PTSD Symptoms Among College Students: Linkages with Familial Risk, Borderline Personality, and Sexual Assault.

College students have high rates of post-traumatic stress disorder (PTSD) symptoms as well as high rates of sexual assault. What is less clear, however, is whether different sexual assault types (e.g. coercive, physically forced, and incapacitation) are associated with greater PTSD symptoms. Moreover, understanding early familial and mental health histories of college students is important for explaining PTSD symptoms. As such, we use a social stress framework to examine the relationships between early familial risk (i.e. child abuse, perceived maternal rejection), borderline personality (BP) symptoms, and three sexual assault types with PTSD symptoms among college students. A total of 783 undergraduate students (65.4% female) completed paper and pencil surveys in fall 2019 and spring 2020 at a large public university. Results revealed that females were more likely to experience child sexual abuse and all three forms of sexual assault, while males experienced higher rates of child physical abuse. OLS regression results showed positive associations between child sexual abuse, perceived maternal rejection, BP symptoms and all three types of sexual assault with PTSD symptoms. Females also experienced more PTSD symptoms compared to males. Findings have implications for targeted interventions to improve mental health outcomes.

Comparison of Sorority and non-Sorority Women: Risks for Different Sexual Assault Types.

Though rates of sexual assault are high among college women, some studies find even greater prevalence rates among women who are sorority members. This study examined the association between familial risk factors (e.g., child physical abuse), PTSD symptoms, and proximal risk factors (e.g., sexual risk behavior) with three sexual assault types (i.e., coercive, incapacitated by alcohol or drugs, and physically forced) among sorority and non-sorority women at a large Midwestern university. Participants completed a paper-and-pencil survey that included measures of different sexual assault types, childhood maltreatment, parental rejection, PTSD symptoms, and sexual and substance use behaviors. A fully recursive path model was estimated to examine the pathways to three different sexual assault types. Results revealed that sorority women experienced coercive and incapacitated sexual assault more so than non-sorority women though there was no significant difference for physically forced sexual assault. Sorority women also reported engaging in more sexual risk behaviors, which was in turn, associated with all three sexual assault types. Sorority women also reported heavier alcohol use, which in turn, was positively associated with coercive and incapacitated sexual assault. These findings have implications for prevention among college undergraduate women.

Risk and protective factors for mental health outcomes among sexual minority and heterosexual college women and men.

Objective: Understand the relationship between risk factors (eg, different sexual assault types - coercive, physical, incapacitation by alcohol/drugs) and protective factors (eg, strong maternal ties) with depressive symptoms and post-traumatic stress disorder (PTSD) symptoms among college students. Participants: Six hundred twenty-five undergraduate students. Methods: Students completed paper and pencil surveys in fall 2019 at a large public university. Results: Risk factors of child physical and sexual abuse, all three sexual assault types, and combined sexual assault were associated with greater PTSD symptoms while maternal relationship quality and religious influence served as protective factors. Risk factors of child physical and sexual abuse, coercive sexual assault, and combined sexual assault were associated with depressive symptoms while maternal relationship quality served as a protective factor. Males who identified as sexual minority (SM) had more PTSD symptoms compared to females who identified as SM. Conclusions: Findings have implications for targeted interventions to improve mental health outcomes.

Family Violence, Personality Traits, and Risk Behaviors: Links to Dating Violence Victimization and Perpetration Among College Students.

Though dating violence (DV) is prevalent on college campuses, few studies have examined a multitude of risk factors that may better explain this process. As such, we examined the role of family violence (i.e., childhood physical abuse, witnessing parental violence), personality traits (i.e., entitlement, antisocial personality [ASP] and borderline personality [BP]) and risk behaviors (i.e., risky sexual behaviors, heavy drinking, marijuana use, illicit drug use) on DV victimization and perpetration among 783 college students. Path analysis revealed that witnessing parental violence was linked to DV perpetration while experiencing more physical abuse was positively correlated with entitlement (females only), ASP traits, and BP traits. ASP traits (both males and females) and entitlement (females only) were directly associated with high-risk behaviors. Among females, entitlement was also indirectly associated with DV victimization and perpetration through sexual risk behaviors. Findings highlight the importance of histories of physical abuse and personality traits in understanding DV.

The Relationship Between College Student Characteristics and Reporting Sexual Assault Experiences on Two Different Scales.

Though high rates of sexual assault are found on college campuses, prevalence rates between studies can vary considerable by gender, sexual orientation, and other student characteristics. Thus, it is unknown whether these are "true" differences for such characteristics or if there are methodological differences to consider. As such the current study examined whether student characteristics including gender, race, sexual orientation, sexual attraction, Greek affiliation, and relationship status are uniquely associated with reporting on two different sexual assault scales. Data were gathered from 783 college students in 2019-2020 at a large Midwestern university. Results revealed that the two different scales consistently provided different prevalence rates of sexual assault. Moreover, for each type of sexual assault (e.g., coercion, incapacitation, and physical force), there were also significant differences with students consistently reporting higher prevalence rates on one scale over the other. Finally, significant differences were found in prevalence rates across gender, sexual attraction, and Greek affiliated status.

Risk Factors for Sexual Assault of Heterosexual and Sexual Minority College Women.

Though college women report high rates of sexual assault, less is known about how protective and risk factors are uniquely associated with assault among heterosexual and sexual minority women. As such, the current study examined protective factors (i.e., maternal relationship quality and religiosity) and risk factors (i.e., child sexual abuse, parent substance misuse, and risky behaviors) for coercive sexual assault and total sexual assault and whether they vary by sexual orientation among college women. Data were gathered in the 2013-2014 academic year at two large public universities in the United States, one in the Midwest and one in the Southeast. Data for the current study included 755 college women, 72 (9.5%) of whom identified as sexual minority. Bivariate results showed that heterosexual women reported greater maternal relationship quality and greater religiosity compared to sexual minority women, while sexual minority women reported more risky sexual behaviors and having experienced more coercive sexual assault than heterosexual women. Multivariate results revealed that child sexual abuse, parent drinking problems, maternal relationship quality, heavy drinking, hooking up, and risky sexual behaviors were significantly associated with total sexual assault. Significant correlates of coercive sexual assault included child sexual abuse, maternal relationship quality, hooking up, and risky sexual behaviors. The relationship between maternal relationship quality and total sexual assault varied by sexual orientation as did the relationship between hooking up and coercive sexual assault. These findings have implications for targeted interventions to improve prevention of sexual assault among heterosexual and sexual minority college women.

Correlates of Support Utilization After Experiencing a Sexual Assault Among College Women and Men.

Though previous research has examined survivors' use of formal and informal services, less research has looked at whether sexual orientation, race, and different sexual assault types (e.g., coercive) are associated with seeking support services. The purpose of this study is to examine factors associated with utilizing services or support from informal sources (e.g., telling a friend) and formal sources (e.g., psychological counseling) following a sexual assault. Data were gathered in Fall and Spring of 2019-2020 from undergraduate students at a Midwestern university. Logistic regression results showed that heterosexual students had 56% lower odds of using informal supports, while females were 2.05 times more likely to have used informal supports compared to their counterparts. Students who reported more heavy drinking had 37% lower odds of using informal supports compared to their counterparts. Those who experienced physical and incapacitated sexual assault were 2.09 times and 3.60 times more likely to have used informal supports, respectively. Additionally, older students were 1.35 times more likely to have used formal supports compared to younger students, whereas heterosexual students had 67% lower odds of using formal supports compared to sexual minority students. Those with greater PTSD symptoms were 1.07 times more likely to access formal services. Finally, students with greater depressive symptoms had 8% lower odds of using formal supports. Identifying college students who are less likely to access support services following a sexual assault has important implications for targeted prevention and intervention.

Development of and Preliminary Evidence for a Psychological Service Barriers Measure Among College Sexual Assault Survivors.

Sexual assault is a widespread problem on college campuses, and survivors rarely use campus supports. However, there is no established measure of service barriers for this population. This study develops and provides preliminary evidence for a measure of psychological service barriers. Data were collected from 100 college sexual assault survivors. Results provide evidence for three factors: social-emotional barriers, negative treatment barriers, and minimization barriers. Additional tests offer evidence for consistency and reliability in these factors over time and across campus supports. This work offers preliminary evidence for the psychometric properties of this measure and lays the groundwork for future validation research.

Poor Parenting, Attachment Style, and Dating Violence Perpetration Among College Students.

Although dating violence is prevalent among college students, little is known about how both attachment style and participation in risky behaviors contribute to this pattern of violence. To address this literature gap, we examine the role of poor parenting, child abuse, attachment style, and risky sexual and drug use behaviors on dating violence perpetration among 1,432 college students (51% female). Path analysis results revealed that females were more likely to report greater attachment anxiety but lower attachment avoidance compared with males. Correlates of attachment anxiety included child physical abuse, witnessing parental violence, and poorer maternal relationship quality whereas attachment avoidant behavior was linked to more physical abuse and poorer maternal relationship quality. Females were more likely to perpetrate dating violence as were those with greater attachment anxiety and lower attachment avoidance. Other correlates of dating violence perpetration included sexual and drug risk behaviors. Finally, distal factors (i.e., more child physical abuse and poorer maternal relationship quality) also were associated with dating violence perpetration. Study implications are also discussed.

Risk Factors for Forced, Incapacitated, and Coercive Sexual Victimization Among Sexual Minority and Heterosexual Male and Female College Students.

Although college students are at high risk for sexual victimization, the majority of research has focused on heterosexual students and often does not differentiate by victimization type. Thus, little is known about prevalence rates and risk factors for sexual victimization among sexual minority college students and whether the interaction between gender and sexual orientation differs by victimization type. To address these gaps, we examine whether risk factors for three types of sexual victimization (i.e., forced, incapacitated, and coerced) differ by gender (n = 681 males; n = 732 females) and sexual orientation (n = 1,294 heterosexual; n = 119 sexual minority) and whether the intersection of gender and sexual orientation is correlated with these three types of sexual victimization among 1,413 college students. Prevalence rate results revealed significant differences between gender and sexual orientation: Sexual minority females had the highest rates of coerced sexual victimization (58%), and their mean was significantly different from the other three groups (i.e., heterosexual females, heterosexual males, and sexual minority males). For both forced and incapacitated sexual victimization, heterosexual males had significantly lower means than the other three groups. Logistic regression results revealed that child sexual abuse increased the odds of experiencing both forced and coerced sexual victimization for both heterosexual and sexual minority students, whereas increased rates of risky sexual behavior were associated with forced and incapacitated sexual victimization but only for heterosexuals. Finally, heavy drinking increased the odds of experiencing incapacitated sexual victimization for both heterosexuals and sexual minorities.

Bullying at School and on the Street: Risk Factors and Outcomes Among Homeless Youth.

Though rates of bullying among general population youth are high, there is elevated prevalence among certain subgroups, in particular sexual minority homeless youth. Enduring bullying can have devastating consequences, including poor mental health, revictimization, and substance abuse. The current study compares risk factors (i.e., sexual orientation, gender, and child abuse) for being bullied both at school and on the street among homeless youth. We also examine the associations of both contexts of bullying (i.e., at school and on the street) with physical and sexual victimization while on the street, with illicit drug use. From July 2014 to October 2015, we interviewed 150 homeless youth aged 16 to 22 years in shelters and on the streets from two Midwestern cities. Our sample was 51% female and 22% identified as lesbian, gay, or bisexual (LGB). Results revealed that LGB youth experienced more frequent bullying at school and were more likely to have ever used one or more illicit drugs at least a few times compared with heterosexual youth. Moreover, youth who experienced more child abuse prior to leaving home were also victimized more often at school (school bullying) and on the street (street bullying). Young people who experienced more sexual and physical street victimization were more likely to report illicit drug use compared with those who had fewer street victimization experiences. Overall, youth who experience victimization in one context (i.e., home) are at heightened risk for being bullied in additional contexts (i.e., school). These findings have important policy and service intervention implications, such that service providers should attend to homeless youth's multiple social contexts of victimization and the potential for youth's illicit drug use as a coping mechanism.

Traumatic Childhood Experiences and Posttraumatic Stress Disorder Among Veterans in Substance Use Disorder Treatment.

Posttraumatic stress disorder (PTSD) dramatically increases the risk of both substance use disorder (SUD) and suicide in veterans. Military-related trauma, however, may not be the only or most significant trauma experienced by veterans. Trauma exposure is high among those joining the military. This study sought to identify the prevalence of five types of childhood trauma (emotional, physical, and sexual abuse and emotional and physical neglect) and three adult trauma symptom clusters (intrusive thoughts, avoidance, and hyperarousal) among veterans seeking SUD treatment and to clarify the associations between types of trauma and specific symptom clusters. Veterans at three Veterans Affairs (VA) SUD treatment facilities in the Midwest completed surveys at treatment entry (n1 = 195) and at 6-month follow-up (n2 = 138). Measures included the Childhood Trauma Questionnaire-Short Form and the PTSD Checklist, either a military or a civilian version, depending on whether the most traumatic event occurred in or out of the military. The prevalence of childhood trauma was high, ranging from 40.5% experiencing physical abuse down to 22.8% experiencing sexual abuse. At baseline, 60.2% of the military trauma group met criteria for PTSD, compared with 33.9% of the civilian trauma group, a significant difference, χ2(1, N = 195) = 14.46, p < .01. Childhood emotional and physical abuse were moderately associated with intrusion and hyperarousal in the military trauma group, but in the civilian trauma group a broader spectrum of childhood traumas were associated with a broader array of symptom clusters, including avoidance. At follow-up, symptoms improved and were less associated with childhood trauma. These findings illuminate the persistence of effects of childhood trauma and recommend more targeted PTSD treatments.

A Latent Class Analysis of Lifetime Victimization Among Homeless Youth.

Homeless youth experience high rates of child physical and sexual abuse, and many are revictimized on the streets. Despite their high rates of victimization, few studies have examined whether specific victimization types (e.g., sexual vs. physical) cluster together and for whom (e.g., sexual minority youth). As such, the purpose of this study was to identify clusters of homeless youth based on their exposure to different forms of child abuse and street victimization, to examine what factors distinguish each cluster, and how unique clusters are related to youths' mental health using data collected at two time points. The sample included 150 youth experiencing homelessness in the Midwest. Latent class analysis was used to identify clusters of youth. Three latent classes emerge: The low exposure class had significantly lower rates of child physical and emotional abuse and threats compared with the medium- and high-exposure groups. The high exposure group had significantly higher rates of child sexual abuse compared with the other groups. Females, sexual minority youth, and those who have lived in more foster care homes were more likely to be in the high exposure group compared with the low and/or medium exposure groups. Multivariate results revealed that those in the medium and high exposure cluster groups had higher rates of Wave 1 depressive symptoms and Wave 1 anxiety compared with youth in the low exposure cluster. Overall, although these young people experience high rates of abuse and victimization both at home and while on the street, there are gradations in these experiences such that certain victimization experiences subgroups are at heightened risk for poor mental health.

Hooking-Up and Sexual Victimization on Campus: Examining Moderators of Risk.

Hooking-up among college students presents an increased risk of sexual victimization, perhaps due to increased contact with potential perpetrators in a risky context. However, little work has examined factors that might increase the risk of victimization associated with hooking-up, and few studies examine victimization among both men and women. To address this gap in the literature, we utilize data from 702 college women and 677 college men to explore childhood sexual abuse, family violence, sexual minority (SM) status, and problematic alcohol use as potential moderators of the association between hooking-up and three forms of sexual victimization: coerced, incapacitated, and forced. Results of regression analyses indicate several significant interactions and significant main effects. For example, SM men and women were each at an increased risk of forced and incapacitated victimization when hook-up frequency was high compared with non-SM students.

Nocardia farcinica Brain Abscess in an Immunocompetent Host With Pulmonary Alveolar Proteinosis: A Case Report and Review of the Literature.

A 55-year-old immunocompetent male presented with new-onset seizures and acute respiratory failure requiring intubation and a stay in the medical intensive care unit. Magnetic Resonance Imaging (MRI) of the brain revealed ring-enhancing lesions, and Computed Tomography (CT) chest showed ground-glass opacity. The patient underwent craniotomy and bronchoscopy, followed by culture of the purulent aspirate from lesions in the brain and bronchoalveolar lavage (BAL). After extensive infectious workup, the patient was diagnosed with a Nocardia farcinica brain abscess plus underlying pulmonary alveolar proteinosis (PAP). Based on a recommendation from an infectious disease expert, the patient was treated with trimethoprim-sulfamethoxazole (TMP/SMX). This case highlights the importance of understanding that, though rare, infections such as nocardiosis can present in immunocompetent patients and cause severe morbidity.

Short Message Service Surveying With Homeless Youth: Findings From a 30-Day Study of Sleeping Arrangements and Well-Being.

Little is known about the location and consistency of sleeping arrangements among youth experiencing homelessness (YEH) and how this is linked to their well-being. This study addresses this gap using ecological momentary assessment (EMA) via short message service (SMS) surveying with 150 YEH over 30 days, to examine how various sleeping arrangements are associated with depression, marijuana use, support received, and service utilization. Results revealed that the average number of consecutive days youth stayed at any particular location varied considerably. Youth who stayed more frequently with a friend/partner or in a transitional living facility (TLF) reported fewer days of being depressed, whereas staying with a friend/ partner was associated with using marijuana more frequently. Finally, youth staying with a friend/partner, stranger, or TLF reported using services on fewer days. Because sleeping arrangements change almost daily, on average, this has important public health implications for agencies finding permanent housing for YEH.

Childhood Disadvantage, Social and Psychological Stress, and Substance Use Among Homeless Youth: A Life Stress Framework.

We used a life stress framework to examine linkages between distal or primary stressors (e.g., child abuse) and proximal or secondary stressors (e.g., street victimization) and their association with substance use among 150 youth experiencing homelessness in the Midwestern United States. Results revealed that numerous primary stressors such as number of times youth ran from home and number of foster care placements were associated with secondary stressors, such as anxiety, total duration of homelessness, and street victimization. Only street physical victimization (e.g., been beaten up since leaving home) was associated with greater substance use. Our findings provide a more holistic picture of both distal and proximal life stressors that these young people experience and reveal the complexity of issues that service providers must acknowledge when working with this population.

A comparison of frequency of alcohol and marijuana use using short message service surveying and survey questionnaires among homeless youth.

BACKGROUND: There are several benefits to using short message service surveying (SMS) to gather data on substance use from homeless youth, including capturing data "in the moment" and verifying the timing of one behavior relative to another. Though SMS is a valuable data collection tool with highly mobile populations that otherwise are difficult to longitudinally sample, the reliability of SMS compared with surveys is largely unknown with homeless youth. Examining the reliability of SMS is important because these data can provide a more nuanced understanding of the relationships between various risk behaviors, which may lead to better intervention strategies with these youth. OBJECTIVES: We compared past 30-day survey and SMS data for youth's alcohol and marijuana use. METHODS: Interviewed 150 homeless youth (51% female) using surveys and SMS. RESULTS: Past 30-day survey and SMS data revealed moderately strong correlations for alcohol (rs  = .563) and marijuana (rs  = .564). Regression analysis revealed that independent variables were similarly associated with alcohol and marijuana use when comparing survey and SMS data with two exceptions: heterosexual youth reported less alcohol use in SMS data compared to survey data (ß = -.212; p < .05 vs. ß = -.006; p > .05, respectively) and youth whose parents had alcohol problems reported less marijuana use in survey data compared to SMS data (ß = -.277; p < .01 vs. ß = -.150; p > .05, respectively). CONCLUSION: Findings indicate SMS and surveys are both reliable methods of gathering data from homeless youth on substance use.

Risk and Protective Factors for Substance Use Among Youth Experiencing Homelessness.

BACKGROUND: Though research finds that youth experiencing homelessness (YEH) have high rates of substance use, which can lead to numerous long-term negative health effects, less is known about both risk and protective factors for substance use. Moreover, even less is known about whether these factors differ for lesbian, gay and bisexual (LGB) youth compared to non-LGB youth. In the current study, we compared risk and protective factors for binge drinking, marijuana use, and illicit drug use (i.e. substance use) among heterosexual and sexual minority YEH. METHODS: The sample included 322 young people experiencing homelessness in the Midwestern United States and who were between 16 and 26 years of age. Almost one-half of our sample were female (N = 146; 45%) and 68 youth (21%) identified as LGB. RESULTS: Youth who experienced more child physical abuse, ran away from home more frequently, and those who had a parent(s) with drug problems were more likely to have reported binge drinking in the past 30 days. Additionally, having parents with drug problems was associated with the use of marijuana and illicit drugs. Conversely, having higher parental monitoring while growing up reduced the likelihood of using marijuana and illicit drugs. Tests for interactions revealed that while self-efficacy had no relationship with the probability of binge drinking for heterosexual youth, as self-efficacy increased, the probability of binge drinking declined drastically for sexual minority youth suggesting this protective mechanism operates differently for these two groups of youth. Additionally, tests of interactions showed that the probability of binge drinking among heterosexual and sexual minority youth also varied by child sexual abuse and street sexual victimization. CONCLUSION: Study results have implications for service providers who serve YEH.

Toward a Comprehensive Model of Physical Dating Violence Perpetration and Victimization.

Though physical dating violence is prevalent among college students, the literature remains disjointed due to the number of studies that are a theoretical. As such, we examine physical dating violence perpetration and victimization informed by three theories: the background-situational model of dating violence, social learning theory, and attachment theory. Results revealed that gender, child abuse, styles of attachment, and risky behaviors were associated with both perpetrating and being a victim of physical dating violence. Protective factors, including maternal relationship quality and religiosity, were associated with a lower risk of perpetrating dating violence. Analyses demonstrate that some elements of all three theoretical perspectives were associated with dating violence perpetration and victimization. Implications of the study findings on practice and future research are discussed.