Spirituality/Religion Among First Responders With and Without Posttraumatic Stress Disorder and Alcohol Misuse.

Objective: To examine the co-occurrence of alcohol misuse and posttraumatic stress disorder (PTSD) and potential sources of coping (e.g., spirituality/religion) and clinically relevant variables among first responders (e.g., firefighters, law enforcement corrections officers, paramedics). Method: We assessed rates of independent and co-occurring alcohol misuse and PTSD among a national online sample of 320 first responders as well as the prevalence and salience of S/R, guilt, shame, moral injury, aspects of S/R, and treatment interest. Results: In our sample, 46.88% (n = 150) met criteria for comorbid alcohol misuse and probable PTSD and individuals with these comorbid conditions reported significantly greater negative religious coping, moral injury, and shame than all other diagnostic groups (i.e., independent alcohol misuse, independent PTSD, and neither). Correlations also revealed significant relationships between alcohol misuse and PTSD symptomatology with positive and negative religious coping, moral injury, shame, guilt, interest in treatment, and interest in spiritually integrated treatment. Conclusions: Findings highlight the high rates of independent and co-occurring alcohol misuse and PTSD among first responders as well as the salience of S/R in this population.

Spirituality/Religion and Self-Harm Among Patients With Alcohol/Substance Use Versus Other Disorders.

ABSTRACT: Spirituality/religion (S/R) is clinically relevant to recovery from alcohol use disorders (AUDs)/substance use disorders (SUDs) and also associated with less self-injury; however, the interplay of these factors has not been adequately evaluated. Participants ( n = 1443) were culled from a larger study among psychiatric patients. We assessed for S/R using self-report measures, and medical records were reviewed for demographics, clinical diagnoses, psychiatric medications, and self-harm engagement. Self-harm engagement was significantly higher among patients without AUD/SUD. S/R distress was higher among participants with AUD/SUD, but S/R community activity and importance of religion were lower. Interest in discussing S/R in treatment did not significantly differ across patients. Religious affiliation, importance of religion, and belief in God were associated with less self-harm, but effects were not moderated by presence of AUD/SUD. S/R factors are associated with lower self-harm, irrespective of the presence or absence of AUD/SUD. In contrast with clinical lore, S/R may be equally salient to psychiatric patients with AUD/SUD versus other disorders.

Religious affiliation protects against alcohol/substance use initiation: A prospective study among healthy adolescents.

BACKGROUND: A substantial volume of the literature suggests that religious factors buffer against alcohol/substance use among adults, but research among adolescents is sparse. Further, few studies in this area have been prospective, and therefore it is unclear how religion may impact less alcohol/substance use among adolescents. METHOD: We prospectively evaluated effects of religious affiliation on initiation of alcohol/substance use in a sample of 81 psychiatrically healthy 13-14-year-olds from New England, over a 3-year period (from November 2015 to January 2019). Known risk factors were also evaluated including anxiety, depression, and impulsivity; family history of mental illness and alcohol/substance misuse; and volume of brain regions implicated in adolescent alcohol/substance misuse (assessed by Magnetic Resonance Imaging). RESULTS: Religiously affiliated adolescents were significantly less likely to initiate use of alcohol/substances (hazard ratio [HR] = 0.38). The addition of family history of alcohol/substance misuse to the model increased the predictive value of religious affiliation (HR = 0.34). Other risk factors did not diminish nor increase observed effects. CONCLUSIONS: These findings support and extend the current research by suggesting that religious affiliation protects against initiation of alcohol/substance use during early adolescence, particularly in individuals with elevated risk.

Spirituality, Religion and Transgender and Gender Nonconforming Affirmative Care with Youth and Families: Guidelines and Recommendations.

An increasing number of transgender and gender nonconforming (TGNC) youth are seeking gender-affirming medical treatments and affirmative mental health supports. The field currently lacks guidelines or recommendations for the integration of spirituality and religion into such care. Providers must consider spirituality and religion when working with this population because it may reduce the burden of adversity and may also improve the likelihood of positive outcomes among this population. Informed by an adapted version of the Minority Stress Model and the cultural humility framework, our manuscript details recommendations for interdisciplinary care with TGNC youth and families in the following areas: functional assessment of spirituality and religion as they relate to gender identity, parental support, medical decision making, coping; religious/spiritual referral; psychotherapy referral; and community advocacy. Recommendations offer providers in interdisciplinary settings applicable frameworks and guidelines for integrating spirituality and religion into care with TGNC youth and families.

The scale matters: assessing body size with figure rating scales in a diverse sample of young adults.

PURPOSE: To explore intersectional differences in weight perception accuracy in a diverse sample of young adults using CDC-defined weight status labels and four separate figure rating scales (FRS). METHODS: This cross-sectional study of 322 18-25-year-olds with body mass index (BMI) ranging from 18.5 to 57.2 (MBMI = 26.01, SD = 6.46) enrolled participants as part of a larger university subject pool cohort in the U.S. MidSouth. Height and weight measurements were obtained. Participants (55% Black, 45% white; 74% female) selected images that best represented their current body size using four FRS and described their weight perception using five labels from "very underweight" to "very overweight/obese". Receiver operating characteristic (ROC) curve analyses were used to compare variability in classification of weight status by FRS and weight perception category across gender and race. RESULTS: Area under the curve (AUC) statistics indicated all scales were significantly better at classifying weight status than chance. Among Black females and Black males, the culturally adapted scale had the strongest discriminatory ability [(AUC = 0.93, SE = 0.02, p < 0.001, 95% CI = 0.89-0.97) and (AUC = 0.93, SE = 0.04, p < 0.001, 95% CI = 0.86-1.00), respectively]. Among white females, the silhouette scale had the strongest discriminatory ability (AUC = 0.93, SE = .03, p < 0.001, 95% CI = 0.88-0.99). Among white males, the photo-based scale had the strongest discriminatory ability (AUC = 0.84, SE = 0.06, p = 0.001, 95% CI = 0.71-0.96). Across all groups, weight perception labels were the weakest classifier of weight status. CONCLUSION: Weight perception labels are an ineffective method of assessing weight status and FRS accuracy varies by race and gender, suggesting the value of gender- and culturally tailored scales. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies.

Parenting in matched pairs of women of color experiencing intimate partner violence and living with and without HIV.

This study explored the associations between depression and parenting among women of color with low income levels who were exposed to intimate partner violence (IPV) and HIV. Participants were 60 Black, multiracial, and Hispanic/Latina mothers (Mage = 36.66, SD = 6.99) in the midsouth region of the United States. Mothers were recruited from community organizations and reported their experiences with IPV, HIV, depression, potentially traumatic events (PTE), parenting practices, and child maladaptive functioning. Participants living with HIV and experiencing recent IPV (i.e., cases) were matched on age, race, ethnicity, and educational attainment with mothers experiencing recent IPV (i.e., controls), for a matched sample of 30 pairs. Analyses were conducted to examine how HIV status moderated the associations between depressive symptoms and both negative and positive parenting while accounting for PTE, child maladaptive functioning, and IPV severity. The moderation model for negative parenting was significant, f2 = 0.58, but the moderation model for positive parenting was not, p = .346. Specifically, moderation was supported, B = 0.43, 95% CI [0.03, 0.83], t(53) = 2.17, p = .035, indicating that the association between depressive symptoms and negative parenting was moderated by HIV status. The findings highlight the added burden of a physical health condition on parenting practices. Given the role of negative parenting (i.e., inconsistency, poor monitoring, corporal punishment) in exacerbating poor health outcomes among children exposed to adversity, clinicians and researchers must develop family-based strategies to decrease these practices.

Spiritually Integrated Group Psychotherapy for First Responders: Forgiveness, Trauma, and Alcohol Use.

First responders (e.g. firefighters, law enforcement, paramedics, corrections officers) experience high rates of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Despite the relevance of both spirituality and forgiveness to PTSD and AUD among first responders, spiritually integrated group interventions for this population are rare. This article discusses a forgiveness session of a spiritually integrated group psychotherapy protocol for first responders (SPIRIT-FR) in acute psychiatric care. This brief group psychotherapy intervention includes (a) psychoeducation about the intersection of PTSD, AUD, and forgiveness (b) discussion of the relevance of forgiveness to PTSD and AUD, and (c) the integration of spiritual beliefs and behaviors to move toward forgiveness. We discuss relevant clinical theory as well as the potential clinical application of this protocol.

Spirituality in the line of duty: Perspectives from first responders with acute posttraumatic stress disorder and alcohol use disorder.

Spirituality/religion is clinically relevant to patients experiencing posttraumatic stress disorder (PTSD) and/or alcohol use disorder (AUD). Despite the comorbidity of PTSD and AUD among first responders (i.e., firefighters, law enforcement, paramedics, corrections officers), relatively little research has investigated the lived experience of first responders with PTSD and AUD as it related to spirituality and religion. As such, 12 (100% cisgender men, 91.7% White/European American) first responder psychiatric patients with comorbid PTSD and AUD were recruited from a psychiatric program serving first responders in the Northeast. Participants completed a semistructured interview, and transcripts were coded and thematically analyzed. The following themes and subthemes were identified: spiritual/religious distress (subthemes: abandonment, progressive deterioration of moral certainty, and loss of faith/doubt), spiritual/religious coping (subthemes: supporting sobriety and coping with PTSD), spirituality/religion in treatment, spirituality as distinct from religion, and spirituality and first responder culture. Findings highlight the need for additional research examining the role of spirituality/religion at the intersection of PTSD and AUD among first responders as well as the development of spiritually integrated treatment for this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association between PTSD symptom clusters and religion/spirituality with alcohol use among first responders.

Alcohol misuse and posttraumatic stress disorder (PTSD) co-occur at high rates among first responders (e.g., law enforcement, firefighters, paramedics), underscoring the need to better understand these relations to inform intervention efforts. Identifying malleable processes relevant to the association between PTSD and alcohol among first responders could inform tailored interventions. An example of such a malleable process is spirituality. As such, the current study examined the unique relationships between PTSD symptom clusters and alcohol misuse, while also accounting for the role of select demographics and religion/spirituality, in a sample of first responders. A national online sample of first responders (N = 320) completed measures of PTSD symptomology, alcohol misuse, religion/spirituality and demographics. Hierarchical linear regression analyses revealed that PTSD Intrusion (Cluster B) symptom severity was associated with greater alcohol misuse and PTSD Avoidance (Cluster C) was associated with lower alcohol misuse. Additionally, positive and negative spiritual coping were also associated with alcohol misuse. In the context of similar research among military samples, findings suggest potentially unique associations between PTSD symptom clusters and alcohol misuse among first responders. Additionally, findings highlight the potentially protective role of religion/spirituality in this population. Future research should explore nuanced relationships between PTSD symptom clusters and alcohol misuse as well as the salience of spirituality/religion in this unique population.

Neurobiological correlates of religious coping among older adults with and without mood disorders: An exploratory study.

In this study, 32 older adults with and without mood disorders completed resting-state functional Magnetic Resonance Imaging and measures of demographics, spirituality/religion, positive and negative religious coping, and depression. Group Independent Component Analysis identified and selected three a priori resting state networks [cingulo-opercular salience (cSN), central executive (CEN) and Default Mode Networks (DMN)] within the Triple Network Mode. We investigated associations of religious coping with within- and between-network connectivity, controlling for age. Insular connectivity within the cSN was associated with negative religious coping. Religious coping was associated with anti-correlation between the DMN and CEN even when controlling for depression.

Sexual and gender minority university students in the wake of COVID-19: Unique risks and opportunities for intervention.

Emerging adulthood is a critical period of development as individuals explore their identities and embark on developmental trajectories. Emerging adulthood may be an especially important period for sexual and gender minority (SGM) individuals as they explore, learn, and seek out communities related to their sexuality and gender identity. College is a unique setting in which SGM students may have access to physical and mental healthcare, secure food and housing, and affirming spaces and community related to their identity. However, the COVID-19 pandemic has interrupted or ended many of the services and resources provided by colleges and universities, potentially exacerbating challenges faced by sexual and gender minority students. This article provides recommendations for colleges and universities to improve access to and mitigate potentially negative outcomes among SGM students during and in the wake of the COVID-19 pandemic.

How is everyone doing? Baseline psychological distress and adaptive functioning among transgender, nonbinary, and cis youth presenting for intensive outpatient psychiatric services.

Psychological and psychosocial functioning of binary transgender and nonbinary youth has been understudied in settings treating individuals at risk for psychiatric hospitalization. Further, little is currently known about potential differences in baseline levels of psychiatric distress and adaptive functioning across gender-diverse youth and their psychiatrically distressed cisgender counterparts. Key differences may elucidate avenues for adapted treatment and protocols among youth presenting for psychiatric care. Archival data of 426 youth (Mage = 14.94, SD = 1.5 years) referred to a psychiatric Intensive Outpatient Program (IOP) were used to examine differences in self-reported domains of psychological (e.g., depression, anxiety, Posttraumatic Stress Disorder [PTSD], emotion dysregulation) and psychosocial (e.g., parental and interpersonal relations) functioning across gender. The group included N = 272 cisfemale (64.1%), N = 137 cismale (32.2%), N = 10 transgender (2.3%) and N = 7 nonbinary (1.6%) self-identified youth. Cismales reported the lowest levels of distress and highest levels of adaptive functioning as compared to the other groups, whereas binary transgender and cisfemale youth did not significantly differ across any measured domain. Nonbinary youth reported higher levels of anxiety, hyperactivity, psychological inflexibility, and inadequacy than cisfemales, but largely did not differ from binary transgender youth. Beyond statistical comparisons, nonbinary youth demonstrated globally elevated levels of psychiatric distress and compromised adaptive functioning, with most ratings falling in the clinically significant and/or at-risk ranges. Results highlight the need for clinicians to carefully attend to unique needs of nonbinary youth and for future research to expand upon our preliminary findings. Clinical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The neuroscience of spirituality, religion, and mental health: A systematic review and synthesis.

Prior research highlights the importance of spirituality/religion (S/R) as it relates to several aspects of mental health and clinical interventions. This research has been expanded to include the concurrent examination of neurobiological correlates of S/R to elucidate potential biological mechanisms. However, the majority of neurobiological research on S/R has neglected mental health, and the relationship across all three of these domains (S/R, mental health, and neurobiology) remains unclear. This study systematically reviewed research concurrently examining S/R, mental health, and neurobiology, and rated the methodological quality of included studies. Eighteen identified studies were then included in an integrated literature review and discussion, regarding the neurobiological correlates of S/R as it pertains to depression, anxiety, alcohol/substance misuse, and psychosis. The majority of studies demonstrated moderate to high methodological quality. Findings highlight the need for additional studies in this area as well as research that includes validated assessment of S/R.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence.

PURPOSE: While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important. METHOD: The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality. RESULTS: Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality. CONCLUSIONS: Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Protective Factors Associated With Fewer Generalized Anxiety Disorder Symptoms Among Women Exposed to Intimate Partner Violence.

Generalized anxiety disorder (GAD) has received minimal empirical attention in the context of intimate partner violence (IPV). Furthermore, factors related to lower levels of GAD symptoms in this population have received limited focus. This study evaluated the protective role of four forms of support, spiritual, family, friend, and community, in predicting levels of generalized anxiety among women who have experienced recent IPV. Participants included 116 women who were recruited from local agencies serving IPV-exposed individuals. Participants completed measures of IPV, GAD, stressful life events, spiritual support, social support, and community support during a 1-hr interview. Findings from a hierarchical multiple regression analysis indicated that after accounting for age, income, mental health service utilization, stressful life events, and severity of IPV, lower GAD symptoms were only associated with higher spiritual support (ß = -0.20, p = .02) and community support (ß = -0.25, p = .01), not friend or family support, F(9, 114) = 5.10; p < .001; R2 = .30. These findings indicate that alternative sources of support (i.e., spiritual and community) may be more accessible for IPV-exposed women, contributing to their association with reduced GAD symptomatology. The current study highlights the potential for spiritual and community support to serve a beneficial role above and beyond standard social support proffered by friends and family on symptoms of GAD. Results reinforce the examination of a broad range of multiple supports among women experiencing IPV. This thorough examination of different support systems may provide further insight into novel resources that can be strengthened among IPV-exposed populations.

External Factors Associated With Community Cohesion in Women Living With HIV.

Although community cohesion has been identified as a protective factor associated with positive health outcomes, less is known about factors that increase community cohesion for women living with HIV (WLWH). We examined risk/protective factors associated with community cohesion in WLWH (N = 56) in the US Mid-South (Mage = 41.2 years, SD = 9.01). Participants completed hour-long interviews. Hierarchical linear regression modeling was used to examine factors associated with community cohesion. The final model was significant, F(5, 50) = 6.42, p < .001, adj. R = 33%; greater social support (b = .38, p < .01) and resilience (b = .27, p < .05) were significantly associated with better community cohesion. Given the protective benefits of community connectedness, findings suggest that nurses and community providers work with WLWH to harness friend- and family-support networks. In addition, strategies to enhance access to resilience resources would enable WLWH to recover from adversity.

Risk and protective factors associated with depressive symptoms in young adults with overweight and obesity.

Objective: Approximately one-third of college students are categorized as overweight/obese and elevated weight has been associated with increased risk of depressive symptoms. Less is known about protective factors in this context. This study examined associations between depressive symptoms and health behaviors, as well as body image variables among college students with overweight/obesity, while accounting for contributions of BMI and demographics. Participants: College students (N = 175; Mage = 19.87, SD = 1.93; 70% female; 58% Non-Hispanic Black) with overweight/obesity completed in-person surveys. Methods: Depressive symptoms, exercise and diet engagement, body positivity, and body dissatisfaction were assessed. Data were examined using a hierarchical linear regression. Results: Greater exercise engagement and greater body positivity were significantly associated with lower levels of depressive symptoms. Conclusions: Established links between elevated weight and depression are complex but imperative to understand, as mutable factors that contribute to this relationship may provide novel avenues for intervening.

Relating shape/weight based self-esteem, depression, and anxiety with weight and perceived physical health among young adults.

Simultaneous contributions of self-esteem, depression, and anxiety to weight and perceived physical health in young adults is understudied. A diverse sample of 424 young adults completed measures of shape/weight based self-esteem, depression, anxiety, and perceived physical health. Height and weight were measured to calculate body mass index (BMI). Latent profile analysis was conducted to derive patterns of depression, anxiety, and shape/weight based self-esteem. Then, we examined the association of the profiles with weight status and perceived physical health. Three profiles emerged: (1) High Shape/Weight Influence (HSWI); (2) Low Shape/Weight, Depression, & Anxiety Influence (LSWDAI); and (3) High Depression & Anxiety Influence (HDAI). The HSWI profile had significantly higher BMI than the LSWDAI and HDAI profiles, and significantly lower perceived physical health than the LSWDAI profile. Over emphasis on shape/weight, regardless of depression and anxiety, is associated with elevated weight and negative internalized health views.