Health Risk Behavior and Sexual Assault Among Ethnically Diverse Women.

Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women's attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among ethnic minority samples or identify the mechanisms responsible for this association. The current study examined sexual assault history and two health risk behaviors (hazardous drinking and engaging in sexual behavior to regulate negative affect) in a diverse sample of 1,620 college women. Depression and anxiety were examined as mediators of the relationship between sexual assault and health risk behaviors. There was evidence of moderated mediation, such that for European American women, but not for ethnic minority women, both forms of psychological distress were significant mediators of the sexual assault/hazardous drinking relationship. In contrast, among all ethnic groups, the relationship between sexual assault and both forms of psychological distress was mediated by the use of sexual behavior as an affect regulation strategy. Results support a need to evaluate the assault experiences of ethnically diverse women, as well as the impact of the assault on their postassault experiences including health risk behaviors and psychological adjustment. Additionally, results suggest that practitioners should carefully assess health risk behaviors among victims of sexual assault and be aware that there may be differences in the risk factors and motives for these behaviors among women of various ethnic backgrounds.

Multisystemic therapy for child non-externalizing psychological and health problems: a preliminary review.

Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the "presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness" (Henggeler et al. in J Am Acad Child Psy 38:1331-1345, p. 1332, 1999b). Additionally, youth with "serious emotional disturbance (SED)" defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were "currently in or at imminent risk of a costly out-of-home placement" (Rowland et al. in J Emot Behav Disord 13:13-23, pp. 13-14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes.

Anxiety and inattention as predictors of achievement in early elementary school children.

The objective of this study was to examine the relations among anxiety, inattention, and math/reading achievement, as well as the mediating/moderating role of inattention in the anxiety-achievement association both concurrently and longitudinally. Participants included 161 ethnically diverse children (aged 6-8) and their teachers. At the middle and end of first grade (approximately 5 months apart), students completed measures of anxiety and achievement while their teachers completed a measure of inattention. For the concurrent analyses, greater harm avoidance anxiety was associated with better attention, which was in turn related to better achievement. For the longitudinal analyses, mid-year inattention interacted with harm avoidance and separation anxiety to predict end of year reading fluency. For those rated as more attentive, greater separation anxiety symptoms were associated with decreased fluency performance while greater harm avoidance symptoms were associated with increased performance. Findings were discussed in terms of the importance of considering socioemotional variables in the study of children's academic achievement and the potential utility of early anxiety prevention/intervention programs, especially for children experiencing academic difficulties who also show internalizing behaviors.

Anxiety and reading difficulties in early elementary school: evidence for unidirectional- or bi-directional relations?

The present study examined competing models of the bi-directional influences of anxiety and reading achievement. Participants were 153 ethnically-diverse children (84 male, 69 female) from general education classes evaluated in the winter and spring of their first-grade academic year. Children completed standardized measures of reading achievement involving decoding and fluency along with an anxiety rating scale. Hierarchical linear regression analyses revealed that separation anxiety symptoms were negatively predicted by fluency performance and harm avoidance symptoms were positively predicted by decoding performance. Fluency performance was positively predicted by harm avoidance and total anxiety (for girls only) symptoms, while decoding was not predicted by any anxiety subscale.

From Survivor to Thriver: A Pilot Study of an Online Program for Rape Victims.

Approximately 15% to 20% of women have been victims of rape and close to a third report current rape-related PTSD or clinically significant depression or anxiety. Unfortunately, very few distressed rape victims seek formal help. This suggests a need to develop alternative ways to assist the many distressed victims of sexual violence. Online treatment programs represent a potentially important alternative strategy for reaching such individuals. The current paper describes a pilot evaluation of an online, therapist-facilitated, self-paced cognitive behavioral program for rape victims. Five college women with current rape-related PTSD were recruited to complete the From Survivor to Thriver (S to T) program in a lab setting over the course of 7 weeks. After completing the program, 4 participants reported clinically significant reductions in PTSD symptoms and no longer met criteria for PTSD. All participants reported clinically significant reductions in vulnerability fears and 4 reported significant reductions in negative trauma-related cognitions. Implications of the results for further development of the S to T program and how clinicians could utilize this program in treating rape-related PTSD are discussed.

Prior Sexual Trauma and Adjustment Following the Virginia Tech Campus Shootings: Examination of the Mediating Role of Schemas.

A sizable body of research supports trauma's cumulative nature. However, few studies have evaluated potential mechanisms through which the experience of multiple traumas leads to elevated distress. The current study sought to evaluate differences between sexual trauma victims and women who had not experienced sexual trauma in their adjustment following a mass trauma (college women exposed to the 2007 Virginia Tech campus shooting). In addition, the study examined whether maladaptive schema change (lower self-worth and less belief in benevolence) and social support mediated the relationship between experiencing multiple traumas (sexual trauma and the campus shooting) and distress. The sample consisted of 215 college women who were assessed preshooting as well as two months and one year following the campus shooting. Women who had experienced sexual trauma (either contact sexual abuse or sexual assault) were compared to those who had not on their one-year postshooting PTSD and depressive symptoms. Results supported that sexual trauma victims reported significantly more depressive symptoms and shooting-related PTSD as well as less belief in benevolence and lower family support. Family support and benevolence beliefs at the two month postshooting assessment were significant medi-ators of the association between sexual trauma history and depression and PTSD. Implications of the findings for future research evaluating the cumulative impact of multiple traumatic experiences are discussed.

Social support, world assumptions, and exposure as predictors of anxiety and quality of life following a mass trauma.

This study examined the influence of a mass trauma (the Virginia Tech campus shootings) on anxiety symptoms and quality of life, as well as the potential vulnerability/protective roles of world assumptions and social support. Pre-trauma adjustment data, collected in the six months prior to the shooting, was examined along with two-month post-shooting data in a sample of 298 female students enrolled at the university at the time of the shootings. Linear regression analyses revealed consistent predictive roles for world assumptions pertaining to control and self-worth as well as family support. In addition, for those more severely exposed to the shooting, greater belief in a lack of control over outcomes appeared to increase vulnerability for post-trauma physiological and emotional anxiety symptoms. Implications of the results for research and intervention following mass trauma are discussed.

Longitudinal evaluation of the relationship between maladaptive trauma coping and distress: examination following the mass shooting at Virginia Tech.

Growing evidence supports that the coping strategies that individuals utilize are a key predictor of distress following trauma. However, there is limited longitudinal research examining the relationship between psychological distress and coping over time, and even less research examining the possibility of reciprocal relationships between distress and coping, despite the fact that prior theoretical work posits such a relationship. The current study modeled the relationship between distress (PTSD and general distress) and maladaptive coping over time in a sample of 368 college women exposed to the mass shooting at Virginia Tech (VT). Participants completed web surveys regarding their distress, shooting-related coping, and shooting-related PTSD 2 months, 6 months, and 1 year following the shooting. They also completed measures of their psychological distress prior to the shooting as part of an unrelated study. A structural cross-lagged model with latent variables supported a reciprocal relationship between maladaptive coping and general psychological distress over time. In contrast, the cross-lagged model evaluating the relationship between PTSD and maladaptive coping supported that PTSD symptoms predicted coping over time, but there was no reciprocal relationship between coping and PTSD. Implications of the findings for future work examining adjustment following traumatic events are discussed.

Evaluation of an information processing model following sexual assault.

There is growing recognition that individuals vary in their response to traumatic experiences. Resick and Schnicke (1992) developed an information processing model of trauma response patterns, theorizing that individuals vary in how they integrate the experience into their schematic beliefs. Specifically, individuals can respond to trauma by assimilation, altering the trauma to fit with extant schemas; accommodation, altering extant schemas; or over-accommodation, engaging in maladaptive schema change. Littleton (2007) supported that these response patterns are reflected in distinct coping patterns among rape victims. The current study utilized latent profile analysis (LPA) to replicate Littleton's (2007) findings in a sample of 340 college rape victims, as well as evaluated the extent to which these response patterns were related to distress, trauma-related schemas, re-victimization risk behaviors, and re-victimization. Results of the LPA supported the existence of the three response patterns. In addition, victims classified into the three response patterns differed in their distress, adherence to trauma-related schemas, and re-victimization risk behaviors. While no significant differences in re-victimization rates were found, re-victimization was common. Implications of the findings for future research and intervention are discussed.

Fear of anxiety as a partial mediator of the relation between trauma severity and PTSD symptoms.

Fear of anxiety has previously been found to be a predictor of overall symptoms of posttraumatic stress disorder (PTSD). The current exploratory study examines the relationship between fear of anxiety and symptoms of PTSD in a sample of adults exposed to Hurricane Katrina. Fear of anxiety was found to partially mediate the relationship between the severity of trauma and the severity of PTSD. Further, this mediation was found to operate differently by gender, with the mediation holding true for men but not for women. For both men and women, fear of anxiety was positively correlated with PTSD symptoms.

A longitudinal examination of factors predicting anxiety during the transition to middle school.

The transition from elementary to middle or junior high school is commonly regarded as a period of stress and turmoil for young adolescents, and has been associated with changes in anxiety and other psychological problems. However, less is known about risk and resilience factors that may predict these changes. This study examined changes in anxiety, as well as predictors of these changes among 77, predominantly Caucasian (88%), male and female (52%) adolescents from Grades 6 to 8. Repeated measures analysis of variance was conducted to examine the predicted grade and gender differences. Multiple regression analyses were conducted to examine the prediction of eighth grade anxiety symptoms by sixth grade self-worth, perceived social acceptance, and social support, as well as the potential moderating role of gender in these relations. Results suggested a significant decrease in anxiety, particularly social anxiety, over this period for boys but not girls. Examination of predictors of changes in anxiety suggested that, in general, global self-worth, social acceptance, and gender were each associated with overall and social anxiety. Findings are integrated with extant literature on developmental changes associated with anxiety and school transitions and clinical implications of these findings are discussed.

The psychological impact from hurricane Katrina: effects of displacement and trauma exposure on university students.

The following study examined the reactions of university students to Hurricane Katrina. A group of 68 New Orleans area students who were displaced from their home universities as a result of the hurricane were matched on race, gender, and age to a sample of 68 students who had been enrolled at Louisiana State University (LSU) prior to the hurricane. All students were enrolled at LSU at the time they participated in an online survey, conducted 3 months following the hurricane. The survey included symptom measures of depression, anxiety, stress, posttraumatic stress disorder (PTSD), and other variables. Results indicated displaced students experienced more trauma exposure and greater subsequent distress, more symptoms of PTSD, and more symptoms of depression. Moreover, traumatic exposure and distress from the traumatic exposure were found to fully mediate depressive symptoms and posttraumatic symptoms in the displaced students.

Resource loss as a predictor of posttrauma symptoms among college women following the mass shooting at Virginia Tech.

We examined risk factors for posttrauma symptomatology, 2 and 6 months following the April 2007 mass shooting at Virginia Tech. Using a conservation of resources framework and a Web-based survey methodology, we prospectively evaluated the relations among preshooting distress, social support, resource loss, and posttrauma symptomatology in a sample of 293 female students enrolled at the university at the time of the shootings. Structural equation modeling supported that preshooting social support and distress predicted resource loss postshooting. Resource loss predicted symptomatology 2 months and 6 months after the shooting. Implications of the results for research and intervention following mass trauma are discussed.

Impaired and incapacitated rape victims: assault characteristics and post-assault experiences.

Alcohol is the most common "rape drug," with up to two-thirds of victims consuming alcohol prior to the assault. Surprisingly, little research has examined the assault and postassault experiences of victims who were impaired or incapacitated as a result of substance use, including alcohol, during a rape. Thus, the current study evaluated the assault and postassault experiences of a sample of 340 nonimpaired, impaired, and incapacitated college rape victims. Results supported that these three groups differed in several assault characteristics, including threats by the assailant, resistance by the victim, and relationship with the assailant. In addition, impairment and incapacitation were associated with several postassault factors, including self-blame, stigma, and problematic alcohol use. Results also highlighted similarities in victims' experiences, including levels of postassault distress. Implications of the findings for future research investigating impaired and incapacitated sexual assault victims are discussed.

Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders.

In the present review, we examine one of the critical issues that have been raised about evidence-based treatments and their portability to real-world clinical settings: namely, the presence of comorbidity in the participants who have been treated in these studies and whether the presence of comorbidity predicts or moderates treatment outcomes. In doing so, we examine treatment outcomes for the four most commonly occurring childhood psychiatric disorders: Anxiety disorders, affective disorders, attention deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD)/conduct disorder (CD). For each of these disorders, we first review briefly the prevalence of comorbidity in epidemiological and clinical samples and then highlight the evidence-based treatments for these disorders. We next determine the effects of comorbidity on treatment outcomes for these disorders. For the most part, comorbidity in the treated samples is the rule, not the exception. However, the majority of studies have not explored whether comorbidity predicts or moderates treatment outcomes. For the not insignificant number of studies that have examined this issue, comorbidity has not been found to affect treatment outcomes. Notable exceptions are highlighted and recommendations for future research are presented.

Reexamination of the MASC factor structure and discriminant ability in a mixed clinical outpatient sample.

Anxiety problems in youth are common, suggesting the need for developmentally appropriate and psychometrically sound measures in this area. The Multidimensional Anxiety Scale for Children (MASC) was created with this goal in mind, but has yet to be examined with samples representative of youth typically seen in clinical settings. Two hundred and sixty-two outpatient youth with mixed clinical presentations completed the MASC, a measure that includes a total anxiety score, as well as subscale scores for social anxiety, harm avoidance, separation anxiety/panic, and physical symptoms of anxiety. Internal consistency, means, and factor structure were comparable to that reported previously. Model invariance was supported across gender, diagnosis, and age. The MASC total score significantly differentiated children who received anxiety disorder diagnoses from those who did not. The social anxiety subscale significantly predicted social phobia and the harm avoidance subscale significantly predicted generalized anxiety disorder. Further support was found for the MASC. However, caution should be exercised given mixed discriminant ability findings. That is, the MASC seems best suited as a screening instrument for anxiety and when used in conjunction with a multiple method/informant assessment approach.

Parental modeling, reinforcement, and information transfer: risk factors in the development of child anxiety?

The purpose of this article is to provide a comprehensive review and a conceptual integration of research examining the potential role of learning from parents in the development of child anxiety. Specifically, research in this area is discussed within the framework of three specific mechanisms: parental modeling, information transfer, and parental reinforcement of anxious/avoidant behavior. Implications of the research in this area are discussed, as well as limitations and directions for future research.