HIV status affects PTSD symptom severity, psychophysiology, and heart rate variability in women with low but not high exposure to childhood maltreatment.

Objective: People living with HIV (PLWH) experience high rates of childhood trauma exposure, which is a significant risk factor for the development of posttraumatic stress disorder (PTSD). Because Black Americans living in urban environments are exposed to high levels of trauma, suffer from chronic PTSD, and are at increased risk for HIV infection, it is important to understand how HIV status interacts with childhood maltreatment to influence PTSD symptom severity and underlying psychophysiology. Methods: The current cross-sectional study assessed whether HIV status interacts with childhood maltreatment to influence PTSD symptom severity and heart rate variability during a dark-enhanced startle (DES) task in 88 Black women with (n=30) and without HIV (n=58). Results: HIV was associated with greater PTSD symptom severity only in women with low levels of childhood maltreatment (p=.024). Startle potentiation during DES was highest in women living without HIV and with high childhood maltreatment (p=.018). In women who had experienced low levels of childhood maltreatment, respiratory sinus arrhythmia (RSA) was lower during the dark phase of DES in women living without HIV than women living with HIV (WLWH), (p=.046). RSA during the light phase of DES was lower in WLWH than in women living without HIV (p=.042). Conclusion: In the current sample of Black women, HIV status was associated with PTSD symptom severity in a manner dependent on level of childhood maltreatment, suggesting that HIV status may be an important factor to consider for behavioral and pharmacological treatment strategies for PTSD. Additionally, HIV status is associated with lower percent potentiation to darkness and lower RSA during the light phase of DES, suggesting physiological mechanisms by which HIV may contribute to PTSD symptoms in individuals exposed to low levels of childhood maltreatment.

Predicting aggressive behaviors: Examining unique and interactive roles of PTSD and emotion dysregulation in a minority sample.

Aggression is a costly public health problem with severe and multi-faceted negative consequences and thus, identifying factors that contribute to aggression, particularly in understudied populations, is necessary to develop more effective interventions to reduce the public health cost of aggression. The goal this study was to test whether difficulties regulating emotions moderated the association between posttraumatic stress disorder (PTSD) symptoms and aggression in a community sample of predominantly Black females with high levels of trauma exposure. Furthermore, we explored unique relations between PTSD symptom clusters and distinct subscales of difficulties regulating emotions and aggression. The sample included 601 community participants recruited from an urban public hospital. Symptoms were assessed using self-report measures including the Difficulties in Emotion Regulation Scale (DERS) and Behavioral Questionnaire-Short. Regression analyses were conducted using PTSD symptoms and total DERS to test their interaction as predictors for aggression (using BQ-Short). We found that higher levels of PTSD arousal symptoms and difficulty controlling impulses when upset were positively related to aggression. We also conducted an exploratory analysis to examine the association between PTSD symptom clusters using the Alternative Symptom Clusters hybrid model. The results suggest that some PTSD symptoms (externalizing behavior) and some emotion dysregulation processes (difficulties controlling impulses when upset), relate to aggression in independent, rather than multiplicative ways. These results offer insights for new directions of research that focuses on the independent association between specific emotion dysregulation processes and PTSD symptoms on aggression.

Interactive Effects of Racism and Racial Centrality on ADHD Symptoms.

OBJECTIVE: Although race-related stress is associated with numerous mental health outcomes, no previous research has examined associations with ADHD symptoms. We examine how such associations differ in Black Americans based on racial identity to allow for more nuanced understandings of racial discrimination's association with ADHD symptoms. METHODS: This study asked a sample of Black Americans to answer questionnaires assessing race-related stress, ADHD symptoms, and racial centrality. RESULTS: In predicting ADHD symptoms, we found a positive effect of race-related stress and a negative effect of centrality. At low levels of centrality, the association between ADHD symptoms and race-related stress was stronger than at mean and high levels of centrality. Through additional sub-group analyses we found the interaction effect not replicating in one of our conditions. CONCLUSION: These results suggest experiences of race-related stress and racial identity are important factors for consideration in the treatment of ADHD symptoms.

Feasibility and acceptability of a virtual mindfulness intervention for Black adults with PTSD and depression: Randomized controlled trial.

Mindfulness-based cognitive therapy (MBCT) offers promise as a group-based intervention to alleviate posttraumatic stress disorder (PTSD) and depression symptoms in traumatized Black adults. Given the high level of barriers that exist for low-income Black adults, virtual delivery of MBCT may be helpful. This pilot randomized controlled trial assessed feasibility and acceptability of an adapted 8-week virtual MBCT group intervention for Black adults screening positive for PTSD and depression. Forty-six participants (89.3% women) recruited from an urban safety net hospital were randomized to MBCT or waitlist control (WLC). Overall feasibility was fair (70%); however, completion rates were higher for WLC than MBCT (90% vs. 54%). Group acceptability was high across quantitative and qualitative measures for study completers. Perceived barriers to psychological treatment were high (>9). While showing potential via improved coping skills and positive health changes, this intervention's success hinges on mitigating engagement barriers for future delivery; additional studies are warranted.

The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals.

Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.

Eyes of the beholders: Multi-method relationships between internalizing and externalizing symptom dimensions and aggression risk.

Although aggression occurs across a range of disorders, associations between dimensions of psychopathology and self- and other-directed aggression are not well understood. Investigating associations between psychopathology dimensions and aggression helps further understanding about the etiology of aggression, and ultimately, can inform intervention and prevention strategies. This study adopted a multi-method approach to examine associations between internalizing and externalizing dimensions of psychopathology and self- and other-directed aggression as a function of reporter (participant and informant) and modality of aggression measurement (subjective and objective). Participants were an unselected sample of 151 racially diverse adults recruited from the community. Dimensions of psychopathology were assessed using interview and questionnaire reports from participants and collateral informants, and forms of aggression were measured via subjective reports and an objective, laboratory aggression paradigm. Analyses of participant-reported psychological symptom data consistently linked externalizing symptoms to other-directed aggression, and internalizing symptoms to self-directed aggression. Results across informant and participant reporters replicated prior findings showing a significant interaction between internalizing and externalizing dimensions in predicting intimate partner violence. Most other effects in informant models were nonsignificant. The findings uncover consistency in and replicability of relationships between dimensions of psychopathology and certain manifestations of aggression and highlight the importance of examining multiple forms of aggression in etiological research. Examining aggression through a transdiagnostic lens can help us better understand and intervene upon processes implicated in devasting forms of self- and other-directed aggression.

How well does the Index of Race-Related Stress-brief function in a trauma-exposed Black community sample? An item response theory examination of discrimination and difficulty parameters.

BACKGROUND: Race-related stress negatively impacts the mental health of Black Americans to a greater degree than other racialized groups. Additionally, trauma exposure is associated with more severe levels of posttraumatic stress disorder for individuals who also experience race-related stress. Therefore, an accurate assessment of race-related stress in a trauma-exposed sample of Black Americans is necessary to ensure the validity and reliability of empirical findings regarding race-related stress and intervention efficacy. The Index of Race-Related Stress (IRRS) is one of the most commonly used measures to assess race-related stress among Black Americans. Due to a lack of psychometric support for the abbreviated version of IRRS-brief (IRRS-B) on a trauma-exposed sample of Black Americans, our study aims to address this gap in literature. METHOD: We used item response theory (IRT) to assess item difficulty, discrimination, and factor structure in a sample of trauma-exposed Black Americans (n = 226). We employed a multidimensional graded response model with corresponding items loaded on to the three previously established factors of the IRRS. RESULTS: The most discriminating items asked about observing harsh treatment of Black individuals, experiencing less courtesy in establishments, and being stared at as though you do not belong. The item with the lowest difficulty described negative media representation of Black individuals while the item with the highest difficulty described lack of positive media portrayals of Black Americans. DISCUSSION: These results indicate that items varied considerably in the degree to which they adequately captured race-related stress. Future research should use IRT with newly worded questions to further improve the assessment of race-related stress in Black Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability.

INTRODUCTION: Depressive and mixed symptoms in bipolar disorder (BD) have been linked to higher suicide risk. Based on Klonsky and May's three-step theory and Joiner's Interpersonal Psychological Theory of Suicide, we hypothesized that patients diagnosed with BD who reported severe levels of depressive symptoms and mixed depressive and manic symptoms would also report higher levels of suicidal desire and acquired capability of suicide, as well as suicidal thoughts and behaviors. METHODS: The sample included 177 outpatients diagnosed with BD. Latent class analysis was conducted to replicate the identified groups of a previously conducted study using a smaller but overlapping dataset. Between-class and pairwise analyses with measures of suicidal desire and acquired capability were conducted. RESULTS: As expected, the classes characterized by severe depressive symptoms and mixed symptoms reported higher levels of suicidal desire. However, the results regarding acquired capability were less consistent. CONCLUSION: Given the overall elevated suicide risk of BD and the consistent relationship between depressive symptoms and other strong correlates of suicide, clinicians who work with patients diagnosed with BD should closely monitor changes in their depressive symptoms.

Civilian Moral Injury and Amygdala Functional Connectivity During Attention to Threat.

BACKGROUND: Moral injury references emotional and spiritual/existential suffering that may emerge following psychological trauma. Despite being linked to adverse mental health outcomes, little is known about the neurophysiological mechanisms of this phenomenon. In this study, we examined neural correlates of moral injury exposure and distress using the Moral Injury Exposure and Symptom Scale for Civilians. We also examined potential moderation of these effects by race (Black vs. White individuals) given the likely intersection of race-related stress with moral injury. METHODS: Forty-eight adults ages 18 to 65 years (mean age = 30.56, SD = 11.93) completed the Moral Injury Exposure and Symptom Scale for Civilians and an affective attentional control measure, the affective Stroop task (AS), during functional magnetic resonance imaging; the AS includes presentation of threat-relevant and neutral distractor stimuli. Voxelwise functional connectivity of the bilateral amygdala was examined in response to threat-relevant versus neutral AS distractor trials. RESULTS: Functional connectivity between the right amygdala and left postcentral gyrus/primary somatosensory cortex was positively correlated with the Moral Injury Exposure and Symptom Scale for Civilians exposure score (voxelwise p < .001, cluster false discovery rate-corrected p < .05) in response to threat versus neutral AS distractor trials. Follow-up analyses revealed significant effects of race; Black but not White participants demonstrated this significant pattern of amygdala-left somatosensory cortex connectivity. CONCLUSIONS: Increased exposure to potentially morally injurious events may lead to emotion-somatosensory pathway disruptions during attention to threat-relevant stimuli. These effects may be most potent for individuals who have experienced multilayered exposure to morally injurious events, including racial trauma. Moral injury appears to have a distinct neurobiological signature that involves abnormalities in connectivity of emotion-somatosensory paths, which may be amplified by race-related stress.

Examination of race-based traumatic stress symptom networks in Black adults in the United States: A network analysis.

In the United States, racism is theorized to exert its negative effects on Black individuals' mental health by triggering a response known as "race-based traumatic stress" (RBTS), a multidimensional construct comprising seven clusters of symptoms that can occur following exposure to race-based traumatic events (e.g., racial discrimination, racist incidents): depression, intrusion, anger, hypervigilance, physical symptoms, (low) self-esteem, and avoidance. However, little is known about which symptoms and clusters are strongest and most influential in the maintenance of RBTS. Network analysis is a powerful tool for understanding the etiology of traumatic stress, but it has not yet been applied to the examination of this construct. The present study aimed to identify the symptoms most central to RBTS and examine associations between symptoms and symptom clusters. Participants (N = 1,037) identified as Black, and lived in the United States (Mage = 45.12 years, range: 18-82 years) and completed the Race-Based Traumatic Stress Symptom Scale-Short Form (RBTSSS-SF). Regularized partial correlation networks were estimated using R/RStudio. The cluster- and item-level networks demonstrated adequate centrality stability, CS = .44. The depression and physical symptoms clusters were the most central nodes in the cluster network. Feelings of meaninglessness, experiencing mental images of the event, and physical trembling were the most central items within the item-level network. These findings offer insights and implications for assessing and treating symptoms of RBTS in Black adults in the United States who are exposed to race-based traumatic events.

How can white parents raise anti-racist children? Introducing the routes to effective anti-racist parenting (REAP) model.

In response to highly publicized instances of overt racial injustice, there has been a recent resurgence of interest and commitment to identifying processes through which anti-racist behaviors develop among White individuals. One particularly important context in which anti-racist behaviors can develop is within families and as a result of childrearing. Theories of anti-racism typically neglect the role of families and family science research typically neglects a focus on anti-racist parenting outcomes. To further research and applied work on fostering anti-racism within White families, this paper introduces a new integrative model called routes to effective anti-racist parenting (REAP). The model draws on theories from various fields, including family science and social psychology, and uses a metaphor of nurturing a plant to explain the nuanced, multi-faceted approaches to anti-racist parenting. The model incorporates factors related to the "pot" (i.e., fundamental values and structure necessary to contain more specific anti-racist skills and behaviors), "soil" (i.e., characteristics that define anti-racist commitment), "seeds" (i.e., direct transmission of anti-racism skills), and "environment" (i.e., influential external factors). Finally, we describe the intended benefits that can be reaped from this intentional approach to anti-racist parenting. The REAP model contributes to the family science literature by providing an empirically grounded theoretical model describing the roles that parents can play in children's anti-racist development.

Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples.

BACKGROUND: Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS: Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS: Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS: Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.

Indirect effect of race-related stress on traumatic stress and depression symptoms via subjective social status in a Black community sample.

Experiencing racism is linked to lower subjective social status (SSS), defined as one's perception of their position in society. SSS is influenced by power, prestige, and objective socioeconomic status (SES). Previous findings suggest that race-related stress may be related to adverse mental health outcomes through SSS in Black Americans, a population that has been deeply affected by continuing legacies of oppression. The current study examines the indirect association between race-related stress and posttraumatic stress disorder (PTSD) and depression symptoms through SSS in a community sample of largely trauma-exposed Black Americans (N = 173). Hierarchical regression analyses indicated that overall race-related stress significantly predicted lower SSS, higher PTSD symptoms, and higher depression symptoms. Analyses also revealed indirect effects of cultural race-related stress on PTSD and depression symptoms through SSS after controlling for SES. Results suggest that the experience of race-related stress, particularly cultural race-related stress, which involves the degradation and disparagement of one's culture and worldview, is associated with more severe PTSD and depression symptoms potentially due to these experiences decreasing Black Americans' SSS. Findings support the need for systemic intervention strategies to disrupt the cultural oppression of Black Americans and improve the societal value and mental health of this population.

Moral injury appraisals and dissociation: Associations in a sample of trauma-exposed community members.

Appraisal of trauma is a critical factor in the development of impairing post-traumatic stress symptoms, such as dissociation. Individuals may appraise trauma as morally injurious (i.e., moral injury exposure [MIE]) and experience subsequent moral distress related to this exposure (i.e., moral injury distress [MID]). To date, however, investigation into the relations between moral injury appraisals and dissociation has been limited, particularly within community populations. This study investigated MIE and MID in relation to six facets of dissociation (disengagement, depersonalization, derealization, memory disturbances, emotional constriction, identity dissociation) in a sample of trauma-exposed community members (n = 177, 58.2% Black, 89.3% female) recruited from a public hospital and/or community advertisements. Participants completed measures assessing trauma exposure, MIE, MID, dissociation, and posttraumatic stress disorder (PTSD) symptoms. Partial correlation analyses revealed that after controlling for PTSD symptoms, MIE was correlated with disengagement, r = .23, p ≤ .025, and depersonalization, r = .25, p ≤ .001, and MID was correlated with depersonalization, r = .19, p ≤ .025. Sex moderated each association, with stronger associations observed for female participants. Findings suggest that moral injury appraisals are linked to more severe dissociative symptoms among female civilians, and as such, may need to be specifically targeted in empirically supported treatments.

Intergenerational Transmission of Depression: Examining the Roles of Racism and Trauma Among Black Mothers and Youth.

OBJECTIVE: Racism is a multifaceted system of oppression that disproportionately harms Black mothers and children across the lifespan. Despite reliable evidence that racism is associated with worse mental health outcomes (eg, increased depressive symptoms), less is known about potential intergenerational effects of Black mothers' experiences of racism on children's mental health, as well as how traumatic experiences influence these pathways. In this cross-sectional quantitative study, we aimed (1) to replicate the finding that maternal experiences of racism are associated with both maternal and child depression; (2) to identify whether maternal experiences of racism are indirectly associated with child depression via the effect of maternal depression; and (3) to test whether the indirect effect of racism on child depression via maternal depression is conditioned on maternal trauma. METHOD: Black mothers and their children (N = 148 dyads) were recruited from an urban hospital and were interviewed about their experiences of racism, trauma, and mental health symptoms. The mothers' average age was 35.16 years (SD = 8.75) and the children's average age was 10.03 years (SD = 1.51). RESULTS: First, we found that maternal experiences of racism were associated with more severe maternal depression (r = 0.37, p < .01) as well as more severe child depression (r = 0.19, p = .02). Second, we found that maternal experiences of racism were indirectly associated with child depression through the effect of maternal depression (ab = 0.76, 95% CI = 0.26, 1.37). Third, we found that maternal trauma exposure moderated this indirect effect such that, at relatively lower levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was nonsignificant (ωlow = -0.05, 95% CI = -0.50, 0.45), whereas at relatively higher levels of maternal trauma exposure, the indirect effect of maternal experiences of racism on child depression was statistically significant (ωhigh= .65, 95% CI = 0.21, 1.15). CONCLUSION: These findings suggest that the indirect effect of maternal experiences of racism on child depression through the effect of maternal depression depends on the degree of maternal trauma exposure. This study advances the literature by shedding light on key processes that can explain the intergenerational effects of racism as well as contextual factors that can exacerbate racism's downstream consequences across generations.

Intersections of oppression: Examining the interactive effect of racial discrimination and neighborhood poverty on PTSD symptoms in Black women.

Black Americans living in urban environments are disproportionately impacted by posttraumatic stress disorder (PTSD). Both racial discrimination and neighborhood poverty are factors that contribute to this health disparity. However, studies focused on the intersection of these two oppressive systems on PTSD symptoms are lacking. To address this gap in the literature, we assessed the interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in an urban sample of trauma-exposed Black women (N = 300). Simple moderation analysis was used to assess the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms. The overall model significantly predicted PTSD symptoms, with a main effect of racial discrimination (B = 1.87, p = .009) and neighborhood poverty rate (B = 0.29, p = .008), independent of prior trauma exposure and percentage of Black residents in the zip code. More frequent experiences of racial discrimination and higher rates of neighborhood poverty both predicted higher PTSD symptoms. There was also a trending interaction of racial discrimination and neighborhood poverty (B = -0.05, p = .054), where the effect of neighborhood poverty on PTSD symptoms was only present for those who reported fewer experiences of racial discrimination. Our results suggest that people who have experienced more instances of racial discrimination show high levels of PTSD symptoms regardless of neighborhood poverty rates and highlight the importance of considering multiple levels of oppression that Black individuals face while diagnosing and treating stress-related psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Concurrent validity and reliability of suicide risk assessment instruments: A meta-analysis of 20 instruments across 27 international cohorts.

OBJECTIVE: A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behavior. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. METHOD: Here, we examine this issue through two approaches: (a) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments and (b) by pooling data (N ∼ 6,000 participants) from cohorts from the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Major Depressive Disorder and ENIGMA-Suicidal Thoughts and Behaviour working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behavior. RESULTS: We observed moderate-to-high correlations between measures, consistent with the wide range (κ range: 0.15-0.97; r range: 0.21-0.94) reported in the literature. Two common multi-item instruments, the Columbia Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation were highly correlated with each other (r = 0.83). Sensitivity analyses identified sources of heterogeneity such as the time frame of the instrument and whether it relies on self-report or a clinical interview. Finally, construct-specific analyses suggest that suicide ideation items from common psychiatric questionnaires are most concordant with the suicide ideation construct of multi-item instruments. CONCLUSIONS: Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behavior but share a modest core factor with single suicidal ideation items. Retrospective, multisite collaborations including distinct instruments should be feasible provided they harmonize across instruments or focus on specific constructs of suicidality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population.

The properties and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) remain unstudied in community-based populations. This study evaluates the performance of the PC-PTSD-5 to determine whether it can be used as a brief alternative to the PTSD Checklist for DSM-5 (PCL-5) in a large public hospital in the southeastern United States. Participants (N = 422; 92.7% Black; 85.8% female; Mage = 42.0 years, SDage = 13.4 years) completed the PCL-5 and PC-PTSD-5 after recruitment from medical clinic waiting rooms and admission lists. Using chance-corrected test quality indices and item response theory (IRT) analyses, we determined optimal cut-scores for screening and examined item performance. Approximately 45.0% of the sample screened positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 demonstrated high internal consistency and strong associations with PCL-5 scores (total, r = .79; items, rs = .51-.61). A cut-score of one was optimally sensitive for screening (κ[1] = .96), and a cut-score of four had the highest quality of probable efficiency (κ[.5] = .66) for detecting self-reported DSM-5 PTSD on the PCL-5. IRT analyses indicated Item 1 (nightmares, intrusive memories) provided the most information, and other items may not be incrementally useful for this sample. Findings provide preliminary support for the use of the PC-PTSD-5 as a brief alternative to the PCL-5 among chronically trauma-exposed patients in the public healthcare setting.

Indirect Effects of Racial Discrimination on Health Outcomes Through Prefrontal Cortical White Matter Integrity.

BACKGROUND: Racial discrimination is consistently associated with adverse health outcomes and has been linked to structural decrements in brain white matter. However, it is unclear whether discrimination-related neuroplastic changes could indirectly affect health outcomes. Our goal was to evaluate indirect associations of racial discrimination on health outcomes through white matter microstructure in a sample of trauma-exposed Black women. METHODS: A trauma study in an urban hospital setting recruited 79 Black women who received a history and physical examination to assess medical disorders (compiled into a summed total of disorder types). Participants reported on experiences of racial discrimination and underwent diffusion tensor imaging; fractional anisotropy values were extracted from white matter pathways previously linked to racial discrimination (corpus callosum, including the body and genu; anterior cingulum bundle; and superior longitudinal fasciculus) and entered into mediational models. RESULTS: Indirect effects of racial discrimination on medical disorders through left anterior cingulum bundle fractional anisotropy were significant (ß = 0.07, SE = 0.04, 95% CI [0.003, 0.14]) after accounting for trauma and economic disadvantage. Indirect effects of racial discrimination on medical disorders through corpus callosum genu fractional anisotropy were also significant (ß = 0.08, SE = 0.04, 95% CI [0.01, 0.16]). CONCLUSIONS: Racial discrimination may increase risk for medical disorders via neuroplastic effects on microstructural integrity of stress-sensitive prefrontal white matter tracts. Racial discrimination-related changes in these tracts may affect health behaviors, which, in turn, influence vulnerability for medical disorders. These data highlight the connections between racial discrimination, prefrontal white matter connections, and incidence of medical disorders in Black Americans.

Ignoring race and denying racism: A meta-analysis of the associations between colorblind racial ideology, anti-Blackness, and other variables antithetical to racial justice.

One critical role counseling psychologists can play in dismantling anti-Blackness and eradicating systemic racism is to build on the field's strength in understanding individual-level processes (i.e., systems are created and maintained by individual actors). Drawing on antiracism scholarship, we aimed to better understand how colorblind racial ideology (CBRI), or the denial and minimization of race and racism, may serve as a barrier to engaging in antiracist praxis. Specifically, we conducted a meta-analysis to determine if color evasion (ignoring race) and power evasion (denying structural racism) CBRI were differentially associated with anti-Blackness and processes linked to antiracism. Findings based on 375 effects drawn from 83 studies with more than 25,000 individuals suggest different effects based on CBRI type. As hypothesized, we found that power evasion CBRI was related to increased endorsement of anti-Black prejudice (r = .33) and legitimizing ideologies (r = .24), and negatively associated with a range of other variables associated with antiracism, including social justice behaviors (r = -.31), multicultural practice competencies (r = -.16), diversity openness (r = -.28), and racial/ethnocultural empathy (r = -.35). Consistent with theory, color evasion CBRI was related to increased diversity openness (r = .12). We discuss limitations of our study, as well as outline future directions for research and practice to focus on the role of CBRI in sustaining and perpetuating anti-Blackness and systemic racism. Thus, this meta-analysis has implications for pushing the field of counseling psychology to build the bridge between individual ideologies and creating structural change. (PsycInfo Database Record (c) 2023 APA, all rights reserved).