Military Sexual Trauma and Chronic Pain in Veterans.

OBJECTIVE: Chronic pain rehabilitation warrants sensitivity to unique psychosocial factors, such as trauma history. In Veterans of the United States Armed Forces, military sexual trauma (MST) is a pervasive type of trauma associated with a host of physical and psychological sequelae. A growing literature suggests a relationship between history of MST and chronic pain. This study sought to clarify the relationship between MST and chronic pain among male and female Veterans and explore whether individual factors moderate this relationship. DESIGN: A baseline survey of 328 Veterans seeking care for chronic pain via behavioral pain treatments was conducted. RESULTS: MST was reported by 31.4% of the sample and uniquely predicted pain interference. A significant interaction was found between MST and age, such that younger Veterans with a history of MST reported greater pain interference than younger Veterans with no MST. CONCLUSION: Findings provide further evidence that the experience of MST may intensify the overall burden of chronic pain and suggest that younger Veterans with MST seem to be most vulnerable to impaired pain rehabilitation. Unique study contributions include a robust sample of women and men with elevated rates of MST and examination of MST-age relationships concurrent with chronic pain.

The effect of trauma proximity and ruminative response styles on posttraumatic stress and posttraumatic growth following a university shooting.

OBJECTIVE: Shootings in academic settings are associated with the development of both posttraumatic growth (PTG) and posttraumatic stress (PTS) symptoms (Bardeen, Kumpula, & Orcutt, 2013). Traumatic events can challenge an individual's cognitive framework and contribute to the development of PTS and PTG. Intrusive rumination is thought to increase vulnerability to PTS symptoms, whereas deliberate rumination is likely to be associated with PTG. Literature that serves to distinguish the contextual and intraindividual predictors differentially leading to the development of PTS and PTG symptoms is limited. This cross-sectional study examined the relations between trauma proximity and posttraumatic outcomes as mediated by deliberate and intrusive ruminative responses to a university shooting. We hypothesize that (a) physical and emotional proximity would exert distinct effects on posttraumatic outcomes, (b) the effects of proximity on PTS would be mediated by intrusive rumination, and (c) the effects of proximity on PTG would be mediated by deliberate rumination. METHOD: Three hundred and eighty-five students, faculty, and staff who were exposed to a university campus shooting completed a series of questionnaires 4 months after the event. RESULTS: Emotional proximity was associated with PTS and PTG, whereas physical proximity was only associated with PTS. Of our four hypothesized mediation relationships, intrusive rumination mediated the relationship between physical proximity and PTS, and deliberate rumination mediated the relationship between emotional proximity and PTG. CONCLUSIONS: These results suggest that physical and emotional proximity to a traumatic event uniquely contribute to the development of posttraumatic outcomes and that intrusive rumination promotes maladaptive outcomes, whereas deliberate rumination may promote adaptive outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Mental and Physical Health Correlates of Pain Treatment Utilization Among Veterans With Chronic Pain: A Cross-sectional Study.

INTRODUCTION: The annual cost of treatment and lost productivity due to chronic pain is estimated to be $635 billion within the USA. Self-management treatments for chronic pain result in lower health care costs and lower utilization of provider-management treatments, such as hospitalization and medication use. The current study sought to identify and characterize patient factors and health conditions associated with chronic pain treatment utilization to inform ways to improve engagement in self-management pain treatment (e.g., applying heat or ice, exercising, or practicing relaxation). This study predicted (1) greater pain intensity and pain interference would be associated with greater utilization of self-management treatments and (2) this association would be moderated by patient factors (gender and age) and health comorbidities (anxiety, trauma, depression, and sleep disturbance). MATERIALS AND METHODS: Baseline data from a three-arm clinical trial were collected for 127 Veterans seeking treatment for chronic pain. Veterans were recruited via clinician referral and medical record review at the Veterans Affairs Puget Sound Health Care System, Washington, USA. RESULTS: Self-management treatments were more utilized than provider-management treatments. Pain intensity and pain interference were not uniquely associated with provider-management or self-management treatment utilization after controlling for demographics and mental health status. Sleep disturbance moderated the relationship between pain interference and provider-management treatment utilization. Depression moderated the relationship between pain intensity and provider-management treatment utilization. CONCLUSIONS: While study conclusions may not generalize to all Veteran populations, findings suggest that Veterans with chronic pain were more likely to seek provider-management treatments when experiencing high-pain interference and high-sleep disturbance. In addition, Veterans were more likely to seek provider-management treatments when experiencing low-pain intensity and high-depression symptoms.

Reduced Symptoms of Post-Traumatic Stress Disorder and Irritable Bowel Syndrome Following Mindfulness-Based Stress Reduction Among Veterans.

Objectives: Post-traumatic stress disorder (PTSD) and irritable bowel syndrome (IBS) are highly comorbid conditions associated with reduced health-related quality of life. Comorbid prevalence is especially high among veterans, ranging from 23% to 51%, but there is limited research on integrative treatments. Design: To improve treatment of comorbid PTSD and IBS, this study examined the impact of mindfulness-based stress reduction (MBSR) on symptom reduction and mindfulness skill building among veterans with this comorbidity. We hypothesized that veterans would report reduced trauma-related, gastrointestinal (GI) symptom-specific anxiety (GSA), and depression symptoms and greater mindfulness skills post-treatment. We also hypothesized that veterans who reported lower trauma-related GSA and depression symptoms, and reported greater mindfulness skills and MBSR session attendance would report lower irritable bowel symptoms post-treatment. Settings/Location: VA (Veterans Administration) Puget Sound Health Care System, Seattle, Washington. Subjects: Participants were 55 veterans with PTSD and IBS. Interventions: Veterans participated in an 8-week open trial of MBSR group. Outcome measures: This study measured the impact of MBSR on PTSD, IBS, GSA, and depression symptoms as well as mindfulness skills. Results: Veterans reported reduced trauma-related, irritable bowel, GSA, and depression symptoms and greater mindfulness skills immediately post-treatment. Trauma-related and depression symptom reduction were maintained 4 months post-treatment, but irritable bowel and GSA symptoms were nonsignificant. Lower baseline GSA predicted lower irritable bowel symptoms immediately post-treatment. At 4 months post-treatment, 77.50% met PTSD criteria and 40.38% met IBS criteria compared with 100% veteran comorbidity pretreatment. Conclusions: MBSR holds promise as a transdiagnostic intervention for individuals with comorbid trauma-related, depression, GSA, and irritable bowel symptoms, with maintenance of trauma-related and depression symptom improvement 4 months post-treatment.

Don't worry, be happy: The role of positive emotionality and adaptive emotion regulation strategies for youth depressive symptoms.

OBJECTIVES: Low positive emotionality (PE) represents a temperamental vulnerability to depression in youth. Until now, little research has examined the mechanisms linking PE to depressive symptoms. Starting from integrated cognitive-affective models of depression, we aimed to study adaptive emotion regulation (ER) as a key underlying mechanism in the temperament-depression relationship. METHODS: This study investigated whether adaptive ER strategies mediate the association between PE and depressive symptoms in a large community-based sample of youth, using a cross-sectional design. Participants were 1,655 youth (54% girls; 7-16 years, M = 11.41, SD = 1.88) who filled out a set of questionnaires assessing temperament, adaptive ER strategies, and depressive symptoms. RESULTS: Results revealed that low PE was significantly related to higher depressive symptoms among youth and that a lack of total adaptive ER abilities mediated this relationship. More specifically, the infrequent use of problem-solving appeared to be of significant importance. Problems in positive refocusing and a deficient use of forgetting mediated the relationships between low PE and high negative emotionality (NE) in predicting depressive symptoms. Reappraisal and distraction were not significant mediators. CONCLUSION: Results highlight the need to account for temperamental PE and adaptive ER strategies when studying youth depression. The findings contribute to a more nuanced understanding on the differential role of temperamental risk factors for developing depressive symptoms at an early stage and advocate for greater attention to adaptive ER strategies. PRACTITIONER POINTS: Clinical interventions for youth depression may be improved by incorporating adaptive emotion regulation (ER) strategies and enhancing positive emotions. Youth low in positive emotionality (PE) may especially benefit from learning adaptive ER skills. Clinical practitioners should focus on alleviating negative emotions and enhancing positive emotions, especially among youth low in PE.

Is Rumination a Risk and a Protective Factor?

High trait positive affect (PA) protects against depressive symptoms through cognitive responses such as rumination. However, how rumination in response to positive emotions (positive rumination) protects against depressive symptoms while rumination in response to negative emotions (brooding) predicts depressive symptoms is poorly understood. We hypothesized that (a) positive rumination and brooding represent a shared cognitive process of affect amplification on distinct affective content and (b) less brooding and greater positive rumination would distinctly mediate greater trait PA in predicting fewer depressive symptoms. Our prospective design among 321 adults first compared three confirmatory factor analysis models of the relationship between brooding and positive rumination. We then utilized structural equation modeling to examine whether brooding and positive rumination mediated the relationship between trait PA and depressive symptoms, controlling for baseline depressive symptoms, trait negative affect (NA), and the distinct effects of each mediator. Results supported a conceptualization of brooding and positive rumination as distinct but related constructs, represented as a common process of affect amplification to explain how rumination may amplify resilience or risk in predicting depressive symptoms (χ = 195.07, Δχ = 8.78, p < .001, CFI = .91, RMSEA = .07). Furthermore, positive rumination and brooding were distinctly predicted by trait PA, suggesting that trait PA exerts distinct effects on protective and risk forms of rumination. Less brooding mediated the relationship between greater trait PA and fewer depressive symptoms (ß = -.04, p = .012), but positive rumination did not (ß = .02, p = .517). Rumination may represent a protective and a risk factor, which may better enable individuals who brood to redirect their rumination on positive content and thereby reduce their risk of depressive symptoms.

Disentangling vulnerabilities from outcomes: Distinctions between trait affect and depressive symptoms in adolescent and adult samples.

BACKGROUND: Trait negative affect and trait positive affect are affective vulnerabilities to depressive symptoms in adolescence and adulthood. While trait affect and the state affect characteristic of depressive symptoms are proposed to be theoretically distinct, no studies have established that these constructs are statistically distinct. Therefore, the purpose of the current study was to determine whether the trait affect (e.g. temperament dimensions) that predicts depressive symptoms and the state affect characteristic of depressive symptoms are statistically distinct among early adolescents and adults. We hypothesized that trait negative affect, trait positive affect, and depressive symptoms would represent largely distinct factors in both samples. METHOD: Participants were 268 early adolescents (53.73% female) and 321 young adults (70.09% female) who completed self-report measures of demographic information, trait affect, and depressive symptoms. RESULTS: Principal axis factoring with oblique rotation for both samples indicated distinct adolescent factor loadings and overlapping adult factor loadings. Confirmatory factor analyses in both samples supported distinct but related relationships between trait NA, trait PA, and depressive symptoms. LIMITATIONS: Study limitations include our cross-sectional design that prevented examination of self-reported fluctuations in trait affect and depressive symptoms and the unknown potential effects of self-report biases among adolescents and adults. CONCLUSIONS: Findings support existing theoretical distinctions between adolescent constructs but highlight a need to revise or remove items to distinguish measurements of adult trait affect and depressive symptoms. Adolescent trait affect and depressive symptoms are statistically distinct, but adult trait affect and depressive symptoms statistically overlap and warrant further consideration.

Cognitive Mechanisms Reciprocally Transmit Vulnerability between Depressive and Somatic Symptoms.

Despite high comorbidity between depressive and somatic symptoms, cognitive mechanisms that transmit vulnerability between symptom clusters are largely unknown. Dampening, positive rumination, and brooding are three cognitive predictors of depression, with rumination theoretically indicated as a transdiagnostic vulnerability through amplifying and diminishing affect in response to events. Specifically, the excess negative affect and lack of positive affect characteristic of depressive symptoms and underlying somatic symptoms may cause and be caused by cognitive responses to events. Therefore, the current study examined whether comorbidity between depressive and somatic symptoms may be explained by the cognitive mechanisms of dampening and positive rumination in response to positive events and brooding in response to negative events among adults (N = 321) across eight weeks of assessment. We hypothesized that greater dampening and brooding would reciprocally predict greater depressive and somatic symptoms, while greater positive rumination would reciprocally predict fewer depressive and somatic symptoms. Mediation analyses in AMOS 22 indicated that dampening and brooding mediated reciprocal pathways between depressive and somatic symptoms, but positive rumination did not. Findings propose dampening and brooding as mechanisms of the reciprocal relationship between depressive and somatic symptoms through diminishing positive affect and amplifying negative affect in response to positive and negative events.

Cognitive mechanisms linking low trait positive affect to depressive symptoms: a prospective diary study.

Low trait positive affect represents an affective vulnerability to depression, but little research has examined mechanisms linking low trait positive affect to depressive symptoms. The current study investigated whether the cognitive strategies of dampening and positive rumination mediated the prospective association between low trait positive affect and depressive symptoms. Participants were 209 undergraduate students who participated in an eight-week online study. Depressive symptoms and trait temperament were assessed at baseline, followed by seven weekly questionnaires which assessed cognitive strategies in response to weekly events and weekly depressive symptoms. Data were analysed using multilevel modelling following the mediation approach proposed by Nezlek. Results indicated that low trait positive affect significantly predicted less positive rumination but not greater dampening in response to weekly positive events. Less positive rumination in response to weekly positive events partially mediated the association between low trait positive affect and greater depressive symptoms across the study.