Healthcare experiences among adults with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder in the United States.

PURPOSE: This cross-sectional mixed-method study examined healthcare experiences among individuals in the US with hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD), genetic connective tissue disorders. We hypothesized that many individuals with these conditions would report low satisfaction with healthcare and low health-related quality of life, and that lower healthcare satisfaction would be related to lower health-related quality of life and self-efficacy for symptom management. METHODS: Adults living in the US with hEDS or HSD (N= 2125) completed an online survey assessing satisfaction with healthcare, health-related quality of life, and symptom management self-efficacy. Qualitative data also were gathered on desired changes to improve healthcare. RESULTS: Participants reported low satisfaction with healthcare and lower health-related quality of life and symptom management self-efficacy than norm groups. Lower satisfaction with healthcare was associated with lower health-related quality of life and lower symptom management self-efficacy, ps <.001. The most common desired change to improve healthcare was more knowledge about hEDS and HSD among healthcare professionals. CONCLUSIONS: U.S. adults with joint hypermobility report negative healthcare experiences and poor health-related quality of life. Future research should explore ways to improve the healthcare experiences and quality of care for individuals with hEDS and HSD.Implications for RehabilitationIndividuals with hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) score worse than the U.S. population on most health-related quality of life domains and symptom management self-efficacy.Individuals with HSD and hEDS report low levels of satisfaction with healthcare compared to norm groups.Participants particularly wanted to see improvements in the level of awareness and education about HSD and hEDS among healthcare professionals, provider attitudes about HSD and hEDS, and healthcare accessibility and convenience.Individuals who were less satisfied with their healthcare reported lower health-related quality of life and lower symptom management self-efficacy, underscoring the importance of improving healthcare experiences.

Coping strategy-situation fit vs. present control: relations with perceived stress in U.S. college students.

BACKGROUND: According to the strategy-situation fit hypothesis, it is adaptive to match coping strategies to the controllability of stressors. Although early research generally supported this hypothesis, recent findings have been inconsistent. The goals of this study were to test the strategy-situation fit hypothesis, addressing limitations of past research, and compare it to an alternative hypothesis from the temporal model of control (i.e., to focus on what one can control rather than matching coping strategies to control appraisals). DESIGN AND METHODS: College students (n = 159) completed measures assessing their stressors, coping strategies, stressor controllability, perceived control over present aspects of stressors, and perceived stress. Data were collected via online surveys in Fall 2020. RESULTS: Consistent with the strategy-situation fit hypothesis, using a higher ratio of problem-solving coping for more controllable stressors was associated with less stress. However, using more emotion-focused coping for less controllable stressors was not associated with less stress. In addition, focusing on what one could control in the present was associated with less stress, above and beyond strategy-situation fit. CONCLUSIONS: It may be more adaptive to focus on what one can control in the present than to match coping styles to stressor controllability.

Predictors of Sexual Harassment Using Classification and Regression Tree Analyses and Hurdle Models: A Direct Replication.

Sexual harassment affects a large percentage of higher education students in the US. A previous study identified several risk factors for sexual harassment using hurdle models and classification and regression tree (CART) analyses. The purpose of the present study was to assess the robustness of these findings by replicating the analyses with a new sample of students. Secondary data analysis was conducted using data from 9,552 students from two- and four-year colleges. Hurdle model coefficients were assessed for replicability based on statistical significance and consistency of the replication effect size relative to the original effect size. Kotzé et al.'s findings were robust, with 91% of all tested effects meeting at least one of two replication criteria in the hurdle models and 88% of the variables replicating in the CARTs. Being younger, consuming alcohol more frequently, attending a four-year college, and having experienced more prior victimization and adversity were important predictors of peer harassment whereas being LGBQ+ was an important predictor of sexual harassment from faculty/staff. These findings can inform targeted prevention and intervention programs. More research is needed to understand why certain demographic and contextual variables are associated with greater harassment risk.

Mental health of US undergraduate and graduate students before and during the COVID-19 pandemic: Differences across sociodemographic groups.

The purposes of this study were to assess differences between sociodemographic groups in student mental health before and during the COVID-19 pandemic, to investigate whether the pandemic disproportionately affected certain groups, and to examine between-group differences in pandemic-related stressors. Data from Minnesota undergraduate and graduate students who completed an online survey in 2020 (N = 2,067) were compared to data collected from students in 2018 (N = 3,627). The survey assessed days of poor mental health, stress, stress management ability, days of adequate sleep, and pandemic-related stressors (2020 only). Multivariate analyses of variance assessed differences between study years (2020 vs. 2018), sociodemographic groups (gender, sexual orientation, race, disability, international student), and their interactions with study year in predicting mental health, and the sociodemographic groups in predicting pandemic stressors, among undergraduate and graduate students. Stress management ability decreased and sleep improved from 2018 to 2020. The sociodemographic variables most associated with poorer mental health were identifying as female, a sexual minority, or having a disability. Undergraduates reported poorer mental health than graduate students. Differences between sociodemographic groups were not larger during the pandemic, except among students with disabilities. All five sociodemographic variables were related to greater pandemic stressors in some domains.

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches.

Several studies have analyzed longitudinal data on posttraumatic stress symptoms (PTSS) from individuals who were proximal to the September 11, 2001, terrorist attacks (9/11) in an attempt to identify different trajectories of mental health in the years following mass trauma. The results of these studies have been heterogeneous, with researchers who used latent growth mixture modeling (LGMM) tending to identify four trajectories and those who used group-based trajectory modeling (GBTM) identifying five to seven trajectories. Given that no study has applied both GBTM and LGMM to their data, it remains unknown which modeling approach and what number of trajectories best fit post-9/11 PTSS data. The present study aimed to address that question by applying both LGMM and GBTM to data from the largest sample of survivors to date, comprising 37,545 New York City community members. When analyzing four waves of PTSS, reflecting participants' mental health up to 15 years post-9/11, LGMM fit the data better than GBTM. Our optimal solution consisted of four trajectories: low-stable (72.2% of the sample), decreasing (12.8%), increasing (9.5%), and high-stable (5.5%) symptoms. Covariate analyses indicated that economic factors (i.e., having a household income less than $25,000 and experiencing job loss due to 9/11) increased the odds of belonging to the high-stable symptom trajectory group to the greatest degree, ORs = 4.93-6.08. The results suggest that providing financial support, including affordable mental health care, could be an important intervention in the wake of future mass traumatic events.

Childhood Abuse-Related Weight Gain: An Investigation of Potential Resilience Factors.

INTRODUCTION: Childhood physical, sexual, and emotional abuse are linked to adult obesity, and little is known about what protective factors might mitigate this association. METHODS: Data from female (n=4,247) and male (n=1,982) participants in the longitudinal Growing Up Today cohort study from 1996 to 2013 were used to examine whether factors found to promote mental health resilience after abuse also operate as buffers (modifiers) of the abuse-weight status association. At ages 20-25 years, participants were asked about their history of child abuse before age 18 years. Potential resilience factors (modifiers) included childhood family SES, neighborhood safety, supportive relationships with adult nonfamily members, quality of maternal relationship, family structure, religious service attendance, and prayer/meditation. Associations between child abuse and BMI at ages 25-32 years were modeled using linear regression, adjusted for sociodemographic variables and baseline BMI. Potential modifiers were tested with interaction terms. Analyses were run in 2019-2020. RESULTS: Severe abuse was associated with 0.9 kg/m2 (95% CI=0.5, 1.2) higher adult BMI than no abuse, corresponding to a 46% increased risk of obesity (95% CI=1.28, 1.67). Less severe abuse was not significantly associated with BMI (ß=0.1, 95% CI= -0.2, 0.4). There were no significant interactions between modifiers and abuse. CONCLUSIONS: Factors previously found to promote resilience to mental health sequelae after abuse did not modify the association of severe child abuse with higher weight status.

Identifying Correlates of Peer and Faculty/Staff Sexual Harassment in US Students.

Sexual harassment and its negative consequences continue to affect a large percentage of higher education students in the US. Previous research has identified a limited number of harassment risk factors, and has generally not examined them in combination. In this study, an expanded set of individual, relationship, and community-level risk factors were examined using hurdle models and classification and regression tree (CART) analyses to identify key risk factors for peer and faculty/staff sexual harassment. Secondary data analysis was conducted using data from a sample of 9,285 students from 18 two-year and four-year schools in Minnesota. CART analyses indicated that, for peer sexual harassment, being younger; consuming alcohol more than once a month; attending a four-year school; being transgender, genderqueer, self-identified, or a cisgender woman; and having experienced bullying were the most important risk factors for peer harassment on campus. For faculty/staff harassment, being gay, lesbian, bisexual, questioning, or having a self-identified sexual orientation was the most important risk factor. These and other risk factors were significant in the hurdle models. More research is needed to understand why these factors are associated with harassment. Limitations and implications for prevention programming at higher education institutions are discussed.

Relations among daily stressors, childhood maltreatment, and sleep in college students.

This study aimed to assess (a) the within- and between-person associations between daily stress and sleep; (b) the relation between childhood maltreatment and sleep; and (c) whether the relation between stress and sleep was moderated by the extent of childhood maltreatment among college students. Participants (N = 181) comprised the active control group in a previous intervention study. Participants completed a self-report measure of childhood maltreatment and 14 daily self-report measures of stressor exposure and severity (evenings) and 6 sleep measures (e.g., quality, duration; mornings). Experiencing more daily stressors than usual (within-person relation) was significantly associated with delayed sleep latency (i.e., time falling asleep). Greater daily stressor severity was also significantly associated with lower sleep efficiency within persons. Participants who reported more stressors in general had shorter sleep duration, poorer sleep quality, and less restful sleep (between-person relations). Students who reported more childhood maltreatment also reported significantly lower quality sleep and feeling less rested upon awakening. Childhood maltreatment did not moderate the within-person association between daily stress and sleep. Unexpectedly, at the between-person level, maltreatment moderated the association between stressors and stressor severity and several sleep parameters (e.g., efficiency and latency) such that there was a weaker relation between stress and sleep among those with more maltreatment. Interventions on campus could aim to reduce stress and improve sleep. Additional awareness of the prevalence of maltreatment and how it may be related to sleep also appears warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived Control, Voice Handicap, and Barriers to Voice Therapy.

OBJECTIVE: To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN: Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING: Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS: Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS: Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS: Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.

Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders.

IMPORTANCE: Communicative participation can be conceptualized as taking part in life situations in which people are socially engaged. Communicative participation is an important aspect in the lives of patients with voice disorders, although it has not been formally assessed among a broad sample of patients with voice disorders. The associations between communicative participation and associated concepts (vocal impairment, psychosocial distress, and voice-specific perceived control) are unknown yet important for integrated treatment approaches. OBJECTIVE: The primary objective was to examine the associations between communicative participation and vocal impairment, psychosocial distress, and voice-specific perceived control. The secondary objective was to examine whether perceived control moderates the association of distress with communicative participation and vocal impairment, the latter of which would replicate previous research. The hypotheses were that communicative participation would be associated with lower vocal impairment, lower distress, and higher perceived control and that higher perceived control would moderate the association between communicative participation and both vocal impairment and psychosocial distress. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from June 2014 to May 2017 among a consecutive sample of adult patients with voice disorders at an academic voice clinic affiliated with the University of Minnesota. Of the 744 patients approached to participate in the survey study, 590 patients agreed. Data analysis was performed from January to June 2020. MAIN OUTCOMES AND MEASURES: Communicative participation (measured by the 10-item general short form of the Communicative Participation Item Bank), vocal impairment (measured by the 10-item version of the Voice Handicap Index), psychosocial distress (measured by the 18-item version of the Brief Symptom Inventory), and voice-specific perceived control (measured by the 8-item present control subscale of the Perceived Control Over Stressful Events Scale). RESULTS: The sample comprised 590 patients (mean [SD] age, 51.9 [17.1] years; 390 women [66.1%]) with voice disorders. Communicative participation was associated with lower vocal impairment (r = -0.73; 95% CI, -0.77 to -0.69), lower overall psychosocial distress (r = -0.22; 95% CI, -0.30 to -0.14), and higher voice-specific perceived control (r = 0.30; 95% CI, 0.23-0.37). Moderation analyses indicated that communicative participation was negatively associated with distress at all levels of perceived control and, replicating previous findings, greater vocal impairment was associated with higher psychosocial distress only in patients with lower perceived control. CONCLUSIONS AND RELEVANCE: In this study, communicative participation was associated with, but distinct from, vocal impairment and was also associated with psychosocial distress and voice-specific perceived control. The study's results suggest that communicative participation is an important addition to voice research and clinical care.

Identity disruption and its association with mental health among veterans with reintegration difficulty.

Most research and theory on identity integration focuses on adolescents and young adults under age 30, and relatively little is known about how identity adjusts to major life events later in life. The purpose of the present study was to operationalize and investigate identity disruption, or a loss of temporal identity integration following a disruptive life event, within the developmental context of established adulthood and midlife. We used a mixed-methods approach to examine identity disruption among 244 Afghanistan and Iraq war veterans with reintegration difficulty who participated in an expressive writing intervention. Participants completed measures of social support, posttraumatic stress disorder (PTSD) symptom severity, satisfaction with life, and reintegration difficulty at baseline right before writing, and 3 and 6 months after the expressive writing intervention. The expressive writing samples were coded for identity disruption using thematic analysis. We hypothesized that identity disruption would be associated with lower social support, more severe PTSD symptoms, lower satisfaction with life, and greater reintegration difficulty at baseline. Forty-nine percent (n = 121) of the sample indicated identity disruption in their writing samples. Identity disruption was associated with more severe PTSD symptoms, lower satisfaction with life, and greater reintegration difficulty at baseline, and with less improvement in social support. The findings suggest that identity disruption is a meaningful construct for extending the study of identity development to established adult and midlife populations, and for understanding veterans' adjustment to civilian life. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Childhood maltreatment predicts daily stressor exposure in college students but not perceived stress or stress reactivity.

The purpose of this observational longitudinal study was to investigate the role of childhood maltreatment in explaining individual differences in daily stress processes. College students (N = 253) completed the Childhood Trauma Questionnaire and a measure of neuroticism at baseline before completing 14 nightly surveys assessing exposure to daily stressors (particularly interpersonal stressors), perceived stressor severity, and negative affect. Given mixed findings in past research, no specific hypotheses were proffered. Generalized linear mixed modeling showed that students with a history of maltreatment experienced roughly one more stressor every 1-to-2 days compared with those without a history of maltreatment, and experienced an interpersonal stressor on approximately half of the 14 study days compared to about one quarter of the study days for those without a history of maltreatment. In contrast, childhood maltreatment (except for physical abuse) was unrelated to perceived stressor severity and stress reactivity, controlling for gender and neuroticism. This suggests that college students reporting childhood maltreatment have more daily stressors, but they neither perceive them as more stressful nor react to them more strongly. In exploratory analyses assessing exposure to specific stressors, childhood maltreatment was associated with reporting more financial, work-related, career, and grade-related stressors in addition to interpersonal stressors. These findings underscore the importance of assessing stressor exposure separately from stress reactions. They also suggest that both individualized skill-based interventions to reduce stressor exposure and campus-wide programs to reduce financial and other burdens on students may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Web-Based Perceived Present Control Intervention for Voice Disorders: A Pilot Study.

OBJECTIVE: Voice disorders are common and negatively affect various life domains such as occupational functioning and emotional well-being. Perceived present control, a factor that is amenable to change, may reduce the effect of voice disorders on these outcomes. This pilot study aimed to (1) establish the feasibility, usability, and acceptability of a web-based perceived present control intervention for individuals with voice disorders and (2) gather preliminary data on the effectiveness of the intervention. This study is the first to assess whether a web-based psychological intervention would decrease self-reported voice handicap in this population. METHODS: Participants (N = 20) were recruited from an otolaryngology clinic at a large, Midwest university and the surrounding urban community, and completed a 3-week web-based intervention that incorporated psychoeducation and written exercises on increasing perceived present control. RESULTS: Supporting feasibility, the intervention components had high completion rates (75%-95%). Most participants planned to continue the perceived control exercises after study completion and would recommend the intervention to others, demonstrating usability and acceptability. There was a significant decrease in self-reported voice handicap (Voice Handicap Index-10) from pretest (M = 18.38, standard deviation = 4.41) to post-test (M = 15.22, standard deviation = 4.55) with a large effect size (within-group d = -0.86, P < 0.05). CONCLUSIONS: Focusing on perceived present control as a teachable skill may be a useful addition to voice disorder treatment armamentarium. Future studies will incorporate a comparison group and larger sample sizes to assess further the role of perceived present control interventions in voice care.

Post-sexual assault cigarette smoking: Findings from a randomized clinical trial of a video-based intervention.

Sexual assault (SA) is associated with elevated risk for cigarette smoking. The current study tested whether a brief video intervention delivered in the emergency department was effective at reducing smoking following SA. Participants were 233 girls and women (age 15+) who received a SA medical forensic examination (SAMFE) and were randomized to one of three conditions: 1) Prevention of Post-Rape Stress (PPRS), a brief video designed to reduce post-SA psychopathology; 2) Pleasant Imagery and Relaxation Information (PIRI), an active control video involving relaxation training; and 3) treatment as usual (TAU). Among those who participated at baseline, 154 participants completed at least one follow-up at 1.5, 3, and 6 months after the SAMFE. Participants reported the number of days of smoking and the average number of cigarettes smoked per day in the two weeks prior to the sexual assault as well as in the two weeks prior to each follow-up. Two-thirds (68.8%) of participants smoked prior to the SA or during any follow-up. One-fifth of participants who did not smoke prior to the SA smoked at one or more follow-ups. Smoking declined on average over follow-up although TAU was associated with increased initial smoking compared to PPRS; PPRS and PIRI did not differ. SA contributes to increases in smoking and the PPRS, a brief and cost-effective video-based intervention delivered during the SAMFE, can protect against increases in post-SA smoking. Trial registration: NCT01430624.

Assessing Change Over Time in Voice Handicap and Voice-Related Perceived Control Using Ecological Momentary Assessment.

OBJECTIVES: Voice handicap has generally been measured at a single timepoint. Little is known about its variability from hour to hour or day to day. Voice handicap has been shown to be negatively related to voice-related perceived control in cross-sectional studies, but the within-person variability in voice-related perceived control is also unknown. We aimed to use ecological momentary assessment (EMA) to (1) assess the feasibility of EMA to examine daily voice handicap and voice-related perceived control in patients with voice disorders, (2) measure within-person variability in daily voice handicap and perceived control, and (3) characterize temporal associations (eg, correlations over time) between daily voice handicap and perceived control. METHODS: Adults with voice problems were recruited from a large public university medical center in the Midwest. They completed baseline measures, followed by twice-daily assessments, including selected items measuring voice handicap and perceived control, and then repeated the baseline measures at the final timepoint. Feasibility was assessed via completion rates. Within-person variability was measured using standard deviations. Temporal associations were characterized using simulation modeling analysis. RESULTS: EMA of voice handicap and perceived control was feasible in this patient population. Momentary voice handicap varied more than perceived control, though both were variable. Multiple patterns of temporal associations between daily voice handicap and perceived control were found. CONCLUSIONS: These findings identified important variability in (1) measures of voice handicap and perceived control and (2) their associations over time. Future EMA studies in patients with voice disorders are both feasible and warranted.

Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study.

OBJECTIVES: The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. METHODS: Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. RESULTS: Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. CONCLUSIONS: In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function.

Understanding posttrauma reactions within an attachment theory framework.

The purpose of this paper is to review recent research on posttrauma reactions (i.e., posttraumatic stress disorder [PTSD] symptoms and self-reported posttraumatic growth [PTG]) using attachment theory as a framework. Attachment orientations are significantly related to PTSD symptoms: insecure attachment orientations (particularly attachment anxiety) are positively associated with PTSD symptoms whereas attachment security is negatively associated with PTSD symptoms. Although associations appear to be reciprocal, research typically focuses on insecure attachment orientations predicting PTSD symptoms and the possible mechanisms of those relations, particularly a lack of social support. Some trauma characteristics (e.g., trauma severity) also appear to moderate the association between attachment and PTSD symptoms. Research on attachment orientations and PTG, however, has yielded mixed results. More rigorous methods are needed to better understand the role of attachment orientations in actual growth from pre to post-trauma.

Sexual victimization, childhood emotional abuse, and distress: Daily coping and perceived control as mediators.

The primary aim of the present study was to assess 2 potential mediators (daily avoidant coping and perceived control) of the relations between past sexual victimization and childhood emotional abuse and current distress. Participants (N = 268) were undergraduate students in psychology courses at a large Midwestern university who completed measures of sexual victimization, childhood emotional abuse, neuroticism, and distress at baseline; daily measures of avoidant coping and perceived control over stressors for 14 days (Time 2); and measures of avoidant coping, perceived control, and distress at Time 3. Structural equation modeling (SEM) was used to test the mediation model. The indirect path between childhood emotional abuse and T3 distress through daily avoidant coping was significant and remained significant in an alternate model that controlled for baseline neuroticism. The indirect effect of childhood emotional abuse on T3 distress through perceived control was not significant. Sexual victimization was not associated with greater use of avoidant coping or perceived control in the SEM models. The present study added to the literature by assessing multiple traumas and multiple mediators using longitudinal, daily diary methods. (PsycINFO Database Record

Posttraumatic Stress Disorder Symptoms and Problematic Overeating Behaviors in Young Men and Women.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a risk factor for obesity, but the range of behaviors that contribute to this association are not known. PURPOSE: The purpose of this study was to examine associations between self-reported PTSD symptoms in 2007, with and without comorbid depression symptoms, and three problematic overeating behaviors in 2010, and to estimate the associations of PTSD-related overeating behaviors with obesity. METHODS: Cross-sectional and longitudinal analyses included 7438 male (n = 2478) and female (n = 4960) participants from the Growing Up Today Study (mean age 22-29 years in 2010). Three eating behavior outcomes were assessed: binge eating (eating a large amount of food in a short period of time with loss of control), top quartile of coping-motivated eating (from the Motivations to Eat scale), and top quartile of disinhibited eating (from the Three-Factor Eating Questionnaire). RESULTS: PTSD symptoms were associated with two- to threefold increases in binge eating and top-quartile coping-motivated eating; having ≥4 PTSD symptoms, relative to no PTSD symptoms, was associated with covariate-adjusted RRs of 2.7 (95% CI 2.1, 3.4) for binge eating, 2.1 (95% CI 1.9, 2.4) for the top quartile of coping-motivated eating, and 1.5 (95% CI 1.3, 1.7) for the top quartile of disinhibited eating. There was a trend toward PTSD symptoms in 2007 predicting new onset binge eating in 2010. Having depression symptoms comorbid with PTSD symptoms further increased risk of binge eating and coping-motivated eating. All eating behaviors were associated with obesity. CONCLUSION: Clinicians treating patients with PTSD should know of potential comorbid problematic eating behaviors that may contribute to obesity.

Identity adjustment among Afghanistan and Iraq war veterans with reintegration difficulty.

OBJECTIVE: To examine perceptions of identity adjustment in a diverse, national sample of U.S. veterans of the wars in Afghanistan and Iraq. METHOD: The authors conducted a planned thematic analysis of text written by Afghanistan and Iraq war veterans when they were asked to describe their reintegration difficulties as part of a randomized controlled trial (RCT) of online expressive writing (Sayer et al., 2015). Participants were 100 randomly selected veterans from the larger study (42 women and 58 men, 60 active duty and 38 reserves or National Guard). RESULTS: Nearly 2/3s of participants wrote about their identity adjustment. The 5 interrelated areas of identity adjustment difficulty were (a) feeling like one does not belong in civilian society, (b) missing the military's culture and structured lifestyle, (c) holding negative views of civilian society, (d) feeling left behind compared to civilian counterparts due to military service, and (e) having difficulty finding meaning in the civilian world. The authors did not observe differences by gender. However, those deployed from active duty were particularly likely to feel as if they did not belong in civilian society and that they had not acquired needed skills, whereas those deployed from the reserves or National Guard experienced difficulty in reestablishing former civilian identities. CONCLUSIONS: Identity adjustment is a critical yet understudied aspect of veteran reintegration into community life following combat deployment. (PsycINFO Database Record