Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

BACKGROUND: The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology. METHODS: Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination. RESULTS: Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination. CONCLUSIONS: The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

Posttraumatic Stress in Children After Injury: The Role of Acute Pain and Opioid Medication Use.

OBJECTIVES: After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. METHODS: Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. RESULTS: Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. CONCLUSIONS: Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.

Cognitive risk, coping-oriented substance use, and increased avoidance tendencies among depressed outpatients: A prospective investigation.

OBJECTIVE: The present study was designed to assess the interplay between depressive cognition, coping-oriented substance use, and future behavioral disengagement tendencies. Cognitive risk subtypes examined include brooding rumination, attributional bias (internal/stable/global), and dysfunctional attitudes. METHOD: Individuals were recruited from outpatient treatment settings and met criteria for a unipolar depressive disorder (N = 70; 66% female; 81% White; Mage = 31; SDage = 13.2). Participants completed self-report measures of brooding rumination, attributional style, dysfunctional attitudes, coping-oriented substance use, and behavioral disengagement tendencies following a 3-week period. RESULTS: Brooding rumination, stable attributional style, and dysfunctional attitudes were positively associated with later behavioral disengagement tendencies. Coping-oriented substance use moderated associations between both internal attributional style, as well as dysfunctional attitudes onto later behavioral disengagement. CONCLUSIONS: With regard to stress-related avoidance, subsyndromal substance use may play a detrimental role among cognitively vulnerable, depressed outpatients when said drug or alcohol use serves as a means of coping.

A Prospective Examination of Child Avoidance Coping and Parental Coping Assistance After Pediatric Injury: A Mixed-Methods Approach.

OBJECTIVE: Millions of children experience injuries annually, and avoidance coping increases risk of negative emotional and physical outcomes after injury. Little is known about how children select avoidance coping strategies. Parents may help their children cope with an injury by encouraging or discouraging the use of specific strategies, such as avoidance coping. The present study examined parental influence of child use of avoidance coping post-injury. METHODS: Children ages 8-13 (65% male; 50% White) hospitalized for pediatric injury and their parents (N = 96 child-parent dyads) participated in an interview and discussion task about coping at baseline, and then completed coping/coping assistance measures at three time points: T1 (within 2 weeks post-injury), T2 (6-weeks post-injury), and T3 (12-weeks post-injury). RESULTS: When presented with an ambiguous situation in the observational interview and discussion task, the number of avoidance coping solutions offered by children independently as well as during a discussion with their parent predicted the child's ultimate avoidance versus non-avoidance coping choice. The number of avoidance coping solutions offered by parents did not predict children's final choice to use avoidance coping. Longitudinal data suggest that parent encouragement of avoidance coping predicted child avoidance coping within the first 6-weeks post-trauma. CONCLUSIONS: Our study suggests that child avoidance coping is multifaceted and may result from both parent encouragement as well as independent decisions by children. Future research may explore additional factors that influence child avoidance coping, outside of parental suggestion, in response to trauma exposure.

A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.

Adolescents' co-rumination and stress predict affective changes in a daily-diary paradigm.

Co-rumination has been related to both high quality friendship and depressive symptoms. However, little is known regarding the extent to which co-rumination may be detrimental, its distinction from rumination and potential gender differences in co-rumination. This study used a modified version of Rose's Co-rumination Questionnaire (Rose, 2002) to examine the behaviour of daily co-rumination with daily stress and negative affect among adolescents. Results demonstrated that co-rumination did not have a main effect in predicting negative affect, but did evidence a significant interaction with life stress. Additionally, co-rumination demonstrated incremental utility above that of rumination. Finally, gender differences were not supported. In conclusion, this investigation revealed that co-rumination exacerbates the effects of life stress and is predictive of increased internalising symptoms.

The impact of sleep on female sexual response and behavior: a pilot study.

INTRODUCTION: The etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross-sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined. AIM: We sought to examine the influence of nightly sleep duration, sleep quality, and sleep onset latency on daily female sexual response and activity. METHODS: This study used a longitudinal design to study 171 women free of antidepressants and with reliable Internet access who were recruited from a university setting in the United States. Participants first completed baseline measures in a laboratory, and then completed web-delivered surveys at their habitual wake time for 14 consecutive days. MAIN OUTCOME MEASURES: All outcome measures were modified for daily recall. Participants completed the Profile of Female Sexual Function's desire, subjective arousal, and orgasmic functioning scales and the Female Sexual Function Index's genital arousal scale, and indicated whether they engaged in partnered sexual activity or self-stimulation in response to dichotomous items. RESULTS: Analyses revealed that longer sleep duration was related to greater next-day sexual desire (b = 0.32, P = 0.02), and that a 1-hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity (odds ratio = 1.14, P < 0.05). In contrast, sleeping longer predicted poorer next-day genital arousal (b = -0.19, P < 0.01). However, results showed that women with longer average sleep duration reported better genital arousal than women with shorter average sleep length (b = 0.54, P = 0.03). CONCLUSIONS: Obtaining sufficient sleep is important to the promotion of healthy sexual desire and genital response, as well as the likelihood of engaging in partnered sexual activity. These relationships were independent of daytime affect and fatigue. Future directions may investigate sleep disorders as risk factors for sexual dysfunction.

The Validation of the Female Sexual Function Index, Male Sexual Function Index, and Profile of Female Sexual Function for Use in Healthy Young Adults.

Past research has typically used clinical samples to evaluate the validity of sexual function measures. As normal variations in sexually healthy individuals are of important research and clinical interest, evaluating the applicability of common sexual function measures to these populations is important. Factor structures of the Female Sexual Function Index (FSFI), Male Sexual Function Index (MSFI) (adapted for this investigation), and Profile of Female Sexual Function (PFSF) were examined in young, healthy men and women. We predicted the factor structures to be consistent with past evaluations. In a cross-sectional study, 1,258 participants (M age = 19.56 years; 59 % women) completed these measures. Confirmatory factor analyses did not initially support the factor structures. However, factor loadings showed marked differences between positively and negatively worded items. As such, each measure's factor structure was tested using multi-trait multi-method confirmatory factor analysis which accounted for variance due to item valence. These models supported the predicted structures of the FSFI and MSFI, whereas the PFSF's Responsiveness scale required modification, resulting in an Avoidance scale for both genders. This study was one of few to validate the FSFI in young, healthy adults and the first to examine the MSFI and PFSF in these populations. Additionally, this investigation was the first to propose a reconceptualization of the PFSF Responsiveness scale into an Avoidance scale. Lastly, our study highlights the significant impact of item valence on how individuals respond to questions regarding their sexual functioning.

The Transaction Between Depression and Anxiety Symptoms and Sexual Functioning: A Prospective Study of Premenopausal, Healthy Women.

A number of studies have called attention to the problematic interplay between depression and anxiety symptoms and sexual difficulties. However, despite the bidirectional conceptualization of the association between affective and sexual problems, few studies have adequately examined temporal precedence or state-level fluctuations between these two constructs. Using Clark and Watson's (1991) tripartite model of anxiety and depression, the current study employed a repeated measures design to examine how weekly changes in affective symptoms were related to weekly changes in sexual functioning in a non-clinical sample of premenopausal women. First, we examined how general distress, anxious arousal, and anhedonia were concurrently related to various indices of sexual functioning. Next, we examined lagged effects of mood and anxiety symptoms predicting later levels of sexual functioning. Finally, we tested sexual functioning's influence on later reports of affective symptoms. Hierarchical linear modeling analyses revealed that, of the three symptom types tested, anhedonic depression was the most consistently related to sexual problems, and that these relations were more proximal than distal. The preponderance of data suggested temporal precedence of mood on sexual symptoms. These findings emphasize the importance of prospective studies in the investigation of mental and sexual health.

How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: a daily diary study.

INTRODUCTION: A large body of literature supports the co-occurrence of depression, anxiety, and sexual dysfunction. However, the manner in which affective symptoms map onto specific female sexual response indices is not well understood. AIMS: The present study aimed to examine changes in depression and anxiety symptoms and their correspondence to fluctuations in desire, subjective arousal, genital response, orgasmic function, and vaginal pain. METHODS: The study used a 2-week daily diary approach to examine same-day and temporal relations between affective symptoms and sexual function. MAIN OUTCOME MEASURES: The unique relations between shared and disorder-specific symptoms of depression and anxiety (i.e., general distress, anhedonia, and anxious arousal) and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) were examined, controlling for baseline levels of sexual distress, depression, and anxiety, as well as age effects and menstruation. RESULTS: Analyses revealed that changes in depression and anxiety severity corresponded to same-day variations in sexual response. Specifically, anhedonia (depression-specific symptom) was related to poorer same-day sexual desire, whereas greater anxious arousal (anxiety-specific symptom) was independently related to simultaneous increases in subjective sexual arousal, vaginal lubrication, and sexual pain. Increases in general distress (i.e., shared symptoms) were associated with greater same-day difficulties achieving orgasm. Notably, only one temporal relation was found; it indicated that higher levels of anhedonia predicted a next-day decrease in sexual desire. CONCLUSIONS: It is proposed that the simultaneous changes in affective symptoms and sexual function may indicate that they are products of shared underlying mechanisms. That is, in response to stress, the processes manifesting as feelings of weak positive affect and amotivation are the very same processes responsible for diminished capacity for sexual desire. In contrast, the physiological hyperarousal associated with anxiety also gives rise to sexual arousal difficulties and vaginal pain.

Specificity of emotion regulation difficulties related to anxiety in early adolescence.

Etiological models identify difficulties in emotion regulation as potential contributors to the development and maintenance of anxiety. To date, studies with adolescents have not tested whether different types of anxiety symptoms are related to different emotion regulation difficulties. The current study aimed to examine specificity of associations between emotion regulation difficulties and symptoms of social and generalized anxiety in early adolescence. Ninety adolescents (ages 11-14 years) completed measures of emotion regulation and anxiety symptoms. Social and generalized anxiety symptoms showed similar bivariate correlations with emotion regulation. However, when controlling for generalized anxiety, social anxiety symptoms were uniquely related to emotion understanding, acceptance, evaluation, and reactivity. Generalized anxiety symptoms were uniquely related to emotion modification. The current study suggests that social and generalized anxiety symptoms have both common and unique associations with emotion regulation difficulties in early adolescence, and has implications for which emotion regulation skills to target in clinical interventions.

An examination of PTSD symptoms as a mediator of the relationship between trauma history characteristics and physical health following a motor vehicle accident.

BACKGROUND: It has been suggested that a history of trauma exposure is associated with increased vulnerability to the physical health consequences of subsequent trauma exposure, and that posttraumatic stress symptoms (PTSS) may serve as a key pathway in this vulnerability. However, few studies have modeled these relationships using mediation, and most have failed to consider whether specific characteristics of the prior trauma exposure have a differential impact on physical and mental health outcomes. METHODS: The present study examined 180 victims of a serious motor vehicle accident (MVA) who reported prior exposure to traumatic events. PTSS were assessed by clinical interview 6 weeks post-MVA, and physical health was assessed 6 months post-MVA. Using structural equation modeling, the present study examined the extent to which event (age at first trauma, number, and types of trauma) and response (perceptions of life threat, physical injury, and distress) characteristics of prior trauma were related to physical health outcomes following a serious MVA, and whether these relationships were mediated by PTSS. RESULTS: Results revealed that both event and response characteristics of prior trauma history were associated with poorer physical health, and that PTSS served as a mechanism through which response characteristics, but not event characteristics, led to poorer physical health. CONCLUSIONS: These results highlight the enduring impact of trauma exposure on physical health outcomes, and underscore the importance of considering multiple mechanisms through which different aspects of prior trauma exposure may impact physical health.

Positive Interpretation Bias Predicts Longitudinal Decreases in Social Anxiety.

Theoretical models of social anxiety suggest that distorted interpretation processes contribute to its development and maintenance, although the pathways through which this occurs are not well understood. Therefore, the present longitudinal study sought to determine whether negative interpretation bias, positive interpretation bias, and interpretation inflexibility (the degree to which participants correctly revise initial interpretations) predict changes in social anxiety over time. In an important advance over prior studies, individual differences in working memory capacity (WMC) were accounted for, as WMC is thought to play a crucial role in the generation and maintenance of interpretation biases. Following a baseline assessment of social anxiety, interpretation biases, and WMC, participants completed follow-up assessments of social anxiety both 2 weeks (n = 106) and 4 weeks (n = 96) later. After controlling for baseline social anxiety and WMC, greater positive interpretation bias was found to predict lower social anxiety at both follow-ups. Neither negative interpretation bias nor interpretation inflexibility was significantly associated with follow-up social anxiety. These results provide support for greater positive interpretation bias as a facilitator of decreases in social anxiety and a potential target for clinical intervention.

Delta-8- and Delta-9-THC Use Frequency, Use Motives, and Mental Health Outcomes.

Use of delta-8-THC ("delta-8") has proliferated after the passage of the 2018 Farm Bill. Yet, research on the mental health effects of this increasingly popular cannabinoid is scant. The current study sought to examine mental health correlates of delta-8 use frequency and motives, investigate whether delta-8 use motives predict use frequency, and compare use motives and problems between delta-8 and traditional cannabis. Participants consisted of 363 self-reported delta-8 users who completed measures of delta-8 use frequency, motives, and problems that were adapted from comparable measures for cannabis, as well as measures of mental health outcomes. Delta-8 use frequency was unrelated to use problems and other mental health outcomes. Delta-8 use frequency was positively associated with social and coping motives, but negatively associated with enhancement and conformity motives. Coping and conformity motives were associated with greater depression, anxiety, insomnia, and delta-8 use problems. Participants were more likely to report coping and enhancement motives for delta-8 use compared to cannabis use, but less likely to report conformity motives. Further longitudinal research is needed to assess causality for associations between delta-8 use frequency, use motives, and mental health outcomes.

Specificity of anhedonic depression and anxious arousal with sexual problems among sexually healthy young adults.

INTRODUCTION: Past research has suggested that depression and anxiety are similarly associated with sexual problems. However, methodological limitations may have hindered the ability of prior studies to detect potential specificity between depression and anxiety with distinct sexual problems. Specifically, previous studies have frequently used measures that confound depression and anxiety, focused exclusively on populations with medical complications, and failed to account for the iatrogenic effects of antidepressants. AIM: Clark and Watson's tripartite model was used to differentiate anxious and depressive symptoms and examine their associations with indices of sexual functioning. Specifically, we examined how general distress, anxious arousal, and anhedonia are differentially related to sexual desire, arousal, erection and lubrication difficulties, orgasm achievement, pain, satisfaction, avoidance, pleasure, concerns, and sexual self-image. METHODS: In a cross-sectional study, 1,258 young men and women completed the Female Sexual Function Index, Male Sexual Function Index (adapted for the current investigation), Profile of Female Sexual Function, and Mood and Anxiety Symptom Questionnaire. RESULTS: Zero-order correlations revealed some specificity between the three affective constructs, as they were associated with sexual problems. However, multiple regression analyses revealed clearer patterns, showing that anhedonic depression was more uniquely related to most sexual problems among women, whereas the relations of anxiety and depression with male sexual problems were more mixed. DISCUSSION: This study of young subjects not identified to have affective or sexual disorders suggests that specificity exists between depression and anxiety as they relate to sexual functioning, and that this specificity varies between genders. Such findings highlight the importance of considering the unique influences of anxiety and depression in the conceptualization and treatment of sexual dysfunction.

Dispositional mindfulness moderates the effects of stress among adolescents: rumination as a mediator.

Recent research has demonstrated that higher levels of mindfulness are associated with greater psychological and physical health. However, the majority of this research has been conducted with adults; research is only beginning to examine the effects of mindfulness among adolescents. Further, research into adolescent mindfulness has typically conceptualized mindfulness as a unidimensional phenomenon and has not yet examined multidimensional models of mindfulness that have emerged in the adult literature. Further, the mechanisms through which mindfulness influences these outcomes are presently unclear. The present study examined the effects of three facets of mindfulness among adolescents. Seventy-eight adolescents (61% female, 94% Caucasian, M age = 16) completed a measure of dispositional mindfulness at baseline. Participants then completed measures of daily stress, dysphoric affect, and state rumination over a 7-day period. Multilevel modeling analyses revealed that facets of mindfulness (i.e., nonreactivity and nonjudgment) were associated with lower levels of dysphoric mood. Mindfulness interacted with daily stress to predict later dysphoria; less mindful individuals were particularly vulnerable to the negative effects of stress. Finally, analyses demonstrated that the effect of the Mindfulness × Stress Moderation was significantly mediated by increases in daily rumination. These findings support the importance of mindfulness among adolescents and help to elucidate the mechanisms through which mindfulness influences psychological health.

Cognitive vulnerability to depression: a comparison of the weakest link, keystone and additive models.

Multiple theories of cognitive vulnerability to depression have been proposed, each focusing on different aspects of negative cognition and utilising different measures of risk. Various methods of integrating such multiple indices of risk have been examined in the literature, and each demonstrates some promise. Yet little is known about the interrelations among these methods, or their incremental validity in predicting changes in depression. The present study compared three integrative models of cognitive vulnerability: the additive, weakest link, and keystone models. Support was found for each model as predictive of depression over time, but only the weakest link model demonstrated incremental utility in predicting changes in depression over the other models. We also explore the correlation between these models and each model's unique contribution to predicting onset of depressive symptoms.

Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis.

Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.

Dampening of positive affect and depression: A meta-analysis of cross-sectional and longitudinal relationships.

Dampening responses to positive affect have been posited to confer vulnerability to depression, but longitudinal studies have not consistently shown dampening tendencies to predict follow-up depression. The cross-sectional, longitudinal, and cross-lagged relationships between dampening and depression were determined using meta-analytic methods. A systematic literature search of the PsycINFO and PubMed databases supplemented by Google Scholar yielded 60 samples suitable for inclusion in the cross-sectional analyses and 12 samples meeting criteria for the longitudinal analyses. In the first meta-analytic study to examine the relationship between dampening and depression, we found dampening to be associated with depression both cross-sectionally (r = .45) and prospectively (r = 0.34). Crucially, dampening at baseline remained a significant predictor of follow-up depression even after controlling for baseline levels of depression in cross-lagged analyses (ß = .09). A bidirectional effect was also found, with baseline levels of depression predicting follow-up tendencies to engage in dampening (r = 0.36). This relationship was again diminished but remained significant after controlling for initial levels of dampening (ß = .14). These results suggest that dampening responses to positive affect are a risk factor for the development of depression and highlight the importance of targeting dampening cognitions in treatment.

The impact of caregiver distress on the longitudinal development of child acute post-traumatic stress disorder symptoms in pediatric injury victims.

OBJECTIVE: The present study prospectively examined the development of child PTSD symptoms (PTSS) and the impact of caregiver PTSS on child PTSS following injury. METHODS: One hundred and eighteen ED patients and their caregivers were interviewed in-hospital and 2- and 6-weeks posttrauma. Structural equation modeling and hierarchical linear regressions examined the development of PTSS. RESULTS: A model combining child and caregiver 2-week PTSS into one latent family PTSS variable provided the best fit to the data. Child in-hospital avoidance symptoms predicted higher levels of 2-week family PTSS. Two-week family PTSS predicted child 6-week PTSS. Post hoc analyses revealed an interaction between in-hospital caregiver avoidance symptoms and child reexperiencing symptoms in predicting 6-week child PTSS. CONCLUSIONS: Results highlight the dynamic development of child PTSS. Different symptom clusters may be related to higher PTSS at differing times posttrauma and may inform the development of time-sensitive methods of assessment and intervention for injury victims.