The relationship between PTSD arousal symptoms and depression among mothers exposed to the World Trade Center attacks.

Posttraumatic stress disorder (PTSD) is associated with greater risk of developing comorbid depression. However, little is known about the relationship between specific PTSD symptom clusters and comorbid depression. Approximately 4 years after the World Trade Center (WTC) attacks, we examined the association between PTSD symptom clusters and depression severity among 64 mothers directly exposed to the WTC attacks. Severity scores were computed for each PTSD symptom cluster by summing symptom frequency. Partial correlations with depression severity were calculated separately for PTSD symptom clusters, controlling for demographic variables, time elapsed since the attacks, WTC attack exposure, meeting PTSD criterion A, and the other cluster scores. Higher arousal symptom cluster scores were significantly correlated with persistent depression, but the re-experiencing and avoidance symptom clusters were not. Subsequent analyses isolating shared symptoms of PTSD and depression from those unique to PTSD suggest a complex interrelationship among symptoms of arousal, numbing, and depression.

Dating violence among college men and women: evaluation of a theoretical model.

This study empirically evaluates the Riggs and O'Leary (1989) model of dating violence. A sample of 200 college students completes assessments concerning the occurrence of violence in their dating relationships. The incidence of self-reported partner violence is 25% for women and 10% for men. Multivariate logistic regression analyses are performed to determine the most salient predictors of dating violence for each gender. Findings reveal that the model is more accurate in predicting female, as compared with male perpetration of dating violence. The model accurately classifies 83% of violent women and only 30% of violent men. This study has several implications for the field of dating violence. Results indicate that although there is some degree of overlap, variant constructs predict violence for each gender. Identifying these constructs will guide prevention efforts in more effectively decreasing the occurrence of dating violence.

Child Trauma Exposure and Posttraumatic Stress Disorder: Identification in Community Mental Health Clinics.

We examined the identification of trauma exposure and post-traumatic stress disorder (PTSD) in help-seeking urban children (N=157) presenting for care in community mental health clinics. Children and their parents completed a standard intake assessment conducted by a community clinician followed by a structured trauma-focused assessment conducted by a study clinician. Clinicians provided ratings of child functional impairment, parents reported on internalizing/externalizing problems, and children provided self-reports of PTSD symptom severity. Although community clinicians were mandated by clinic policy to ask about exposure to physical abuse, sexual abuse, and witnessed domestic violence, they identified exposure to these at significantly lower rates than study clinicians. Rates of PTSD based on community clinician diagnosis (1.9%) were also much lower than rates obtained by study clinicians (19.1%). A review of clinical charts one year after intake revealed no change in PTSD diagnosis rate following additional clinical contacts. Clinician-rated impairment, parent-rated emotional/behavioral problems, and child-rated PTSD symptom severity measures provided support for the validity of trauma exposure and PTSD as identified by study clinicians. Trauma exposure and PTSD diagnosis among help-seeking urban youth appear to be under-identified by community clinicians, which may compromise clinicians' ability to respond to environmental risks and provide appropriate evidence-based treatments.

A prospective analysis of sexual assault perpetration: risk factors related to perpetrator characteristics.

This study prospectively evaluated perpetrator risk factors for sexual assault perpetration, including peer influences, beliefs and attitudes about sexuality, alcohol use, and token resistance. Perpetration of sexual assault was evaluated at three time periods: pretest, 3-month follow-up, and 7-month follow-up. Retrospective and prospective analyses yielded differential predictors of sexually aggressive behavior. However, perpetration of sexual assault at any particular assessment period was a predictor of perpetration during the subsequent follow-up period. Furthermore, several variables that have previously been demonstrated in the literature to be related to the perpetration of sexual assault were not significant in regression analyses, indicating that these variables may be rendered insignificant when accounting for past perpetration in prospective analyses. These findings may have significant potential impact on development of sexual assault prevention programming with men.

A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children.

BACKGROUND: This study evaluated the potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early use of a medication to prevent PTSD in children. METHODS: Twenty-six children aged 6-20 were assessed in a 24-week double-blind placebo-controlled design. Each child received either flexibly dosed sertraline between 25-150 mg/day or placebo. At each reassessment, information was collected in compliance with the study medication, parental assessment of the child's symptomatology and functioning, and the child's self-report of symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children. RESULTS: The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated a greater decrease in parent-reported symptoms over 8 weeks (-4.1 vs. -0.5, p=0.005), over 12 weeks (-4.4 vs. -1.2, p=.008), and over 24 weeks (-4.0 vs. -0.2, p=0.017). CONCLUSIONS: Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.

Effects of clinician-assisted emotional disclosure for sexual assault survivors: a pilot study.

This study assessed the effects of clinician-assisted emotional disclosure (CAED), an integration of emotion focused therapy (Greenberg, Rice, & Elliott, 1993) and emotional disclosure, in ameliorating distress experienced by survivors of sexual assault. A total of 670 female university students were screened for both histories of sexual victimization and clinically significant levels of global psychological distress. Twenty-eight females entered the treatment phase of the study and were randomly assigned to participate in either treatment or no-treatment control conditions. Participants completed a battery of instruments at each evaluation to assess interpersonal, global, and traumatic stress symptoms. At termination and 1-month follow-up, there were no significant differences between CAED and control group on any of the outcome variables. However, there were several differences between the CAED treatment and control groups at 3 month posttreatment. Specifically, individuals in the CAED group reported significant reductions in interpersonal distress, namely, hostility and dependency and reductions in avoidance symptoms associated with posttraumatic stress disorder. These findings are useful for the development of emotion-focused therapies and, specifically, toward psychotherapy integration strategies that combine imaginal exposure with experiential techniques for emotional processing of previously avoided experience.

Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents.

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.