Trauma reminders and disgust: The roles of posttraumatic stress disorder symptom severity, trauma type, and reminder type.

Disgust is a common emotional response to trauma but is studied less frequently than fear or other negative emotions. In laboratory settings, individuals with a history of sexual assault report more disgust following exposure to trauma reminders than those exposed to other trauma types, and people with more severe posttraumatic stress disorder (PTSD) symptoms typically report more disgust than those with lower symptom levels. It remains unknown whether this association is also present in ecological contexts and if these associations vary by trauma reminder type. The present sample included 80 trauma-exposed community members (PTSD: n = 39, no PTSD: n = 41) who completed up to 17 prompts per day for 3 days (2,158 total completed surveys). Multilevel models indicated that trauma reminders were associated with increased feelings of disgust, B = 0.16, SE = 0.06, p < .001, which was consistent across trauma reminder types, p < .001-p = .001. PTSD symptom severity moderated the association between trauma reminders and disgust such that it was stronger for participants with higher CAPS-5 scores, B = 0.02, SE = 0.01, p = .011. All trauma reminder types demonstrated the same pattern of moderation, ps = .003-.022, except flashbacks, p = .070. Trauma type was not a significant moderator of any trauma reminder type, ps = .193-.929. These findings suggest that trauma reminders encountered in daily life are associated with feelings of disgust. The results underscore the importance of exploring disgust as a trauma-related emotional experience among trauma survivors.

Margarita glasses and high heels: How attention to shape, age, and vocabulary impacts children's recognition of typical and atypical exemplars.

Children's ability to recognize object shape is foundational for successful early word learning. However, the prototypical shape of objects may not be easily accessible-take margarita glasses, for instance. The current study examined 304 U.S. children 17- to 42-month-old (152 females) from 2017 to 2020, asking how shape, age, and vocabulary abilities predict recognition of everyday objects. Children's ability to recognize objects increases with age and vocabulary, replicating prior work. Moreover, performance was partially moderated by object's typicality and shape features, and children's own attention to shape (shape bias) may mediate the effect, especially with prototypically shaped objects. The current study highlights how both child-specific variables and context features interact to shape language abilities, underscoring the emergent and multi-causal nature of word learning.

Positive emotion in posttraumatic stress disorder: A global or context-specific problem?

Problems with positive emotion are an important component of posttraumatic stress disorder (PTSD), with competing perspectives as to why. The global model suggests that people with PTSD experience a relatively permanent shift in their capacity for positive emotion regardless of context, whereas the context-specific model posits access to the full repertoire of positive emotion that only becomes reduced during exposure to trauma reminders. We tested the global versus context-specific models using ecological momentary assessment (EMA). Trauma-exposed adult community members (N = 80) with (n = 39) and without diagnosed PTSD completed 3 days of EMA (n = 2,158 observations). Participants with PTSD reported lower average momentary levels of positive emotion, B = -0.947, 95% CI [-1.35, -0.54], p < .001, and positive situations, B = -0.607, 95% CI [-1.16, -0.05], p = .032, and more thinking about trauma reminders, B = 0.360, 95% CI [0.21, 0.51], p < .001. There was no between-group difference in positive emotion reactivity (degree of positive emotion derived from positive situations), B = 0.03, 95% CI [-0.09, 0.14], p = .635. Increased thinking about trauma reminders predicted lower momentary levels of positive emotion, B = -0.55, 95% CI [-0.83, -0.26], p < .001, but not reactivity, B = 0.02, 95% CI [-0.35, 0.40], p = .906, irrespective of PTSD status. Findings supported the global model and were inconsistent with the context-specific model. This study helps clarify positive emotional functioning in trauma-exposed adults and highlights future directions to better understand problems with positive emotion in PTSD.

Effects of trauma-focused rumination among trauma-exposed individuals with and without posttraumatic stress disorder: An experiment.

Rumination, or thinking repetitively about one's distress, is a risk factor for posttraumatic stress disorder (PTSD). Current theories suggest that rumination contributes to PTSD symptoms directly, by increasing negative reactions to trauma cues (i.e., symptom exacerbation), or represents a form of cognitive avoidance, if verbal ruminations are less distressing than trauma imagery. The goal of this study was to test the symptom exacerbation and cognitive avoidance accounts of trauma-focused rumination. We recruited 135 trauma-exposed participants (n = 60 diagnosed with PTSD) and randomly assigned them to ruminate about their trauma, distract themselves, or engage in trauma imagery. For individuals with and without PTSD, rumination led to larger increases in subjective distress (i.e., negative affect, fear, sadness, subjective arousal, valence) than distraction, ηp 2 s = .04-.13, but there were no differences between rumination and imagery ηp 2 s = .001-.02. We found no evidence that rumination or imagery elicited physiological arousal, ds = 0.01-0.19, but did find that distraction reduced general physiological arousal, as measured by heart rate, relative to baseline, d = 0.84, which may be due to increases in parasympathetic nervous system activity (i.e., respiratory sinus arrhythmia), d = 0.33. These findings offer no support for the avoidant function of rumination in PTSD. Instead, the findings were consistent with symptom exacerbation, indicating that rumination leads directly to emotional reactivity to trauma reminders and may be a fruitful target in PTSD intervention.

Acute kidney injury in cystic fibrosis patients treated with intravenous colistimethate sodium or tobramycin.

OBJECTIVES: Colistimethate sodium and tobramycin are important systemic antibiotics for treatment of cystic fibrosis (CF) pulmonary exacerbations but can induce acute kidney injury (AKI). We characterize the rate of AKI in CF patients treated with systemic colistimethate sodium compared with tobramycin. METHODS: This single-centre, retrospective cohort study included hospitalized CF patients treated with IV colistimethate sodium or tobramycin. The primary outcome was AKI defined using the RIFLE criteria. Multivariate logistic regression using a mixed model was performed to identify variables that were independently associated with AKI. RESULTS: Overall, 156 patients representing 507 care encounters were included. The OR of AKI was not increased with IV colistimethate sodium relative to IV tobramycin after adjusting for other potential predictor variables (aOR 1.00; 95% CI 0.16-6.03). The frequency of AKI was 9.5% across all encounters, 6.9% with IV colistimethate sodium and 9.9% with IV tobramycin, with RIFLE category R (risk) being the most common stage, accounting for 4.2% of encounters with IV colistimethate sodium and 9.2% with IV tobramycin. The concomitant use of another nephrotoxin (aOR 2.51; 95% CI 1.27-4.95) or the combination of vancomycin and piperacillin/tazobactam (aOR 5.95; 95% CI 2.05-17.3) were both associated with increased odds of AKI. CONCLUSIONS: Systemic treatment with colistimethate sodium or tobramycin in the CF patient population is associated with a similar rate of nephrotoxicity. However, clinicians should be mindful of the increased risk for AKI in patients treated with either IV colistimethate sodium or IV tobramycin when used concurrently with other nephrotoxic agents, particularly the combination of vancomycin and piperacillin/tazobactam.

Posttraumatic stress disorder-related anhedonia as a predictor of psychosocial functional impairment among United States veterans.

Prior research suggests that anhedonia symptoms related to posttraumatic stress disorder (PTSD; i.e., diminished interest, detachment from others, and difficulty experiencing positive emotions) are consistently associated with a higher degree of impairment in psychosocial functioning beyond that associated with other PTSD symptoms. Unfortunately, much of this research has used cross-sectional study designs; relied upon outdated DSM diagnostic criteria; and failed to control for potentially confounding variables, such as the presence of co-occurring depression. This study used data from Waves 2 and 4 (n = 1,649) of the Veterans' After-Discharge Longitudinal Registry (Project VALOR), a longitudinal dataset of U.S. Army and Marine veterans. As measured using the Inventory of Psychosocial Functioning, Wave 4 psychosocial functioning was regressed on seven PTSD symptom factors at Wave 2 (i.e., intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal) and potential Wave 2 confounds. The Anhedonia factor, ß = .123, most strongly predicted later psychosocial functional impairment beyond the impact of other PTSD symptom factors, ßs = -.076-.046. Clinical implications of these findings are also discussed.

A prospective examination of health care costs associated with posttraumatic stress disorder diagnostic status and symptom severity among veterans.

Posttraumatic stress disorder (PTSD) is associated with increased health care costs; however, most studies exploring this association use PTSD diagnostic data in administrative records, which can contain inaccurate diagnostic information and be confounded by the quantity of service use. We used a diagnostic interview to determine PTSD diagnostic status and examined associations between PTSD symptom severity and health care costs and utilization, extracted from Veteran Health Administration (VHA) administrative databases. Using a nationwide longitudinal sample of U.S. veterans with and without PTSD (N = 1,377) enrolled in VHA health care, we determined the costs and utilization of mental health and non-mental health outpatient, pharmacy, and inpatient services for 1 year following cohort enrollment. Relative to veterans without PTSD, those with PTSD had higher total health care, B = 0.47; mental health clinic care, B = 0.72; non-mental health clinic care, B = 0.30; and pharmacy costs, B = 0.72, ps < .001. More severe PTSD symptoms were associated with mental health clinic care costs, B = 0.12; non-mental health clinic care costs, B = 0.27; and higher odds of inpatient, B = 0.63, and emergency service use, B = 0.39, p < .001-p = .012. These findings indicate that veterans' PTSD status, determined by a clinician-administered semistructured diagnostic interview, was associated with higher health care costs and increased use of mental health and non-mental health clinic services. The findings also suggest that more severe PTSD is associated with increased costs and utilization, including costly emergency and inpatient utilization.

Supporting habitat restoration in the northern Gulf of Mexico through synthesis of data on multiple and interacting benefits and stressors.

Outcomes of landscape scale restoration and conservation can be maximized when planning is based upon quantitative and decision-relevant information. Existing tools to support data-driven planning are hindered by regionally inconsistent information and a need for advanced methods to analyze data of varying spatial resolution and coverage. We present a synthesis methodology for region-wide derived metrics to characterize natural resource value, ecosystem stress, and social vulnerability to inform implementation of conservation and restoration projects. Our three-part methodology was developed and tested for the Gulf of Mexico in support of the Southeast Conservation Blueprint that was created to advance the Southeast Conservation and Adaptation Strategy. The first step included integration of prioritized natural resource metrics alongside socio-ecological metrics to create a data layer of synthesized natural resource priority across the northern Gulf of Mexico. The second component was calculation of ecosystem stress indices based on ecologically relevant thresholds and a cumulative ecosystem stress layer, in addition to analyzing correlations between individual stressors and their relative importance. The final component was development of a social vulnerability (SoVI) index. Analysis of these metrics illustrate their ability to effectively capture variability at multiple scales in the Gulf of Mexico, including expected spatial correlation of stressors such as road density and non-point source pollution in populated areas and the dominance of sea-level rise as a future stressor along the coast. Significant composite components of social vulnerability for the northern Gulf of Mexico region were identified and include economic status, professional workforce, elderly population, population stability, migrant workforce, and rural population. To demonstrate the utility of the data synthesis approach, we used the developed data layers to evaluate proposed marsh creation projects in southern Louisiana. The synthesized data layers were capable of distinguishing differences at the scale of individual habitat restoration projects, and high-value projects could be aligned with the goals of key funding streams. This pilot application illustrates how restoration programs could use the methodology developed here to maximize benefits from conservation and restoration actions along the northern Gulf of Mexico or other regions globally.

Temporal Stability of Self-Reported Trauma Exposure on the Life Events Checklist for DSM-5.

The Life Events Checklist for DSM-5 (LEC-5) is a comprehensive screening instrument used to detect exposure to a range of potentially traumatic events. Despite its widespread use, research assessing the psychometric properties of scores on the LEC-5-and trauma exposure more broadly-is scarce. Using a large sample of undergraduate students (N = 1,013), we sought to evaluate the reliability of trauma exposure reporting on the LEC-5 across 8- (N = 379) and 12-week (N = 343) intervals. Reliability estimates were examined for trauma exposure type (e.g., experiencing, witnessing), traumatic event type (e.g., sexual assault), and index trauma (i.e., "worst event") reporting. Reliability was more stable for events that were directly experienced, intraclass correlation coefficients (ICCs) = .62-64, than events that were witnessed, ICCs = .47-.52, or learned about, ICCs = .48-.53. Test-retest agreement was fair to good for reports of sexual assault, physical assault, transportation accidents, natural disasters, and other sexual experiences, κs = .49-.72, but only when individuals directly experienced these events. By contrast, across both assessment intervals, the agreement was attenuated, all κs < .40, for events that individuals witnessed or learned about regardless of event type. For index events, only sexual assault and sudden accidental or violent deaths were consistently reported with a fair or better agreement, κs = .42-.64. These findings suggest that reliable trauma reporting varies largely based on the nature of the traumatic event, yielding important implications for the assessment of DSM-5 Criterion A and posttraumatic stress disorder.

Correcting eyewitness suggestibility: does explanatory role predict resistance to correction?

Many studies have documented that exposure to post event misinformation can lead eyewitnesses to misremember witnessing events they did not see and do so with high confidence. The goal of the present study was to investigate whether reporting of suggested misinformation can be reversed following a correction, and if so, whether misinformation would be more resistant to correction when it serves an explanatory function than when it does not. In two experiments participants witnessed an event, were exposed to a blatantly false suggestion(s) and one week later received a correction followed by a test of their memory for the witnessed event. We found evidence for both the persistence of misinformation following a correction (E1) and the complete reversibility of misinformation effects following a highly salient correction (E2). Although false reporting of the misinformation doubled when it served an explanatory function relative to when it did not (E1 and E2), in both experiments we found no evidence that resistance to correction varied as a function of the misinformation's explanatory role. Our findings suggest that, with a salient correction provided by a credible source, people are capable of updating their knowledge with new information that reverses what they previously thought.

Posttraumatic Stress Disorder Symptom Network Structures: A Comparison Between Men and Women.

This study estimated gender differences in the posttraumatic stress disorder (PTSD) symptom network structure (i.e., the unique associations across symptoms) using network analysis in a Latin American sample. Participants were 1,104 adults, taken from epidemiological studies of mental health following natural disasters and accidents in Mexico and Ecuador. Symptoms of DSM-IV PTSD were measured dichotomously with the Spanish version of the Composite International Diagnostic Interview. We estimated the PTSD symptom network of the full sample and in male and female subsamples as well as indices of centrality, the stability and accuracy of the modeled networks, and communities of nodes within each network. The male and female networks were compared statistically using the Network Comparison Test (NCT). Results indicated strength centrality was the only stable centrality measure, with correlation stability (CS) coefficients of .59, .28, and .44 for the full, male, and female networks, respectively. We found the most central symptoms, measured by strength centrality, were loss of interest and flashbacks for men; and concentration impairment, avoiding thoughts/feelings, and physiological reactivity for women. The NCT revealed that the global structure (M = 0.84), p = .704, and global strength (S = 5.04), p = .556, of the male and female networks did not differ significantly. Although some gender differences in the most central symptoms emerged, thus offering some evidence for gender differences pending replication in larger samples, on the whole, our results suggest that once PTSD develops, the way the symptoms are associated does not differ substantially between men and women.

Emotion regulation in posttraumatic stress disorder (PTSD): Rumination accounts for the association between emotion regulation difficulties and PTSD severity.

OBJECTIVE: The current study investigated whether rumination accounts for the relationship between multiple aspects of emotion regulation (ER) difficulties and posttraumatic stress disorder (PTSD) severity. METHOD: Participants were 90 community members (43% diagnosed with PTSD; Mage = 26.7, 86% female) who were interviewed using the Clinician-Administered PTSD Scale-5 and completed self-reported measures of ER and rumination. RESULTS: The indirect effect of rumination completely accounted for the relationship between overall ER difficulties and PTSD severity. This finding was replicated for three unique aspects of ER (i.e., nonacceptance of negative emotions, impulse control difficulties under emotional distress, and the ability to maintain goal-oriented behavior under emotional distress). Reverse models testing the indirect effect of ER on the link between rumination and PTSD were nonsignificant. CONCLUSIONS: Rumination is an important cognitive process linking specific aspects of ER difficulties to PTSD. Clinical interventions focused on improving ER abilities among those with PTSD may benefit from targeting rumination.

Overestimating Self-Blame for Stressful Life Events and Adolescents' Latent Trait Cortisol: The Moderating Role of Parental Warmth.

Cognitive interpretations of stressful events impact their implications for physiological stress processes. However, whether such interpretations are related to trait cortisol-an indicator of individual differences in stress physiology-is unknown. In 112 early adolescent girls (M age = 12.39 years), this study examined the association between self-blame estimates for past year events and latent trait cortisol, and whether maternal warmth moderated effects. Overestimating self-blame (versus objective indices) for independent (uncontrollable) events was associated with lower latent trait cortisol, and maternal warmth moderated the effect of self-blame estimates on latent trait cortisol for each dependent (at least partially controllable) and interpersonal events. Implications for understanding the impact of cognitive and interpersonal factors on trait cortisol during early adolescence are discussed.

OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer.

BACKGROUND: Patients with HPV+ oropharyngeal squamous cell carcinoma were assigned to dose and volume de-escalated radiotherapy (RT) or chemoradiotherapy (CRT) based on response to induction chemotherapy in an effort to limit treatment-related toxicity while preserving efficacy. PATIENTS AND METHODS: Patients were classified as low-risk (≤T3, ≤N2B, ≤10 pack-year history) or high-risk (T4 or ≥N2C or >10 PYH). After three cycles of carboplatin/nab-paclitaxel, response was assessed using Response Evaluation Criteria in Solid Tumors 1.1. Low-risk patients with ≥50% response received 50 Gray (Gy) RT (RT50) while low-risk patients with 30%-50% response or high-risk patients with ≥50% response received 45 Gy CRT (CRT45). Patients with lesser response received standard-of-care 75 Gy CRT (CRT75). RT/CRT was limited to the first echelon of uninvolved nodes. The primary end point was 2-year progression-free survival compared with a historic control of 85%. Secondary end points included overall survival and toxicity. RESULTS: Sixty-two patients (28 low risk/34 high risk) were enrolled. Of low-risk patients, 71% received RT50 while 21% received CRT45. Of high-risk patients, 71% received CRT45. With a median follow-up of 29 months, 2-year PFS and OS were 95% and 100% for low-risk patients and 94% and 97% for high-risk patients, respectively. The overall 2-year PFS was 94.5% and within the 11% noninferiority margin for the historic control. Grade 3+ mucositis occurred in 30%, 63%, and 91% of the RT50, CRT45, and CRT75 groups, respectively (P = 0.004). Rates of any PEG-tube use were 0%, 31%, and 82% for RT50, CRT45, and CRT75 groups, respectively (P < 0.0001). CONCLUSIONS: Induction chemotherapy with response and risk-stratified dose and volume de-escalated RT/CRT for HPV+ OPSCC is associated with favorable oncologic outcomes and reduced acute and chronic toxicity. Further evaluation of induction-based de-escalation in large multicenter studies is justified. CLINICAL TRIAL REGISTRATION: Clinical trials.gov identifier: NCT02258659.

A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans.

BACKGROUND: Suicide rates among veterans have increased markedly since the onset of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF; LeardMann et al., 2013). Identification of factors with the greatest contribution to suicide risk among veterans is needed to inform risk assessment and to identify intervention targets. METHODS: This study examined predictors of suicide attempts among participants in the Veterans After-Discharge Longitudinal Registry; a nationwide cohort of OEF/OIF veterans enrolled in Department of Veterans Affairs (VA) services. Veterans with and without probable posttraumatic stress disorder (PTSD) were sampled at a 3:1 ratio, and male and female veterans were sampled at a 1:1 ratio. Participants (N = 1,649) were assessed at two time points, roughly 2 years apart (M = 28.74 months, SD = 8.72). RESULTS: Seventy-four participants (4.49%) attempted suicide during the follow-up period. The strongest predictors of suicide attempts among the full sample were suicidal intent, attempt history, suicide ideation, PTSD symptoms, alcohol use disorder (AUD) symptoms, and depression. Veterans with multiple risk factors were particularly vulnerable; of veterans with 0, ≥1, ≥2, ≥3, or ≥ 4 of these risk factors, 0%, 7.81%, 10.31%, 18.45%, and 20.51% made a suicide attempt, respectively. CONCLUSIONS: This prospective study identified several strong predictors of suicide attempts among OEF/OIF veterans which may be important targets for suicide prevention efforts. Further, co-occurrence of multiple risk factors was associated with markedly greater risk for suicide attempts; veterans with multiple risk factors appear to be at the highest risk among OEF/OIF veterans enrolled in VA care.

Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study.

BACKGROUND: Combat exposure is associated with increased risk of mental disorders and suicidality. Moral injury, or persistent effects of perpetrating or witnessing acts that violate one's moral code, may contribute to mental health problems following military service. The pervasiveness of potentially morally injurious events (PMIEs) among U.S. combat veterans, and what factors are associated with PMIEs in this population remains unknown. METHODS: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary and nationally representative survey of a population-based sample of U.S. veterans, including 564 combat veterans, collected September-October 2013. Types of PMIEs (transgressions by self, transgressions by others, and betrayal) were assessed using the Moral Injury Events Scale. Psychiatric and functional outcomes were assessed using established measures. RESULTS: A total of 10.8% of combat veterans acknowledged transgressions by self, 25.5% endorsed transgressions by others, and 25.5% endorsed betrayal. PMIEs were moderately positively associated with combat severity (ß = .23, P < .001) and negatively associated with white race, college education, and higher income (ßs = .11-.16, Ps < .05). Transgressions by self were associated with current mental disorders (OR = 1.65, P < .001) and suicidal ideation (OR = 1.67, P < .001); betrayal was associated with postdeployment suicide attempts (OR = 1.99, P < .05), even after conservative adjustment for covariates, including combat severity. CONCLUSIONS: A significant minority of U.S combat veterans report PMIEs related to their military service. PMIEs are associated with risk for mental disorders and suicidality, even after adjustment for sociodemographic variables, trauma and combat exposure histories, and past psychiatric disorders.

Associations Among Posttraumatic Stress Disorder Symptoms, Substance Use, and Affective Attentional Processing in OEF/OIF/OND Veterans.

The majority of research examining affective attentional bias in posttraumatic stress disorder (PTSD) has not examined the influence of co-occurring psychiatric disorders. This study examined the individual and interactive effects of PTSD symptoms and substance use disorders (SUDs) on affective attentional processing among 323 veterans deployed to Iraq or Afghanistan. Participants were divided into those with SUD (SUD+, n = 46) and those without (SUD-, n = 277). Substance use disorder was determined using the Structured Clinical Interview for DSM-IV. Posttraumatic stress disorder was measured using the Clinician Administered PTSD Scale. A computerized go/no-go task (Robbins et al., 1994, Robbins et al.,1998) assessed affective attentional processing. Relative to those without SUD, those with SUD showed a significant association between PTSD symptoms and increased omission and commission accuracy rates and decreased d prime. No effects of valence were found. Findings suggest the need to consider co-occurring SUD when investigating the effects of PTSD on attentional control.

Negative interpretation bias as a mechanism of the relationship between rejection sensitivity and depressive symptoms.

Rejection sensitivity and negative cognitive biases have been identified as important risk factors for depression. Rejection sensitivity is defined as the tendency to anxiously anticipate, easily perceive, and overreact to rejection. Although prior studies have found an association between one component of rejection sensitivity, the tendency to anxiously anticipate rejection, and depression, little is known about the mechanisms through which anxious anticipation of rejection might confer depression risk. One possibility is that rejection anticipation leads to negatively biased interpretations, a cognitive risk factor for depression. Results from two studies (one cross-sectional, one longitudinal) indicate that negative interpretation biases mediate the association between the anxious anticipation of rejection and depressive symptoms. These findings indicate that interpretation biases represent a mechanism through which anxious anticipation of rejection confers risk for depression, and suggest that interventions designed to challenge negative interpretations may help to decrease depression risk among individuals who anticipate rejection.