Factors predicting the development of psychopathology among first responders: A prospective, longitudinal study.

Objective: Previous research has shown that first responders exhibit elevated rates of psychopathology. Factors predicting the development of this psychopathology, however, remain understudied. This study longitudinally examined predictors of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in first responders. Method: Participants included 135 emergency medical service (EMS) providers. Multiple linear regressions were used to model predictors of change in PTSD, depression, and anxiety symptomatology from baseline to 3-month follow-up. Baseline levels of social support, sleep, emotional stability, and perceived stress were examined as potential predictors. Results: Results revealed that (a) increases in PTSD symptoms, (b) increases in depression symptoms, and (c) increases in anxiety symptoms at 3-month follow-up were each predicted by worse sleep and lower social support at baseline. In particular, the sleep subscale of disturbed sleep and the social support subscale of appraisal appeared to be driving these effects. Conclusion: These results highlight the importance of social support and sleep hygiene in protecting against increases in psychopathology symptoms in EMS providers, and set the stage for future interventions to target sleep disturbances and encourage deeper social connections in order to foster resilience in first responders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Identifying Frequency of Mild Traumatic Brain Injury in Firefighters.

Background: Mild traumatic brain injury (mTBI) is a nationwide problem; yet, no firefighter mTBI data are available. Methods: In this cross-sectional study, we assessed retrospective head injuries using WHO guidelines. We captured mTBI frequency and examined firefighters' symptoms (e.g., using Ohio State University Traumatic Brain Injury Identification method, Brief Traumatic Brain Injury Screen, Warrior Administered Retrospective Causality Assessment Tool). Findings: Of 1,112 firefighters contacted, 60 responses were included. Most participants were White (80%), male (90%), former athletes (75%). 62% met mTBI symptom criteria. 75% reported at least one lifetime head injury. Number of head injuries and depression symptoms were associated (r = .36, p < .05). Conclusion/application to practice: Overall, it appears most firefighters have sustained at least one lifetime mTBI. Those with multiple head injuries may be at increased risk of depression. Occupational health professionals should be aware of firefighters' mTBI risk. Further research is warranted given findings.

Factor Structure and Initial Validation of a Brief Measure of Perceived Emotional and Physical Distress Tolerance in Post-9/11 US Veterans.

Distress tolerance (i.e., perceived or actual capacity to tolerate aversive internal states) has received considerable research attention as a transdiagnostic risk-factor underlying the development and maintenance of psychopathology. Lower levels of emotional distress tolerance have been linked to psychopathology (e.g. Posttraumatic Stress Disorder) within Military populations; however, the association of physical distress tolerance to psychopathology in this population has been under-researched. This research gap may be due in part to a paucity of comprehensive, temporally stable and brief measures of distress tolerance that have been validated within Military populations, which may hinder further examination and refinement of the construct. Addressing this problem, the current study evaluates the psychometric properties of a novel and brief measure of emotional and physical distress tolerance in a sample of United States post-9/11 Veterans. Participants were 307 Veterans (Mage= 38.9, 67.7% male) who completed the 10-item Distress Tolerance Inventory at baseline and annual follow-up. Exploratory structural equation modeling was used to examine the optimal latent factor structure and longitudinal invariance of the DTI measurement model, along with correlational analyses to examine the convergent properties of the DTI subscales. The DTI reflected a longitudinally invariant two-factor structure (emotional and physical distress tolerance), with excellent internal consistency and preliminary evidence of convergent validity. Thus, the DTI represents a brief, reliable and temporally stable measure of physical and emotional distress tolerance.

Neuropsychological functioning, coping, and quality of life among returning war veterans.

PURPOSE: The present research tested the hypothesis that action- and emotion-focused coping strategies would mediate the relationship between neuropsychological functioning and quality of life among a sample of returning Iraq/Afghanistan veterans. METHOD: Veterans (N = 130) who served as part of the wars in Iraq and Afghanistan completed a diagnostic assessment of PTSD, a battery of questionnaires assessing coping style, traumatic brain injury (TBI), and quality of life, and neuropsychological tests measuring attention, learning and memory, working memory, inhibition, executive control, and visual motor coordination. RESULTS: Executive control, immediate and delayed verbal recall, and visual motor coordination were associated with quality of life. However, after controlling for the effects of combat exposure, PTSD, and probable TBI, no measure of neuropsychological functioning was directly associated with quality of life. Mediation analyses indicated that delayed verbal recall influenced quality of life through its effect on action-focused coping. CONCLUSIONS: Although replication is needed, these findings indicate that delayed verbal recall may indirectly influence quality of life among Iraq/Afghanistan veterans through its association with action-focused coping strategies. Psychologists who are working with veterans that are experiencing memory difficulties and poor quality of life may consider focusing on improving coping skills prior to rehabilitation of memory deficits. (PsycINFO Database Record

A test of whether coping styles moderate the effect of PTSD symptoms on alcohol outcomes.

Coping style may partially account for the frequent co-occurrence of posttraumatic stress disorder (PTSD) and alcohol-use disorder (AUD). We hypothesized that avoidant and action-oriented coping styles would moderate the association between PTSD symptom severity and alcohol outcomes among U.S. Operation Enduring Freedom/Operation Iraqi Freedom veterans, such that PTSD symptoms would be most strongly and positively associated with negative alcohol-related consequences and drinking quantity when action-oriented coping was low and avoidant coping was high. The sample (N = 128; 85.2% male, M = 37.8 years old, 63.3% Caucasian) completed a diagnostic assessment for PTSD and AUD and self-report surveys measuring coping styles, drinking quantity, and negative alcohol-related consequences. Consistent with the main hypothesis, a 3-way interaction among PTSD symptom severity, avoidant coping, and action-oriented coping was found in the predicted direction (d = 0.47-0.55). Post hoc descriptive analyses indicated that veterans with a current diagnosis of PTSD, low action-oriented coping, and high avoidant coping had worse alcohol outcomes and were twice as likely to meet criteria for current AUD compared with veterans with fewer risk factors. Findings suggest that the combination of PTSD and maladaptive coping styles may be more important for understanding alcohol-related outcomes than the presence of any of these variables in isolation.

Differences in drinking patterns, occupational stress, and exposure to potentially traumatic events among firefighters: predictors of smoking relapse.

BACKGROUND AND OBJECTIVES: Despite the increased awareness regarding the risks of cigarette smoking, this behavior continues to be a serious public health concern. As such, the goal of the current study was to examine risk factors for smoking relapse among individuals employed through fire service. METHODS: In this report, drinking changes, trauma exposure, and occupational stress were compared among firefighters (N = 81) who reported a relapse to cigarette smoking (n = 27), a lifetime former history of smoking (n = 27), or no history of smoking (n = 27). Mechanisms behind tobacco relapse occurring after employment in fire service were explored. RESULTS: Firefighters who relapsed to smoking, when compared to their nonsmoking peers, had higher rates of weekly alcohol consumption throughout their first year of fire service and had greater increases in drinking from preacademy to postacademy. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Gaining a better understanding of these behaviors within this understudied and high-risk population may provide valuable information that can be used in designing future relapse prevention strategies as well as smoking cessation interventions.

Effects of alcohol availability, access to alcohol, and naltrexone on self-reported craving and patterns of drinking in response to an alcohol-cue availability procedure.

OBJECTIVE: Craving has long been cited by patients and providers as a principal construct in alcohol use disorders and an essential target for treatment. The goal of the current study was to examine the effects of alcohol availability (20% vs. 80% availability), access to alcohol ("open" vs. "locked" trials), and medication (oral naltrexone [Revia] vs. placebo) on self-reported craving and two behavioral measures of drinking (latency of attempt to access alcohol, amount of alcohol consumed when access permitted) in response to an alcohol-cue availability procedure. METHOD: Non-treatment-seeking, alcohol-dependent men and women (N = 58) self-referred for an alcohol administration study and were administered a modified alcohol-cue availability procedure under two medication conditions (naltrexone, placebo) using a within-subjects, repeated-measures design. RESULTS: Analyses demonstrated that the experimental manipulations used in this study had differential effects on craving and patterns of drinking. Specifically, reduced availability of alcohol (i.e., when alcohol was available in only 20% as opposed to 80% of trials) resulted in greater amounts of alcohol consumed per open trial; the unanticipated blocking of access to alcohol (i.e., a "locked" trial during the 80% availability condition) triggered more rapid attempts to obtain alcohol on subsequent trials. Naltrexone, relative to placebo, was associated with significant reductions in cravings for alcohol. CONCLUSIONS: Taken together, these findings offer partial support for the cognitive processing model and reinforce the utility of evaluating both self-report and behavioral indicators of motivation to drink in studies designed to identify factors associated with the construct of craving.

Neuropsychological sequelae of PTSD and TBI following war deployment among OEF/OIF veterans.

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including use of combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that addiitonal studies are required to examine and understand the impact of specific factors on neurocognitive outcome. Of particular relevance are temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.

Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.

OBJECTIVE: A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans. METHOD: 213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression. RESULTS: Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs. CONCLUSIONS: These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans.

Mental Health Treatment Involvement and Religious Coping among African American, Hispanic, and White Veterans of the Wars of Iraq and Afghanistan.

Although racial/ethnic differences have been found in the use of mental health services for depression in the general population, research among Veterans has produced mixed results. This study examined racial/ethnic differences in the use of mental health services among 148 Operation Enduring/Iraqi Freedom (OEF/OIF) Veterans with high levels of depression and posttraumatic stress disorder (PTSD) symptoms and evaluated whether religious coping affected service use. No differences between African American, Hispanic, and Non-Hispanic white Veterans were found in use of secular mental health services or religious counseling. Women Veterans were more likely than men to seek secular treatment. After controlling for PTSD symptoms, depression symptom level was a significant predictor of psychotherapy attendance but not medication treatment. African American Veterans reported higher levels of religious coping than whites. Religious coping was associated with participation in religious counseling, but not secular mental health services.

Behavioral risks during the transition from high school to college.

The transition from high school to college is an important developmental milestone that holds the potential for personal growth and behavioral change. A cohort of 2,245 students was recruited during the summer before they matriculated into college and completed Internet-based surveys about their participation in a variety of behavioral risks during the last 3 months of high school and throughout the 1st year of college. Alcohol use, marijuana use, and sex with multiple partners increased during the transition from high school to college, whereas driving after drinking, aggression, and property crimes decreased. Those from rural high schools and those who elected to live in private dormitories in college were at highest risk for heavy drinking and driving after drinking.

Influence of physical attractiveness and alcohol on men's perceptions of potential sexual partners and sexual behavior intentions.

The current research presents the results of 2 related experimental studies designed to evaluate the influence of physical attractiveness and a moderate dose of alcohol on men's perceptions of potential sexual partners and sexual behavior intentions. Analyses revealed significant effects of physical attractiveness on partner perceptions and sexual behavior intentions. Although no main effects of alcohol were observed, alcohol differentially moderated the relations between perceived risk and sexual behavior intentions by limb of absorption. Results suggest that greater attention should be focused on identifying the specific physical characteristics of a potential sexual partner--beyond attractiveness--that influence perceptions of risk and intentions to engage in safer sex behaviors and highlight the importance of assessing limb of absorption in evaluating the complex association between alcohol and risky sexual behavior.