Examination of the heterogeneity in PTSD and impulsivity facets: A latent profile analysis

Relationship between the latent profiles of health information-seeking behaviour and glycated haemoglobin levels in patients with type 2 diabetes: a cross-sectional survey in rural areas of China

OBJECTIVE

The purpose of this study was to analyse the heterogeneity of health information-seeking behaviour (HISB) among patients with type 2 diabetes (T2D) in rural areas based on latent profiles and to explore the relationship between various behaviours and glycaemic control rates and the factors influencing glycaemic control rates.

METHODS

Between January and July 2022, a stratified cluster random sampling method was used to sample T2D patients in the rural Guangxi Zhuang Autonomous Region. Participants completed a general information questionnaire and a HISB scale. Latent profile analysis (LPA) identified behaviour categories, and χ2 tests examined differences in glycaemic control rates across these categories. Multivariate logistic regression was used to analyse factors influencing glycaemic control. The glycaemic control rate was defined as the proportion of individuals whose HbA1c levels are less than 7.0%, indicating good control, in relation to the total number of individuals assessed.

RESULTS

A total of 2178 valid questionnaires were received in this study, and respondents were divided into three categories according to the LPA of their HISB: negative (18.3%), occlusive (46.8%) and inefficient (34.9%). The glycaemic control rate of patients with T2D in rural areas was 22.6% (494/2178 cases). Multivariate logistic regression analysis revealed that the category of patients' HISB profile, age, course of disease and educational level were the factors influencing the glycaemic control rate (all p<0.05).

CONCLUSION

Patients with T2D in rural areas had poor glycaemic control and inadequate HISB. Three latent profile categories were identified that reflect the HISB of this group. We recommend that clinical medical professionals develop personalised health management education based on the various latent profile characteristics of patients to promote HISB and thereby achieve optimal glycaemic control.

Neural and psychological correlates of post-traumatic stress symptoms in a community adult sample

A multitude of factors are associated with the symptoms of post-traumatic stress disorder. However, establishing which predictors are most strongly associated with post-traumatic stress disorder symptoms is complicated because few studies are able to consider multiple factors simultaneously across the biopsychosocial domains that are implicated by existing theoretical models. Further, post-traumatic stress disorder is heterogeneous, and studies using case-control designs may obscure which factors relate uniquely to symptom dimensions. Here we used Bayesian variable selection to identify the most important predictors for overall post-traumatic stress disorder symptoms and individual symptom dimensions in a community sample of 569 adults (18 to 85 yr of age). Candidate predictors were selected from previously established risk factors relevant for post-traumatic stress disorder and included psychological measures, behavioral measures, and resting state functional connectivity among brain regions. In a follow-up analysis, we compared results controlling for current depression symptoms in order to examine specificity. Poor sleep quality and dimensions of temperament and impulsivity were consistently associated with greater post-traumatic stress disorder symptom severity. In addition to self-report measures, brain functional connectivity among regions commonly ascribed to the default mode network, central executive network, and salience network explained the unique variability of post-traumatic stress disorder symptoms. This study demonstrates the unique contributions of psychological measures and neural substrates to post-traumatic stress disorder symptoms.

Stress response and experiential avoidance among firefighters: Preliminary insights from network analyses

Firefighters are at increased risk of developing posttraumatic stress disorder (PTSD) due to exposure to potentially traumatic events during their careers. However, little is known about the prevalence of PTSD among this population, particularly when taking moderating variables into account. Using Gaussian Graphical Models and Directed Acyclic Graphs, we conducted network analyses to examine the interactions between clusters of PTSD symptoms, perceived stress, hardiness, and experiential avoidance among 187 firefighters. The data and code are published with the paper. Experiential avoidance, as part of psychological inflexibility, was found to be the only variable that interacted with PTSD symptomatology. Strong positive associations were observed between experiential avoidance and the "negative mood and cognitions" subscale of the PTSD Checklist for DSM-5 (PCL-5). Through this association, other PTSD symptoms were activated, particularly avoidance and arousal. Our findings suggest that experiential avoidance and negative mood and cognition symptoms are particularly important in the expression of PTSD symptomatology in firefighters. In addition, experiential avoidance may be used as a coping strategy to reduce perceived stress during potentially traumatic events. Therefore, experiential avoidance may be a prime target for future interventions and training focused on flexible self-regulation strategies in this population.

Measuring psychiatric symptoms online: A systematic review of the use of inventories on Amazon Mechanical Turk (mTurk)

Symptom measurement in psychiatric research increasingly uses digitized self-report inventories and is turning to crowdsourcing platforms for recruitment, e.g., Amazon Mechanical Turk (mTurk). The impact of digitizing pencil-and-paper inventories on the psychometric properties is underexplored in mental health research. Against this background, numerous studies report high prevalence estimates of psychiatric symptoms in mTurk samples. Here we develop a framework to evaluate the online implementation of psychiatric symptom inventories relative to two domains, that is, the adherence to (i) validated scoring and (ii) standardized administration. We apply this new framework to the online use of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorder Identification Test (AUDIT). Our systematic review of the literature identified 36 implementations of these three inventories on mTurk across 27 publications. We also evaluated methodological approaches to enhance data quality, e.g., the use of bot detection and attention check items. Of the 36 implementations, 23 reported the applied diagnostic scoring criteria and only 18 reported the specified symptom timeframe. None of the 36 implementations reported adaptations made in their digitization of the inventories. While recent reports attribute higher rates of mood, anxiety, and alcohol use disorders on mTurk to data quality, our findings indicate that this inflation may also relate to the assessment methods. We provide recommendations to enhance both data quality and fidelity to validated administration and scoring methods.

The influence of trauma-related shame on the associations between posttraumatic symptoms and impulsivity facets

INTRODUCTION

The co-occurrence of posttraumatic symptoms (PTS) and impulsivity is associated with higher levels of risky and self-destructive behaviors and consequent safety and health risks. Trauma-related shame (TRS) may influence the association between PTS and impulsivity such that engaging in impulsive behaviors may serve to cope with emotional distress. Alternatively, TRS may motivate a deliberate consideration of behaviors (i.e., less impulsivity) to prevent further cognitive and emotional distress.

OBJECTIVE

The goal of the current study was to examine the influence of TRS on the associations between PTS and impulsivity facets (lack of premeditation, lack of perseverance, negative urgency, positive urgency, sensation seeking).

METHOD

Data were collected from 506 community individuals who endorsed lifetime sexual trauma (Mage = 34.56, 54.3% women, 78.7% White).

RESULTS

Findings indicated that TRS moderated associations between PTS and impulsivity facets of lack of perseverance, b = -.001, SE = .0003; t = -2.68, p = .008, 95% confidence interval [-.001, -.0002], and premeditation, b = -.001, SE = .0003; t = -3.70, p < .001, [-.002, -.001]; these associations were significant at low, but not high, levels of TRS.

CONCLUSIONS

Findings suggest that in the context of PTS, TRS may reduce certain forms of impulsivity, potentially as a means to self-protect against further cognitive and emotional distress. Findings have important implications for understanding how individuals regulate and respond to shame in the context of PTS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of Teachers' Post-Traumatic Stress Due to Violence Victimization: Moderated Mediation Effect of Living a Calling

Based on the Affective Events Theory, Work as a Calling Theory, and related studies, this research examined the moderated mediating effects of Living a Calling and the mediating effect of social interaction anxiety and psychological burnout on the relationships between post-traumatic stress disorder symptoms consequent to violence victimization, self-destructive behaviors, and turnover intention. Data from 420 Korean elementary and secondary school teachers were analyzed using the moderated mediation model. The analysis revealed that post-traumatic stress disorder caused by violence victimization positively affected self-destructive behavior and turnover intention through the sequential mediation of social interaction anxiety and psychological burnout. Further, Living a Calling moderated the indirect effect of violence victimization; the stronger the Living-a-Calling experience, the greater the indirect effect of violence victimization on turnover intention. Additionally, when the sense of Living a Calling was low, post-traumatic stress disorder caused by violence did not significantly affect turnover intention through social interaction anxiety, but contrary to expectations, the stronger the sense of Living a Calling, the more positive the mediating effect of social interaction anxiety. Therapeutic interventions in teachers' work environment, improvements, and suggestions for future research are discussed.

Using Latent Profile Analysis to Identify Associations Between Gestational Chemical Mixtures and Child Neurodevelopment

BACKGROUND

Unsupervised machine learning techniques have become increasingly popular for studying associations between gestational exposure mixtures and human health. Latent profile analysis is one method that has not been fully explored.

METHODS

We estimated associations between gestational chemical mixtures and child neurodevelopment using latent profile analysis. Using data from the Maternal-Infant Research on Environmental Chemicals (MIREC) research platform, a longitudinal cohort of pregnant Canadian women and their children, we generated latent profiles from 27 gestational exposure biomarkers. We then examined the associations between these profiles and child Verbal IQ, Performance IQ, and Full-Scale IQ, measured with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III). We validated our findings using k-means clustering.

RESULTS

Latent profile analysis detected five latent profiles of exposure: a reference profile containing 61% of the study participants, a high monoethyl phthalate (MEP) profile with moderately low persistent organic pollutants (POPs) containing 26%, a high POP profile containing 6%, a low POP profile containing 4%, and a smoking chemicals profile containing 3%. We observed negative associations between both the smoking chemicals and high MEP profiles and all IQ scores and between the high POP profile and Full-Scale and Verbal IQ scores. We also found a positive association between the low POP profile and Full-Scale and Performance IQ scores. All associations had wide 95% confidence intervals.

CONCLUSIONS

Latent profile analysis is a promising technique for identifying patterns of chemical exposure and is worthy of further study for its use in examining complicated exposure mixtures.

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.

PTSD's risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample

Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.

The Impact of PTSD-Linked Strain Sensitivity on Violent Offending: Differences in Effects During Adolescence Versus Early Adulthood

OBJECTIVES

Investigate the relevance of post-traumatic stress disorder (PTSD)-linked strain sensitivity associated with exposure to violence for predicting violence outcomes among juvenile offenders during adolescence and early adulthood.

METHODS

This study uses the Pathways to Desistance data and to test relevant relationships. Two series of negative binomial regression models were estimated to test hypotheses, one corresponding to each period of the life course.

RESULTS

Results indicated that witnessed violence interacted with PTSD status in adolescence, indicating that individuals afflicted with PTSD demonstrated heightened sensitivity to this strain, manifested in increased violent offending.

CONCLUSIONS

Results indicate that witnessed violence may act as a trigger during adolescence, resulting in juvenile offenders with PTSD responding with violence. This may have treatment implications for individuals suffering from PTSD.

Predicting Gambling Situations: The Roles of Impulsivity, Substance Use, and Post-Traumatic Stress

Gambling disorder and symptoms of post-traumatic stress are highly comorbid. Numerous studies suggest that the presence of one (either disordered gambling or post-traumatic stress) substantially increases the odds of later developing the other. However, little is known about the etiological links between these two domains or the nuances of the comorbidity. Past research has suggested that symptoms of post-traumatic stress might be related to unique motivations for and beliefs about gambling. The present work sought to examine whether or not symptoms of post-traumatic stress might also be related to specific situational vulnerabilities to gambling behaviors. Using a large cross-sectional sample of Internet-using adults in the United States who were primarily recreational gamblers (N = 743; 46% men, M_age = 36.0, SD = 11.1), as well as an inpatient sample of US Armed Forces veterans seeking treatment for gambling disorder (N = 332, 80% men, M_age = 53.5, SD = 11.5), the present work tested whether or not symptoms of post-traumatic stress were uniquely related to a variety of gambling situations. Results in both samples revealed that even when controlling for potentially confounding variables (eg, substance use and trait impulsivity), symptoms of post-traumatic stress were uniquely related to gambling in response to negative affect, gambling in response to social pressure, and gambling due to a need for excitement. These findings are consistent with recent work suggesting that individuals with post-traumatic stress symptoms are more likely to engage in gambling behaviors for unique reasons that differ from gamblers without such symptoms.

Heterogeneity in the Co-occurrence of Substance Use and Posttraumatic Stress Disorder: A Latent Class Analysis Approach

Objective: Posttraumatic stress disorder (PTSD) often co-occurs with substance use (SU). Although there has been independent research on subgroups of participants based on their PTSD or SU responses, rarely are PTSD-SU typologies examined consistent with a precision medicine approach (and corresponding person-centered statistical approaches). The current study examined the nature and construct validity (covariates of depression, physical aggression, verbal aggression, anger, hostility, reckless and self-destructive behaviors [RSDB]) of the best-fitting latent class solution in categorizing participants based on PTSD (PTSD Checklist for DSM-5) and alcohol/drug use responses (Alcohol Use and Disorders Identification Test Alcohol Consumption Questions, Drug Abuse Screening Test). Methods: The sample included 375 trauma-exposed participants recruited from Amazon's Mechanical Turk online labor market. Results: Latent class analyses indicated an optimal three-class solution (low PTSD/SU, moderate PTSD/drug and high alcohol, and high PTSD/SU). Multinomial logistic regressions indicated that depression (OR = 1.22) and frequency of RSDBs (OR = 1.20) were significant predictors of the moderate PTSD/drug and high alcohol class versus the low PTSD/SU class. Depression (OR = 1.55) and frequency of RSDBs (OR = 1.19) were significant predictors of the high PTSD/SU class versus the low PTSD/SU class. Only depression (OR = 1.27) was a significant predictor of the high PTSD/SU class versus the moderate PTSD/drug and high alcohol class. Conclusions: Results provide construct validity support for three meaningful latent classes with unique relations with depression and RSDBs. These findings improve our understanding of heterogeneous PTSD-SU comorbidity patterns and highlight acknowledgment of such subtyping (subgrouping) in considering differential treatment options, treatment effectiveness, and resource allocation.

Typologies of PTSD clusters and reckless/self-destructive behaviors: A latent profile analysis

Posttraumatic stress disorder (PTSD) is comorbid with diverse reckless and self-destructive behaviors (RSDBs). We examined the nature and construct validity (covariates of age, gender, depression severity, number of trauma types, functional impairment) of the optimal class solution categorizing participants based on PTSD symptom and RSDB endorsement. The sample included 417 trauma-exposed individuals recruited through Amazon's MTurk platform who completed the Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, the Posttrauma Risky Behaviors Questionnaire, and Patient Health Questionnaire-9. Latent profile analyses indicated an optimal three-class solution: the Low PTSD-RSDBs, High PTSD-Low RSDBs, and High PTSD-RSDBs classes. Multinomial logistic regression indicated that impairment and depression predicted the High PTSD-Low RSDBs vs. the Low PTSD-RSDBs classes. Impairment, age, being female, and depression predicted the High vs. Low PTSD-RSDBs classes. Number of trauma types, age, being female, and depression predicted the High PTSD-RSDBs vs. High PTSD-Low RSDBs classes. Results support the presence of a reckless behaviors subtype of PTSD (characterized by greater depression, greater impariment, greater number of trauma types, being male, and being younger), conducting comprehensive assessments of RSDBs for individuals reporting PTSD symptoms and of PTSD symptoms for individuals reporting RSDBs, and the need to tailor interventions to treat PTSD and RSDBs concurrently.

Heterogeneous Patterns of Marijuana Use Motives Using Latent Profile Analysis

Background: Given that marijuana use is often associated with detrimental physical and mental health problems, research examining motives for its use is critical for effective remedial and preventive treatment. To date, the majority of research on marijuana use motives has used variable-centered analyses, which overlooks potentially meaningful heterogeneous response patterns and the associations of those patterns with other risk/protective factors. Methods: To address this gap, in the current study, we conducted a person-centered analysis (latent profile analysis) to identify subgroups of participants based on endorsed marijuana use motives, and examined the construct validity of the optimal class solution (covariates included sociodemographic (e.g., age), psychiatric (e.g., depression), and marijuana-use indices (e.g., use-frequency, use-related problems). Participants were 898 college students (M_age = 20.93, SD_age = 3.10; 68.9% female) who completed an anonymous online survey examining substance use and psychological well-being, were 18 years or older, and endorsed lifetime marijuana use. Data were collected November 2016 through February 2018. Results: Results identified four unique classes of coping, conformity, social, and enhancement marijuana use motives: (a) "Low Motives" (37.6%), (b) "High Conformity" (4.9%), (c) "Low Conformity" (45.8%), and (d) "High Motives" (11.7%). In terms of covariates, higher motive classes tended to report more frequent and problematic use. The two classes uniquely characterized by conformity motives only differed on past-month marijuana use frequency. Conclusions/Importance: The current findings provide evidence that specific classes of motives were not only associated with marijuana use frequency and problems but other risk and protective factors, such as anxiety sensitivity and social support.