Clinical Inquiry: do oral contraceptives put women with a family history of breast cancer at increased risk?

A systematic review of the effect of combined OCPs on women with a family history of breast cancer found no additional increase in risk. Investigators identified 3 retrospective cohort studies (N=66,500, with 8500 cases) and 7 case-control studies (total 10,500 cases) from the past 40 years, most including women from the United States and Canada, but one including women from 5 continents.

PTSD and conflict behavior between veterans and their intimate partners.

This study examined the influence of trauma history and PTSD symptoms on the behavior of veterans and their intimate partners (287 couples; N=574) observed during conflict discussions and coded using the Rapid Marital Interaction Coding System (Heyman, 2004). Dyadic structural equation modeling analyses showed that PTSD was associated with more frequent displays of hostility and psychological abuse and fewer expressions of acceptance and humor in both veterans and their partners. Findings provide new insight into the social and emotional deficits associated with PTSD and emphasize the importance of addressing the trauma histories and PTSD of both partners when treating veteran couples with relationship disturbance.

A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

CONTEXT: The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance. OBJECTIVES: To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma. DESIGN: A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation. SETTINGS: The VA Boston Healthcare System and the New Mexico VA Health Care System. PARTICIPANTS: A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD. MAIN OUTCOME MEASURES: Item-level scores on the Clinician-Administered PTSD Scale. RESULTS: A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma. CONCLUSIONS: These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.

Feasibility, Acceptability, and Initial Findings from a Community-Based Cultural Mental Health Intervention for American Indian Youth and Their Families.

Through a CBPR partnership, university and American Indian (AI) tribal members developed and tested Our Life intervention to promote mental health of AI youth and their families by addressing root causes of violence, trauma, and substance abuse. Based on premises that well-being is built on a foundation of traditional cultural beliefs and practices, and that it requires a process of healing and understanding, the 6-month intervention had four components: 1) recognizing/healing historical trauma; 2) reconnecting to traditional culture; 3) parenting/social skill-building; and 4) strengthening family relationships through equine-assisted activities. Feasibility, acceptability, appropriateness, and preliminary outcomes were examined in a mixed-method within-group design. Engagement and retention were challenging, suggesting that families faced numerous barriers to participation. Youth who completed the program experienced significant increases in cultural identity, self-esteem, positive coping strategies, quality of life, and social adjustment. Qualitative data supported these findings and suggested additional positive effects.

INVOLVING PARENTS IN A COMMUNITY-BASED, CULTURALLY-GROUNDED MENTAL HEALTH INTERVENTION FOR AMERICAN INDIAN YOUTH: PARENT PERSPECTIVES, CHALLENGES, AND RESULTS.

An important predictor of youth well-being and resilience is the presence of nurturing adults in a youth's life. Parents are ideally situated to fulfill this role but often face challenges and stressors that impede their ability to provide adequate support and guidance. American Indian parents may also be affected by intergenerational transmission of trauma and loss of traditional parenting practices, as a result of forced boarding school and/or relocation. Members of a community-university partnership sought to interrupt cycles of violence and poor mental health of youth through a culturally-grounded intervention for youth and their parents that focused on healing historical trauma, strengthening positive parenting practices and social skills, reconnecting to traditional cultural knowledge, and improving parent-child relationships/communication. This article describes parental involvement and its challenges and provides mixed-method results for 10 parents related to enculturation, parenting practices, parent-child communication, family cohesion, historical loss and associated symptoms, and community involvement.

A behavior-analytic account of cognitive bias in clinical populations.

Cognitive bias refers to a well-established finding that individuals who suffer from certain clinical problems (e.g., depression, anxiety, posttraumatic stress disorder, substance abuse, etc.) selectively attend to, remember, and interpret events relevant to their condition. Although a body of literature exists that has tried to examine this phenomenon, most existing explanations are mentalistic and mediational. In this paper we offer a behavior-analytic account of cognitive bias, its development, and how it may contribute to maintenance of clinical problems. This account is based on establishing operations or motivating events, verbal processes, and relational responding. Clinical and future research implications are also discussed.