistreatment.

OBJECTIVE

The aim of this study was to systematically review the evidence on the associations between multiple different types of interpersonal victimization or polyvictimization, and indicators of psychopathology among children ages 0-17.

METHODS

The review included studies across all economic strata and research on nationally representative, community, and at-risk samples, using the same standardized assessment tool (i.e. the Juvenile Victimization Questionnaire or JVQ). The review was conducted using peer-reviewed evidence published up until August 2019 from Scopus, EMBASE, PsycINFO, Medline, CINAHL, and ERIC. Out of 4998 relevant references screened, 255 met the inclusion criteria, 22 of which aimed to address childhood polyvictimization and psychopathology.

RESULTS

A total of 21 of the 22 included studies identified a significant positive association between polyvictimization and various indicators of psychopathology comprising both externalizing (e.g. anger), internalizing problems (e.g. depression) and total psychological distress. A range of studies demonstrated that polyvictimization was a stronger risk factor for psychopathology than individual (sub)types of victimization. Based on the study findings, we provide a set of recommendations for future research on polyvictimization and psychopathology.

CONCLUSION

The present systematic review was the first to review the evidence on the associations between polyvictimization (as measured by the JVQ) and child and adolescent psychopathology in the global research literature. As a novel approach, the present review included both normative and high-risk samples. The results showed that polyvictimization is a substantial risk factor for mental health problems spanning both inner-directed and outer-directed mental health difficulties. However, the inconsistency in methods of defining and measuring polyvictimization severely undermines the scientific impact of this body of work. Additional well-designed, longitudinal studies that take account of the context-specific nature of polyvictimization are required to better establish the causal relationships between childhood polyvictimization and psychopathology so as to improve prevention and intervention efforts.

Trauma, posttraumatic stress disorder severity, and positive memories

Positive memories play an important role in the aetiology and maintenance of posttraumatic stress disorder (PTSD). However, most trauma research/clinical work has focused solely on the role of traumatic memories. Thus, we examined the relationship between count of retrieved positive memories and PTSD severity, factors associated with count of retrieved positive memories (i.e., rumination, negative/positive emotion dysregulation, fear of positive emotions), and the relationship between positive memory phenomenological domains and PTSD severity. The sample included 185 trauma-exposed participants recruited through Amazon's Mechanical Turk (Mage = 35.69 years; 63.80% female). Results of linear/hierarchical regressions showed that (1) PTSD severity did not predict count of (specific) positive memories; (2) greater positive emotion dysregulation predicted fewer retrieved positive memories controlling for PTSD severity; and (3) greater PTSD severity predicted more negative valence, less vividness, less coherence, less accessibility, less clear time perspective, fewer sensory details, and greater distancing ratings of the retrieved positive memory, controlling for sleep quantity/quality. Findings add to the literature by informing PTSD theoretical perspectives; enhancing an understanding of positive memories in PTSD/trauma treatments; and highlighting potential clinical targets (e.g., positive emotion regulation), when integrating a focus on positive memories into PTSD intervention.

The Trauma and Suicide Potential Index-5: Psychometric Evaluation in College Samples

We provide a brief description of the development of the Trauma and Suicide Potential Index-5 (TSPI-5) and report on the psychometric properties of scores from the new instrument. The TSPI-5 is designed to assess an individual's desire to attempt suicide due to experiencing a trauma. We examined the structure of the instrument in two independent undergraduate samples. Study 1 (N = 415) examined the structure of the TSPI-5 using exploratory structural equation modeling. Study 2 (N = 538) reexamined the instrument structure using the same modeling strategy and also examined other validity estimates. Study 1 demonstrated an adequate fit to the sample data (χ2 [1, N = 415] = 215.99, p < .001, comparative fit index (CFI ) = .969, Tucker-Lewis non-normed fit index (TLI) = .939, root mean squared error of approximation (RMSEA) = .319 [90% confidence interval (CI) = .283, .356], p < .001) and suggested evidence for unidimensionality. Study 2 confirmed the unidimensionality of the TSPI-5 as shown by acceptable fit estimates to the sample data, χ2 (5, N = 538) = 80.45, p < .001, CFI = .996, TLI = .99, RMSEA = .17 (90% CI = .140, .200), p < .001. Scale reliability estimates for the TSPI-5 were good in Study 1 (omega = .94) and Study 2 (omega = .96). The TSPI-5 is a brief unidimensional instrument and its scores demonstrated good reliability and validity for assessing suicide-related behaviors due to experiencing a trauma in undergraduate samples.

The utility of college student samples in research on trauma and posttraumatic stress disorder: A critical review

There is a widespread notion of the 'college sophomore problem' in social science research that posits that college student samples are samples of convenience with little generalizability to the general population. To address this concern, we conducted a critical review of the literature on college student samples in trauma research. Specifically, we reviewed how college student samples differ from non-college samples in four key areas of trauma research: (1) exposure rates to potentially traumatic events (PTEs), (2) prevalence of posttraumatic stress disorder (PTSD) symptoms, (3) factor structure of PTSD symptoms, and (4) PTSD's relation with common markers, correlates, and consequences. Lastly, we discussed the value and advantages of using college student samples in trauma research. Results of the critical review indicated similar trends of trauma-related findings (Points 1-4) between college student samples and both U.S. nationally collected and treatment-seeking samples; specifically, we identified a comparable lifetime PTE exposure rate, comparable rates of PTSD, a comparable factor structure of PTSD symptoms, and a comparable pattern of associations between PTSD symptoms and post-trauma markers/correlates/consequences. Although trauma-exposed college student samples are biased in some key areas, they may be no more biased than other commonly used trauma samples (e.g. epidemiological, treatment-seeking). Results of this critical review highlight the need to re-examine potentially unfounded biases on the part of the trauma research community, as well as the need to consider advantages of using college student samples in trauma research.

Extending our understanding of the association between posttraumatic stress disorder and positive emotion dysregulation: A network analysis approach

Posttraumatic stress disorder (PTSD) has empirically-established associations with positive emotion dysregulation. Extending existing research, we utilized a network approach to examine relations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive emotion dysregulation dimensions (nonacceptance, impulse control, goal-directed behavior). We identified (1) differential relations of PTSD symptom clusters with positive emotion dysregulation, and (2) central symptoms accounting for the PTSD and positive emotion dysregulation inter-group interconnections. Participants were 371 trauma-exposed community individuals (M_age = 43.68; 70.9 % females; 34.5 % white). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD symptom clusters and three nodes representing positive emotion dysregulation dimensions. Study results indicated the key role of AAR and intrusions clusters in the PTSD group and impulse control difficulties in the positive emotion dysregulation group. Regarding cross-group connectivity patterns, findings indicate the pivotal role of (1) AAR in its link with positive emotion dysregulation dimensions, and (2) nonacceptance of positive emotions and impairment in goal-directed behavior in the context of positive emotions in their link to PTSD symptom clusters. Thus, the current study indicates the potentially central role of particular PTSD symptom clusters and positive emotion dysregulation dimensions, informing assessment and treatment targets.

Severity profiles of posttraumatic stress, depression, anxiety, and somatization symptoms in treatment seeking traumatized refugees

BACKGROUND

Western countries are facing many challenges hosting refugees from several regions in the world. Many of them are severely traumatized and suffer from a variety of mental health symptoms, which complicates the identification and treatment of refugees at risk. This study examined subgroups based on a broad range of psychopathology, and several predictors, including trauma characteristics and gender.

METHODS

Participants were 1147 treatment-seeking, traumatized refugees. Latent profile analysis was conducted to identify different subgroups based on levels of posttraumatic stress disorder (PTSD), depression, anxiety, and somatic symptoms. Multinomial logistic regression was used to identify predictors of subgroup membership.

RESULTS

Three distinct subgroups were identified, reflecting Moderate (10.2%), Severe (43.0%), and Highly Severe (45.9%) symptom severity levels, respectively. Symptom severity of all psychopathology dimensions was distributed equally between the subgroups. Participants in the Severe and Highly Severe Symptoms subgroups reported more types of traumatic events compared to the Moderate subgroup. In particular, traumatic events associated with human right abuses, lack of human needs and separation from others predicted subgroup membership, as did gender.

LIMITATIONS

The results are confined to treatment-seeking, traumatized refugee populations.

CONCLUSIONS

Distinguishable symptom severity profiles of PTSD, depression, anxiety and somatic complaints could be identified in this large treatment-seeking refugee population, without qualitative differences in symptom distribution. Instead of focusing on specific mental disorders, classification based on overall symptom severity is of interest in severely traumatized patients. This knowledge will help to identify individuals at risk and to enhance existing treatment programs for specific patient groups.

Effects of processing positive memories on posttrauma mental health: A preliminary study in a non-clinical student sample

BACKGROUND AND OBJECTIVES

Although trauma research and therapy primarily focus on traumatic memories, recent evidence indicates positive memory processes play a role in the etiology/maintenance of posttraumatic stress disorder (PTSD) symptom severity. We examined the effects of a novel positive memory processing technique on PTSD symptom severity, depression symptom severity, affect, posttrauma cognitions, and self-esteem.

METHODS

Sixty-five trauma-exposed participants were randomly assigned to one of three conditions (narrating/processing vs. writing/processing two specific positive memories, or a time-matched control) and completed self-report measures pre- and post-task (T0). About one week later, participants repeated their assigned task condition and completed self-report measures pre- and post-task (T1). We conducted mixed ANOVAs to examine the impact of the technique on study variables over time.

RESULTS

The narrating condition had significant decreases in PTSD symptom severity, posttrauma cognitions, and negative affect from T0 pre-task to T1 post-task; and significant increases in positive affect from T0 pre-to-post-task and from T1 pre-to-post-task. The writing condition had significant increases in positive affect from T0 pre-to-post-task, but a significant decrease from T0 post-task to T1 post-task; and significant decreases in negative affect from T0 pre-to-post-task with an increase from T0 post-task to T1 post-task.

LIMITATIONS

Use of self-report measures, non-clinical convenience sample with less gender/ethnic/racial diversity, small sample size, methodological differences in time frames for measures, and no examination of follow-up effects.

CONCLUSIONS

Narrating and processing specific positive memories had a beneficial impact on PTSD symptom severity, posttrauma maladaptive cognitions, and affect; such results provide an impetus to examine positive memory interventions in trauma clinical work.

Relation between PTSD symptom clusters and positive memory characteristics: A network perspective

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (M_age = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.

Intimate partner violence in Nepal: Latent patterns and association with depressive symptoms

Existing data suggest that there are distinct patterns (or classes) of intimate partner violence (IPV) experience that depart from dichotomous categorizations used to monitor progress toward Sustainable Development Goal 5.2. Less is known about the patterning of IPV in non-Western settings. This study estimates distinct classes of IPV experience in Nepal and examines potential community-level variability in these classes and in the association between IPV class and depressive symptoms. This study used data collected in 2016 from a random sample of Nepalese married women of reproductive age (N = 1440) living in 72 communities in three districts (Nawalparasi, Chitwan, and Kapilvastu). We used fixed effects and random effects latent class models of 2 through 6 classes. We fit a negative binomial regression model adjusted for relevant confounders to examine the relationship of the latent IPV classes with depressive symptoms. A four-class model was the best fitting. It included a "low exposure" class (77.36% of the sample) characterized by a low probability of experiencing any form of IPV, a "sexual violence" class (9.03% of the sample) characterized by a high probability of experiencing a form of sexual violence, a "moderate violence" class (6.60% of the sample) characterized by modest probabilities of experiencing less severe emotional and physical IPV, and a "systematic violence" class (7.01% of the sample) characterized by a high probability of being exposed to all forms of IPV. Adding random effects did not improve model fit, suggesting no community-level variations in classes. Relative to membership in the low exposure class, membership in all other classes was associated with a higher count of depressive symptoms. Those in the systematic class had a mean weighted symptom count 2.29 times that of the low exposure group. Classes of IPV exposure must be identified to ensure that surveillance and programming are attuned to women's experiences of violence.

The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse

INTRODUCTION

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement.

METHOD

The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (M_age = 35.62, 55.4% women, 77.0% White).

RESULTS

Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model.

CONCLUSIONS

Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.