Prevalence and Risk Factors of Depression and Posttraumatic Stress Disorder After a Mass Shooting.

This cross-sectional study examines the self-reported mental health outcomes of adults 4 years after witnessing and surviving the shooting at the Route 91 Harvest Music Festival in Las Vegas, Nevada.

Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations.

Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.

The REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Protocol: Using a Universal Screener to Improve Mental Health and Enhance HIV Care Outcomes.

Among people living with HIV (PLWH), 50% report substance use disorders (SUDs), and 30-61% report posttraumatic stress disorder (PTSD). Comorbid PTSD/SUD/HIV has been linked to faster HIV progression and twice the rate of death, lower medical adherence and retention, and increased viral load compared to PLWH without co-occurring PTSD or SUD. A critical first step in establishing comprehensive mental health services for PLWH is the implementation of an evidence-based screening protocol for PTSD and SUDs to facilitate referrals to specialty mental health providers. Guided by the Consolidated Framework for Implementation Research, this mixed-methods study aimed to examine the feasibility of delivering the REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Screening protocol. Three case managers were instructed to provide the REACH screening electronically to all patients that they saw for enrollment or re-enrollment appointments over 3 months (n=102). Of the 70 patients who completed the screener, 27% had clinically significant PTSD symptoms and 48.6% had SUD concerns. Qualitative feedback revealed themes related to beliefs about SU and PTSD, attitudes toward screening, comfort in the discussion of SU and PTSD, and referral and treatment considerations. Discussion includes lessons learned for implementation of this assessment of PTSD/SUD in PLWH as a novel approach to increase mental health engagement and promote health equity, with the potential long-term impact of improving HIV care outcomes via ameliorating mental health/SUD, and implications for prevention of HIV transmission. Implementation science can be leveraged to understand the gap in the utilization of existing evidence-based screening tools in HIV care settings.

Association of mental health symptoms on HIV care outcomes and retention in treatment.

OBJECTIVE: The purpose was to examine associations between HIV care engagement and mental health symptoms among persons living with HIV (PLWH) receiving ART. This study builds upon previous findings indicating a significant association between mental health and retention in HIV care,1 while also advancing the literature by examining the impact of substance use on this link, as well as potential bidirectional associations. METHOD: Participants of the current study were 493 patients who engaged in care and received antiviral therapy (ART) from Infectious Disease physicians between 2017 and 2019 in a large academic medical center. RESULTS: Results from hierarchical regression analyses revealed that patients who missed more days of ART medication had higher depressive symptoms, even when accounting for the effect of demographic variables and alcohol use. Further, depressive symptoms predicted significant variance in number of "no show" visits, but was not individually predictive of ""no show"" visits beyond the effect of other HIV care outcomes (e.g., number of days of medication missed). CONCLUSION: Findings reflect linkages among HIV treatment adherence, mental health, and substance use, and highlight the need to target mental health symptoms to improve outcomes among PLWH and prevent HIV transmission.

Assessment Tools for Children who Experience Traumatic Loss: A Systematic Review.

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures.

Facial expressions can be categorized along the upper-lower facial axis, from a perceptual perspective.

A critical question, fundamental for building models of emotion, is how to categorize emotions. Previous studies have typically taken one of two approaches: (a) they focused on the pre-perceptual visual cues, how salient facial features or configurations were displayed; or (b) they focused on the post-perceptual affective experiences, how emotions affected behavior. In this study, we attempted to group emotions at a peri-perceptual processing level: it is well known that humans perceive different facial expressions differently, therefore, can we classify facial expressions into distinct categories in terms of their perceptual similarities? Here, using a novel non-lexical paradigm, we assessed the perceptual dissimilarities between 20 facial expressions using reaction times. Multidimensional-scaling analysis revealed that facial expressions were organized predominantly along the upper-lower face axis. Cluster analysis of behavioral data delineated three superordinate categories, and eye-tracking measurements validated these clustering results. Interestingly, these superordinate categories can be conceptualized according to how facial displays interact with acoustic communications: One group comprises expressions that have salient mouth features. They likely link to species-specific vocalization, for example, crying, laughing. The second group comprises visual displays with diagnosing features in both the mouth and the eye regions. They are not directly articulable but can be expressed prosodically, for example, sad, angry. Expressions in the third group are also whole-face expressions but are completely independent of vocalization, and likely being blends of two or more elementary expressions. We propose a theoretical framework to interpret the tripartite division in which distinct expression subsets are interpreted as successive phases in an evolutionary chain.

Typical and atypical neurodevelopment for face specialization: an FMRI study.

Individuals with autism spectrum disorder (ASD) and their relatives process faces differently from typically developed (TD) individuals. In an fMRI face-viewing task, TD and undiagnosed sibling (SIB) children (5-18 years) showed face specialization in the right amygdala and ventromedial prefrontal cortex, with left fusiform and right amygdala face specialization increasing with age in TD subjects. SIBs showed extensive antero-medial temporal lobe activation for faces that was not present in any other group, suggesting a potential compensatory mechanism. In ASD, face specialization was minimal but increased with age in the right fusiform and decreased with age in the left amygdala, suggesting atypical development of a frontal-amygdala-fusiform system which is strongly linked to detecting salience and processing facial information.