Towards a more comprehensive understanding of PTSD and parenting.

BACKGROUND: The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain. PROCEDURE: We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting. FINDINGS: We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account. CONCLUSION: With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.

Early predictors of chronic posttraumatic stress disorder symptom trajectories in U.S. Army soldiers deployed to the Iraq war zone.

The course of posttraumatic stress disorder (PTSD) symptoms varies among veterans of war zones, but sources of variation in long-term symptom course remain poorly understood. Modeling of symptom growth trajectories facilitates the understanding of predictors of individual outcomes over time. Although growth mixture modeling (GMM) has been applied to military populations, few studies have incorporated both predeployment and follow-up measurements over an extended time. In this prospective study, 1,087 U.S. Army soldiers with varying military occupational specialties and geographic locations were assessed before and after deployment to the Iraq war zone, with long-term follow-up assessment occurring at least 5 years after return from deployment. The primary outcome variable was the PTSD Checklist-Civilian Version summary score. GMM yielded four latent profiles, characterized as primarily asymptomatic (n = 194, 17.8%); postdeployment worsening symptoms (n = 84, 7.7%); mild symptoms (n = 320, 29.4%); and preexisting, with a chronic postdeployment elevation of symptoms (n = 489, 45.0%). Regression models comparing the primarily asymptomatic class to the symptomatic classes revealed that chronic symptom classes were associated with higher degrees of stress exposure, less predeployment social support, military reservist or veteran status at the most recent assessment, and poorer predeployment visual memory, ORs = 0.98-2.90. PTSD symptom course varies considerably over time after military deployment and is associated with potentially modifiable biopsychosocial factors that occur early in its course in addition to exposures and military status.

Free to be me with you: Development of the Individuality in Couples Questionnaire.

Despite multiple theories and treatment modalities emphasizing the importance of individuality in couple relationships, the field is lacking a reliable and valid measure of this construct. In the present study, we developed the Individuality in Couples (ICQ) questionnaire and demonstrated its strong psychometric properties across two samples of participants in committed intimate relationships (Sample 1 = 580 undergraduates; Sample 2 = 445 community members). The ICQ is comprised of 25 items that can be combined into a reliable total score to measure individuality in the context of couple relationships (i.e., the extent to which someone feels respected by their partner for their individuality and experiences personal autonomy in the relationship). Scores on the ICQ demonstrated high internal consistency, excellent construct replicability, convergent and divergent validity with measures of other relationship dimensions (i.e., intimacy, support, sexual satisfaction, psychological aggression, communication), criterion validity with measures of relationship satisfaction and partner health, and incremental predictive validity for explaining relationship satisfaction and partner well-being when controlling for other relationship dimensions. Results suggest that individuality in couples is largely a unidimensional construct that is distinct from more severe patterns of control and coercion characteristic of psychological aggression. The ICQ holds promise for identifying and promoting dynamics essential for healthy couple relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Women's Disengagement Behaviors During Couple Conflict: Investigating Risk Indicators of Intimate Partner Violence.

Intimate partner violence (IPV) is a major public health concern, leading to prevention efforts focused on identifying risk indicators of escalating conflict between partners. Certain behaviors during conflict discussions have been uniquely linked to IPV, and there is evidence that disengagement behaviors-an emerging construct-are associated with IPV as well. However, research on disengagement and IPV has largely been limited to self-report, and available observational research is largely cross-sectional. Addressing these limitations, this study prospectively examined the association between observed disengagement behaviors during couple's conflict discussions and IPV 1 year later, using a sample of 83 heterosexual married or cohabitating partners. Behavioral coding was used to assess each partner's observed disengagement behaviors and each partner's psychological and physical IPV was assessed via questionnaire 1 year later. Linear regressions were used to investigate links between indicators of engagement (i.e., listening, questions, eye contact) and psychological and physical IPV perpetration and victimization. Less question asking and higher eye contact by women were associated with greater psychological and physical IPV perpetrated by both women and men 1 year later. Lower listening behaviors by women were associated with greater psychological (but not physical) IPV perpetrated by men 1 year later. In contrast, no disengagement behaviors displayed by men were significantly related to IPV. Applying a latent change score framework using baseline IPV data, findings indicated replicability of results, though with less consistency, suggesting that women's disengagement behaviors may reflect a larger pattern of abuse that predates and follows disengaged couple interactions. Findings suggest that a unique blend of verbal and nonverbal indicators of women's disengagement during couple conflict provides a meaningful signal of the emotional climate of the relationship.

Promoting resilience to depression among couples during pregnancy: The protective functions of intimate relationship satisfaction and self-compassion.

Pregnancy, while often marked by joy, may pose considerable risk for depression among parents. Against a backdrop of adverse life events, expectant parents may be even more vulnerable to developing symptoms of depression during the prenatal period. Thus, it is critical to identify sources of resilience that might facilitate a successful transition to parenthood among couples who have a history of adversity. Prior work suggests that interpersonal and intrapersonal factors associated with resilience, such as intimate relationship satisfaction and self-compassion (i.e., self-kindness, common humanity, and mindfulness), have the potential to attenuate prenatal depression among couples with a history of stressful life experiences. We tested this possibility in a sample of 159 couples navigating pregnancy. As predicted, a greater number of prior stressful life experiences was associated with increased depression symptom severity for both mothers and fathers. However, moderation analyses revealed the positive link between cumulative stressful life experiences and depression symptom severity was attenuated among mothers who reported greater self-compassion in the form of feelings of common humanity, and fathers who reported higher levels of intimate relationship satisfaction and self-compassion in the form of mindfulness. Findings suggest enhancing intimate relationship satisfaction and self-compassion among expectant couples may be valuable in attenuating prenatal depression among those with a greater history of adversity.

Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems.

Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.

The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters.

Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.

Parenting behaviors of mothers with posttraumatic stress: The roles of cortisol reactivity and negative emotion.

Although posttraumatic stress disorder (PTSD) is associated with negative family outcomes, including parenting challenges, little is known about the biological and emotional processes that might underlie this association. The present project addressed this gap by examining associations between maternal PTSD and parenting behaviors in a lab setting. We expected that PTSD would be associated with more ineffective parenting behaviors and that negative emotion and cortisol reactivity would mediate this relation. A total of 78 mothers and their toddler-aged children completed a task designed to elicit parental responses to typical instances of child misbehavior. Salivary cortisol was collected from mothers prior and subsequent to the lab paradigm and mothers provided ratings of their experienced emotion while viewing a video of the interaction. Contrary to hypotheses, cortisol reactivity did not mediate associations between PTSD and parenting. However, findings suggest that PTSD is associated with greater permissive parenting behaviors, and mothers with even subthreshold symptoms of PTSD may experience more negative emotion during challenging parent-child interactions that ultimately interferes with parenting. Mothers with PTSD may benefit from interventions that focus on modifying the intensity of their negative emotions in the context of child misbehavior to more effectively set limits in everyday discipline encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PTSD and parental functioning: The protective role of neighborhood cohesion among Black and White veterans.

OBJECTIVE: Caregivers with a history of trauma exposure may struggle to parent effectively, particularly when symptoms of PTSD are prominent. Consequently, identifying factors that buffer associations between PTSD and poor parental functioning is critical to help trauma-exposed families thrive. One important source of resilience may spring from being part of a socially cohesive neighborhood that offers positive social connections and resources. The purpose of this study was to examine whether greater neighborhood cohesion buffers associations between PTSD and perceived parental functioning. METHOD: A diverse national sample of 563 Black and White veterans raising children in single or dual parent households completed questionnaires assessing PTSD symptoms and neighborhood cohesion at baseline, as well as parental functioning four months later. RESULTS: Multigroup moderation analyses that controlled for crime index, income, and sex revealed that among single Black veterans, but not other groups, the relationship between higher PTSD and poorer parental functioning was weakened for veterans who reported higher neighborhood cohesion. CONCLUSIONS: Findings suggest that PTSD symptoms and neighborhood cohesion affect parenting differently across racial and family makeup configurations, and that higher neighborhood cohesion might be particularly useful in buffering the association between PTSD and parenting among single Black veterans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neurocognitive Performance Predicts Future Partner Violence Among U.S. Iraq-and Afghanistan-deployed Army Soldiers and Veterans.

Objective: Intimate partner violence (IPV) constitutes a major U.S. national health concern and disproportionately affects military families. Prior research, which has been conducted primarily in civilian populations, suggests that relative neurocognitive weaknesses may increase risk for IPV. This prospective study examined the associations between post-deployment neurocognitive performance and subsequent IPV (5-13 years later) among warzone veterans in the context of psychological health and TBI. Method: Participants were 217 warzone veterans from a nationally-dispersed sample of service members and veterans who had previously deployed to the Iraq war zone and their intimate partners. Warzone veterans had previously completed performance-based neurocognitive assessments at a post-deployment assessment. An average of eight years later, participants completed structured psychiatric interviews and psychometric surveys assessing TBI history, posttraumatic stress disorder (PTSD), depression, alcohol use, and IPV perpetration. Results: Regression analyses revealed that relatively greater psychopathology and history of TBI were significantly associated with more frequent warzone veteran IPV psychological perpetration. Further, relatively poorer post-deployment neurocognitive performance predicted higher subsequent psychological and physical IPV perpetration, adjusting for demographics, psychological health, and TBI. Conclusions: Our findings highlight the importance of identifying both psychological/behavioral and neurocognitive correlates of IPV among warzone veterans. An integrative understanding of IPV risk can help inform both IPV prevention and treatment efforts for warzone veterans.

Examining strength at home for preventing intimate partner violence in civilians.

The Strength at Home (SAH) intervention, a trauma-informed, cognitive-behavioral intervention for intimate partner violence (IPV), was examined in a sample of court-mandated men. Evidence from prior research indicates that SAH is effective in military veterans but the program has not been examined in civilians. It was expected that SAH participants would evidence reductions in physical and psychological IPV, as well as secondary outcomes of post-traumatic stress disorder (PTSD) symptoms and alcohol use problems. Participants included 23 men court mandated to IPV intervention. The sample was low income and 72.7% had a reported prior history of severe physical IPV perpetration. Data from these participants and collateral partners were examined across assessments reflecting baseline, post-treatment, and two 3-month follow-ups. The outcome variables were assessed at each time point to examine change over time and a post-treatment satisfaction measure was also administered immediately following the intervention. Participants showed a significant linear decrease between baseline and post-treatment in all of the primary and secondary IPV outcomes, which maintained at 3- and 6-month follow-up time points. Effect sizes across models were moderate to large. Participants reported high satisfaction with SAH. Study findings provide preliminary support that the SAH intervention is associated with reductions in IPV among civilians and addresses other trauma- and alcohol-related problems. Further research including larger randomized controlled trials are needed to determine the efficacy of this intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations of warzone veteran mental health with partner mental health and family functioning: Family Foundations Study.

INTRODUCTION: Warzone participation is associated with increased risk of stress-related psychopathology, including posttraumatic stress disorder (PTSD) and depression. Prior research suggests that the mental health of spouses of warzone veterans (WZVs) is linked to that of their partners. Additionally, PTSD among WZVs has been associated with marital dysfunction. Less is known about the effects of depression among WZVs on partner mental health and family relationships. We sought in this study to examine associations between WZV PTSD and depression and partner mental health and relationship outcomes. METHODS: Using a nationally dispersed sample of Iraq and Afghanistan veterans and their married and unmarried intimate partners, 245 dyads completed structured psychiatric interviews and psychometric surveys assessing family functioning and relationship aggression. RESULTS: Adjusted regression analyses indicated that depression among WZVs was associated with partner depression and anxiety disorders. WZV PTSD and depression were also associated with partner-reported relationship dysfunction, dissatisfaction, and communication issues, and higher rates of intimate partner aggression victimization and perpetration. CONCLUSIONS: Mental health consequences of war extend beyond WZVs to the mental health of their intimate partners and their relationships with intimate partners.

Validation of a behavioral coding system for measuring mutually responsive orientation in intimate relationships.

Mutually responsive orientation (MRO) reflects a system of reciprocity between members of a dyad (Kochanska, 2002), and MRO observed in parent-child relationships is a robust predictor of child development (Kim, Boldt, & Kochanska, 2015; Kim & Kochanska, 2012; Kochanska, Aksan, & Joy, 2007; Kochanska, Forman, Aksan, & Dunbar, 2005). The goal of the present study was to adapt an observational coding system previously validated in parent-child dyads to assess MRO in intimate relationships and test the reliability and validity of scores from this adapted coding system. One hundred and fifty-nine couples were observed engaging in a series of standardized, naturalistic, interactive contexts. A team of trained behavioral coders rated MRO across several paradigms. Participants also completed semistructured interviews and self-report questionnaires assessing numerous dimensions of intimate relationship quality to assess convergent and divergent validity and individual and relationship health outcomes to assess criterion and incremental validity. Interrater reliability estimates established that multiple coders could reliably rate MRO across multiple contexts. As anticipated, MRO had small to moderate correlations with other relationship processes (e.g., conflict management, support), demonstrating that MRO is a unique but related dimension of intimate relationship quality. MRO scores were also associated with numerous outcomes including global relationship satisfaction, relationship security, partner mental health, and parent-infant bonding, even when controlling for neuroticism. The assessment of MRO in intimate relationships holds promise for tapping into a unique dimension of intimate relationship quality with implications for explaining a range of outcomes of interest to couples researchers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Posttraumatic Stress and Parenting Behaviors: The Mediating Role of Emotion Regulation.

Purpose: Maternal trauma has been linked with problematic parenting, including both harsh and permissive behaviors. However, little is known about mechanisms accounting for this association. The current study examined the potential impact of posttraumatic stress disorder (PTSD) and emotion regulation on dysfunctional parenting behaviors in a sample of community mothers. We hypothesized a mediation model wherein PTSD would be associated with dysfunctional parenting (i.e., lax and overreactive behaviors) indirectly through deficits in maternal emotion regulation. Method: Seventy-eight community mothers of 18- to 36-month-old children were administered the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and 19 mothers met criteria for PTSD. Mothers also completed self-report measures of difficulties with emotion regulation and maternal laxness and overreactivity in parenting. Results: Results revealed that emotion dysregulation fully mediated relations between PTSD status and lax (but not overreactive) parenting behaviors. Compared to mothers without PTSD, those with PTSD reported greater lax parenting behaviors indirectly through greater emotion dysregulation. Conclusions: Mothers with PTSD may struggle to parent assertively when trauma symptoms interfere with emotion regulation abilities. The current study highlights the need to design interventions focused on helping trauma-exposed mothers manage distress, ultimately aiming to enhance parenting effectiveness and improve child outcomes.

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low-Income Outpatients.

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro-level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low-income outpatients from community mental health clinics who completed a semi-structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.

Gran cantidad de investigaciones respaldan las conexiones bidreccionales entre los desacuerdos en las relaciones afectivas y la psicopatología individual, incluidos los síntomas depresivos. Sin embargo, pocos estudios han utilizado los métodos de registro diario para captar los procesos a pequeñísima escala que subyacen a la asociación entre el desacuerdo entre las parejas y la depresión, particularmente entre poblaciones que tienen un riesgo elevado de disfunción interpersonal e individual. Para abordar esta brecha, analizamos si los cambios diarios en la satisfacción con el funcionamiento de la relación estuvieron asociados con los cambios diarios en el afecto negativo y el afecto positivo durante el periodo de dos semanas entre los pacientes ambulatorios de salud mental de bajo nivel socioeconómico. Los participantes fueron 53 pacientes ambulatorios de bajos ingresos de clínicas comunitarias de salud mental que se sometieron a una entrevista semiestructurada acerca de la calidad de sus relaciones afectivas seguida de 14 informes diarios de estado de ánimo positivo y negativo y de satisfacción con el funcionamiento de la relación en varias áreas. Las técnicas analíticas de la curva de crecimiento revelaron las relaciones bidireccionales planteadas como hipótesis. La disminución de la satisfacción con el funcionamiento de la relación predijo un aumento del afecto negativo y un deterioro del afecto positivo durante dos semanas, y el deterioro del estado de ánimo predijo una disminución de la satisfacción con el funcionamiento de la relación. Conclusiones: Este estudio amplía el conocimiento existente sobre la disfunción en la pareja y la psicopatología individual destacando la índole inmediata de este proceso dinámico a medida que se desarrolla poco a poco con el tiempo.

Further Validation of a Laboratory Analog Sexual Aggression Task: Associations With Novel Risk Factors for Sexual Violence.

Official crime statistics and self-reports of sexual aggression perpetration are limited by various factors (e.g., lack of reporting, social desirability bias), as well as an inability to use these measures in experimental studies of sexual aggression. To address these issues, Nagayama Hall et al. (1994) developed a laboratory analog measure of sexual aggression, which has received empirical support as a valid measure of sexual aggression proclivity. Here, we seek to replicate these findings and further validate the paradigm by examining sexually aggressive responses in relation to a range of recently emerging predictors of sexual aggression (e.g., sexual objectification, sexual narcissism) as well as participants' perceptions of a female confederate serving as the target of sexual aggression. A sample of 49 undergraduate men completed questionnaires and participated in the sexual aggression analog task. Results of logistic regression analyses supported both criterion and construct validity of the analog task; men who chose the sexually explicit video were more likely to report prior sexual aggression, greater sexual objectification of women, higher sexual narcissism, greater hostile sexism, and higher impersonal dating. These men were also more likely to express dehumanizing beliefs about the female confederate, consider her less intelligent, and believe she was more distressed by the video. These results replicate and extend prior research supporting this paradigm as a valid laboratory-based measure of sexual aggression proclivity that can be used in tandem with validated self-report measures.

Does drinking to cope explain links between emotion-driven impulse control difficulties and hazardous drinking? A longitudinal test.

Difficulty controlling impulsive behaviors when experiencing negative emotions is a prominent risk factor for hazardous alcohol use, and prior research suggests that drinking to cope may mediate this association. The present study examines this possibility prospectively in a sample of 490 young adult women between the ages of 18 and 25. Participants completed measures of emotion-driven impulse control difficulties, drinking to cope, and hazardous alcohol use at 6 time points over the course of approximately 20 months (i.e., 1 assessment every 4 months). Multilevel structural equation modeling revealed that drinking to cope fully mediated the relationship between emotion-driven impulse control difficulties and hazardous alcohol use when examining these relationships between individuals and partially mediated this relation when examining these relationships within individuals. These findings suggest that drinking to cope is a key mechanism in the relationship between emotion-driven impulse control difficulties and hazardous drinking. Results highlight the importance of targeting both emotion dysregulation and drinking to cope when treating young women for alcohol use problems.

Relationships among predeployment risk factors, warzone-threat appraisal, and postdeployment PTSD symptoms.

Previous research indicates a relationship between perceived fear for one's safety (i.e., threat appraisal) and posttraumatic stress disorder (PTSD). This prospective study examined relationships among deployment- and predeployment-related variables, threat appraisal, and postdeployment PTSD symptom severity. Prior to Iraq deployment, 774 U.S. Army soldiers completed self-report measures assessing previous life stressors, deployment history, current (predeployment) PTSD symptoms, deployment preparedness, and unit cohesion. Following deployment, participants completed self-report measures assessing combat intensity, deployment threat appraisal, and current (postdeployment) PTSD symptoms. Structural equation modeling revealed that predeployment PTSD symptom severity, prior warzone deployment, unit cohesion, and preparedness were each independently associated with deployment threat appraisal, even after taking into account combat intensity. Deployment threat appraisal was associated with postdeployment PTSD severity. Results indicated that predeployment PTSD symptom severity, history of warzone deployment, and preparedness-risk factors previously thought to influence PTSD outcomes directly-were either partially or fully mediated by threat appraisal. The model explained 15% of the variance in deployment threat appraisal and 50% of the variance in postdeployment PTSD severity. Helping service members cope with exposure to extreme stress during deployment by modifying certain prewar risk factors may facilitate reduction of PTSD symptoms following deployment.

Childhood sexual abuse, alcohol use, and PTSD symptoms as predictors of adult sexual assault among lesbians and gay men.

Prior research has indicated that childhood sexual abuse (CSA), alcohol use, and posttraumatic stress disorder (PTSD) symptoms are important risk factors for adult sexual assault (ASA). A notable limitation of this prior work, however, is that it has almost exclusively focused on heterosexual women. The present study sought to remedy this by examining the extent to which CSA, alcohol use, and PTSD symptoms related to ASA among lesbians (n = 122) and gay men (n = 117). Using structural equation modeling, we found that alcohol use was the best predictor of ASA among lesbians whereas CSA was the best predictor of ASA among gay men. These results suggest that certain risk factors may be differentially related to ASA among groups with different sexual orientations. Such findings deepen our current understanding of ASA and offer important directions for reducing the risk of ASA for lesbian and gay individuals.