Not all traumas are created equal: Phenotypic heterogeneity of PTSD symptoms in relation to index traumas in U.S. military veterans.

Posttraumatic stress disorder (PTSD) is prevalent in military veterans. Although exposure to trauma is subsumed under the diagnostic criteria for PTSD, there is great variability in index traumatic events, and the clinical presentation of PTSD may vary in individuals depending on the type of event experienced. We examined the relationship between different index traumas and PTSD symptoms in 3507 trauma-exposed U.S. military veterans who participated in the National Health and Resilience in Veterans Study. Results showed that interpersonal violence and combat/captivity was associated with greater overall severity of PTSD symptoms relative to illness/injury and disaster/accident. Interpersonal violence and combat/captivity were also associated with greater severity of intrusive, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms, relative to the other two categories. Implications of these findings for tailoring treatment approaches for PTSD in veterans are discussed.

Effectiveness of the "Living with Cancer" peer self-management support program for persons with advanced cancer and their relatives: study protocol of a non-randomized stepped wedge study.

BACKGROUND: Persons with advanced cancer and their relatives experience physical, emotional, and psychosocial consequences of the illness. Most of the time, they must deal with these themselves. While peer self-management support programs may be helpful, there is little evidence on their value for this population. We present the research protocol of our SMART study that will evaluate the effectiveness of the "Living with Cancer" peer self-management support program, aimed at improving self-management behaviors, self-efficacy, and health-related quality of life of persons with advanced cancer and their relatives. METHODS: We will conduct a non-randomized stepped wedge study in the Netherlands. We will include 130 persons with advanced cancer and 32 relatives. Participants can choose to either start the program within 4 weeks after inclusion or after eight to 10 weeks. The "Living with Cancer" is a peer self-management support program, based on the Chronic Disease Self-Management Program. It consists of six 1,5 hours video-conferencing group meetings with eight to 12 participants, preceded by two or three preparatory audio clips with supportive text per session. The program has the following core components: the learning of self-management skills (action-planning, problem-solving, effective communication, and decision-making), discussing relevant themes (e.g. dealing with pain and fatigue, living with uncertainty, and future planning), and sharing experiences, knowledge, and best practices. The primary outcome for both persons with advanced cancer and relatives is self-management behavior assessed by the subscale "constructive attitudes and approaches" of the Health Education Impact Questionnaire. Secondary outcomes are other self-management behaviors, self-efficacy, health-related quality of life, symptoms, depression and anxiety, and loneliness. Participants complete an online questionnaire at baseline, and after eight and 16 weeks. After each session, they complete a logbook about their experiences. Group meetings will be video recorded. DISCUSSION: SMART aims to evaluate an innovative program building on an evidence-based self-management program. New features are its use for persons with advanced cancer, the inclusion of relatives, and the video-conferencing format for this population. The use of both quantitative and qualitative analyses will provide valuable insight into the effectiveness and value of this program. TRIAL REGISTRATION: This study was registered in the Dutch Trial Register on October 2021, identifier NL9806 .

Non-suicidal self-injury in US military veterans: Results from the National Health and Resilience in Veterans Study.

BACKGROUND: To evaluate the prevalence of lifetime non-suicidal self-injury (NSSI) among US military veterans and identify sociodemographic, military, psychiatric and clinical correlates associated with NSSI. METHODS: Data were analysed from the 2019-2020 National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 4069 US veterans. Outcomes measured included lifetime history of NSSI, trauma history, lifetime and current DSM-V mental disorders and lifetime and recent suicidal behaviours. RESULTS: The overall prevalence of lifetime NSSI was 4.2% (95% confidence interval [3.6%, 4.9%]). Multivariable analyses revealed that veterans who endorsed lifetime NSSI were more likely to be younger, female, non-Caucasian, unmarried or unpartnered, and to have a lower annual household income. Veterans who endorsed lifetime NSSI reported more adverse childhood experiences and lifetime traumas and were more likely to have experienced military sexual trauma. They also were more likely to screen positive for lifetime posttraumatic stress disorder, major depressive disorder (MDD) and substance use disorders and to have attempted suicide. Finally, lifetime NSSI was associated with current MDD, generalized anxiety disorder, and substance use disorders, as well as past-year suicidal ideation. CONCLUSION: Results of this study provide the first-known data on the epidemiology of NSSI in US military veterans. They suggest that certain correlates can help identify veterans who may be at greater risk for engaging in NSSI, as well as the potential prognostic utility of lifetime NSSI in predicting current psychiatric problems and suicide risk in this population.

Binge drinking following residential treatment for posttraumatic stress disorder among veterans with and without alcohol use disorder.

Posttraumatic stress disorder (PTSD) is complicated by high rates of problematic drinking and comorbid alcohol use disorder (AUD). This study examined veterans seeking residential PTSD treatment, comparing those with and without AUD, to determine whether trauma type and/or PTSD symptom changes during treatment were associated with binge drinking at 4-month follow-up. Analyses compared characteristics of veterans (N = 758) in residential treatment, as well as associations of demographic, trauma, and alcohol-related variables, with binge drinking episodes at follow-up. Results showed no differences in PTSD symptom improvements based on AUD diagnosis. Among AUD-diagnosed veterans, 21.3% endorsed binge drinking 4 or more (14.3% endorsed 9 or more) days, while 10.8% of veterans without AUD endorsed binge drinking 4 or more (5.2% endorsed 9 or more) days at follow-up. Among AUD-diagnosed veterans, while PTSD symptom improvements were not associated with binge drinking outcomes, drinking days at admission and military sexual trauma (MST) predicted a greater likelihood of binge drinking. Among veterans without AUD, drinking days at admission, PTSD symptom increases, being unmarried, 'other' race, and less education, were associated with a higher likelihood of binge drinking, while MST and combat exposure predicted a lower likelihood of binge drinking. In conclusion, drinking days at admission is a predictor of binge drinking following treatment; thus, alcohol use should be assessed at intake and addressed among those who endorse drinking to reduce the likelihood of alcohol resumption following residential treatment. Furthermore, among AUD-diagnosed veterans, despite PTSD symptom decreases during treatment, MST predicted a greater likelihood of 9 or more binge drinking days at follow-up.

Transdiagnostic Psychiatric Symptoms, Burnout, and Functioning in Frontline Health Care Workers Responding to the COVID-19 Pandemic: A Symptomics Analysis.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to an increased risk of psychiatric symptoms among frontline health care workers (FHCWs). In the current study, a novel "symptomics" approach was employed to examine the association between acute transdiagnostic symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) and burnout and work and relationship difficulties in FHCWs at an urban tertiary care hospital in New York City. METHODS: Symptoms of COVID-19-related PTSD (4-item PTSD Checklist-5), MDD (Patient Health Questionnaire-8), GAD (Generalized Anxiety Disorder-7), burnout (Single-Item Mini-Z Burnout Assessment), and functional difficulties (Brief Inventory of Psychosocial Functioning) were assessed. Relative importance analyses were conducted to identify PTSD, MDD, and GAD symptoms associated with burnout and functional difficulties. RESULTS: The total number of eligible participants included 6,026 presumed FHCWs, of which 3,360 (55.8%) completed the survey and 2,579 (76.8%) of whom endorsed directly treating patients with COVID-19 and provided sufficient responses to our outcome variables for analysis. Feeling tired/having little energy, being easily annoyed or irritable, and feeling nervous, anxious, or on edge were most strongly associated with burnout; feeling tired/having little energy accounted for the greatest amount of explained variance (> 15%). Negative expectations of oneself or the world, trouble concentrating, and feeling easily annoyed or irritable were most strongly associated with work difficulties; negative expectations of oneself or the world accounted for the greatest amount of explained variance (> 9%). Feeling easily annoyed or irritable, negative expectations about oneself or the world, and feeling bad about oneself were most strongly associated with relationship difficulties; feeling easily annoyed or irritable accounted for the greatest amount of explained variance (> 10%). CONCLUSIONS: Results of this study underscore the importance of a transdiagnostic, symptom-based approach when examining associations between acute psychopathology and burnout and functional difficulties in FHCWs. Further work is needed to determine if early interventions aimed at ameliorating specific psychiatric symptoms may help mitigate risk for peri- and posttraumatic burnout and functional difficulties in this population.

Trauma-related guilt and posttraumatic stress disorder symptoms in military veterans: The role of psychological inflexibility.

A growing body of evidence has shown consistent support for the association between trauma-related guilt and posttraumatic stress disorder (PTSD). However, factors that account for this association are not well understood. The present study examined psychological inflexibility as a potential mediator between trauma-related guilt and PTSD symptoms in a sample of U.S. military veterans. Secondary data analyses from a larger randomized control trial were conducted. Specifically, three separate mediation models were used to test if psychological inflexibility mediated the association between trauma-related guilt (guilt cognitions, guilt distress, overall guilt) and PTSD symptoms in 85 treatment-seeking veterans diagnosed with PTSD and alcohol use disorder. All three components of trauma-related guilt were positively associated with both psychological inflexibility and PTSD symptoms; psychological inflexibility was also positively associated with PTSD symptoms. Furthermore, psychological inflexibility partially mediated the association between all facets of trauma-related guilt and PTSD severity. These findings provide further support for the association between trauma-related guilt and PTSD and also provide insight into one mechanism linking trauma-related guilt to PTSD symptoms. Thus, psychological inflexibility may serve as an important intervention target for veterans with comorbid PTSD and alcohol use disorder struggling with trauma-related guilt.

Mindfulness as a mediator between trauma exposure and mental health outcomes: Results from the National Health and Resilience in Veterans Study.

OBJECTIVE: Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumatic events by increasing acceptance of trauma-related experiences and decreasing trauma-related negative affect and avoidance of trauma reminders. The current study evaluated whether mindful attention to the present moment mediated the association between number of lifetime traumas and mental health. METHOD: The sample consisted of 1,268 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative study of U.S. veterans. On average, the sample was 60.6 years of age (SD = 15.2, range = 20-94), predominantly male (89.8%), Caucasian (75.0%), and noncombat veterans (59.2%). RESULTS: Path analyses revealed that mindfulness partially mediated the relation between number of lifetime traumas and PTSD symptoms (ß = -.55), AUD (ß = -.17), and QOL (ß = .38), and fully mediated the relation between number of lifetime traumas and SI (ß = -.36). CONCLUSIONS: The relationship between lifetime trauma burden and various mental health issues of relevance to U.S. veterans may be mediated by mindfulness, or the ability to pay attention to the present moment. Interventions that bolster mindfulness may help mitigate the negative impact of cumulative traumas in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nicotine Dependence in US Military Veterans: Results from the National Health and Resilience in Veterans Study.

BACKGROUND: Veterans are a unique population that may be at increased risk of tobacco use disorder and nicotine dependence (ND). We analyzed data from the National Health and Resilience in Veterans Study (NHRVS), a large nationally representative sample of US veterans, in order to more fully understand the prevalence and correlates of lifetime ND in US Veterans. METHODS: Descriptive statistics were conducted to summarize health and functioning/quality of life characteristics among veterans with and without lifetime ND. Hierarchical binary logistic regression analyses were conducted to evaluate the relationship between ND and psychiatric and physical health variables. RESULTS: Compared with veterans without lifetime ND, veterans with lifetime ND were more likely to screen positive for several lifetime psychiatric disorders including current alcohol use disorder (odds ratio [OR] 2.79 [95% confidence interval [CI] 2.23, 3.49]), depression (OR 1.86 [1.38, 2.50]), and PTSD (OR 1.68 [1.14, 2.47]). From a medical standpoint, they were more likely to endorse having kidney disease (OR 4.18 [2.55, 6.86]), heart attack (OR 2.09 [1.51, 2.89]), and rheumatoid arthritis (1.90 [1.20, 3.00]) in addition to other conditions. They scored lower in overall physical functioning and higher in somatization symptoms. CONCLUSIONS: Veterans with lifetime ND in the NHRVS survey were more likely to have psychiatric and medical conditions and lower physical functioning compared with Veterans without lifetime ND. Veterans with lifetime ND may therefore require a comprehensive and integrated approach to care that includes attention to co-morbid illness in addition to drug addiction.

Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach.

OBJECTIVE: To examine the association between individual symptoms of posttraumatic stress disorder (PTSD) and measures of functioning, quality of life, and suicidal ideation given that previous research has focused on PTSD diagnosis and symptom clusters. METHODS: Data from a large, contemporary, nationally representative sample of 1,484 US military veterans who participated in the National Health and Resilience in Veterans Study from September-October 2013 were analyzed to examine the association between individual DSM-5 PTSD symptoms and measures of mental, physical, and cognitive functioning; quality of life; and suicidal ideation. RESULTS: Nonspecific anhedonic and hyperarousal symptoms of PTSD were significantly associated with the various measures of functioning and explained a significant portion of variance across the different measures (P values < .05). Specifically, the following symptoms explained the most variance in physical functioning: loss of interest (12.4%), sleep difficulties (12.3%), and psychogenic amnesia (8.3%); mental functioning: concentration difficulties (11.4%), negative thoughts (9.2%), and difficulties experiencing positive affect (8.4%); cognitive functioning: concentration difficulties (18.6%), heightened startle (6.4%), and difficulty experiencing positive affect and risky/destructive behavior (both 6.3%); quality of life: concentration difficulties (11.5%), difficulty experiencing positive affect (11.1%), and sleep difficulties (9.4%); and suicidal ideation: difficulty experiencing positive affect (12.3%), negative thoughts (11.3%), and irritability/aggression (9.5%). These findings persisted after adjustment for lifetime trauma burden and severity of PTSD and depressive symptoms. CONCLUSIONS: Nonspecific PTSD symptoms are most strongly related to measures of functioning, quality of life, and suicidal ideation in US veterans. These results underscore the potential clinical utility of a symptom-based approach to the assessment, monitoring, and treatment of PTSD.

Protective correlates of suicidality among veterans with histories of posttraumatic stress disorder and major depressive disorder: Results from the National Health and Resilience in Veterans Study.

BACKGROUND: Although several studies have identified risk factors for suicidal behaviors in general samples of Veterans, fewer studies have examined protective factors, particularly in high-risk samples. To address this gap, we examined protective correlates of suicidal ideation (SI) and suicide attempts (SA) in a sample of Veterans with histories of posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). METHOD: Data were analyzed from a nationally representative sample of 3157 U.S. Veterans who completed the first wave of a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Of this sample, 577 Veterans met criteria for history of PTSD, MDD or both. RESULTS: Multivariable logistic regression analyses were used to examine relationships between protective factors (curiosity, resilience, purpose in life, dispositional gratitude, optimism, and community integration) and suicidal behaviors (SI and SA). The prevalence of any SI during the previous two weeks was 29.4% and the prevalence of lifetime SA was 28.0%. After adjusting for relevant sociodemographic and military characteristics, greater purpose in life, curiosity, and optimism were negatively associated with SI. None of the protective correlates were associated with SA. LIMITATIONS: Given the cross-sectional nature of this study, conclusions about causality cannot be made. The assessment of suicidality also was limited to three self-report items. CONCLUSION: Results provide a characterization of protective factors for suicidality, and may help inform prevention and treatment approaches designed to mitigate suicide risk among high-risk military Veterans.

Trajectories of alcohol consumption in U.S. military veterans: Results from the National Health and Resilience in Veterans Study.

BACKGROUND AND OBJECTIVES: While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans. METHODS: Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption. RESULTS: Latent growth mixture modeling revealed that a four-class model best fit the data: rare drinkers (65.3%), moderate drinkers (30.2%), excessive drinkers (2.6%), and recovering drinkers (1.9%). Lifetime major depressive disorder (MDD) was linked to an excessive drinking trajectory, while fewer medical conditions and lower social support were linked to a moderate drinking trajectory. Having a secure attachment style and greater social support, and absence of lifetime MDD was linked to recovery from excessive drinking. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Four predominant trajectories of alcohol consumption were identified. Targeting MDD and related interpersonal factors such as attachment style and social support in population-based prevention and treatment initiatives may help prevent, mitigate, and promote recovery from excessive alcohol consumption in veterans. (Am J Addict 2018;XX:1-8).

Suicidal ideation in military veterans with alcohol dependence and PTSD: The role of hostility.

BACKGROUND AND OBJECTIVES: Suicide is a significant public health problem among US military Veterans with rates exceeding civilian samples. Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are both associated with increases in suicidality. Given that risk of suicide is higher among those with both disorders, the study of relevant risk factors among those in this group is important. The current investigation focused on one such factor, hostility, and examined both overt hostility (ie, hostility that is more behavioral in nature and directed outwardly) and covert hostility (ie, hostility that is cognitive in nature and introspective) and their relationships to suicidal ideation. METHODS: Ninety-three Veterans participating in a randomized, double-blind, placebo-controlled treatment study evaluating the efficacy of the alpha-adrenergic agonist prazosin completed measures assessing overt hostility, covert hostility, and suicidal ideation at baseline. Depression symptoms and PTSD symptom severity also were assessed. RESULTS: Of the total sample, 60 participants (63.8%) indicated that they experienced suicidal ideation at some point in their lives. Covert hostility, in addition to PTSD symptom severity were found to be associated with the presence of lifetime suicidal ideation. Furthermore, depression symptoms were found to be associated with greater intensity of that ideation. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Findings highlight the importance of covert hostility as it relates to suicidal ideation among those with comorbid PTSD and AD and provides information which may help inform treatment approaches for high-risk military Veterans. (Am J Addict 2018;27:124-130).

The burden of hostility in U.S. Veterans: Results from the National Health and Resilience in Veterans Study.

Hostility is associated with substantial mental and physical health consequences. Population-based data regarding the nature and longitudinal course of hostility in U. S. veterans are scarce. We analyzed data from 2157 U. S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U. S. veterans. We identified the prevalence of longitudinal courses of hostility (chronic, increasing, decreasing, or no hostility). We then evaluated relationships between sociodemographic, risk, and protective correlates measured at baseline and longitudinal courses of two aspects of hostility-aggressive urges and difficulties controlling anger. The majority of veterans (61.2%) reported experiencing difficulties controlling anger and a sizable minority of veterans (23.9%) reported experiencing aggressive urges over a two-year period. Protective psychosocial characteristics (e.g., optimism) and aspects of social connectedness (e.g., secure attachment style) were negatively associated with hostility. Psychological distress predicted all symptomatic hostility courses, while alcohol misuse predicted chronic aggressive urges and all symptomatic courses of difficulties controlling anger. These findings provide the first known population-based evaluation of the prevalence, course, and risk and protective correlates of hostility in U. S. veterans, and suggest targets for prevention and treatment efforts that can help mitigate risk for hostility in this population.

The burden of alcohol use disorders in US military veterans: results from the National Health and Resilience in Veterans Study.

AIMS: To analyze data from a large, contemporary, nationally representative sample of US veterans to evaluate: (1) the prevalence of life-time alcohol use disorder (AUD) and past-year AUD; (2) common psychiatric comorbidities associated with life-time AUD; and (3) correlates of life-time and past-year probable AUD. DESIGN: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a web-based survey of a random probability sample of a contemporary, nationally representative sample of US military veterans. SETTING: United States. PARTICIPANTS: Nationally representative sample of 3157 US veterans aged 21 years and older. MEASUREMENTS: Life-time alcohol abuse and dependence were assessed according to DSM-IV diagnostic criteria using the Mini International Neuropsychiatric Interview, and combined into a single variable: AUD. Past-year probable AUD was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Correlates of AUD, including psychiatric comorbidities, suicidality and demographic characteristics, were also assessed. FINDINGS: The prevalence of life-time AUD and past-year probable AUD was 42.2% [95% confidence interval (CI) = 40.5-43.9%)] and 14.8% (95% CI = 13.6-16.0%), respectively. Compared with veterans without AUD, those with life-time AUD had substantially elevated rates of life-time and current mood and anxiety disorders [odds ratios (ORs) = 2.6-4.1], drug use disorder (OR = 10.7), life-time suicide attempt (OR = 4.1) and current suicidal ideation (OR = 2.1). Younger age, male sex, lower education, lower annual household income and greater number of life-time traumatic events were associated independently with life-time AUD. Younger age, male sex, unpartnered marital status and a life-time diagnosis of major depressive disorder were associated independently with past-year probable AUD. CONCLUSIONS: More than 40% of US military veterans have a life-time history of alcohol use disorder. Veterans with a life-time history of alcohol use disorder have substantial comorbid psychiatric burden, including elevated rates of suicidal ideation and attempts. Certain socio-demographic (e.g. younger age, male sex, lower education) and clinical (e.g. trauma burden, history of depression) characteristics are associated with increased risk of AUD.

The Impact of Infidelity on Combat-Exposed Service Members.

This study examined relationships between combat-exposed Operation Enduring Freedom/Operation Iraqi Freedom veterans' experiences related to infidelity during deployment (i.e., indicating that a partner was unfaithful or reporting concern about potential infidelity) and postdeployment mental health, as well as the role of subsequent stress exposure and social support in these associations. The sample consisted of 571 individuals (338 men). There were 128 participants (22.2%) who indicated that their partners were unfaithful during their most recent deployment. Of the remaining 443 participants, 168 (37.8%) indicated that they were concerned that their partners might have been unfaithful. Individuals who indicated that their partners were unfaithful exhibited higher levels of posttraumatic stress symptomatology (ß = .08; f(2) = .18) and depression symptom severity (ß = .09; f(2) = .14), compared to individuals who did not indicate that their partners were unfaithful. For both men and women, reported infidelity was associated with mental health indirectly via postdeployment life stressors, whereas infidelity concerns were indirectly associated with mental health via postdeployment life stressors for men only. Findings suggested that infidelity can have a significant impact on combat-exposed veterans' mental health and highlight the need for additional research on this understudied topic within the military population.

Alcohol expectancies and evaluations of aggression in alcohol-related intimate-partner verbal and physical aggression.

OBJECTIVE: Alcohol aggression expectancies have been found to be associated with increases in aggressive behavior. However, research has not consistently examined evaluations of such behavior. This is unfortunate as both expectancies and evaluations may play a role in whether such behavior will occur. Given this, the current study cross-sectionally examined the associations between alcohol aggression expectancies, evaluations of alcohol-related aggression, indicators of excessive drinking, and alcohol-related verbal and physical aggression. METHOD: The sample consisted of 280 married and cohabiting couples. These couples reported on excessive drinking indicators, alcohol expectancies and evaluations, and alcohol-related verbal and physical aggression during the past year. RESULTS: Findings showed that verbal aggression was positively associated with indicators of excessive drinking among females and with alcohol aggression expectancies for females who evaluated such aggression positively. For males, aggression expectancies and indicators of excessive drinking were positively associated with verbal aggression. For physical aggression, results showed that indicators of excessive drinking and aggression expectancies were associated with physical aggression for females. For males, aggression expectancies were positively associated and evaluations were negatively associated with physical aggression. CONCLUSIONS: These findings add to previous research on alcohol aggression expectancies in close relationships and emphasize the importance of considering evaluations of alcohol-related behavior and how they may play a role in intimate-partner violence and aggression.

Adaptation of the chronic disease self-management program for cancer survivors: feasibility, acceptability, and lessons for implementation.

Self-management in chronic disease has been shown to improve patient-reported and health care-related outcomes. However, relatively little information about its utility in cancer survivorship is known. We evaluated the feasibility and acceptability of the delivery of an adaptation of the evidence-based Chronic Disease Self-management Program (Stanford) called Cancer Thriving and Surviving (CTS). Triangulated mixed methods were used to capture baseline characteristics and post-program experiences using a combination of closed- and open-ended survey items; emergent coding and simple descriptive statistics were used to summarize the data. Twenty-seven workshops were delivered by 22 CTS leaders to 244 participants between August 2011 and January 2013 in a variety of settings (48 % community, 30 % health care, 22 % regional/community cancer center). Representing a variety of cancer types, about half the participants were 1-3 years post-diagnosis and 45 % were 4 or more years from diagnosis. Program attendance was high with 84 % of participants attending four or more of the six sessions in the workshop. Overall, 95 % of the participants were satisfied with the program content and leaders, and would recommend the program to friends and family. These results confirm the feasibility and acceptability of delivery of a high-fidelity, peer-led model for self-management support for cancer survivors. Expansion of the CTS represents a powerful tool toward improving health-related outcomes in this at-risk population.

Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study.

OBJECTIVE: To examine whether trauma and posttraumatic stress disorder (PTSD) are differentially associated with binge and hazardous patterns of drinking among women and men. METHODS: Secondary analysis of the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); the analytic sample included 31,487 respondents (54.6% female) without past-year alcohol abuse/dependence. Participants' trauma-exposure/PTSD status was characterized as: no exposure to trauma in lifetime (reference), lifetime trauma exposure, PTSD before past-year, or past-year PTSD. Past-year binge and hazardous drinking were examined with multinomial logistic regression models (past-year abstinence was modeled as the non-event); models included the main effects of trauma-exposure/PTSD status and gender, the trauma-exposure/PTSD status-by-gender interaction, psychiatric comorbidity, and socio-demographic covariates. RESULTS: The gender-specific effects of trauma, before past-year PTSD, and past-year PTSD were significantly elevated for all drinking behaviors in women (range of odds ratios (ORs) = 1.8-4.8), and for some drinking behaviors in men (range of ORs = 1.3-2.0), relative to no trauma exposure. Trauma exposure was more strongly associated with high-frequency binge drinking, low-frequency binge drinking, and non-binge drinking among women as compared to men. Past-year PTSD was also more strongly associated with low-frequency binge drinking and non-binge drinking among women compared to men. Findings for hazardous drinking followed a similar pattern, with significant gender-related differences in ORs for hazardous drinking and non-hazardous drinking observed with respect to trauma exposure and past-year PTSD.. CONCLUSION: Mental health practitioners should be mindful of the extent to which trauma-exposed individuals both with and without PTSD engage in binge and hazardous drinking, given the negative consequences associated with these patterns of drinking..

Maladaptive dependency schemas, posttraumatic stress hyperarousal symptoms, and intimate partner aggression perpetration.

This study examined the associations between maladaptive dependency-related schemas, posttraumatic stress disorder (PTSD) hyperarousal symptoms, and intimate-partner psychological and physical aggression in a sample of court-referred men (N = 174) participating in a domestic-abuser-intervention program. The men were largely African American; average age was 33.5 years. The extent to which hyperarousal symptoms moderated the association between dependency schemas and aggression was also examined. Maladaptive dependency-related schemas were positively associated with severe psychological, and mild and severe physical aggression perpetration. Hyperarousal symptoms were positively associated with mild and severe psychological aggression, and mild physical aggression perpetration. Multiple regression analyses showed a significant interaction for mild physical aggression: For those with high levels of hyperarousal symptoms, greater endorsement of maladaptive dependency schemas was associated with the perpetration of aggression (B = 0.98, p = .001). For those with low levels of hyperarousal symptoms, there was no association between dependency schemas and aggression (B = 0.04, ns). These findings suggest that focusing on problematic dependency and PTSD-hyperarousal symptoms in domestic-abuser-intervention programs may be helpful, and that examining related variables as possible moderators between dependency schemas and intimate aggression would be a fruitful area for future research.

Correlates of intimate partner psychological aggression perpetration in a clinical sample of alcoholic men.

This study longitudinally examined correlates of intimate partner psychological aggression in a sample of 178 men seeking treatment for alcoholism and their partners, building on a previous investigation examining correlates of intimate partner physical aggression (Taft et al., 2010). The men were largely Caucasian; average age was 41.0 years. Participants completed a battery of questionnaires that assessed distal and proximal predictors of psychological aggression perpetration. Distal factors, assessed at baseline, included initial alcohol problem severity, beliefs about alcohol, and antisocial personality characteristics. Proximal factors, assessed at baseline and at follow-ups 6 and 12 months later, included alcohol and drug use, relationship adjustment, and anger. Psychological aggression was assessed at all three time points. Findings showed that both groups of variables were associated with psychological aggression perpetration. Beliefs that drinking causes relationship problems and variables related to alcohol consumption exhibited the strongest associations with psychological aggression. The findings are consistent with theoretical models that emphasize both distal and proximal effects of drinking on intimate partner aggression. Implications for clinical interventions and directions for future research are discussed.