The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation.

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

We examined the Significant Others' Responses to Trauma Scale (SORTS), a measure of symptom accommodation in PTSD, among a large sample of family members.As measured by the SORTS, accommodation in PTSD could be broken down into two aspects: anger-related accommodation and anxiety-related accommodation.Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction.

Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (helping end addiction long-term®) communities study.

BACKGROUND: Scaling up overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD) is needed to reduce opioid overdose deaths, but barriers are pervasive. This study examines whether the Communities That HEAL (CTH) intervention reduced perceived barriers to expanding OEND and MOUD in healthcare/behavioral health, criminal-legal, and other/non-traditional venues. METHODS: The HEALing (Helping End Addiction Long-Term®) Communities Study is a parallel, wait-list, cluster randomized trial testing the CTH intervention in 67 communities in the United States. Surveys administered to coalition members and key stakeholders measured the magnitude of perceived barriers to scaling up OEND and MOUD in November 2019-January 2020, May-June 2021, and May-June 2022. Multilevel linear mixed models compared Wave 1 (intervention) and Wave 2 (wait-list control) respondents. Interactions by rural/urban status and research site were tested. RESULTS: Wave 1 respondents reported significantly greater reductions in mean scores for three outcomes: perceived barriers to scaling up OEND in Healthcare/Behavioral Health Venues (-0.26, 95% confidence interval, CI: -0.48, -0.05, p = 0.015), OEND in Other/Non-traditional Venues (-0.53, 95% CI: - 0.84, -0.22, p = 0.001) and MOUD in Other/Non-traditional Venues (-0.34, 95% CI: -0.62, -0.05, p = 0.020). There were significant interactions by research site for perceived barriers to scaling up OEND and MOUD in Criminal-Legal Venues. There were no significant interactions by rural/urban status. DISCUSSION: The CTH Intervention reduced perceived barriers to scaling up OEND and MOUD in certain venues, with no difference in effectiveness between rural and urban communities. More research is needed to understand facilitators and barriers in different venues.

Effect of the Communities that HEAL intervention on receipt of behavioral therapies for opioid use disorder: A cluster randomized wait-list controlled trial.

BACKGROUND: The U.S. opioid overdose crisis persists. Outpatient behavioral health services (BHS) are essential components of a comprehensive response to opioid use disorder and overdose fatalities. The Helping to End Addiction Long-Term® (HEALing) Communities Study developed the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths in 67 communities in Kentucky, Ohio, New York, and Massachusetts through the implementation of evidence-based practices (EBPs), including BHS. This paper compares the rate of individuals receiving outpatient BHS in Wave 1 intervention communities (n = 34) to waitlisted Wave 2 communities (n = 33). METHODS: Medicaid data included individuals ≥18 years of age receiving any of five BHS categories: intensive outpatient, outpatient, case management, peer support, and case management or peer support. Negative binomial regression models estimated the rate of receiving each BHS for Wave 1 and Wave 2. Effect modification analyses evaluated changes in the effect of the CTH intervention between Wave 1 and Wave 2 by research site, rurality, age, sex, and race/ethnicity. RESULTS: No significant differences were detected between intervention and waitlisted communities in the rate of individuals receiving any of the five BHS categories. None of the interaction effects used to test the effect modification were significant. CONCLUSIONS: Several factors should be considered when interpreting results-no significant intervention effects were observed through Medicaid claims data, the best available data source but limited in terms of capturing individuals reached by the intervention. Also, the 12-month evaluation window may have been too brief to see improved outcomes considering the time required to stand-up BHS. TRIAL REGISTRATION: Clinical Trials.gov http://www. CLINICALTRIALS: gov: Identifier: NCT04111939.

Associations between transdiagnostic traits of psychopathology and hybrid posttraumatic stress disorder factors in a trauma-exposed community sample.

Dimensional conceptualizations of psychopathology hold promise for understanding the high rates of comorbidity with posttraumatic stress disorder (PTSD). Linking PTSD symptoms to transdiagnostic dimensions of psychopathology may enable researchers and clinicians to understand the patterns and breadth of behavioral sequelae following traumatic experiences that may be shared with other psychiatric disorders. To explore this premise, we recruited a trauma-exposed online community sample (N = 462) and measured dimensional transdiagnostic traits of psychopathology using parceled facets derived from the Personality Inventory for DSM-5 Faceted-Short Form. PTSD symptom factors were measured using the PTSD Checklist for DSM-5 and derived using confirmatory factor analysis according to the seven-factor hybrid model (i.e., Intrusions, Avoidance, Negative Affect, Anhedonia, Externalizing Behaviors, Anxious Arousal, And Dysphoric Arousal). We observed hypothesized associations between PTSD factors and transdiagnostic traits indicating that some transdiagnostic dimensions were associated with nearly all PTSD symptom factors (e.g., emotional lability: rmean = .35), whereas others showed more unique relationships (e.g., hostility-Externalizing Behavior: r = .60; hostility with other PTSD factors: rs = .12-.31). All PTSD factors were correlated with traits beyond those that would appear to be construct-relevant, suggesting the possibility of indirect associations that should be explicated in future research. The results indicate the breadth of trait-like consequences associated with PTSD symptom exacerbation, with implications for case conceptualization and treatment planning. Although PTSD is not a personality disorder, the findings indicate that increased PTSD factor severity is moderately associated with different patterns of trait-like disruptions in many areas of functioning.

Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation.

INTRODUCTION: The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. METHODS: Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse-Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). RESULTS: Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. CONCLUSIONS: Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.

Five-year incidence of substance use and mental health diagnoses following exposure to opioids or opioids with benzodiazepines during an emergency department encounter for traumatic injury.

BACKGROUND: Benzodiazepines and opioids are used alone or in conjunction in certain care settings, but each have the potential for misuse. OBJECTIVE: This longitudinal observational study evaluated substance use and mental health outcomes associated with providing opioids with or without benzodiazepine to treat traumatic injury in the emergency department (ED) setting. METHODS: We analyzed a limited dataset obtained through the IBM Watson Health Explorys. Matched cohorts were defined for: 1) patients treated with opioids during the ED encounter (ED-Opioid) vs. neither opioid or benzodiazepine treatment (No medication) (n = 5372); 2) patients treated with opioids and benzodiazepines during the ED encounter (ED-Opioid+Benzodiazepines) vs. No Medication (n = 2454); and 3) ED-Opioid+Benzodiazepines vs. ED-Opioid (n = 2454). Patients consisted of adults with an emergency department encounter in the MetroHealth System (Cleveland, Ohio) with a chief complaint of traumatic injury and medical records for five years following the encounter. Control patients for each cohort were matched to the exposure patients on demographics, body mass index, and residential zip code median income. Outcomes were five-year incidence rates for alcohol, substance use, depression, and anxiety-related diagnoses. RESULTS: Our results indicate that, although receiving opioids during the ED visit predicted a relatively lower likelihood of subsequent substance use and mental health diagnoses, the brief co-use of benzodiazepines was strongly associated with poorer outcomes. CONCLUSIONS: Even brief exposure to co-prescribed opioids and benzodiazepines during emergency traumatic injury care may be associated with negative substance use and mental health consequences in the years following the event.

Cognitive and Affective Mediators of Alcohol-Facilitated Intimate Partner Aggression.

This multisite study examined whether aggressive cognitions and facial displays of negative affect and anger experienced during provocation mediated the association between alcohol intoxication and intimate partner aggression (IPA). Participants were 249 heavy drinkers (148 men, 101 women) with a recent history of IPA perpetration. Participants were randomly assigned to an Alcohol or No-Alcohol Control beverage condition and completed a shock-based aggression task involving apparent provocation by their intimate partner. During provocation, a hidden camera recorded participants' facial expressions and verbal articulations, which were later coded using the Facial Action Coding System and the Articulated Thoughts in Simulated Situations paradigm. Results indicated that the positive association between alcohol intoxication and partner-directed physical aggression was mediated by participants' aggressive cognitions, but not by negative affect or anger facial expressions. These findings implicate aggressogenic cognitions as a mediating mechanism underlying the association between the acute effects of alcohol and IPA perpetration.

Alcohol, Affect, and Aggression: An Investigation of Alcohol's Effects Following Ostracism.

OBJECTIVE: Ostracism is distressing to those who experience it and people are motivated to find ways to cope, including self-medication or aggression. However, we know little about how alcohol intoxication may affect individuals' reactions to ostracism. This study investigates predictions informed by Alcohol Myopia Theory to observe how alcohol influences changes to one's affect, basic needs fulfillment, and aggression following ostracism. METHOD: Participants (N = 97) were randomly assigned to either consume an alcohol, placebo, or nonalcohol beverage, and then participate in a game that simulated ostracism. Following this, participants engaged in a task wherein they were able to aggress against an ostensible ostracizer. Affect and basic psychological needs were measured at baseline, post-ostracism, and post-aggression timepoints. RESULTS: Results indicated that all groups reacted adversely to ostracism and experienced partial recovery toward baseline for negative and positive affect and basic psychological needs. Further, alcohol facilitated recovery across these outcomes post-aggression for participants who felt more intoxicated. Alcohol, relative to the control beverages, increased ostracizer-directed aggression intensity for low trait physically aggressive, but not highly aggressive, people. CONCLUSION: This randomized study provides novel preliminary evidence suggesting that alcohol enhances aggressive urges toward ostracizers in those who are not typically aggressive. Those who feel more drunk when intoxicated, compared to those who feel less so, may experience greater recovery from ostracism after aggressing toward an ostracizer hinting at potentially pleasurable effects that must be replicated in future studies.

Trauma Cognitions and Partner Aggression: Anger, Hostility, and Rumination as Intervening Mechanisms.

OBJECTIVE: Previous research has demonstrated a significant association between trauma and intimate partner aggression (IPA) perpetration. However, the precise mechanisms underlying this relationship have yet to be fully elucidated. In the present study, we examined the impact of several key factors implicated in Ehlers and Clark's (2000) cognitive model of trauma (i.e., trauma cognitions, anger, hostility, and rumination) on IPA perpetration. METHOD: Participants in this study were 271 male and female heavy drinkers at high risk for IPA from the community who completed measures of dysfunctional posttraumatic cognitions, dispositional rumination, trait anger and hostility, and IPA perpetration. A moderated mediational model was tested to determine how these variables interact to predict IPA perpetration. RESULTS: Results indicated that anger and hostility mediated the effect of negative cognitions about the world on IPA perpetration, with this indirect effect being stronger for individuals with higher levels of rumination. CONCLUSION: These findings suggest that cognitive and affective processes that may result from trauma exposure are associated with IPA and should be targeted in prevention and intervention programs for individuals at risk for perpetration.

It's time to start asking all patients about intimate partner violence.

Many people endure a menacing or violent romantic partner--yet few physicians ask about this risk, or actual harm. Here is a roadmap for screening.

Anger, problematic alcohol use, and intimate partner violence victimisation and perpetration.

BACKGROUND: Anger and problematic alcohol use have been established as individual risk factors for intimate partner violence (IPV) victimisation and perpetration, but it is unknown how these factors convey risk for IPV perpetration for men and women within the context of mutually violent relationships. HYPOTHESES: Anger and problematic alcohol use were hypothesised to mediate the association between IPV victimisation and perpetration for men and women, with direct and indirect influences from partner variables. METHODS: Heterosexual couples (N = 215) at high-risk for IPV completed questionnaires indexing trait anger, problematic alcohol use and extent of past-year IPV perpetration and victimisation. An actor-partner interdependence modelling (APIM) framework was used to evaluate these cross-sectional data for two hypothesised models and one parsimonious alternative. RESULTS: The best-fitting model indicated that IPV victimisation showed the strongest direct effect on physical IPV perpetration for both men and women. For women, but not men, the indirect effect of IPV victimisation on physical IPV perpetration through anger approached significance. For men, but not women, the victimisation-perpetration indirect effect through problematic drinking approached significance. IMPLICATIONS FOR CLINICAL PRACTICE: The results suggest that anger and problem drinking patterns play different yet important roles for men and women in mutually violent relationships.

Mechanisms of Alcohol-Facilitated Intimate Partner Violence.

Intimate partner violence (IPV) is a critical public health problem that requires clear and testable etiological models that may translate into effective interventions. While alcohol intoxication and a pattern of heavy alcohol consumption are robust correlates of IPV perpetration, there has been limited research that examines the mediating mechanisms of how alcohol potentiates IPV. We provide a theoretical and methodological framework for researchers to conceptualize how alcohol intoxication causes IPV, and propose innovative laboratory methods that directly test mediational mechanisms. We conclude by discussing how these innovations may lead to the development of interventions to prevent or reduce alcohol-related IPV.