Online Search Strategies and Results From a Crowdsourced Survey on Asymptomatic Bacteriuria.

IMPORTANCE: Despite the prevalence of asymptomatic bacteriuria (ASB), what proportion of the population is aware of this condition and the quality of internet resources are currently unknown. OBJECTIVE: This study aimed to use an online crowdsourcing platform to explore general knowledge and internet search strategies, along with the quality of information, on ASB. STUDY DESIGN: An online survey was administered through a crowdsourcing platform to women 50 years or older via Qualtrics, which is a sophisticated online survey tool. Participants completed a survey on ASB, and participants were asked how they would search the internet for information both on urinary test results and on ASB. Outcomes included survey responses, and qualitative data were coded and analyzed thematically. χ2 Testing and regression modeling were used to look for variables associated with concern for ASB. RESULTS: There were a total of 518 participants who passed attention check qualifications, and only 45 respondents (8.7%) had heard of ASB. Many were concerned about progress to a worsening infection (n = 387 [77.6%]). When controlling for confounders, education beyond a college degree was not associated with a lower concern for ASB when compared with those with a high school education or less (adjusted odds ratio, 0.63; 95% confidence interval, 0.25-1.55; P = 0.31). Medical providers were the target audience for a majority of the websites, and many of the patient-facing results were of poor quality. CONCLUSIONS: Our national survey of women demonstrated a prevalent knowledge deficit surrounding ASB. We must seek to create high-quality, readily available, patient-facing information to increase awareness of ASB, allay concerns, and increase antibiotic stewardship.

Stakeholder Group Differences on Knowledge, Attitudes, and Perspectives of Coordinated Community Response Teams for Domestic Violence.

The goal of the mixed methods parallel design observational study was to examine belief, attitude, and knowledge differences among stakeholder groups in a coordinated community response team (CCRT). A second purpose was to assess the perceived strengths, weaknesses, and barriers to success of a CCRT for domestic violence (DV). Participants were members of a CCRT from victim advocacy, law enforcement, and court-affiliated agencies. Results demonstrate differences among stakeholder groups on myth acceptance, knowledge of DV, diversity beliefs, cultural competence, and trauma knowledge. The results provide guidance on how to improve CCRTs for DV, focusing on cross-training, cultural competence, and clarification of roles and procedures.

Gender, Myths, and Assumptions: Correlates of Risk Perception in Sexual Assault Scenarios.

Sexual violence continues to plague college campuses even with the implementation of bystander intervention programs. Previous research has demonstrated that diminished situational risk recognition increases the risk for sexual assault victimization. However, there is a paucity of research comparing men's and women's risk perception in sexual assault scenarios, risk perception from a victim or perpetrator perspective, or the role of previous sexual violence history, rape myth acceptance, and world assumptions on sexual risk perception. The current study examined male and female college students' risk perception while reading a sexual assault scenario. Participants also completed measures of victim and perpetrator blame, rape myth acceptance, and beliefs in a just world. The results suggested that men's and women's risk perception is influenced by different rape myths and world assumptions. Specifically, women's risk perception and victim blame are associated with sexual communication myths and beliefs in the randomness of the world, while men's risk perception and victim blame are related to the acceptance of myths that women ask for sexual assault and that the world is a just, cruel place. The results call for the incorporation of additional training on how rape myths and world assumptions may impact risk recognition and intervention in sexual assault education. It will also be important to target different barriers to intervention for men and women.

Rumination Mediates the Relationship Between Negative Affect and Posttraumatic Stress Disorder Symptoms in Female Interpersonal Trauma Survivors.

Prior research has identified both rumination and negative affect (NA) as dimensional constructs related to the development and maintenance of posttraumatic stress disorder (PTSD). While both dimensions demonstrate significant positive relationships with symptoms of PTSD, the relationship between the two within the context of the disorder has yet to be explored. Consistent with prior research in the social anxiety literature, the present study seeks to examine a model of mediation by which rumination accounts for the significant relationship between NA and PTSD symptoms. Participants included 65 female interpersonal trauma survivors diagnosed with PTSD using structured, clinician-administered interviews. Both NA and rumination were observed as significant predictors of PTSD symptoms, and the variables were significantly associated with each other. However, NA was no longer a significant predictor of PTSD symptoms when rumination was entered into the mediation model, suggesting full mediation of the relationship by rumination. Results from the current study suggest a complex relationship between NA and rumination in interpersonal trauma survivors with PTSD, such that a ruminative cognitive coping style may either mitigate or exacerbate PTSD symptoms in the presence of sustained negative emotion. The current findings provide support for a cognitive model of PTSD, within which PTSD symptoms are influenced via negative, ruminative cognitions. Primary implications of these results include (a) the consideration of assessment of rumination in interpersonal trauma survivors with PTSD in clinical settings; (b) the selection of treatment that may address a ruminative cognitive style in this population, given the mediation between subjective distress and PTSD symptoms by rumination; and (c) the necessity for the validation of this mediation model within other traumatized populations.

Caught by Connections: The Mediating Roles of Social and Community Support after Interpersonal Violence.

The purpose of the present study was to examine the potential mediating roles of different sources of social support and sense of community on the relationship between interpersonal violence and mental health outcomes, negative posttraumatic cognitions, and posttraumatic growth. Participants (n = 459) completed an online survey. Interpersonal violence had a significant, direct effect on all posttraumatic outcomes. Support from significant others mediated the relationship between interpersonal violence and posttraumatic stress. Both support from family and a negative sense of community mediated the relationship between interpersonal violence and posttraumatic cognitions, while social support from friends and family and a positive sense of community mediated the relationship between interpersonal violence and posttraumatic growth. The results suggest that posttraumatic distress and growth may be impacted by different connection sources.

Work Engagement and Resiliency Impact the Relationship Between Nursing Stress and Burnout.

Nursing is a stressful occupation, and consequently, nurses are at risk for work-related burnout. This is highly problematic, as numerous negative consequences are associated with burnout. Most notably, burnout may result in nurses leaving the profession, thereby exacerbating the nursing shortage. The purpose of the present study was to advance the understanding of burnout in the nursing profession. Specifically, three types of work engagement (i.e., vigor, dedication, and absorption) and resiliency were hypothesized to mediate the relationship between work-related stress and burnout. Nurses and nursing students were recruited through a college and a state nursing association, and participants (N = 76) completed a series of online surveys. Mediation models were assessed using multiple regression analyses and the bootstrapping method of testing indirect effects. Results indicated that vigor, dedication, absorption, and resiliency partially mediated the relationship between work-related stress and burnout, although the exact pattern of results varied depending on the specific type of burnout (Emotional Exhaustion, Depersonalization, and Reduced Personal Accomplishment). These results could be useful in helping to prevent burnout in the nursing profession and should be taken into consideration when designing employee training and support programs.

The Mediating Roles of Hostility and Dissociation in the Relationship Between Sexual Assault and Suicidal Thinking in College Students.

Sexual assault and suicide are two serious public health concerns. Research has documented the relationship between sexual assault and suicidal thinking and attempts; however, limited research explores the more multifaceted relationships between posttraumatic stress reactions and suicidal ideation in college students through unsuccessful modulation of emotion. The authors hypothesized a mediation model where the relationship between sexual assault and suicidal ideation is mediated by dissociation and hostility. In total, 1,677 undergraduate students were administered modified versions of the Traumatic Life Events Questionnaire (TLEQ), Symptom Checklist-90-Revised (SCL-90-R), and Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The results revealed both significant partial but equal mediators of hostility and dissociation. However, a portion of the direct effect between sexual assault and suicidal ideation remained unaccounted for by indirect effects. The current model supports previous work on dialectical behavior therapy that says either side of the dialectic between extreme expression and suppression of hostility increases the likelihood of suicidal thinking after sexual assault. With sexual assault survivors, practitioners should use strategies that emphasize both anger expression and healthy avoidance as a way to modulate emotion to potentially reduce suicidal thoughts. Future research should focus on different gender models, additional possible mediators such as alcohol use and guilt, and different forms of sexual assault. Limitations of the correlational, cross-sectional methodology are discussed.

What Did You Expect? Substance Use Expectancies Mediate the Relationships Between Dark Triad Traits, Substance Use, and Substance Preference.

This study explores the role of substance use expectancies as mediators between the Dark Triad of personality, substance use, and substance use preferences. A sample of college students ( M = 19.38, SD = 2.63, N = 207) completed an online questionnaire that assessed the Dark Triad traits, substance use history, substance preferences, and substance use expectancies. Three specific substance use expectancies-increased confidence, tension reduction, and cognitive enhancement-were shown to either partially or fully mediate the relationships between the Dark Triad and substance use behaviors and preference for certain substances of abuse. These findings may hold clinical implications for the treatment of substance use disorders and further the understanding of factors contributing to the etiology and progression of substance abuse and substance use disorders.

"You Blame Me, Therefore I Blame Me": The Importance of First Disclosure Partner Responses on Trauma-Related Cognitions and Distress.

Trauma recovery processes may be understood within a socioecological model. Individual factors (such as sex of the survivor) and microsystem factors (including trauma characteristics) have been studied extensively. However, there is a paucity of research examining the effects of macrosystem factors on the impact of trauma-especially examining how the response of the first person to whom the survivor disclosed affects trauma-related cognitions and distress. Sixty-three college student participants reported a history of disclosing at least one traumatic event in an online, anonymous survey. Participants also provided information on the first person they told about the trauma, the social reactions of that person, general social reactions to trauma disclosure, the participants' trauma-related cognitions and psychological distress (PTSD, other mental health issues), details about the traumatic event, and basic demographic information. Paired sample t tests showed that participants experienced the responses of the first person they told about their trauma as more favorable than the responses of the all of the people to whom they told about the event. Women and survivors of non-interpersonal trauma reported more supportive responses than men and survivors of interpersonal trauma. Hierarchical linear regressions showed that interpersonal trauma and victim blame on the part of the first person the survivor told were associated with more negative trauma-related cognitions. Interpersonal trauma, emotional support, and victim blame were associated with a greater degree of trauma-related distress. The results suggest that participants perceived the response of the first person they told as more beneficial than the response of the rest of their exosystem. However, the reactions of the first person the survivor told differed based on the sex of the survivor and the type of trauma they experienced. Consistent with previous research, interpersonal trauma and victim blame by the first person the survivor told about the trauma were associated with more trauma-related distress and negative cognitions. Trauma-related distress was also associated with greater emotional support by the disclosure partner. The results support the use of the socioeological model to better understand the complex nature of trauma recovery and have implications for prevention.

Interrelationships Among Three Avoidant Coping Styles and Their Relationship to Trauma, Peritraumatic Distress, and Posttraumatic Stress Disorder.

Research suggests the existence of distinct avoidant coping mechanisms after trauma: peritraumatic dissociation, secondary alexithymia, and experiential avoidance. Within the Emotional Processing Model (Foa and Kozak, Psychol Bull. 99:20-35, 1986), research suggests that each of these avoidant coping mechanisms comes into play at a different phase of traumatic stress development. The present study sought to confirm if these three avoidant coping mechanisms are different constructs and how they relate to each other and the experience of trauma, peritraumatic distress, and posttraumatic stress disorder (PTSD). A total of 227 participants with a trauma history completed measures on trauma experience, peritraumatic distress, peritraumatic dissociation, secondary alexithymia, experiential avoidance, and PTSD. Structural equation modeling confirmed that peritraumatic dissociation, secondary alexithymia, and experiential avoidance influence different phases of the development of traumatic stress problems. These results also confirm that the Emotional Process Model provides a good context for understanding the interrelationships among the avoidant coping mechanisms.

Voices from the past: Mental and physical outcomes described by American Civil War amputees.

Studies of trauma commonly concentrate on the psychological and physiological effects of recent violent events. Although today connections are becoming more explicitly drawn, early studies of the aftermath of amputation serve to shed light on modern understanding of the interaction of the physical and emotional. The study of combat amputation, dissociation, and related posttraumatic stress largely began with the work of 19th-century Philadelphia physician Silas Weir Mitchell, who brought attention to the phenomenon of phantom limb pain. Less known, however, are the data he and his son, John K. Mitchell, also collected on the mental outcomes of trauma. Using an archived collection of original surveys of double-amputee patients dating largely from 1893 housed at the Historical Medical Library at the College of Physicians of Philadelphia, an interdisciplinary team explored the historical, anthropological, and psychological background of the study of combat trauma. Almost 30 years following the end of hostilities, the majority of the sample of U.S. Civil War veterans indicated that their general disposition, general health, and sleeping or eating patterns had changed following limb amputation. More telling, possibly, are the written comments on the surveys and letters that indicate frustration with the continuous suffering and the knowledge of their mental and physical changes. These data illustrate the value of historical archives in documenting the development of the study of trauma and modern concepts of combat experiences.

Predicting problematic Internet use in men and women: the contributions of psychological distress, coping style, and body esteem.

Problematic Internet use (PIU) is becoming a prevalent and serious problem among college students. Rates of PIU are higher in men, which may be due to psychological variables, such as comorbid psychological disorders and beliefs about one's body. We examined the ability of psychological distress, coping style, and body esteem to predict levels of PIU in men and women in a sample of 425 undergraduate students (46.8 percent male; mean age = 19.0, SD = 1.7). For men, phobic anxiety, wishful thinking, and overweight preoccupation were significant predictors of increased PIU. For women, depression, keeping to oneself, and decreased tension reduction were associated with increased PIU. The findings suggest that men and women may have different psychological reasons for excessive Internet use, including different types of psychological distress and coping styles. Unlike women, men may use the Internet because of weight concerns.

To dissociate or suppress? Predicting automatic vs. conscious cognitive avoidance.

Cognitive avoidance is a common response to sexual assault and reminders of trauma, but there is a paucity of research regarding predictors of automatic and conscious cognitive avoidance in response to trauma-related stimuli. The present study examined whether posttraumatic stress disorder (PTSD) and depression symptoms, physiological responses, and subjective emotional responses predicted peritraumatic dissociation and thought suppression in a sample of 86 female sexual assault victims. Participants provided information about their current symptoms of PTSD and depression as well as their emotional reactions and physiological responses to hearing a personalized sexual assault narrative. PTSD and self-reported anger predicted thought suppression; peritraumatic dissociation was predicted by PTSD symptoms, changes in skin conductance, and self-reported arousal. Heart rate failed to predict either cognitive avoidance response. The results suggest that peritraumatic dissociation and thought suppression are associated with different physiological and emotional responses to trauma cues, perhaps because they tap different memory systems. Limitations and suggestions for future research are discussed.

A meta-analytic investigation of therapy modality outcomes for sexually abused children and adolescents: an exploratory study.

OBJECTIVE: The purpose of the current study was to investigate the independent effects of different treatment elements on a number of secondary problems related to childhood and adolescent sexual abuse, as well as investigate a number of different moderators of treatment effectiveness. METHOD: Twenty-eight studies that provided treatment outcome results for children and adolescents who had been sexually abused were included in the meta-analysis. Different aspects of psychological treatment, such as specific treatment modalities (individual, cognitive-behavioral, etc.) or secondary problems (behavior problems, psychological distress, etc.) were investigated. RESULTS: The overall mean weighted effect size for the meta-analysis was d=.72 (SE=.02). The results indicate that psychological treatment after childhood or adolescent sexual abuse tended to result in better outcomes than no treatment. There was significant heterogeneity in the effectiveness of the various psychological treatment elements. Play therapy seemed to be the most effective treatment for social functioning, whereas cognitive-behavioral, abuse-specific, and supportive therapy in either group or individual formats was most effective for behavior problems. Cognitive-behavioral, family, and individual therapy seemed to be the most effective for psychological distress, and abuse-specific, cognitive-behavioral, and group therapy appeared to be the most effective for low self-concept. CONCLUSIONS: The choice of therapy modality should depend on the child's main presenting secondary problem. Further research should be conducted investigating other possible moderators and secondary problem outcomes.

PTSD as a mediator of sexual revictimization: the role of reexperiencing, avoidance, and arousal symptoms.

Theory and research suggest that posttraumatic stress disorder (PTSD) may mediate the relationship between child sexual abuse and adult sexual assault. However, little empirical research has examined the mediational role of PTSD. In the present study, the authors use structural equation modeling to examine the degree to which the three symptom clusters that define PTSD (reexperiencing, avoidance, and hyperarousal) contribute to sexual revictimization. To assess PTSD symptomatology, undergraduate women completed questionnaires (N = 1,449), which detailed the history and severity of childhood and adult sexual assault experiences. Results indicated that PTSD mediated sexual revictimization. When PTSD symptom clusters were examined individually, only the hyperarousal cluster was a significant mediator. Results are discussed in terms of information-processing mechanisms that may underlie sexual revictimization.