Moderating effects of brooding on the link between functional impairment and interpersonal needs in survivors of serious trauma.

OBJECTIVES: Trauma and resulting functional limitations demonstrate associations with perceived burdensomeness and thwarted belongingness, factors contributing to elevated risk for suicidal ideation. However, survivors display differential risk in response to impairment, highlighting the need for research on exacerbating factors. The current study examined the impact of brooding on the association of functional impairment with burdensomeness and belongingness among trauma-exposed undergraduates (N = 262). METHOD: Trauma was assessed via clinical interview with questionnaires for study variables. Regression models examined the unique and interactive effects of physical impairment, emotional impairment, and brooding on burdensomeness and thwarted belongingness. RESULTS: An interaction of brooding and impairment due to emotional difficulties was observed for burdensomeness with impairment linked to elevated burdensomeness at high (ß = -0.46; p < 0.001), but not low (ß = -0.07; p = 0.476) brooding. Impairment due to emotional difficulties (ß = -0.38; p < 0.001) and brooding (ß = 0.25; p < 0.001) were associated with belongingness. CONCLUSIONS: Findings identify brooding as a potential target for assessment and intervention in trauma-exposed individuals.

Behavioral inhibition and posttrauma symptomatology: Moderating effects of safety behaviors and biological sex.

OBJECTIVES: Behavioral inhibition is a trait-level factor associated with posttraumatic stress. Safety behaviors may impact this link by interfering with anxiety habituation. The current study examined the unique and interactive effects of behavioral inhibition, safety behaviors, and participant sex on posttrauma symptom clusters. METHOD: Participants (N = 131; 75.6% female; M = 19.9 years) completed a trauma history interview and questionnaires assessing behavioral inhibition, safety behavior, and posttrauma symptom severity. RESULTS: Safety behaviors were associated with intrusion (partial correlations [pr] = 0.319), avoidance (pr = 0.274), cognition-mood (pr = 0.274), and arousal-reactivity (pr = 0.538) symptoms (all p ≤ 0.001). An interaction of sex and safety behaviors was noted for avoidance (p = 0.047, pr = -0.159) with a significant relation observed only among women ( p < 0.001, pr = 0.442). Safety behaviors also moderated the link between behavioral inhibition and arousal-reactivity (p = 0.002, pr = 0.272) with inhibition predicting symptoms at high levels of safety behavior (p = 0.024, pr = 0.171). CONCLUSION: Trauma-related safety behaviors are associated with greater posttrauma symptoms and evidence differential effects across individual symptom domains.

Stability of reported trauma over extended intervals: Initial evaluation of an exposure screening protocol.

The reliability and validity of reported exposure to significant trauma is critical to research evaluating outcomes following serious and distressing life events. The current study examined the reliability of reported exposure to disaster, fire, transportation accidents, physical assault, and sexual assault across 5- (N = 251), 12- (N = 223), and 24-month (N = 109) intervals in undergraduates completing a screening measure of probable trauma (N = 3,045). Concordance with later responses to an alternate checklist and events assessed via clinical interview was examined in a subset of participants (N = 274). Five-month reliabilities ranged from good to fair (κ = .40-.71) and were similar to 1-2 week retest estimates in the extant literature. Reliabilities for fire, accidents, and sexual assault remained stable over 12- and 24-month intervals. Coefficients for disaster and physical assault decreased over time. Agreement with the alternate checklist was fair to excellent in those completing the follow-up assessment (κ = .51-.87). Concordance with interview-based trauma was acceptable for accidents (κ = .52) and sexual violence (κ = .82) but poor for disaster, fire, and physical assault (κ = .34-.38). Specificity, negative predictive power, and negative likelihood ratios suggest checklists may hold utility in ruling out previous trauma. Sensitivities indicate that screening instruments may broadly capture individuals experiencing traumatic life events although positive predictive power was limited except in the prediction of traffic accidents and sexual assault. Variability across domains suggests that the properties of checklist measures could be better conceptualized at the level of individual exposure events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exploring the relation between posttraumatic stress disorder and interpersonal outcomes: The role of social acknowledgment and trauma type.

OBJECTIVES: Research demonstrates consistent relations between posttrauma symptoms and interpersonal dysfunction. The current study examined the extent to which perceptions of community rejection account for the relation between posttraumatic stress disorder (PTSD) and interpersonal outcomes in students exposed to assaultive and nonassaultive trauma. METHOD: Participants (N = 137; 66.4% female; M = 20 years) completed a trauma history interview, questionnaires assessing symptom severity, social disapproval, and interpersonal outcomes. RESULTS: Assault survivors (n = 83) reported greater symptoms (d = 0.57), disapproval (d = 0.80), and social impairment (d = 0.51) relative to the nonassault group (n = 54). However, regression analyses indicated stronger associations between PTSD and community disapproval in survivors of nonassaultive (ß = 0.69; p < 0.001) versus assaultive (ß = 0.34; p < 0.001) events. Indirect effects of PTSD on perceived support and interpersonal functioning through social disapproval were also larger for nonassaultive versus assaultive groups (p < 0.05). CONCLUSION: Despite greater dysfunction among assault survivors, perceptions of disapproval may be a more salient factor for interpersonal dynamics following nonassaultive trauma.

Interventions for alcohol-related risky sexual behaviors among college students: A systematic review.

Alcohol-related risky sexual behaviors are common among college students. Though various interventions targeting these behaviors have been examined, the literature does not currently include a review of these strategies. A comprehensive literature search was conducted, yielding 7 randomized controlled trials. Relevant outcome variables included unprotected sex, alcohol in conjunction with sex, and number of sexual partners. Findings suggested that interventions utilizing reminder cues or motivational interviewing-based techniques were largely found to be effective in increasing condom use behaviors among intoxicated individuals, while support for personalized normative feedback (PNF) for the same outcome was mixed. However, PNF interventions were generally effective in reducing alcohol use in conjunction with sex. Finally, though few studies examined number of sexual partners, there are mixed findings for interventions (i.e., motivational interviewing, PNF) targeting this outcome. Overall, there is promising, albeit mixed, evidence of the effectiveness of interventions targeting various alcohol-related risky sexual behaviors among college students. Strengths, limitations, and implications of the findings of this systematic review for future research are discussed. (PsycINFO Database Record

The safety and efficacy of baclofen to reduce alcohol use in veterans with chronic hepatitis C: a randomized controlled trial.

BACKGROUND AND AIMS: Alcohol use disorders (AUDs) are common among people with chronic hepatitis C (HCV) and accelerate the development of fibrosis and cirrhosis caused by HCV. Baclofen, a gamma-aminobutyric acid (GABA) beta-receptor agonist, differs from medications for AUDs currently approved by the United States Food and Drug Administration (FDA), as it is metabolized primarily through the kidneys. The primary outcome of this study was to compare baclofen with a placebo in the percentage of days abstinent from alcohol. DESIGN: A double-blind, placebo-controlled randomized trial. SETTING: Hepatology clinics in four separate US Veteran Affairs Medical Centers in the United States. PARTICIPANTS: One hundred and eighty Veteran men and women older than 18 years with chronic HCV, a comorbid AUD and current alcohol use. INTERVENTION AND COMPARATOR: Oral baclofen was given at dosages of 0 (placebo) or 30 mg/day over 12 weeks with concomitant manual-guided counseling. MEASUREMENTS: The primary measurement was percentage of days abstinent during the 12-week study period between the baclofen and placebo groups [measured by time-line follow-back (TLFB)]. Secondary measurements were the percentage of Veterans who achieved complete abstinence, the percentage of Veterans who achieved no heavy drinking between weeks 4 and 12 of the study, alcohol craving, anxiety, depression and post-traumatic stress disorder (PTSD). FINDINGS: Primary outcome: compared with placebo, baclofen did not improve the percentage of days abstinent. For all subjects there were significant reductions from baseline to 12 weeks in percentage of days abstinent from 37.0% [standard error (SE) = 2.7] to 68.6% (SE = 2.8, F(1151.1)  = 66.1, P < 0.001). However, there was no statistically significant difference between groups for change in percentage of days abstinent over the 12-week study period [absolute difference 1.3% (-9.1 to 1.7%), F(1152.6)  = 0.005, P = 0.95]. SECONDARY OUTCOMES: Of subjects who completed the first 4 weeks of the study, 8.9% (15 of 168) achieved complete abstinence; 10.1% (nine of 89) in the placebo group and 7.6% (six of 79) in the baclofen group [χ2(1)  = 0.33, odds ratio (OR) = 0.73 (0.24-2.15)]. The percentage of no heavy drinking for all subjects between weeks 4 and 12 was 20.2% (34 of 168), but no statistically significant differences were found between placebo 15.7% (14 of 89) and baclofen 25.3% (20 of 79) [χ2(1)  = 2.38, OR = 1.82 (0.85-3.90)]. There were significant reductions for all subjects in all other secondary variables over the course of the study, but no differences between groups. Measures of various biomarkers of alcohol use did not change significantly throughout the course of the study for either the baclofen or placebo groups. CONCLUSIONS: Baclofen administered at 30 mg/day does not appear to be superior to placebo in increasing abstinence or in reducing alcohol use, cravings for alcohol or anxiety among people with alcohol use disorder.

Transformation to a recovery-oriented model of care on a veterans administration inpatient unit.

OBJECTIVES: Recovery-oriented care is among the highest treatment priorities for the Veteran Health Administration, which has endorsed organizational change of mental health care to reflect recovery values. The purpose of this quality improvement project was to determine whether recovery interventions would yield positive outcomes when delivered on in inpatient psychiatry. METHOD: Recovery interventions on the unit included recovery-focused interdisciplinary team meetings, opportunities for stakeholder feedback, recovery staff education, increased group programming, peer support, and changes to treatment planning to include increased Veteran engagement and responsibility. Participants included 352 patients and 27 staff. Outcomes were number of restraints/seclusions used, 30-day readmission rates, and staff satisfaction. RESULTS: Our results showed an overall decrease in restraint/seclusion use by over 50% and an increase in staff satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our results suggest that implementing a recovery-oriented model of care in an acute psychiatric inpatient unit may have significant benefits for both staff and patients. (PsycINFO Database Record

Psychiatric and substance use disorders co-morbidities and hepatitis C: Diagnostic and treatment implications.

Chronic hepatitis C virus (HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world's population or 170-200 million people are infected. In the United States as many as 3-5 million people may have HCV. Psychiatric and substance use disorders (SUDs) are common co-morbid conditions found in people with HCV and are factors in predisposing people to HCV infection. Also, these co-morbidities are reasons that clinicians exclude people from antiviral therapy in spite of evidence that people with HCV and co-morbid psychiatric and SUD can be safely and effectively treated. Furthermore, the neuropsychiatric side effects of interferon (IFN), until recently the mainstay of antiviral therapy, have necessitated an appreciation and assessment of psychiatric co-morbidities present in people with HCV. The availability of new medications and IFN-free antiviral therapy medication combinations will shorten the duration of treatment and exposure to IFN and thus decrease the risk of neuropsychiatric side effects. This will have the consequence of dramatically altering the clinical landscape of HCV care and will increase the number of eligible treatment candidates as treatment of people with HCV and co-morbid psychiatric and SUDs will become increasingly viable. While economically developed countries will rely on expensive IFN-free antiviral therapy, less developed countries will likely continue to use IFN-based therapies at least until such time as IFN-free antiviral medications become generic. The current manuscript discusses the efficacy and viability of treating HCV in people with psychiatric and SUDs comorbidities, the treatment of the neuropsychiatric side effects of IFN -based therapies and the impact of new medications and new treatment options for HCV that offer the promise of increasing the availability of antiviral therapy in this vulnerable population.

VISN 22 Evidenced-Based Psychotherapy Telemental Health Center and Regional Pilot.

A pilot program that delivers telemental health care for posttraumatic stress disorder provides best practices for facilities looking to expand in-home and remote care to veterans.