Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms.

Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average "large" effect size improvement, d = 1.49). Significant and "moderate-to-large" main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62-1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.

Child Maltreatment, Adult Trauma, and Mental Health Symptoms Among Women Veterans: A Scoping Review of Published Quantitative Research.

The objective of this scoping review was to describe and synthesize the measures, methods, and key findings of published quantitative research examining the influence of child maltreatment (i.e., abuse and/or neglect) and adult trauma exposure on mental health symptoms among women Veterans. A systematic search from database inception to June 2023 generated 18,861 unique articles retrieved and independently screened for eligibility. A total of 21 articles met pre-established inclusion criteria: (a) quantitative data and results within a sample or subsample of U.S. women veterans, (b) published in a peer-reviewed journal, and (c) examining variables of interest simultaneously (i.e., child maltreatment, adult trauma exposure, mental health symptom) in quantitative analyses. Reviewed literature showed a lack of uniformity in measurement and methodologies to evaluate women veterans' lifetime trauma exposure in relation to mental health. Studies most frequently used self-report survey data to evaluate exposure to child maltreatment and/or adult trauma with convenience samples of women veterans (52.4%, n = 11) and examined depressive and/or posttraumatic stress symptomatology. Findings demonstrate the need for additional research attending to the interplay between child maltreatment and adult trauma exposures in relation to women veterans' mental health using comprehensive assessment, longitudinal methods, and understudied as well as more representative samples.

Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration.

Importance: The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well. Objective: To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration. Design, Setting, and Participants: This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023. Exposure: Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period. Main Outcomes and Measures: Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients. Results: A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience. Conclusions and Relevance: In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.

Understanding Veterans' intimate partner violence use and patterns of healthcare utilization.

OBJECTIVE: To understand the association between Veterans' healthcare utilization and intimate partner violence (IPV) use (i.e., perpetration) in order to (1) identify conditions comorbid with IPV use and (2) inform clinical settings to target for IPV use screening, intervention, and provider training. DATA SOURCES AND STUDY SETTING: We examined survey data from a national sample of 834 Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans. STUDY DESIGN: We assessed associations between past-year IPV use and medical treatment, health issues, and use of Veterans Health Administration (VA) and non-VA services using chi-square tests and logistic regression. DATA COLLECTION/EXTRACTION METHODS: Data were derived from the Department of Defense OEF/OIF/OND Roster. Surveys were sent to all women Veterans and a random sample of men from participating study sites. PRINCIPAL FINDINGS: Half (49%) of the Veterans who reported utilizing VA healthcare in the past year indicated using IPV. Q values using a 5% false discovery rate indicated that Veterans who used IPV were more likely than Veterans who did not use IPV to have received treatment for post-traumatic stress disorder (PTSD; 39% vs. 27%), chronic sleep problems (36% vs. 26%), anxiety or depression (44% vs. 36%), severe chronic pain (31% vs. 22%), and stomach or digestive disorders (24% vs. 16%). Veterans who used IPV were also more likely than Veterans who did not use IPV to have received medical treatment in the past year (86% vs. 80%), seen psychiatrists outside VA (39% vs. 20%), and have outpatient healthcare outside VA (49% vs. 41%). IPV use was not related to whether Veterans received care from VA or non-VA providers. CONCLUSIONS: Veterans' IPV use was related to greater utilization of services for mental health, chronic pain, and digestive issues. Future research should examine whether these are risk factors or consequences of IPV use.

Longitudinal Analysis of Persistent Postconcussion Symptoms, Probable TBI, and Intimate Partner Violence Perpetration Among Veterans.

OBJECTIVE: To determine veterans' intimate partner violence (IPV) perpetration following report of traumatic brain injury (TBI) and persistent postconcussion symptoms (PPCSs). SETTING: Five Department of Veterans Affairs (VA) medical centers. PARTICIPANTS: Veterans with nonmissing data on main measures, resulting in N = 1150 at baseline and N = 827 at follow-up. DESIGN: Prospective cohort study with secondary data analysis of self-reported TBI, PPCSs, and IPV perpetration, controlling for common predictors of IPV, including binge drinking, marijuana use, pain intensity, and probable posttraumatic stress disorder. MAIN MEASURES: VA TBI Screening Tool to assess for probable TBI and PPCSs; Conflict Tactics Scale-Revised (CTS-2S) to assess for IPV perpetration. RESULTS: Almost half (48%) of participants reported IPV perpetration at follow-up. Both probable TBI and higher PPCSs at baseline were associated with overall IPV perpetration and more frequent IPV perpetration at follow-up. Only PPCSs significantly predicted IPV perpetration after controlling for common predictors of IPV perpetration. Neither probably TBI nor PPCSs predicted frequency of IPV perpetration. CONCLUSION: When considered alongside common risk factors for IPV perpetration, PPCS was uniquely associated with the likelihood of IPV perpetration in this veteran sample. Given post-9/11 veterans' elevated risk for head injury, findings emphasize the distinctive value of PPCSs in understanding risk for IPV perpetration. We recommend increased assessment for PPCSs in clinical practice among veterans enrolled in VA care and highlight several important areas for future research and intervention development.

Treatment of anger problems in previously deployed post-911 veterans: A randomized controlled trial.

BACKGROUND: Problems with anger and aggression affect many veterans who have deployed to a warzone, resulting in serious impairment in multiple aspects of functioning. Controlled studies are needed to improve treatment options for these veterans. This randomized controlled trial compared an individually delivered cognitive behavioral therapy adapted from Novaco's Anger Control Therapy to a manualized supportive therapy to control for common therapeutic factors. METHODS: Ninety-two post-911 veterans deployed during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), or Operation New Dawn (OND) with moderate to severe anger problems were randomized to receive the cognitive behavioral intervention (CBI) or the supportive intervention (SI). Anger, aggression, multiple areas of functioning and quality of life were assessed at multiple time points inclu\ding 3- and 6-month follow-up. RESULTS: Hierarchical linear modeling (HLM) analyses showed significant treatment effects favoring CBI for anger severity, social and interpersonal functioning, and quality of life. The presence of a PTSD diagnosis did not affect outcomes. CONCLUSIONS: CBI is an effective treatment for OEF/OIF/OND veterans with anger problems following deployment, regardless of PTSD diagnosis.

Gender-based violence and suicidal ideation among Indian women from slums: An examination of direct and indirect effects of depression, anxiety, and PTSD symptoms.

OBJECTIVE: India accounts for 36.6% of suicide-related deaths among women worldwide. One social determinant of suicide in India is gender-based violence (GBV), and it disproportionately affects women from poorer socioeconomic classes. Although Indian women from slums are at high risk of GBV, the direct and indirect relationships between types of GBV and suicidal ideation (SI) for Indian women remain unexplored. This study examined: (a) the direct associations between types of GBV and SI and (b) indirect associations between GBV and risk for SI through depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. METHOD: Trauma-exposed Indian women were recruited (N = 112); 98 completed a trauma screen, PHQ-9, GAD-7, and PCL-5 in Hindi. Traumatic events were categorized as GBV overlapping with Criterion A trauma (CA-GBV), emotional/economic GBV without Criterion A (E-GBV), and Criterion A without GBV (CA). The relation between trauma types and SI was examined through the indirect role of depression, anxiety, and PTSD symptoms. RESULTS: Logistic regression analyses revealed that CA-GBV was associated with higher odds of SI than other trauma types. This relationship was explained through the indirect role of depression symptom severity after accounting for other trauma types, anxiety, and PTSD symptoms. CONCLUSION: Results align with research showing that CA-GBV is particularly pernicious and affects SI. While anxiety and PTSD symptoms are related to CA-GBV, results suggest the relative importance of depression severity in the relation between CA-GBV and SI. Screening for SI among GBV survivors and treating depression symptoms may reduce the risk of suicide. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of the Alliance and Negotiation Scale-Supervision Version.

OBJECTIVE: This study examines the psychometric properties of the Alliance Negotiation Scale-Supervision Version (ANS-S) for clinical trainees. Analyses were designed to evaluate the relationship between the ANS-S and other measures of supervision process and outcome. METHOD: Online surveys included items from established measures in addition to questions about supervisor and supervisee training experiences. The survey was administered to a sample of mental health clinicians practicing under a licensed supervisor (N = 113). RESULTS: The ANS-S (a 12-item unidimensional scale) demonstrated sound psychometric properties, including evidence of reliability as well as content and construct validity. CONCLUSIONS: The ANS-S was associated with several related supervision measures and outcome variables in the expected directions. These results extend previous findings on the ANS' psychometric integrity and offer a validated measure that can be used in further research on supervision.

Dealing with complexity and comorbidity: Opportunity for transdiagnostic treatment for PTSD.

PURPOSE OF REVIEW: This review synthesizes literature on transdiagnostic treatments for PTSD and trauma-related psychopathology over the last three years and discusses their across diverse contexts. RECENT FINDINGS: Global and domestic studies suggest that a transdiagnostic approach has the potential to address many challenges providers encounter when treating traumatized populations. Existing research shows that transdiagnostic approaches (including the Unified Protocol, Common Elements Treatment Approach, and Modular Approach to Therapy for Children) are effective across low and high resourced settings, populations, and with comorbid mental health symptoms. Moreover, transdiagnostic approaches offer flexibility in treatment delivery, adaptability across contexts, and parsimonious training to treatment providers. They also provide a standalone alternative for unable or unwilling individuals to engage in traditional single diagnosis trauma-focused treatment, or those presenting with complex presentations that might otherwise require sequential courses of targeted interventions. SUMMARY: The promise of transdiagnostic treatment for trauma-populations is strong. Research is needed to examine patient and therapist perceptions of these approaches for optimally addressing PTSD and related symptoms, the extent to which they offer comparable, or perhaps better, outcomes than existing single diagnosis PTSD treatments, and their sustainability overtime. Considerations of adaptations to transdiagnostic treatment manuals across settings are also needed.

An epidemiological evaluation of trauma types in a cohort of deployed service members.

OBJECTIVE: Using Stein et al.'s (2012) categorization scheme for typing Criterion A events (i.e., Life Threat to Self, Life Threat to Other, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Other) and extending Litz et al.'s (2018) prior work, we investigated the prevalence of trauma types, prevalence of posttraumatic stress disorder within each trauma type, and associations between trauma types and behavioral and mental health outcomes for an epidemiological sample of service members. METHOD: Criterion A events coded by independent raters (kappas = .85-1.00) were used to determine prevalence rates and to conduct two path models examining all trauma types in relation to mental health outcomes. RESULTS: Consistent with prior research, we found events containing Life Threat to Self (51.1%) and Life Threat to Other (30.8%) to be most prevalent, and a majority of events (62.9%) were coded with one trauma type. Although least prevalent, Aftermath of Violence (12.0%) and Moral Injury by Self (4.8%) were most frequently and strongly associated with worse mental health outcomes. Path models predicted a very small amount of variance in continuous outcomes, thus limiting the interpretation of findings. CONCLUSION: More epidemiological research is needed to understand the role of trauma type in relation to mental health among nontreatment-seeking service members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Discrimination and mental health in adult transracial adoptees: Can parents foster preparedness?

In response to the growing trend of White parents adopting children from different racial backgrounds, and heeding the call for more research on adoption-related issues, the present study examined the relationship between perceived racial discrimination and mental health of 206 adult transracial adoptees adopted by White parents. In addition, the study examined adoptive parent racial socialization as a buffering variable in the perceived discrimination-mental health link. We hypothesized that racial discrimination experiences would be related to greater psychological distress and poorer psychological well-being. Furthermore, we expected the relationships between perceived discrimination and mental health outcomes to be weaker for transracial adoptees who reported higher levels of parental racial socialization by their adoptive parents during their youth, but stronger for those reporting lower levels of parental racial socialization. Interestingly, our results showed that racial socialization functioned differently depending on the mental health outcome under investigation. Although, as expected, racial discrimination was positively associated with psychological distress and negatively related to psychological well-being, parental racial socialization only moderated the discrimination-distress link. Limitations and implications for research, practice, and policy are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Common Data Elements in the Assessment of Military-Related PTSD Research Applied in the Consortium to Alleviate PTSD.

INTRODUCTION: Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation. MATERIALS AND METHODS: The CAP compiled mandated (core) and optional CDEs based on the following criteria: (1) construct applicability to military-related PTSD; (2) precedence (use) in prior, related research; (3) published and strong psychometric evidence; (4) no cost (public domain); and (5) brevity, to limit participant burden. We provided descriptive statistics and internal consistency reliabilities for mandated measures from an initial cohort of around 400 participants enrolled in CAP studies. RESULTS: Mandated CDEs in the CAP were found to have very good internal consistency reliability. CONCLUSION: Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome.

Dynamic changes in marines' reports of PTSD symptoms and problem alcohol use across the deployment cycle.

Posttraumatic stress disorder (PTSD) and alcohol misuse are commonly co-occurring problems in active-duty service members (SMs) and veterans. Unfortunately, relatively little is known about the temporal associations between these problems in the acute period following exposure to combat stressors. Discerning the temporal associations between these problems across the deployment cycle could inform prevention and treatment efforts. In this study, we examined the association between PTSD symptom severity and problem alcohol use in a large cohort of United States Marines (n = 758) evaluated prior to deployment and approximately 1, 5, and 8 months postdeployment. Results indicate that problem alcohol use was associated with a subsequent exacerbation of PTSD symptoms between the 1st and 2nd and 2nd and 3rd postdeployment assessments. PTSD symptom severity was associated with increased problem alcohol use between the 1st and 2nd postdeployment assessments. These findings suggest that problem drinking may lead to new onset or worsening of PTSD symptoms over time and that SMs with greater PTSD symptom severity upon returning from deployment may increase alcohol use in the weeks immediately following homecoming. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Treatment of trauma related anger in operation enduring freedom, operation Iraqi freedom, and operation New Dawn veterans: Rationale and study protocol.

BACKGROUND: Problems with anger and aggression are highly prevalent in Veterans of multiple war eras, including the most recent conflicts in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF). The consequences of these problems, such as increased rates of divorce, domestic violence, occupational instability, arrests and incarceration, are often devastating. Despite the seriousness of these problems, relatively little is known about effective treatments for anger in Veterans. METHOD AND DESIGN: This paper describes the rationale and study protocol of a randomized controlled trial comparing an adapted cognitive behavioral intervention (CBI) with an active control condition (supportive intervention, SI) for the treatment of anger problems in OEF/OIF Veterans. The sample includes 92 OEF/OIF Veterans, randomized to CBI or SI. Both treatments include 12 weekly, 75-min individual sessions. Participants are assessed at baseline, after sessions 4 and 8, at post-treatment, and at 3 and 6 months post-treatment. Primary outcomes are reduction in anger and aggression; secondary outcomes are improved functioning and quality of life. We hypothesize that CBI will be associated with significantly more improvement than SI on primary and secondary measures. DISCUSSION: Findings from this study will help to address the gap in evidence for effective treatments for anger in Veterans. The use of an active control condition will provide a stringent test of the effects of CBI beyond that of common factors of psychotherapy such as therapeutic relationship, mobilization of hope, and support. Findings have the potential to improve treatment outcomes for Veterans struggling with post-deployment anger problems.

Locus of control in US combat veterans: Unique associations with posttraumatic stress disorder 5-factor model symptom clusters.

Given elevated rates of posttraumatic stress disorder (PTSD) among US military veterans, identifying correlates of PTSD and specific PTSD symptom clusters that best represent PTSD in veterans (i.e., the five-factor Dysphoric Arousal model) is critical to prevention and intervention efforts. One potential correlate is locus of control (i.e., the extent to which individuals believe they have control over events in their lives). The aim of this study was to examine the relations between locus of control and five-factor model PTSD symptom clusters (i.e., re-experiencing, avoidance, numbing, dysphoric arousal, anxious arousal) among combat veterans. Eighty-nine combat exposed veterans completed self-report measures of demographics, locus of control, PTSD symptoms, and combat exposure. Bivariate correlations indicated relations between locus of control and overall PTSD symptoms, avoidance symptoms, and numbing symptoms. When controlling for sex and combat exposure in regression analyses, only avoidance remained a significant correlate of locus of control. Among veterans with the most extreme scores (n = 26), external locus of control predicted overall PTSD symptoms and avoidance symptoms. External locus of control is uniquely associated with avoidance symptoms, and represents a potentially modifiable factor to address in trauma-focused treatments.

Childhood maltreatment and post-deployment psychological distress: The indirect role of emotional numbing.

OBJECTIVE: Childhood maltreatment is an increasingly established predictor of psychological problems. However, limited research addresses pathways though which childhood maltreatment influences the mental health of military personnel following deployment. The current study investigated the direct, and indirect through emotional numbing, relations between childhood maltreatment and psychological distress of recently deployed veterans. METHOD: For a sample of 131 predominantly White, male Operation Iraqi Freedom/Operation Enduring Freedom members of U.S. Army National Guard and Reserve units, a path model was used to test the direct and indirect (through numbing) roles of childhood maltreatment on distress. RESULTS: Results showed that childhood maltreatment was not significantly directly associated with psychological distress one-year post-deployment but was indirectly related to distress by way of emotional numbing symptoms. CONCLUSIONS: Our findings suggest that childhood maltreatment may serve to influence returning veterans' experiences of psychological distress indirectly through increased emotional numbing following deployment. The importance of attending to emotional numbing symptoms among veterans with experiences of childhood maltreatment after deployment is highlighted. (PsycINFO Database Record

Different types of combat experiences and associated symptoms in OEF and OIF National Guard and reserve veterans.

OBJECTIVE: It is well established that exposure to combat is a risk factor for posttraumatic stress disorder (PTSD). The experiences of military personnel serving in combat zones vary widely however, leading to increased attention to the impact of different types of combat trauma. The present study examined the relationships among 3 conceptually based categories of combat exposure with 4 PTSD symptom clusters (reexperiencing, avoidance, numbing, and hyperarousal) and symptoms of guilt, depression, and anxiety. METHOD: Participants were 206 National Guard and Reserve members who had recently returned from deployment to Iraq or Afghanistan. RESULTS: As hypothesized, findings from a multivariate multiple linear regression analysis showed that exposure to personal life threat predicted symptoms of hyperarousal, and exposure to death or severe injury of others predicted symptoms of depression. Hypotheses that personal life threat would predict anxiety symptoms, exposure to death or injury of others would predict numbing, and having killed would predict guilt were not supported. CONCLUSIONS: The relative degree of exposure to life threat and death/loss events in a war-zone may impact the development of different types of symptoms. These findings highlight the importance of considering different types of trauma exposure in future research. (PsycINFO Database Record

Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment.

BACKGROUND: Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD: For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS: Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION: Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.

The moderating role of dysphoria in the relationship between intrusions and alcohol use.

Posttraumatic Stress Disorder (PTSD) is frequently comorbid with alcohol use disorders (AUD; Calabrese et al., 2011; McFall, Mackay, & Donovan, 1992). Among several explanations for this comorbidity, the most empirically supported is the self-medication theory which postulates that substances are used to medicate PTSD-related distress (Keane & Wolfe, 1990; Khantzian, 1985; Stewart, 1996). The current study examines the effects of trauma-related distress on alcohol use (total drinking days, drinks per drinking day, heavy drinking days) in a sample of 127 trauma-exposed Veterans following deployment to Iraq or Afghanistan. The dysphoria symptoms of PTSD were used as an indicator of distress, and examined as a moderator in the relationship between intrusion symptoms of PTSD and alcohol use. The proposed moderation model was tested using cross-sectional data from the first month following return from deployment, and at 6 months and at 12 months post-deployment. Results showed that dysphoria symptoms significantly moderated relations between intrusions and total drinking days and heavy drinking days at one month post-deployment; however, a significant pattern was not demonstrated at 6 months and 12 months. Further, dysphoria did not moderate the relation between intrusion symptoms and drinks per drinking day at the three time points. Theoretical and clinical implications are subsequently discussed.

Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings.

STUDY OBJECTIVE: Inter-clinician communication accounts for more than half of all information exchanges within the health care system. A non-participatory, qualitative time-and-motion observational study was conducted in order to gain a better understanding of inter-clinician communication behaviors, routine workflow patterns, and the use of information communication technologies (ICTs) within the clinical workspace. METHOD: Over a 5-day period, seven attending physicians and two nurses were shadowed for 2-4h at a time. Inter-clinician communication events were tracked in real-time using synchronized digital stopwatches. Observations were recorded on a paper-based, semi-structured observation tool and later coded for analysis. RESULTS: Nine hundred and eighty-seven communication events were observed over 2024.67 min. Clinicians were observed to spend the majority of their time on patient care (85.4% in this study) with about three-fourths of that time spent on indirect patient care (e.g. charting). Clinicians were observed to prefer using synchronous communication modes, which led to multitasking and created a highly interrupted workflow. Forty-two percent (n=415) of communication events were coded as interruptions and study participants were seen multitasking 14.8% of the time. Though each interruption was short-lived (on average 0.98+/-2.24 min for attending physicians), they occurred frequently. Both attending physicians and nurses were the recipients of more interruptions than they initiated. CONCLUSION: This study demonstrated that the clinical workspace is a highly interruptive environment. Multiple interruptions in the communication processes between clinicians consume time and have the potential to increase the risk of error. This workflow analysis may inform the development of communication devices to enhance inter-clinician communication by reducing interruptions or deferring interruptions to more appropriate times.