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Messman BA, Compton SE, Majeed I, Weiss NH, Contractor AA. Beyond the mean: examining associations between intraindividual variability in posttraumatic stress disorder symptoms and posttrauma reckless behaviors. ANXIETY, STRESS, AND COPING 2024; 37:615-631. [PMID: 38268223 PMCID: PMC11266525 DOI: 10.1080/10615806.2024.2307465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND/OBJECTIVES Posttrauma reckless behaviors have been linked to the onset and exacerbation of posttraumatic stress disorder (PTSD) symptoms. However, PTSD symptoms fluctuate across time, triggered by environmental stimuli in daily life, referred to as (intraindividual) variability in PTSD symptoms. DESIGN We utilized experience sampling methods to investigate associations between engagement in posttrauma reckless behaviors and variability in PTSD symptoms and the moderating role of emotion dysregulation in this association. METHODS Data from 166 trauma-exposed university students (Mage = 21.43 ± 5.07, 85.4% women) were collected between January 2019 to August 2020. Participants completed baseline and follow-up surveys to assess engagement in posttrauma reckless behaviors and daily surveys (10-days) to assess variability in PTSD symptoms. Results. Analyzes indicated greater baseline engagement in posttrauma reckless behaviors was associated with greater 10-day variability in PTSD symptoms (β = 0.23, p = .031), and baseline emotion dysregulation moderated this association (β = -0.33, p = .003). Additionally, greater 10-day variability in PTSD symptoms was associated with greater follow-up engagement in posttrauma reckless behaviors (β = 0.14, p = .045). CONCLUSIONS Findings substantiate the interplay between engagement in posttrauma reckless behaviors and daily fluctuations in PTSD symptoms and support therapeutically targeting both engagement in posttrauma reckless behaviors and emotion dysregulation to impact PTSD symptoms.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sidonia E Compton
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Ifrah Majeed
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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2
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Lieberman JM, Rabellino D, Densmore M, Frewen PA, Steyrl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Narikuzhy S, Lanius RA, Nicholson AA. Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD. Brain Behav 2023; 13:e2883. [PMID: 36791212 PMCID: PMC10013955 DOI: 10.1002/brb3.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur. METHODS Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n = 14) and healthy control (n = 15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest. RESULTS During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants. CONCLUSION In summary, observations of PCC connectivity to the DMN and SN provide emerging evidence of neural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.
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Affiliation(s)
- Jonathan M Lieberman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Daniela Rabellino
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada
| | - Sandhya Narikuzhy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada.,Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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3
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Sanchez M, Amaro H. Cumulative exposure to traumatic events and craving among women in residential treatment for substance use disorder: The role of emotion dysregulation and mindfulness disposition. Front Psychol 2022; 13:1048798. [PMID: 36506948 PMCID: PMC9730726 DOI: 10.3389/fpsyg.2022.1048798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Strong evidence links exposure to traumatic life events with subsequent substance use disorders (SUD). Compared to men, women in SUD treatment are more likely to have a history of trauma, characterized in part by emotion dysregulation known to negatively influence treatment outcomes. Existing research has been conducted with predominantly male and non-Hispanic White samples, with an emphasis on adverse childhood experiences. Little is known about how exposure to cumulative traumatic events across the lifespan affects emotion dysregulation and how this may influence craving, particularly among racial and ethnic minoritized women with SUD. Mindfulness disposition may serve as a protective factor that could buffer the impact of trauma exposure and emotion dysregulation on substance use craving among underrepresented minoritized women with SUD. This study examined the association between cumulative exposure to traumatic events, emotion dysregulation, and mindfulness disposition on substance use craving in a sample of predominantly Hispanic and non-Hispanic Black women in residential treatment for SUD. Method Cross-sectional data were analyzed for a baseline sample of 241 women (56.96% Hispanic, 20.7% non-Hispanic White, 20.7% non-Hispanic Black; age: M = 32.11) entering a SUD residential treatment facility who agreed to participate in a parent randomized controlled trial. Results Findings indicated that greater cumulative exposure to traumatic events and emotion dysregulation were associated with higher levels of craving. Cumulative traumatic event exposure was indirectly associated with higher craving via lower levels in the mindfulness dimension of acting with awareness. Interaction effects also revealed greater exposure to traumatic events was associated with higher levels of craving among women with low and average (but not high) levels of mindfulness disposition. Conclusion These findings provide insight into the potential benefits of targeting emotion regulation and mindfulness-building strategies such as acting with awareness in interventions among racial-ethnically diverse women with SUD. These strategies may be particularly beneficial among those that have experienced extensive histories of trauma exposure. Overall, knowledge gained from the present study can be particularly valuable towards informing treatment models in minoritized groups that currently experience disparities in treatment utilization and outcomes.
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Affiliation(s)
- Mariana Sanchez
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States,*Correspondence: Mariana Sanchez,
| | - Hortensia Amaro
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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4
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Flores J, Brake CA, Hood CO, Badour CL. Posttraumatic stress and risky sex in trauma-exposed college students: the role of personality dispositions toward impulsive behavior. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1711-1723. [PMID: 33048640 PMCID: PMC8086839 DOI: 10.1080/07448481.2020.1819289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Objectives: Posttraumatic stress disorder (PTSD) has been linked to risky sexual behavior (RSB). However, little is known regarding the role of impulsivity in this relation among college students. Participants: The present study examined the moderating role of impulsivity dispositions on the relation between PTSD symptoms and past-year RSB in a sample of 221 trauma-exposed undergraduate students (77.4% female). Results: Two separate negative binomial regression models examined each impulsivity disposition's unique moderating effect on the association between PTSD symptoms and high risk/casual sex. In the high risk model, significant interactions were found for the urgency dispositions, (lack of) premeditation and (lack of) perseverance, though the pattern of these relations differed across these dispositions. Only positive main effects for negative urgency and (lack of) premeditation emerged in the casual sex model. Conclusions: The present study expands on the limited literature on the role of impulsivity in the relation between PTSD and RSB in trauma-exposed college students.
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Affiliation(s)
- Jessica Flores
- Department of Psychology, University of Kentucky, Lexington, KY, USA
- Corresponding Authors: Jessica Flores, M.S. . Christal L. Badour, Ph.D.
| | - C. Alex Brake
- Department of Psychology, University of Kentucky, Lexington, KY, USA
- Alpert Medical School, Brown University, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
| | - Caitlyn O. Hood
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Christal L. Badour
- Department of Psychology, University of Kentucky, Lexington, KY, USA
- Corresponding Authors: Jessica Flores, M.S. . Christal L. Badour, Ph.D.
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5
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Seidemann R, Duek O, Jia R, Levy I, Harpaz-Rotem I. The Reward System and Post-Traumatic Stress Disorder: Does Trauma Affect the Way We Interact With Positive Stimuli? CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:2470547021996006. [PMID: 33718742 PMCID: PMC7917421 DOI: 10.1177/2470547021996006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a highly prevalent disorder and a highly debilitating condition. Although anhedonia is an important construct of the disorder, the relationship between PTSD and reward functioning is still under-researched. To date, the majority of research on PTSD has focused on fear: fear learning, maintenance, and extinction. Here we review the relevant literature-including clinical observations, self-report data, neuroimaging research, and animal studies-in order to examine the potential effects of post-traumatic stress disorder on the reward system. Our current lack of sufficient insight into how trauma affects the reward system is one possible hindrance to clinical progress. The current review highlights the need for further investigation into the complex relationship between exposure to trauma and the reward system to further our understandings of the ethology of PTSD.
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Affiliation(s)
- Rebecca Seidemann
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Or Duek
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Ruonan Jia
- Yale University School of Medicine, New Haven, CT, USA
| | - Ifat Levy
- Yale University School of Medicine, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
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Decker SE, Pavlo A, Harper A, Herring Y, Black AC. Themes in experiences of PTSD symptoms and relationships among male veterans with risky sexual behavior. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 12:678-686. [PMID: 32338947 PMCID: PMC8717835 DOI: 10.1037/tra0000569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE United States veterans with posttraumatic stress disorder (PTSD) symptoms are at elevated risk for high-risk sexual behavior (HRSB). Although quantitative research has examined relationships between PTSD symptoms and HRSB, qualitative research to understand the lived experiences of veterans with PTSD symptoms and HRSB has not been conducted. METHOD Qualitative interviews were conducted with N = 29 male veterans of Operation Enduring Freedom or Operation Iraqi Freedom who had PTSD symptoms and reported recent HRSB. The interviews were analyzed using a phenomenological framework. RESULTS Six themes emerged: (a) avoiding social contact due to feeling different since return from service; (b) effortful self-management; (c) supportive relationships; (d) sex as a means to an end; (e) sex, risk, and intimacy; and (f) responsibility and growth. CONCLUSION Male veterans with PTSD symptoms and HRSB reported engagement in significant self-management to reengage in life, and still reported high levels of difficulty in relationships. They described both wanting to avoid perceived risk associated with intimate relationships and wanting to take risks that caused them to feel alive. Implications for treatment include increased efforts to facilitate coping, to recognize and moderate risk-taking urges, and to build intimacy and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Suzanne E Decker
- Veterans Affairs Mental Illness Research, Education, and Clinical Center
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7
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Sommer JL, El-Gabalawy R, Contractor AA, Weiss NH, Mota N. PTSD's risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample. J Anxiety Disord 2020; 73:102247. [PMID: 32502805 DOI: 10.1016/j.janxdis.2020.102247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2, Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, TX, 76203, United States
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, United States
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada.
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8
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Tang C, Goldsamt L, Meng J, Xiao X, Zhang L, Williams AB, Wang H. Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis. BMJ Open 2020; 10:e032435. [PMID: 32345695 PMCID: PMC7213849 DOI: 10.1136/bmjopen-2019-032435] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although people living with HIV (PLWH) have been disproportionately affected by post-traumatic stress disorder (PTSD), the global prevalence of PTSD among PLWH is unknown. This study aimed to systematically review the prevalence of PTSD among PLWH worldwide and explore variation in prevalence across sociodemographic and methodological factors. DESIGN A meta-analysis using a random-effects model was conducted to pool the prevalence estimated from individual studies, and subgroup analyses were used to analyse heterogeneities. SETTING, PARTICIPANTS AND MEASURES Observational studies providing PTSD prevalence data in an adult HIV population were searched from January 2000 to November 2019. Measurements were not restricted, although the definition of PTSD had to align with the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases diagnostic criteria. RESULTS A total of 38 articles were included among 2406 records identified initially. The estimated global prevalence of PTSD in PLWH was 28% (95% CI 24% to 33%). Significant heterogeneity was detected in the proportion of PLWH who reported PTSD across studies, which was partially explained by geographic area, population group, measurement and sampling method (p<0.05). CONCLUSION PTSD among PLWH is common worldwide. This review highlights that PTSD should be routinely screened for and that more effective prevention strategies and treatment packages targeting PTSD are needed in PLWH.
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Affiliation(s)
- Chulei Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jingjing Meng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Li Zhang
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | | | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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9
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Vidaña AG, Forbes CN, Gratz KL, Tull MT. The influence of posttraumatic stress disorder and recurrent major depression on risk-taking propensity following trauma script exposure among patients with substance use disorders. Addict Behav 2020; 102:106181. [PMID: 31775063 DOI: 10.1016/j.addbeh.2019.106181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
Although evidence suggests that risk-taking among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) may be precipitated by trauma-related emotional distress, studies have yet to examine moderators of this effect. One moderator worth investigating is recurrent major depressive disorder (MDD), given its influence on emotional responding and subsequent behavior. This study examined the moderating role of recurrent MDD in the relation of PTSD to risk-taking propensity following neutral and trauma scripts among SUD patients. Participants were 193 patients with and without current PTSD and/or recurrent MDD in residential SUD treatment. Risk-taking propensity, as assessed through the Balloon Analogue Risk Task (BART), was evaluated following a neutral script and a personalized trauma script. A significant script by PTSD by recurrent MDD interaction was found. Participants with PTSD and recurrent MDD exhibited significantly lower risk-taking following the trauma script relative to participants with PTSD but no recurrent MDD. Moreover, participants with PTSD and recurrent MDD exhibited a significantly smaller increase in risk-taking following the trauma script (relative to the neutral script) than participants with PTSD but no recurrent MDD. Participants with PTSD and recurrent MDD did not differ significantly from participants without PTSD. Results provide support for the context-dependent nature of risk-taking among PTSD-SUD patients without (vs. with) recurrent MDD. Results also highlight the importance of considering the presence of recurrent MDD in research and/or clinical work with SUD patients with PTSD.
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Affiliation(s)
- Ariana G Vidaña
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA.
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10
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Armour C, Greene T, Contractor AA, Weiss N, Dixon-Gordon K, Ross J. Posttraumatic Stress Disorder Symptoms and Reckless Behaviors: A Network Analysis Approach. J Trauma Stress 2020; 33:29-40. [PMID: 32086982 DOI: 10.1002/jts.22487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
Abstract
Existing literature indicates a theoretical and empirical relation between engagement in reckless behaviors and posttraumatic stress disorder (PTSD). Thus, the DSM-5 revision of the PTSD nosology added a new "reckless or self-destructive behavior" (RSDB) symptom (Criterion E2). The current study applied a network analytic approach to examine the item-level relations among a range of reckless behaviors and PTSD symptom clusters. Participants were recruited from Amazon's Mechanical Turk (N = 417), and network analysis was conducted with 20 variables: six PTSD symptom clusters, corresponding to the hybrid model of PTSD (Armour et al., 2015) and excluding the externalizing behavior cluster (Community 1), and 14 items related to reckless behavior (Community 2). The results showed that the network associations were strongest within each construct (i.e., within PTSD and within reckless behaviors), although several bridge connections (i.e., between PTSD clusters and reckless behaviors) were identified. Most reckless behavior items had direct associations with one or more PTSD symptom clusters. The present findings support the existence of close relations between a variety of reckless behaviors and PTSD symptom clusters beyond their relations with DSM Criterion E2. The results provide testable hypotheses about the associations between specific reckless behaviors and PTSD symptom clusters, which may inform future research.
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Affiliation(s)
- Cherie Armour
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Nicole Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Katherine Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jana Ross
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
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11
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Weiss NH, Forkus SR, Contractor AA, Darosh AG, Goncharenko S, Dixon-Gordon KL. Do Difficulties Regulating Positive Emotions Contribute to Risky Sexual Behavior? A Path Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2075-2087. [PMID: 31325120 PMCID: PMC6750957 DOI: 10.1007/s10508-019-1410-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 05/15/2023]
Abstract
Within the U.S., risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (1) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (2) Impulse was significantly positively associated with risky anal sex acts; and (3) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, 02881, USA.
| | - Shannon R Forkus
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, 02881, USA
| | | | - Angela G Darosh
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, 02881, USA
| | - Svetlana Goncharenko
- Department of Psychology, University of Rhode Island, 142 Flagg Rd., Kingston, RI, 02881, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Weiss NH, Walsh K, DiLillo DD, Messman-Moore TL, Gratz KL. A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:975-986. [PMID: 30771054 PMCID: PMC6474756 DOI: 10.1007/s10508-019-1392-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 05/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.
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Affiliation(s)
- Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Kate Walsh
- Department of Psychology, Yeshiva University, Bronx, NY, USA
| | - David D DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Mail Stop 948, 2801 West Bancroft Street, Toledo, OH, 43606, USA.
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Pearson CR, Kaysen D, Huh D, Bedard-Gilligan M. Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women. AIDS Behav 2019; 23:695-706. [PMID: 30607757 PMCID: PMC6407746 DOI: 10.1007/s10461-018-02382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.
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Tull MT, Forbes CN, Weiss NH, Gratz KL. An investigation of the effect of trauma script exposure on risk-taking among patients with substance use disorders and posttraumatic stress disorder. J Anxiety Disord 2019; 62:77-85. [PMID: 30639994 DOI: 10.1016/j.janxdis.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Studies show that patients with substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are at high risk for engaging in risky behaviors. However, these studies do not speak to the context in which these behaviors are more likely to occur. This study examined whether SUD patients with current PTSD, compared to those without a history of PTSD, are more likely to exhibit risk-taking on a laboratory-based risk-taking task, the Iowa Gambling Task (IGT), following exposure to a personalized trauma script versus a neutral script. The sample consisted of 122 trauma-exposed SUD patients with and without PTSD. Participants were administered a series of diagnostic interviews and personalized trauma scripts were created. On separate days, participants were exposed to a neutral or trauma script, followed by the IGT. Contrary to expectations, PTSD-SUD patients exhibited significantly greater risk-taking after the neutral (vs. trauma) script than those without PTSD. Moreover, whereas SUD patients without PTSD evidenced stability in IGT performance across scripts, those with PTSD exhibited significantly lower risk-taking on the IGT following the trauma (vs. neutral) script. Results provide support for the context dependent nature of risk-taking in PTSD-SUD patients and suggest they may become more risk averse in the context of trauma-related distress.
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Affiliation(s)
- Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA.
| | | | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA
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Mota NP, Turner S, Taillieu T, Garcés I, Magid K, Sethi J, Struck S, El-Gabalawy R, Afifi TO. Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes. Am J Prev Med 2019; 56:215-223. [PMID: 30553694 DOI: 10.1016/j.amepre.2018.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs. METHODS Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome. RESULTS Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69-4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged. CONCLUSIONS The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.
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Affiliation(s)
- Natalie P Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Sarah Turner
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Isabel Garcés
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kirby Magid
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Japandeep Sethi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shannon Struck
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Typologies of PTSD clusters and reckless/self-destructive behaviors: A latent profile analysis. Psychiatry Res 2019; 272:682-691. [PMID: 30832187 DOI: 10.1016/j.psychres.2018.12.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/22/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
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.
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Weiss NH, Peasant C, Sullivan TP. Avoidant Coping as a Moderator of the Association Between Childhood Abuse Types and HIV/Sexual Risk Behaviors. CHILD MALTREATMENT 2019; 24:26-35. [PMID: 30124064 DOI: 10.1177/1077559518793228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Women who experience intimate partner violence (IPV) report high rates of HIV/sexual risk behaviors. Childhood abuse has been linked to HIV/sexual risk behaviors among IPV-victimized women; however, limited research has examined factors that may influence this association. The current study tested the moderating role of avoidant coping in the relation between childhood abuse types (physical, emotional, and sexual) and HIV/sexual risk behaviors. Participants were 212 community women currently experiencing IPV (mean age = 36.63 years, 67.0% African American). Higher levels of avoidant coping were related to more severe childhood abuse types. Severity of childhood abuse types was associated with greater HIV/sexual risk behaviors. Avoidant coping moderated the relation between childhood sexual abuse severity and HIV/sexual risk behaviors, such that this association was significant for IPV-victimized women with high (but not low) levels of avoidant coping. Findings suggest the utility of targeting avoidant coping in interventions aimed at preventing or reducing HIV/sexual risk behaviors among IPV-victimized women with a history of childhood sexual abuse.
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Affiliation(s)
- Nicole H Weiss
- 1 Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Tami P Sullivan
- 3 Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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18
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Gao M, Xiao C, Zhang X, Li S, Yan H. Social capital and PTSD among PLWHA in China: the mediating role of resilience and internalized stigma. PSYCHOL HEALTH MED 2018; 23:698-706. [PMID: 29334231 DOI: 10.1080/13548506.2018.1426869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Post-traumatic Stress Disorder (PTSD) is frequent among people living with HIV/AIDS (PLWHA). Few studies have investigated social-psychological predictors of PTSD in China. This study aimed to examine relationships between social capital, stigma, resilience and PTSD among PLWHA in China, and to provide effective suggestions for PTSD intervention. A cross-sectional study of 520 PLWHA was conducted from November 2015 to January 2016. Survey data were collected using anonymous self-reported questionnaire. Multivariable analyses were used to examine related factors of PTSD, and causal mediation analyses were conducted to assess whether stigma and resilience were mediators. Results indicated that higher risk of PTSD was independent associated with stronger stigma, decreasing social capital and lower resilience. There was an indirect relationship of social capital on PTSD mediated through resilience and HIV-related stigma. Therefore, PTSD intervention programs should not only pay attention to the role of social capital on PTSD, but also attach importance to stigma and resilience on PTSD symptoms.
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Affiliation(s)
- Mengting Gao
- a Information Center , Renmin Hospital of Wuhan University , Wuhan , China.,b School of Health Science , Wuhan University , Wuhan , China
| | - Chenchang Xiao
- b School of Health Science , Wuhan University , Wuhan , China
| | - Xuan Zhang
- c Department of nosocomial infection management , The Second People's Hospital of Shanxi Province , Taiyuan , China
| | - Shiyue Li
- b School of Health Science , Wuhan University , Wuhan , China
| | - Hong Yan
- b School of Health Science , Wuhan University , Wuhan , China
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19
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Scheidell JD, Lejuez CW, Golin CE, Adimora AA, Wohl DA, Keen LD, Hammond M, Judon-Monk S, Khan MR. Patterns of Mood and Personality Factors and Associations With STI/HIV-Related Drug and Sex Risk Among African American Male Inmates. Subst Use Misuse 2017; 52:929-938. [PMID: 28426364 PMCID: PMC5908473 DOI: 10.1080/10826084.2016.1267221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research on the association between antisocial personality disorder (ASPD) with comorbid mental disorders and sexually transmitted infection (STI)/HIV risk among inmates is scant despite the high prevalence of psychopathology and of STI/HIV in this population. METHODS We used baseline data from Project DISRUPT, a cohort study conducted among incarcerated African American men (n = 207), to measure associations between ASPD and STI/HIV risk. We also conducted latent class analyses (LCAs) to identify subgroups defined by ASPD with comorbid stress, depression, and borderline personality disorder symptoms and measured associations between latent class membership and STI/HIV risk. RESULTS Approximately 15% had ASPD and 39% reported depression. Controlling for sociodemographics, stress, and depression, ASPD was independently associated with illicit [AOR = 3.23, 95% confidence interval (CI): 1.18-8.87] and injection drug use (AOR: 5.49, 95% CI: 1.23-24.42) but not with sexual risk. LCAs suggested that those at high risk of ASPD were likely to experience co-morbid mental disorders. ASPD comorbid with these disorders was linked to drug and sex risk. CONCLUSIONS STI/HIV prevention for inmates should incorporate diagnosis and treatment of ASPD and comorbid disorders, and interventions to address ASPD-related factors (e.g., impulsivity) that drive STI/HIV risk.
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Affiliation(s)
- Joy D Scheidell
- a Department of Population Health , New York University School of Medicine , New York , New York , USA
| | - Carl W Lejuez
- b Center for Addictions, Personality, and Emotion Research, University of Maryland , College Park , Maryland , USA
| | - Carol E Golin
- c Division of General Internal Medicine and Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,d Department of Health Behavior , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Adaora A Adimora
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA.,f Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - David A Wohl
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Larry D Keen
- g Department of Psychology , Virginia State University , Petersburg , Virginia , USA
| | - Michael Hammond
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Selena Judon-Monk
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Maria R Khan
- a Department of Population Health , New York University School of Medicine , New York , New York , USA
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20
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Contractor AA, Weiss NH, Dranger P, Ruggero C, Armour C. PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology. Psychiatry Res 2017; 252:215-222. [PMID: 28285248 PMCID: PMC5472336 DOI: 10.1016/j.psychres.2017.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/02/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder's (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD's symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment.
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Affiliation(s)
- Ateka A. Contractor
- Department of Psychology, University of North Texas, Denton, TX, USA,Corresponding author: (A.A. Contractor)
| | - Nicole H. Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Paula Dranger
- Counseling Services, Valparaiso University, Valparaiso, IN, USA,Choices Counseling Services, Valparaiso, IN
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK
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21
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Brown MJ, Masho SW, Perera RA, Mezuk B, Pugsley RA, Cohen SA. Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors. AIDS Behav 2017; 21:1550-1566. [PMID: 27688144 PMCID: PMC5896316 DOI: 10.1007/s10461-016-1553-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HIV and other sexually transmitted infections (STIs) are important public health challenges in the US. Adverse childhood experiences (ACEs), including abuse (emotional, physical or sexual), witnessing violence among household members, may have an effect on sexual behaviors, which increase the risk of HIV/STIs. The aim of this study was to examine the sex differences in the role of posttraumatic stress disorder (PTSD), major depression (MD), substance use disorders (SUDs), early sexual debut, and intimate partner violence (IPV) perpetration as mediators in the association between ACEs and HIV/STIs. Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the role of PTSD, MD, SUDs, early sexual debut, and IPV perpetration as mediators in the relationships between ACEs and HIV/STIs. Differences and similarities existed in the mediational roles of psychopathology and sexual behaviors. For example, among men, MD fully mediated physical/psychological abuse (β = 0.0002; p = 0.012) and sexual abuse (β = 0.0002; p = 0.006), and HIV/STIs while among women, MD fully mediated physical/psychological abuse (β = 0.0005; p < 0.001) and parental violence (β = -0.0002; p = 0.012). Among men, IPV perpetration fully mediated sexual abuse (β = -0.0005; p = 0.012) and HIV/STIs while among women, IPV perpetration was not a statistically significant mediator. HIV/STI prevention and intervention programs should use a life course approach by addressing adverse childhood events among men and women and consider the sex differences in the roles of psychopathology and sexual behaviors.
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Affiliation(s)
- Monique J Brown
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA.
| | - Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Briana Mezuk
- College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B. Downs Blvd, MHC 2503, Tampa, FL, 33612, USA
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - River A Pugsley
- Office of Epidemiology, Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Steven A Cohen
- Health Studies, University of Rhode Island, Kingston, RI, USA
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Bujarski SJ, Capron DW, Gratz KL, Tull MT. Conformity motives for alcohol use are associated with risky sexual behavior among alcohol-dependent patients in residential substance abuse treatment. JOURNAL OF SUBSTANCE USE 2017; 22:469-473. [PMID: 30906221 DOI: 10.1080/14659891.2016.1245792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol misuse is associated with a variety of negative outcomes, including risky sexual behavior (RSB). In an attempt to better identify the subset of individuals at greatest risk for these negative outcomes, a growing body of research has begun to examine the role of alcohol use motives in risk for alcohol use-related negative outcomes. Although the majority of research in this area has focused on coping motives, conformity motives may be particularly relevant to outcomes such as RSB. Specifically, conformity motives may operate as a proxy risk factor for RSB, reflecting the tendency to engage in interpersonally-oriented risk behaviors in order to avoid rejection, interpersonal conflict, or social ostracism. Therefore, the current study examined the relation between conformity motives for alcohol use and RSB in a sample of 94 patients in a residential substance abuse treatment center. Results indicated that conformity motives were associated with RSB above and beyond other motives for alcohol use, as well as relevant covariates. Findings support the notion that conformity motives may operate as a proxy risk factor that could assist in identifying individuals at elevated risk for engaging in RSB.
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Affiliation(s)
- Sarah J Bujarski
- VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
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Cheek SM, Nestor BA, Liu RT. SUBSTANCE USE AND SUICIDALITY: SPECIFICITY OF SUBSTANCE USE BY INJECTION TO SUICIDE ATTEMPTS IN A NATIONALLY REPRESENTATIVE SAMPLE OF ADULTS WITH MAJOR DEPRESSION. Depress Anxiety 2016; 33:541-8. [PMID: 26393336 PMCID: PMC4958618 DOI: 10.1002/da.22407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/22/2015] [Accepted: 08/11/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although several risk factors for suicidal ideation (SI) have been identified in the research literature, there is a pressing need for studies evaluating markers of risk differentiating ideators from people who have attempted. According to the interpersonal theory of suicide, habituation to painful or provocative experiences increases one's acquired capability for suicide, a necessary component for the transition from SI to attempts. This theory further posits that the acquired capability for suicide should be unrelated to risk for SI. This study tested this theory by examining injection drug use, relative to less painful means of drug use, in relation to SI, suicide plans, and suicide attempts. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), a nationally representative survey conducted annually. Participants included 10,203 adults with a history of injectable drug use and major depression. RESULTS Injection drug use was positively associated with suicide attempts (Odds Ratio [OR] = 1.66, 95% confidence interval [CI] = 1.18-2.34), but not SI or suicide plans in the full sample. Injection drug use was also associated with suicide attempts (OR = 1.64, 95% CI = 1.14-2.35), but not plans, among ideators. Lastly, injection drug use was associated with the suicide attempts among suicide planners (OR = 1.76, 95% CI = 1.01-3.06). All analyses included sex, age, race/ethnicity, family income, substance use disorder symptom severity for injectable drugs, and depressive symptom severity as covariates. CONCLUSIONS Consistent with the interpersonal theory of suicide, injection drug use was associated with specific risk for suicide attempts but not SI or suicide plans.
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Affiliation(s)
- Shayna M. Cheek
- Alpert Medical School; Brown University; Providence Rhode Island
| | | | - Richard T. Liu
- Alpert Medical School; Brown University; Providence Rhode Island
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Posttraumatic stress disorder symptoms and risky behaviors among trauma-exposed inpatients with substance dependence: The influence of negative and positive urgency. Drug Alcohol Depend 2015; 155:147-53. [PMID: 26278196 PMCID: PMC4581985 DOI: 10.1016/j.drugalcdep.2015.07.679] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) among inpatients with substance use disorders (SUDs) is associated with heightened engagement in a variety of risky, self-destructive, and health-compromising behaviors (e.g., risky sexual behavior, aggression). Extant research provides support for the role of emotion dysregulation in the PTSD-risky behavior relation among inpatients with SUD; however, this research has been limited by a focus on emotion dysregulation involving negative (versus positive) emotions. The goal of the current study was to extend past research on the PTSD-risky behavior relation by examining the potential mediating roles of negative and positive urgency (two domains of emotion dysregulation defined by the tendency to engage in risky behavior in the context of negative and positive emotions, respectively). METHODS Participants were 158 trauma-exposed inpatients with (n=91) and without (n=67) lifetime PTSD consecutively admitted to a residential SUD treatment facility (M age=34.34; 59.5% White, 50.6% female). Patients were administered diagnostic interviews and completed self-report questionnaires. RESULTS Significant positive associations were found among lifetime PTSD symptoms, negative and positive urgency, and risky behaviors. Moreover, findings revealed significant indirect effects of lifetime PTSD symptoms on risky behaviors through the pathways of both negative and positive urgency. CONCLUSIONS Results provide initial support for the mediating roles of both negative and positive urgency in the PTSD-risky behavior relation, highlighting the potential utility of teaching trauma-exposed inpatients with PTSD-SUD skills for tolerating negative and positive emotional states without engaging in maladaptive behaviors.
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Weiss NH, Dixon-Gordon KL, Duke AA, Sullivan TP. The underlying role of posttraumatic stress disorder symptoms in the association between intimate partner violence and deliberate self-harm among African American women. Compr Psychiatry 2015; 59:8-16. [PMID: 25752736 PMCID: PMC4363011 DOI: 10.1016/j.comppsych.2014.05.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 11/19/2022] Open
Abstract
African American women are at heightened risk for intimate partner violence (IPV) and its negative consequences, including health-compromising behaviors. Deliberate self-harm (DSH) is one clinically-relevant behavior that has been understudied among African American women generally and those with exposure to IPV in particular. To date, no studies have examined factors that may account for the relationship between IPV and DSH. Therefore, the goal of the present study was to examine the intercorrelations among IPV (physical, psychological, and sexual), PTSD, and DSH history and versatility, and the potentially mediating role of PTSD symptoms in the IPV-DSH relation. Participants were 197 African American community women currently experiencing IPV. Sixty participants (31%) reported a history of DSH. Among participants who reported DSH, there was an average endorsement of 2.3 unique forms of deliberate self-harm (i.e., DSH versatility). Significant positive associations were detected among physical IPV severity, psychological IPV severity, PTSD symptom severity, and DSH history and versatility. PTSD symptom severity mediated the relationships between physical and psychological IPV severity and DSH history and versatility. Results highlight the relevance of PTSD symptoms to DSH and suggest that treatments targeting PTSD symptoms may be useful in reducing DSH among IPV-exposed African American women.
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Overstreet NM, Willie TC, Hellmuth JC, Sullivan TP. Psychological intimate partner violence and sexual risk behavior: examining the role of distinct posttraumatic stress disorder symptoms in the partner violence-sexual risk link. Womens Health Issues 2014; 25:73-8. [PMID: 25498762 DOI: 10.1016/j.whi.2014.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/31/2014] [Accepted: 10/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research has examined how physical and sexual intimate partner violence (IPV) victimization increases sexual risk behavior, yet research is lacking on 1) the effect of psychological IPV on sexual risk behavior and 2) factors through which psychological IPV may be linked to sexual risk behavior. METHODS The current study examined the relationship between psychological IPV and sexual risk behavior controlling for other forms of IPV (i.e., physical and sexual) in a sample of 186 human immunodeficiency virus (HIV)-negative community women currently experiencing IPV. Further, this study examined the potential mediating effects of four posttraumatic stress disorder (PTSD) symptom severity clusters (i.e., re-experiencing, avoidance, numbing, and hyperarousal) on this relationship. FINDINGS Results revealed that greater severity of psychological IPV was uniquely and directly related to greater sexual risk behavior. Additionally, of the four PTSD symptom severity clusters, only avoidance symptom severity mediated the relationship between psychological IPV and sexual risk behavior. CONCLUSION Implications for addressing psychological IPV and PTSD to improve women's sexual health outcomes are discussed.
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Affiliation(s)
| | - Tiara C Willie
- Department of Psychiatry, Yale University School of Medicine, Yale University, New Haven, Connecticut
| | - Julianne C Hellmuth
- Division of Clinical Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Tami P Sullivan
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, Yale University, New Haven, Connecticut.
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Weiss NH, Tull MT, Gratz KL. A preliminary experimental examination of the effect of emotion dysregulation and impulsivity on risky behaviors among women with sexual assault-related posttraumatic stress disorder. Behav Modif 2014; 38:914-39. [PMID: 25155301 PMCID: PMC4343321 DOI: 10.1177/0145445514547957] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with a wide range of risky behaviors (e.g., substance use and risky sexual behaviors); however, few studies have examined mechanisms that may underlie risky behaviors in this population. The present study utilized a prospective experimental design to examine the effects of emotion dysregulation and impulsivity on risky behaviors across time. Thirty women with sexual assault-related PTSD were randomly assigned to receive emotion modulation (EM), impulsivity reduction (IR), or healthy living (HL; comparison condition) skills trainings. Participants completed measures of emotion dysregulation, impulsivity, and risky behaviors pre-manipulation and 1-month post-manipulation. Participants in the EM and IR conditions reported a significant reduction in risky behaviors from pre- to post-manipulation relative to the HL condition. Changes in emotion dysregulation from pre- to post-manipulation fully accounted for reductions in risky behaviors over time. Results provide preliminary experimental support for the role of emotion dysregulation in risky behaviors.
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Affiliation(s)
- Nicole H. Weiss
- Yale University School of Medicine, Department of Psychiatry, 389 Whitney Avenue, New Haven, CT, 06511,
| | - Matthew T. Tull
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 N. State St., Jackson, MS, 39216,
| | - Kim L. Gratz
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 N. State St., Jackson, MS, 39216,
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Pence BW, Whetten K, Shirey KG, Yao J, Thielman NM, Whetten R, Itemba D, Maro V. Factors associated with change in sexual transmission risk behavior over 3 years among HIV-infected patients in Tanzania. PLoS One 2013; 8:e82974. [PMID: 24367575 PMCID: PMC3867466 DOI: 10.1371/journal.pone.0082974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 11/07/2013] [Indexed: 02/06/2023] Open
Abstract
Background The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts. Methodology and Principal Findings The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6–13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11–21% at 6–36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex. Conclusions and Significance Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
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Affiliation(s)
- Brian W. Pence
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kathryn Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- * E-mail: (BWP); (KW)
| | - Kristen G. Shirey
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jia Yao
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | - Nathan M. Thielman
- Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rachel Whetten
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | | | - Venance Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
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