Religion, spirituality, and suicide risk in Iraq and Afghanistan era veterans.

BACKGROUND: United States military veterans experience disproportionate rates of suicide relative to the general population. Evidence suggests religion and spirituality may impact suicide risk, but less is known about which religious/spiritual factors are most salient. The present study sought to identify the religious/spiritual factors most associated with the likelihood of having experienced suicidal ideation and attempting suicide in a sample of recent veterans. METHODS: Data were collected from 1002 Iraq/Afghanistan-era veterans (Mage = 37.68; 79.6% male; 54.1% non-Hispanic White) enrolled in the ongoing Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center multi-site Study of Post-Deployment Mental Health. RESULTS: In multiple regression models with stepwise deletion (p < .05), after controlling for depression and posttraumatic stress disorder (PTSD) diagnoses, independent variables that demonstrated a significant effect on suicidal ideation were perceived lack of control and problems with self-forgiveness. After controlling for age, PTSD diagnosis, and substance use problems, independent variables that demonstrated a significant effect on suicide attempt history were perceived as punishment by God and lack of meaning/purpose. CONCLUSIONS: Clinical screening for spiritual difficulties may improve detection of suicidality risk factors and refine treatment planning. Collaboration with spiritual care providers, such as chaplains, may enhance suicide prevention efforts.

The development and initial validation of the Fatigue Sensitivity Questionnaire.

Currently, there is poor understanding of fatigue and the possible psychological conditions that may underlie chronic fatigue. Although substantial work has been directed to better clinically address fatigue, no work has explored individual differences in expectations or perceptions of the negative consequences associated with fatigue-related symptoms. The goals of this study were to (a) develop and (b) validate a measure of expectations or perceptions of the negative consequences associated with fatigue-related symptoms (e.g. fatigue sensitivity) across two independent samples (N = 1,827; 73.1% female; Mage = 21.68; SD = 4.54) of young adults. Results supported a 10-item measure of fatigue sensitivity, entitled the Fatigue Sensitivity Questionnaire (FSQ). The FSQ demonstrated unidimensionality, excellent internal consistency, and strong convergent and discriminant validity. Overall, the 10-item scale offers a single score that can be employed to measure fatigue sensitivity. Clinically, the FSQ may be a brief, informative, and easily disseminated measure in better understanding and capturing expectations or perceptions about the negative consequences of fatigue. As a research tool, the use of the FSQ may provide broader understanding of vulnerability factors that may influence fatigue-related health outcomes. Future research is needed to test the validity of the FSQ in other samples.

Psychological Distress Among Smokers in the United States: 2008-2014.

Introduction: Decline in smoking in the United States has slowed over the past 25 years. Mental health problems are common among smokers, and may be an impediment to quitting and remaining abstinent. The study investigated the relationship between serious (past-30-day) psychological distress (SPD) and smoking, estimated trends in the prevalence of SPD among current, former, and never smokers in the United States from 2008 to 2014, and investigated whether heterogeneity in these trends varied by sociodemographic characteristics. Methods: Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N = 270 227). SPD and smoking in the past 30 days were examined using logistic regression models among adults 18 and older. The prevalence of SPD was examined annually among current, former, and never smokers from 2008 to 2014. Results: SPD increased among smokers in the United States from 2008 to 2014. An increase in SPD was more rapid among non-daily smokers than daily smokers. The prevalence of SPD was higher among younger smokers, those with less formal education and lower annual family income and higher among current smokers than former and never smokers. The relationships between SPD and smoking were stronger among smokers with higher education levels and annual family income. Conclusions: Our findings suggest an increase in SPD among smokers over time and that as smoking has declined, those with SPD are comprising a greater proportion of the remaining smokers. Results suggest that mental health must be integrated into mainstream tobacco control efforts. Implications: The greater prevalence and increasing rate of Serious Psychological Distress among smokers, relative to former- and never-smokers, from 2008 to 2014 provides support that the greater mental health burden among smokers may be contributing to the slowed reduction in smoking prevalence in the United States. In addition, relationships between SPD and smoking were consistently stronger among smokers with higher levels of education and annual family income. Such results suggest the necessity of incorporating mental health treatments in tobacco use reduction efforts.

Pain severity as a predictor of negative affect following a self-guided quit attempt: An ecological momentary assessment study.

BACKGROUND: Past work has documented bidirectional associations between pain and cigarette smoking behaviors such that those who smoke evidence greater pain, and those in pain tend to smoke more. However, such work has not focused on the role of pain in relation to negative affect, which plays an important role during cessation attempts. OBJECTIVE: The current study evaluated pain as a predictor of negative affect as well as level of interference associated with negative affect among individuals undergoing a self-guided quit attempt. METHODS: Study variables were assessed via ecological momentary assessment (EMA) during the 2 weeks following a self-guided quit attempt. Participants included 54 daily smokers (33.3% female; Mage = 34.7, SD = 13.9). RESULTS: There were statistically significant within-person associations of pain ratings with negative affect and interference due to negative affect, such that greater pain was associated with higher levels of each dependent variable. Additionally, there was a within-person effect of smoking status (i.e., smoking vs. abstinence, measured via EMA) on negative affect, but not ratings of interference; smoking was associated with greater negative affect. CONCLUSION: These findings highlight the importance of bodily pain in relation to negative mood following a quit attempt. Clinically, the results suggest a greater focus on the experience of pain during quit attempts may be warranted.

Acculturative stress, emotion regulation, and affective symptomology among Latino/a college students.

Although recent work has highlighted the relation of acculturative stress with depression and anxiety symptoms specifically among Latino/a university students, the potential mechanisms underlying these associations remain relatively unknown. The present study aims to examine difficulties in emotion regulation as an explanatory factor in the relation of acculturative stress with symptoms of depression, suicidality, social anxiety, and anxious arousal. A sample of 448 Latino/a college students (Mage = 20.67 years, SD = 1.96; 78.3% female) were recruited from a southwestern public university through an online, self-report survey. Indirect effects of acculturative stress via difficulties in emotion regulation on all outcomes were observed among males and females. Follow-up analyses showed the indirect effect on all dependent variables among Latino men occurred exclusively through lack of access to emotion regulation strategies, whereas the indirect effects among Latina women occurred through a different subfactor of difficulties in emotion regulation for each dependent variable. These findings suggest the potential clinical utility of assessing and targeting acculturative stress and difficulties in emotion regulation in the treatment of depression and anxiety problems among Latino/a college students. (PsycINFO Database Record

Clarifying the relation of acculturative stress and anxiety/depressive symptoms: The role of anxiety sensitivity among Hispanic college students.

OBJECTIVES: Recent work has highlighted the link between acculturative stress and depression/anxiety symptoms among Hispanic young adults, but the nature of these relations is not well understood. The present study aimed to clarify the relation between acculturative stress and depression/anxiety symptoms by examining anxiety sensitivity, globally and via subfactors, as an explanatory variable. METHOD: A cross-sectional sample of 788 Hispanic college students (80.8% female; Mage = 20.83 years, SD = 1.93) was recruited from a southwestern public university and completed an online self-report assessment battery. RESULTS: Acculturative stress exerted an indirect effect, via the global construct of anxiety sensitivity, on depression symptoms, suicidality, anxious arousal, and social anxiety symptoms. Follow-up simultaneous analytic models demonstrated indirect effects via the anxiety sensitivity subfactors that were pathognomonic with each of the specific affective outcomes. CONCLUSIONS: These findings suggest the utility of assessing and targeting anxiety sensitivity in the treatment of acculturative stress-related depression/anxiety problems among Hispanic college students. (PsycINFO Database Record

Anxiety sensitivity and acculturative stress among trauma exposed Latinx young adults.

There are elevated rates of trauma exposure, posttraumatic stress symptoms, and greater conditional risk of posttraumatic stress disorder among Latinx relative to other racial/ethnic groups. Such trauma-related health disparities serve to exacerbate or maintain acculturative and other types of stress among the Latinx population. Yet, little research has explored what types of individual difference factors may undergird variability in acculturative stress among trauma-exposed Latinx persons. Accordingly, the present investigation examined individual differences in anxiety sensitivity (fear of the negative consequences of stress sensations) in relation to acculturative stress among a large sample of trauma-exposed Latinx young adults (n = 1,377 persons; Mage = 21.01; SD = 2.50; age range: 18-29 years; 76.7% female). Results demonstrated that anxiety sensitivity explained 10.2% of unique variance in acculturative stress (p < .001, adjusted R² = .188) after accounting for age, sexual minority status, history of trauma exposure, and posttraumatic stress symptom severity. Additionally, each of the 3 subfactors of anxiety sensitivity (Physical, Cognitive, and Social) were directly related to acculturative stress despite sharing variance with one another. Overall, the current findings suggest that anxiety sensitivity may be a heretofore underrecognized individual difference factor that is related to more severe acculturative stress among trauma-exposed Latinx young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Body Mass Index and functional impairment: the explanatory role of anxiety sensitivity among treatment-seeking smokers.

Obesity and smoking are highly prevalent public health concerns in the United States. Data indicate that elevated Body Mass Index (BMI) is related to functional impairment. However, there is limited understanding of mechanisms that may explain their comorbidity among smokers. The current study sought to test whether anxiety sensitivity explained the relation between BMI and functional impairment among 420 (46.9% females; Mage = 38 years, SD = 13.42) treatment-seeking, adult smokers. Results indicated that BMI yielded a significant indirect effect through anxiety sensitivity for functional impairment, b = 0.01, SE = .01, 95% CI = [.002, .021]. These findings remained significant after controlling for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions (i.e. hypertension, heart problems, respiratory disease, asthma). Such data provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.

Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms.

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.

Caregiver alcohol use and mental health among children orphaned by HIV/AIDS in South Africa.

Research in the developed world suggests that parental alcohol use negatively impacts child mental health. However, little research has examined these relations among children in the developing world and no studies to date have done so in the context of AIDS-orphanhood. Therefore, the present study tested the interactive effect of AIDS-orphan status with caregiver alcohol use on child mental health. The sample included 742 children (51.2% female; Mage = 9.18; age range: 7-11 years; 29.8 AIDS-orphans; 36.8% orphaned by causes other than AIDS; 33.4% non-orphaned) recruited from Mangaung in the Free State Province of South Africa. Child mental health was assessed via child self-report, caregiver, and teacher reports; and caregiver alcohol use via self-report. Path analyses, via structural equation modeling, revealed significant direct effects for AIDS-orphan status on caregiver-reported child mental health; and for caregiver alcohol-use problems on teacher-reported child mental health. However, the interaction effect of AIDS-orphan status with caregiver alcohol use did not reach significance on all three reports of child mental health problems. These results suggest that orphan status and caregiver alcohol use may independently relate to mental health problems in children and that the effects of both should be considered in the context of the mental health needs of children in AIDS-affected countries.

Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS.

HIV symptoms are associated with a poorer quality of life (QOL) among persons living with HIV/AIDS (PLWHA). Yet, there is little understanding of emotional factors that impact the relation between HIV symptom severity and QOL. The present study examined the main and interactive effects of emotion dysregulation and HIV symptom severity on multiple indices of QOL, including physical (impact of physical problems related to HIV), psychological (frequency of negative feelings), independence (necessity of medical treatment to function in daily life), social (feelings of acceptance), environmental (satisfaction with living conditions and medical care), and spiritual (fear of the future and death) among a sample of 74 PLWHA. Participants (72.9% male; mean age = 48.24, SD = 7.85) were recruited from AIDS Service Organizations in the United States. Results indicated that higher HIV symptom severity is significantly associated with lower physical and independence QOL, whereas higher emotion dysregulation is significantly associated with lower scores on all measured aspects of QOL. Additionally, results indicated that the interaction of emotion dysregulation and HIV symptom severity was significantly associated with both physical and environmental QOL. The form of the observed significant interactions indicated that HIV symptom severity was related to poorer QOL among those with lower (versus higher) emotion dysregulation. The present findings indicate that emotion dysregulation is related to QOL among PLWHA and may interact with HIV symptom severity to negatively impact certain aspects of QOL. Given the profound impact that HIV has on QOL, this finding is important in understanding these relations mechanistically, and may be important in the development of novel psychological treatment strategies.

The Role of Impulsivity in the Relation Between Negative Affect and Risky Sexual Behaviors.

While risky sexual behavior associates with negative affect, and impulsivity often increases during negative affective states, little is known about the interrelations of these factors. This study examined whether impulsivity explained the relation between negative affect and risky sex among college students. Negative affect exhibited an indirect effect via impulsivity on number of sexual partners for both males and females, and on inconsistent condom use for females, but not males. Results suggest risky sex may serve to regulate negative affect, proposing the importance of negative affect in future strategies to reduce risky sex among young adults.

The Moderating Effect of Smoking Status on the Relation between Anxiety Sensitivity, Sexual Compulsivity, and Suicidality among People with HIV/AIDS.

PURPOSE: The present study examined the moderating effect of cigarette smoking status on the relation between anxiety sensitivity (fear of the expected negative consequences of anxiety and bodily sensations) and hazardous alcohol consumption, sexual compulsivity, and suicidality. METHOD: A series of multiple hierarchical regressions were used to test the proposed hypothesis among a sample of 94 persons living with HIV/AIDS in the USA (64.5 % male, M age = 48.3, SD = 7.5). Fifty-seven percent of the participants (n = 54) reported past-month smoking. RESULTS: The results indicated that those who reported smoking and had higher anxiety sensitivity demonstrated the highest rates of hazardous alcohol use, sexual compulsivity, and suicidality. Simple slope analyses indicated that anxiety sensitivity was associated with higher rates of hazardous alcohol use, sexual compulsivity, and suicidality among individuals who reported past-month smoking, but not among individuals who did not smoke. CONCLUSION: The present results suggest that smoking status moderates the relation between anxiety sensitivity and hazardous alcohol use, sexual compulsivity, and suicidality among persons living with HIV/AIDS. These data add to a growing literature, suggesting that smoking has a negative impact among persons living with HIV/AIDS, which extends beyond physical health problems to a variety of clinically significant behavioral health sequelae.

Acculturative stress and experiential avoidance: relations to depression, suicide, and anxiety symptoms among minority college students.

Although college campuses represent strategic locations to address mental health disparity among minorities in the US, there has been strikingly little empirical work on risk processes for anxiety/depression among this population. The present investigation examined the interactive effects of acculturative stress and experiential avoidance in relation to anxiety and depressive symptoms among minority college students (n = 1,095; 78.1% female; Mage = 21.92, SD = 4.23; 15.1% African-American (non-Hispanic), 45.3% Hispanic, 32.5% Asian, and 7.1% other races/ethnicities. Results provided empirical evidence of an interaction between acculturative stress and experiential avoidance for suicidal, social anxiety, and anxious arousal symptoms among the studied sample. Inspection of the significant interactions revealed that acculturative stress was related to greater levels of suicidal symptoms, social anxiety, and anxious arousal among minority college students with higher, but not lower, levels of experiential avoidance. However, in contrast to prediction, there was no significant interaction for depressive symptoms. Together, these data provide novel empirical evidence for the clinically-relevant interplay between acculturative stress and experiential avoidance in regard to a relatively wide array of negative emotional states among minority college students.

The role of anxiety sensitivity in the relation between trait worry and smoking behavior.

INTRODUCTION: Smoking and anxiety disorders frequently co-occur. Trait worry is a core symptom of anxiety disorders. While research suggests worry processes may be important to certain smoking behaviors, the mechanisms explicating these relations remain unknown. METHOD: The current study examined anxiety sensitivity (AS) as a potential mediator for the relation between trait worry and number of years being a daily smoker, latency to first cigarette of the day, smoking rate, heaviness of smoking, and nicotine dependence among treatment-seeking daily smokers (N = 376; 47% female; M age = 37.76, SD = 13.46). RESULTS: Consistent with prediction, AS significantly mediated the relations between trait worry and the studied smoking variables. CONCLUSION: The present findings suggest it may be useful to clinically address AS among worry-prone, treatment-seeking daily smokers in order to address smoking behavior.

Examination of smoking inflexibility as a mechanism linking anxiety sensitivity and severity of smoking behavior.

BACKGROUND AND OBJECTIVES: Anxiety sensitivity is associated with smoking processes and poorer clinical outcomes. Yet, the specific mechanisms underlying this association are unclear. Smoking-specific avoidance and inflexibility (AIS) is a construct implicated in multiple manifestations of mood regulation that may underlie smoking severity. The current study examined whether AIS accounted for (ie, statistically mediated) the relationship between anxiety sensitivity and multiple indices of smoking severity. METHODS: Baseline self-report data were collected among treatment-seeking smokers (N = 396; 48% female; Mage = 37.8 years) taking part in a larger intervention study. Gender, smoking-related medical history, Axis I diagnoses, hazardous alcohol use, substance abuse/dependence, and negative affectivity were statistically controlled in analyses. RESULTS: Anxiety sensitivity was indirectly related to all smoking severity variables, with the exception of nicotine dependence, through its relation with AIS. DISCUSSION AND CONCLUSIONS: These findings provide initial evidence suggesting AIS may be an important construct in better understanding anxiety sensitivity-smoking relations. SCIENTIFIC SIGNIFICANCE: Results suggest the importance of AIS as a malleable target for smoking cessation intervention.

A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder.

Risky sexual behavior (RSB) during adolescence increases risk for sexually transmitted diseases and teenage pregnancy. Youth with psychiatric diagnoses are more likely to engage in RSB, and borderline personality disorder (BPD) in adolescence may be particularly relevant to RSB. It is not yet clear whether adolescents with BPD engage in higher levels of RSB than adolescents with other psychiatric diagnoses. The present study examined RSB and correlates of RSB among adolescent inpatient females with and without BPD. One hundred twenty-three female adolescent inpatients (Mage = 15.15, 71.5% Caucasian, 40.6% BPD) completed an interview to assess BPD diagnosis and measures of BPD traits, RSB, attitudes and perceived norms related to RSB, and sexual self-efficacy. Results indicated no differences in RSB based on BPD diagnosis. However, the BPD group evidenced significantly lower self-efficacy to refuse sex, and riskier attitudes and perceived peer norms about sexual behavior than inpatient controls. When examined dimensionally using borderline traits and controlling for level of psychopathology, borderline traits were significantly related to lower self-efficacy to refuse sex. Results suggest that adolescent girls with BPD do not engage in higher levels of RSB than inpatient psychiatric controls; however, riskier attitudes and norms related to RSB, and particularly lower self-efficacy to refuse sex, may influence adolescent girls with BPD or BPD traits to engage in higher levels of RSB later in life and therefore present important preventative treatment targets. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Anxiety Sensitivity in Association With Alcohol-Related Behaviors Among College Students: The Role of Negative Urgency.

OBJECTIVE: Extant work has documented the relationship between anxiety sensitivity (AS) and problematic alcohol-related behaviors. However, research on the underlying mechanisms may serve to better explain their association. METHOD: The present study tested the hypothesis that AS would exert an indirect effect on alcohol-related behaviors through negative urgency among a sample of 507 college students (74.4% female; mean age = 22.07 years; SD = 3.83; age range: 18-47 years) who reported at least one heavy episodic drinking (HED) event in the previous month and at least one lifetime sexual partner. Alcohol-related behaviors included sex-related alcohol negative consequences, negative consequences of alcohol use, and alcohol-related protective behavioral strategies. RESULTS: Results indicated that AS was not directly related to alcohol-related behaviors after accounting for negative urgency. However, AS did yield a significant indirect effect through negative urgency for sex-related alcohol negative consequences, negative consequences of alcohol use, and alcohol-related protective behavioral strategies. These findings remained significant after controlling for gender, age, fraternity/sorority membership, number of lifetime sexual partners, negative affectivity, and typical drinking in the past month. CONCLUSIONS: Findings provided novel empirical evidence that, among college students, AS may be a risk factor for alcohol-related behaviors indirectly through negative urgency. Overall, the present investigation extends the growing body of literature aimed to explicate the relationship between AS and alcohol-related behaviors and may aid in intervention approaches among college students.

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3.

The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; Mage = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African-Americans, Asian Americans, and sexual minorities.

The relationship of discrimination related to sexual orientation and HIV-relevant risk behaviors among men who have sex with men.

Men who have sex with men (MSM) are at high risk for contraction and transmission of Human Immunodeficiency Virus (HIV). Increased risk of infection has been linked to high risk behaviors, such as alcohol and drug use, as well as engaging in unsafe sexual behaviors. Experiences of discrimination related to sexual orientation often experienced in this population predict risky behavior outcomes, but little research has examined the mechanisms implicated in this model. The current study examined the effect of anxiety and depressive symptoms in the relationship between discrimination related to sexual orientation and high-risk behaviors of alcohol use, drug use, using sex to cope with negative emotions, frequency of sex without a condom, and frequency of sex with an HIV+ or unknown status partner. Three hundred and eighty-nine MSM were recruited to participate in a survey based study. Results indicated anxiety was maintained a significant indirect effect between discrimination related to sexual orientation and coping behaviors (using sex to cope, alcohol, substance use), but showed no significant indirect associations with risky sexual behavior. Overall, the current study provides novel empirical evidence that discrimination related to sexual orientation is associated with increased anxiety, which in turn, is associated with certain HIV risk behaviors. Importantly, it is possible that alcohol use, drug use, and using sex to cope with negative emotions may be precursors to more risky sexual behavior, such as engaging in anal sex without a condom or having sex with an HIV+ or unknown status partner. Clinically, reducing symptoms of anxiety in the context of discrimination related to sexual orientation may help reduce HIV risk behavior among MSM.