A Broad Examination of Mental Health Literacy Among College Students in the United States.

BACKGROUND: High levels of mental health literacy (MHL) have been linked to the ability to correctly recognize certain problems as mental health issues, which then may lead to effective help-seeking behaviors. Most research on MHL has focused on a limited number of psychiatric diagnoses, using Australian samples. OBJECTIVE: This study aimed to investigate various components of MHL in a large sample of undergraduate students in the United States. METHODS: We conducted a vignette-based study with 843 undergraduate students. Six psychiatric diagnoses (and two "non-disordered" scenarios) were represented in distinct vignettes. Participants rated the severity of each vignette character's problem, the helpfulness of numerous treatment options, and the likelihood that different etiological factors contributed to the character's problem. KEY RESULTS: Across all clinical vignettes, therapy/counseling was perceived to be the most helpful treatment. Participants rated "personal weakness/lack of willpower" as contributing the most to the alcohol use disorder (AUD) character's problems. Our hypothesis related to how perceptions of etiology may impact participants' perceptions of different types of treatment was partially supported for the depression character. When participants described the depression character as having a "psychological/mental health problem," they were more likely to perceive therapy/counseling as being helpful compared to medication. CONCLUSIONS: Participants recognized most of the psychiatric diagnoses as a mental health problem, acknowledged the seriousness of the presenting problems, and recommended effective help-seeking behavior. However, undergraduate U.S. students could benefit from increased MHL specifically related to AUD. [HLRP: Health Literacy Research and Practice. 2023;7(4):e207-e214.].

PLAIN LANGUAGE SUMMARY: This study sought to measure various components of MHL in a large sample of U.S. undergraduate students. Findings demonstrated that AUD remained largely misunderstood and stigmatized. Students would likely benefit from increased education related to factors that contribute to alcohol use disorder.

Exposure to an Anonymous Survivor Instagram Account is Linked to Institutional Betrayal Among Campus Sexual Misconduct Survivors.

The main purpose of this study was to examine whether viewing an anonymous survivor social media (Instagram) account was linked to PTSD symptoms and institutional betrayal among campus sexual misconduct survivors. Data were collected from 259 undergraduate students (78.8% female; 79.2% White) who completed an online cross-sectional survey. Results demonstrated that 85 participants (32.8%) endorsed exposure to at least one unwanted sexual experience since coming to college. Of these trauma-exposed participants, 21 (24.7%) reported clinically elevated symptoms of PTSD secondary to the unwanted sexual experience. The average number of instances of institutional betrayal following the sexual trauma was 2.73 (SD = 2.75), and institutional betrayal was positively correlated with PTSD symptoms (r = .29, p = .008). An independent samples t-test showed that trauma-exposed participants who viewed an anonymous survivor Instagram account specific to their college reported higher institutional betrayal compared to trauma-exposed participants who did not view the account (d = 1.55). Furthermore, frequent viewing of the Instagram account (i.e., at least once per week) was associated with the highest reported institutional betrayal (d = .49). Whether or not trauma-exposed participants viewed the Instagram account did not appear to be associated with PTSD symptoms. To the authors' knowledge, this is the first study to examine the associations among exposure to an anonymous survivor Instagram account, institutional betrayal, and PTSD symptoms. While further research is needed to understand the causal relationship among these variables, these results highlight the continued and urgent need of institutions of higher education to address campus sexual misconduct, in the form of reporting/adjudication processes and robust prevention programming.

Posttraumatic Stress Symptom Severity Mediates the Relationship Between Military Sexual Trauma and Tension Reduction Behaviors in Male and Female Veterans.

Numerous studies attest to the prevalence and complex negative consequences associated with military sexual trauma (MST). However, relatively less is known about male survivors and about the interaction of psychological problems such as posttraumatic stress disorder (PTSD) symptoms and emotion management difficulties following MST. The current study examined the path of psychological distress following MST in both male and female veterans. We predicted that (a) history of MST would predict more severe PTSD symptoms, which in turn would predict greater use of dysfunctional emotion management strategies (specifically, tension reduction behaviors) and that (b) PTSD symptoms would mediate the relationship between history of MST and tension reduction behaviors. Finally, we explored whether the indirect (i.e., mediating) effect was moderated by gender. Data were obtained from pretreatment paper and pencil assessments administered as part of standard clinical care from 338 veterans seeking treatment at a Veterans Affairs (VA) mental health specialty clinic. Veterans who endorsed MST experienced more severe PTSD symptoms and greater reported use of tension reduction behaviors. Bootstrapping testing the indirect effect revealed that PTSD symptoms mediated the relationship between history of MST and tension reduction behaviors. An exploratory moderated mediation analysis found that the indirect effect did not differ as a function of gender. PTSD symptoms appear to mediate the relationship between MST and tension reduction behaviors in veterans, regardless of gender. While previous research has suggested that civilian men report a greater number of tension reduction behaviors following a sexual assault compared to civilian women, we did not find the same gender differences among veterans. These results may provide support for using trauma-focused treatment even when MST survivors are reporting high-risk tension reduction behaviors.

Emotion regulation in undergraduate students with posttraumatic stress symptoms: A multimethod study.

Objective: Existing literature suggests strong positive associations between posttraumatic stress disorder (PTSD) symptoms and emotion regulation difficulties; however, many of these findings are the result of monomethodological approaches (e.g., self-report questionnaires) versus multimethodological approaches. The current study utilized both self-report questionnaires and an emotion regulation choice paradigm (see Sheppes, Scheibe, Suri, & Gross, 2011) to assess various facets of emotion dysregulation in a sample of trauma-exposed undergraduate students with varying levels of self-reported PTSD symptoms (measured by the PTSD Checklist, fifth edition). Method: Data were collected from 83 students who underwent a laboratory paradigm, followed by completion of numerous self-report measures of emotion regulation (e.g., the Difficulties in Emotion Regulation Scale, the Acceptance and Action Questionnaire-II, and the Emotion Regulation Questionnaire). Results: Students with probable PTSD (n = 25) exhibited greater emotion dysregulation on self-report measures compared with students with nonprobable PTSD (n = 58; ηp² ranged from .06 to .42). Additionally, results from the emotion regulation choice paradigm suggested that students with probable PTSD were more likely to exhibit regulatory inflexibility compared with students with nonprobable PTSD (ηp² = .05). In other words, students with probable PTSD were less likely to use reappraisal (vs. distraction) to help regulate their emotions in response to low-intensity negative stimuli compared with students with nonprobable PTSD. Conclusions: Students with probable PTSD report greater perceived emotion regulation difficulties on self-report questionnaires as well as greater behavioral regulatory inflexibility during a laboratory paradigm. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Treatment choice among veterans with PTSD symptoms and substance-related problems: Examining the role of preparatory treatments in trauma-focused therapy.

Although common practice in Veterans Affairs (VA) PTSD clinics, it is unclear whether preparatory treatment improves trauma-focused treatment (TFT) completion and outcomes. Furthermore, little is known about whether treatment-seeking veterans in naturalistic settings would chose to prioritize preparatory treatment if given the option of a phase-based approach or direct access to TFT, and how substance-related problems (SRPs) influence this treatment choice. The first aim of this study was to explore how co-occurring SRPs (ranging from none to moderate/severe) influence PTSD treatment choices in a naturalistic setting where veterans were offered a choice between a phase-based approach (i.e., preparatory treatment) or direct access to TFT. The study also examined whether initial treatment choice and severity of co-occurring SRPs influenced TFT completion and outcomes. The second aim was to investigate whether preparatory treatment led to superior TFT completion or outcomes, irrespective of co-occurring SRPs. Analyses were conducted using archival data from 737 United States veterans referred for outpatient VA PTSD treatment. SRPs did not predict initial treatment choice or the length of preparatory group participation. Neither SRPs nor preparatory group participation predicted TFT completion or outcomes (measured as change in PTSD and depression symptoms from pre- to post-TFT). Preparatory group participation did not predict improved TFT completion or outcomes, irrespective of co-occurring SRPs. These findings suggest that veterans with PTSD symptoms and co-occurring SRPs may make similar treatment choices and benefit from either a phase-based approach or direct TFT initiation, and preparatory treatments may not increase patient readiness for veterans seeking TFT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

High dose alcohol consumption predicts less reduction in post-traumatic stress symptoms after a campus mass shooting.

BACKGROUND: Recognizing that alcohol might affect subsequent processing of trauma-related information, this study examined whether high dose alcohol consumption (HDAC) following a campus mass shooting affected the relation between shooting exposure and post-traumatic stress symptoms (PTSS). METHODS: Female participants (N = 691) recorded levels of physical exposure to the shooting event, alcohol use, and PTSS 1 month following the shooting event and 8 months later. RESULTS: No evidence was found to suggest that pre-shooting HDAC moderated the relationship between trauma exposure and PTSS 1 month following the shooting. HDAC in the month following the shooting predicted less resolution of PTSS 8 months later. Specifically, at higher (but not lower) levels of HDAC, shooting exposure was associated with less reduction in PTSS from 1 to 8 months post-trauma. Several alternate explanations were ruled out. CONCLUSIONS: Less reduction in PTSS seems to occur at high levels of both shooting exposure and HDAC. Theoretical implications and directions for future research are discussed.

Trauma-Related Pain, Reexperiencing Symptoms, and Treatment of Posttraumatic Stress Disorder: A Longitudinal Study of Veterans.

Research has demonstrated a strong positive association between posttraumatic stress disorder (PTSD) symptoms and physical pain. However, few studies have explored the impact of pain problems on the symptoms and treatment of PTSD, and results remain inconsistent. This longitudinal study examined whether trauma-related and trauma-unrelated pain differentially and uniquely predicted reexperiencing symptoms. We also examined whether levels of reexperiencing symptoms mediated the relationship between pain intensity and posttreatment symptoms of avoidance, numbing, and hyperarousal (ANH). Analyses were conducted using archival data from 99 treatment-seeking veterans who reported the etiology and intensity of their pain and severity of PTSD symptoms pre- and posttreatment. Among veterans with trauma-related pain, pain intensity (a) uniquely corresponded to greater posttreatment reexperiencing symptoms (b = 1.09), and (b) was indirectly predictive of ANH symptoms via the reexperiencing symptoms (b = 1.93). However, veterans with trauma-unrelated pain evidenced no associations between pain intensity and reexperiencing (b = 0.04) or ANH symptoms (b = 0.06). We thus found that trauma-related pain was indirectly related to poor PTSD treatment outcomes via reexperiencing symptoms. These findings offer additional insight into factors that may influence PTSD treatment outcomes for pain-suffering trauma survivors.

Childhood Sexual Abuse and Later Alcohol-Related Problems: Investigating the Roles of Revictimization, PTSD, and Drinking Motivations Among College Women.

The current study sought to examine whether symptoms of posttraumatic stress disorder (PTSD), adolescent sexual assault (ASA), and drinking motivations (e.g., drinking to regulate emotional experiences) mediate the relationship between a history of childhood sexual abuse (CSA) and subsequent alcohol-related problems among college women. Participants were 579 female students at a Midwestern university. Participants were recruited as part of a larger longitudinal study that investigated risk and resiliency factors related to sexual revictimization. Using a serial mediation model, the current study found that the proposed constructs mediated the relationship between CSA and subsequent alcohol-related problems via two separate paths. In one path, CSA was associated with PTSD, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. In the second path, CSA was related to ASA, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. These results suggest that individuals with a history of CSA are more likely to experience both revictimization in adolescence and PTSD symptoms in adulthood, which may lead to alcohol-related problems via drinking to regulate emotional experiences. These findings suggest the importance of incorporating skills training in adaptive emotion regulation strategies into treatment for individuals with a history of CSA and ASA.

Addressing Psychometric Limitations of the Difficulties in Emotion Regulation Scale Through Item Modification.

Through its frequent use, a pattern has emerged showing psychometric limitations of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). This 3-part study sought to (a) determine whether these limitations are due to a method effect by rewording all reverse-coded items in a straightforward manner and submitting them to exploratory factor analysis (EFA), and (b) examine the tenability of an adaptation of the original measure. EFA results from Study 1 (N = 743) supported retention of 29 modified items across 5 factors. Consistent with the original theoretical underpinnings of the DERS, Awareness and Clarity items loaded on the same factor. In Study 2 (N = 738), confirmatory factor analysis (CFA) was used to examine the factor structure of the pool of items identified in Study 1. All of the modified subscales clustered strongly with one another and evidenced large loadings on a higher-order emotion regulation construct. These results were replicated in Study 3 (N = 918). Results from Study 3 also provided support for the reliability and validity of scores on the modified version of the DERS (i.e., internal consistency, convergent and criterion-related validity). These findings provide psychometric support for a modified version of the DERS.

Fear-Potentiated Startle and Fear Extinction in a Sample of Undergraduate Women Exposed to a Campus Mass Shooting.

Posttraumatic stress disorder (PTSD) is a common psychological disorder that affects a substantial minority of individuals. Previous research has suggested that PTSD can be partially explained as a disorder of impaired fear inhibition. The current study utilized a previously validated fear acquisition and extinction paradigm in a sample of 75 undergraduate women who were exposed to a campus mass shooting that occurred in 2008. We used a protocol in which conditioned fear was first acquired through the presentation of one colored shape (reinforced conditioned stimulus, CS+) that was paired with an aversive airblast to the larynx (unconditioned stimulus, US) and a different colored shape that was not paired with the airblast (non-reinforced conditioned stimulus, CS-). Fear was extinguished 10 min later through repeated presentations of the CSs without reinforcement. Number of clinically significant posttraumatic stress symptoms (PTSS) immediately following the mass shooting were positively associated with fear-potentiated startle (FPS) to the CS+ and CS- during late periods of acquisition. During early periods of fear extinction, PTSS was positively associated with FPS to the CS+. Results from the current study suggest that PTSS is related to altered fear inhibition and extinction during an FPS paradigm. In line with similar research, women with greater PTSS demonstrated a greater "fear load," suggesting that these women experienced elevated fear to the CS+ during extinction after conditioned fear was acquired.

Self-reported physical health associations of traumatic events in medical and dental outpatients: a cross-sectional study.

The purpose of this cross-sectional study was to understand the prevalence and severity of health-related sequelae of traumatic exposure in a nonpsychiatric, outpatient sample.Self-report surveys were completed by patients seeking outpatient medical (n = 123) and dental care (n = 125) at a large, urban academic medical center.Results suggested that trauma exposure was associated with a decrease in perceptions of overall health and an increase in pain interference at work. Contrary to prediction, a history of interpersonal trauma was associated with less physical and emotional interference with social activities. A history of trauma exposure was associated with an increase in time elapsed since last medical visit. Depression and anxiety did not mediate the relationship between trauma history and medical care.Based on these results, clinical and research implications in relation to the health effects of trauma are discussed. The results suggest that routine screening for traumatic events may be important, particularly when providers have long-term relationships with patients.

Prospective trajectories of posttraumatic stress in college women following a campus mass shooting.

In a sample with known levels of preshooting posttraumatic stress (PTS) symptoms, we examined the impact of a campus mass shooting on trajectories of PTS in the 31 months following the shooting using latent growth mixture modeling. Female students completed 7 waves of a longitudinal study (sample sizes ranged from 812 to 559). We identified 4 distinct trajectories (n = 660): (a) minimal impact-resilience (60.9%), (b) high impact-recovery (29.1%), (c) moderate impact-moderate symptoms (8.2%), and (d) chronic dysfunction (1.8%). Individuals in each trajectory class remained at or returned to preshooting levels of PTS approximately 6 months postshooting. The minimal impact-resilience class reported less prior trauma exposure (η(2) = .13), less shooting exposure (η(2) = .07), and greater emotion regulation skills than all other classes (η(2) > .30). The chronic dysfunction class endorsed higher rates of experiential avoidance prior to the shooting than the minimal-impact resilient and high impact-recovery classes (η(2) = .15), as well as greater shooting exposure than the high impact-recovery class (η(2) = .07). Findings suggest that preshooting functioning and emotion regulation distinguish between those who experience prolonged distress following mass violence and those who gradually recover.