Mapping the Pathways Between Posttraumatic Stress Disorder, Depression, and Alcohol and Cannabis Use: A Network Analysis.

Objective: The present study examines the network structure and, using Bayesian network analysis, estimates the directional pathways among symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and levels of alcohol and cannabis use. Method: A sample of 1471 adults in the United States, who reported at least one potentially traumatic event, completed the PTSD Checklist (PCL-5), Patient Health Questionnaire (PHQ-9), and the Alcohol/Cannabis Use Disorders Identification Test (AUDIT/CUDIT). A regularized partial correlation network provided estimates of symptoms clusters and connections. Directional pathways within the network were then estimated using a directed acyclic graph (DAG). Results: Symptoms clustered in theoretically consistent ways. Risky behavior demonstrated the highest strength centrality and bridge strength. Neither alcohol nor cannabis use appeared central in the network, and DAG results suggested that MDD and PTSD symptoms are more likely to lead to substance use than the other way around. Conclusions: Results suggest that cannabis use is largely connected to alcohol use. Consistent with prior research, risky behavior appeared to be the primary bridge between substance use and PTSD. The direction of associations between substance use and psychological symptoms requires further attention.

Real-World Evaluation of a Large-Scale Blended Care-Cognitive Behavioral Therapy Program for Symptoms of Anxiety and Depression.

Introduction: Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited. Objective: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression. Materials and Methods: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes. Results: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01). Conclusions: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.

Caregiver "objective attitude" toward patients with neurodegenerative disease: Consequences for caregiver strain and relationship closeness.

Many caregivers of patients with neurodegenerative disease experience physical and psychological strain, which is associated with negative health outcomes. Caregiver strain may be partly attributable to negative emotional responses (e.g.of resentment) to the behavioral, cognitive, and physical changes associated with patients' disease. The philosopher Peter Strawson observed that in dealing with people who have neurological impairments, we often choose to suspend such emotional responses, adopting what he labeled the "objective attitude," though this may come at the expense of our relationships with them. In this study, we assessed the mediating effect of caregivers' adoption of the objective attitude on caregiver strain and relationship closeness in the setting of disease progression. Caregivers of patients with neurodegenerative disorders (n = 215) completed the Clinical Dementia Rating, Relationship-Closeness scale, Caregiver Strain Index, and a novel questionnaire assessing the adoption of the objective attitude. A structural equation model assessing associations among these variables demonstrated good fit (χ2 (88)=164.621, p < 0.001; CFI = 0.929, RMSEA = 0.064.) and showed that adoption of the objective attitude mediated the association between disease progression and relationship closeness (total ß= -0.233, 95% CI: -0.351, -0.113; indirect ß= -0.483, 95% CI: -0.602, -0.364; direct ß = 0.250, 95% CI: 0.117, 0.384), but did not mediate the association between disease progression and caregiver strain (total ß = 0.323, 95% CI: 0.234, 0.412; indirect ß = 0.089, 95% CI: -0.027, 0.206; direct ß = 0.153, 95% CI: -0.043, 0.349). For future work, we propose longitudinal measurements of these constructs to test the directionality of associations and consideration of how models for caregiver support can draw upon interdisciplinary insights.

Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation.

Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.

Cultural pathways for suicidal ideation and behaviors.

OBJECTIVE: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts. METHOD: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race). RESULTS: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation. CONCLUSIONS: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Military occupation as a moderator between combat exposure and posttraumatic stress disorder symptoms in US Army personnel.

Military occupational designations are standardized classifications that help define and convey a service member's expected duties and responsibilities. The present study examined how occupational designation was related to adverse combat-reactions, specifically posttraumatic stress disorder (PTSD). It was hypothesized that at comparable levels of combat, non-combat units would display greater symptomology than combat units. The study sample consisted of 785 combat-deployed, active-duty enlisted US Army personnel. Participants were administered self-report questionnaires, including the Combat Experiences Scale and PTSD Checklist for DSM-5. Occupation was coded using the three-branch system (i.e., Operations, Support, & Force Sustainment). Hierarchical multiple linear regression (MLR) was run to examine the effect of occupation, combat, and unit cohesion on PTSD symptoms. Operations units reported the highest frequency of combat exposure; however, Force Sustainment units displayed the highest PTSD symptoms. In MLR analysis, there was a significant interaction between Force Sustainment units and combat exposure (ß = 0.10, p = .019), that was not observed in Operations or Support units. These findings demonstrate that PTSD symptom intensity is not solely a function of combat exposure, and that non-combat units may react differently when exposed to elevated levels of combat.

The Impact of Item Misspecification and Dichotomization on Class and Parameter Recovery in LCA of Count Data.

Mixture analysis of count data has become increasingly popular among researchers of substance use, behavioral analysis, and program evaluation. However, this increase in popularity seems to have occurred along with adoption of some conventions in model specification based on arbitrary heuristics that may impact the validity of results. Findings from a systematic review of recent drug and alcohol publications suggested count variables are often dichotomized or misspecified as continuous normal indicators in mixture analysis. Prior research suggests that misspecifying skewed distributions of continuous indicators in mixture analysis introduces bias, though the consequences of this practice when applied to count indicators has not been studied. The present work describes results from a simulation study examining bias in mixture recovery when count indicators are dichotomized (median split; presence vs. absence), ordinalized, or the distribution is misspecified (continuous normal; incorrect count distribution). All distributional misspecifications and methods of categorizing resulted in greater bias in parameter estimates and recovery of class membership relative to specifying the true distribution, though dichotomization appeared to improve class enumeration accuracy relative to all other specifications. Overall, results demonstrate the importance of accurately modeling count indicators in mixture analysis, as misspecification and categorizing data can distort study outcomes.

Examining cross-level effects in dyadic analysis: A structural equation modeling perspective.

The actor-partner interdependence (APIM) and common-fate (CFM) models for dyadic data are well understood and widely applied. The actor and partner coefficients estimated in the APIM reflect the associations between individual-level variance components, whereas the CFM coefficient describes the association between dyad-level variance components. Additionally, both models assume that the theoretically relevant and/or empirically dominant component of variability resides at the same level (individual or dyad) across the predictor and outcome variables. The present work recasts the APIM and CFM in terms of dyadic nonindependence, or the extent to which a given variable reflects dyad- versus individual-level processes, and describes a pair of hybrid actor-partner and common-fate models that connect variance components residing at different levels. A series of didactic examples illustrate how the traditional APIM and CFM can be combined with the hybrid models to describe mediational processes that span the individual and dyad levels.

Heterogeneity of Pregamers by Consumption and Reinforcement Reasons: A Latent Profile Analysis.

BACKGROUND: Pregaming is a common, high-risk drinking activity among college students that has been largely unchangeable despite targeted intervention approaches. Therefore, identifying profiles of pregamers could enhance understanding of the risks associated with this practice and inform intervention development. METHODS: This study identified subtypes of pregamers in undergraduates (N = 911; 60% female, 42.9% White) attending 3 U.S. universities in 2012. Self-report data assessed recent alcohol use (overall, heavy, and pregaming), pregaming motives, and demographics. Alcohol-related consequences were assessed via the Young Adult Alcohol Consequences Questionnaire. RESULTS: Latent profile analysis using pregaming-specific indicators assessing motives (e.g., to avoid getting caught) and consumption (e.g., estimated pregaming blood alcohol concentration) yielded 5 unique profiles. Three profiles were characterized by pregaming on 50% or more of all drinking events that differed by pregaming consumption and motives: Instrumental (5.3%; heavy consumption, intoxication-driven motives), Global (16.0%; moderate consumption, indistinct motives), and Risk-averse (18.3%; moderate-to-heavy consumption, negatively reinforcing motives). Two profiles reported lower levels of pregaming: Occasional (32.4%; moderate consumption, indistinct motives) and Infrequent (28.0%; lowest pregaming involvement). Cross-profile differences were then examined for demographics, general drinking and pregaming-specific motives, and alcohol-related consequences. Profile comparisons indicated differences in overall alcohol consumption, ethnicity, gender, current living arrangements, Greek involvement, and a variety of alcohol-related consequences (ps < 0.01). CONCLUSIONS: Overall, pregaming is a very heterogeneous behavior among college students in that some students utilize this drinking practice as a means to mitigate risk and others use it to promote intoxication. Results suggest that distinguishing pregamers by consumption as well as motives can facilitate the development of more tailored intervention approaches for students who engage in this high-risk practice.

Determining Cannabis Use Status From a Photograph: An Assessment of the "Jay-dar" in Neuropsychologists.

BACKGROUND: Few studies examining the cognitive effects of chronic cannabis use utilize research designs where examiners are blind to user status. Even in those that do, researchers may be able to guess the user status of participants, leaving these studies vulnerable to the expectancy effect confound. OBJECTIVES: The present study examined the ability of neuropsychologists (those who would conduct research on the cognitive effects of cannabis) to differentiate cannabis users and nonusers based on physical appearance from photographs. METHOD: We recruited 84 participants from an international neuropsychology listserv. The sample was 59.5% female and 95.2% Caucasian, with a mean age of 41.39 years (range 26-65). Each neuropsychologist rated 25 target faces (12 cannabis users, 13 nonusers) on a Marijuana Use Likelihood Index based upon individuals' photographs. RESULTS: Results indicate a main effect of user group, as neuropsychologists ascribed higher ratings to cannabis users on the Marijuana Use Likelihood Index, suggesting they perceive them as more likely to be users, relative to nonusers. Results also demonstrated a main effect of gender, as males received higher user ratings than females, and a significant main effect of rater gender, as female raters were more likely to rate individuals as cannabis users relative to male raters. Conclusions/Importance: The results demonstrate the importance of assessing researchers' expectations when studying the effects of chronic cannabis use, as even those designs that keep examiners blind to participant user status may be vulnerable to expectancy effects if examiners are able to guess user status based upon appearance alone.

Variability in Pregaming Typologies Across the Freshman Year: A Multi-wave Latent Transition Analysis.

BACKGROUND: Though research is rapidly expanding on pregaming and related risks, studies have not yet identified discrete subtypes of college pregamers or modeled how class membership changes across critical times like college entry. OBJECTIVES: Latent Transition Analysis (LTA) identified classes of pregaming behaviors in entering college students and described transitions in latent statuses across the freshman year. METHODS: Students with prior alcohol use (N = 711; 51.3% female; 63% White; Mage = 18) were surveyed at orientation and re-assessed at three follow-ups (Fall, Winter, and Spring). Items assessed overall drinking (past 30-day, number of binge episodes), pregaming (typical quantity, normativity relative to overall use, estimated pregaming BAC, drinks consumed post-pregaming event), and problems (overall and pregaming-specific). RESULTS: LTA modeling yielded three distinct classes of pregaming membership (Low, Medium and High) that varied as a function of both overall use and pregaming practices. Evaluation of changes over the year indicated the greatest movement occurred immediately upon college entry, with significantly less movement was seen across the remainder of the year. Cross-class comparisons across all four time points showed clear differences in alcohol-related problems (overall as well as pregaming-specific), with students in the High class reporting markedly higher levels of problems on all domains. CONCLUSIONS/IMPORTANCE: Overall, there appears to be considerable heterogeneity in pregaming behaviors, across both students and time that are directly related to differential levels of problems. Findings highlight the need to screen students early for risky drinking practices, including pregaming, and include pregaming-specific material in their campus screening and intervention programming.

Tracking Changes in the Endorsement of Injunctive Drinking Norms in Response to the COVID-19 Pandemic Using Longitudinal Alignment Analysis.

The onset of the pandemic saw shifts in messaging around the acceptability of alcohol consumption at different times and contexts. A psychometric analysis of responses to injunctive norms may reveal important differences in specific aspects of norms that were influenced by the pandemic. Study 1 used alignment analysis to evaluate measurement invariance in low- and high-risk injunctive norms across samples of Midwestern college students from 2019 to 2021. Study 2 used an alignment-within-confirmatory factor analysis (CFA) approach to replicate the solution from Study 1 in an independent longitudinal sample (N = 1,148) who responded between 2019 and 2021. For Study 1, the latent mean for high-risk norms was significantly higher in 2021, and the endorsement of four specific norms also differed. In Study 2, increases in latent means for low- and high-risk norms were observed across 2020 and 2021, and differential endorsement emerged for one high-risk norm item. Examining scale-level changes in injunctive drinking norms provides insight into how college students' perceptions changed in response to the COVID-19 pandemic.

Using Dynamic Structural Equation Modeling to Examine Between- and Within-Persons Factor Structure of the DASS-21.

The recent integration of traditional time series analysis and confirmatory factor analysis techniques allows researchers to evaluate the psychometric properties of measurement instruments at between- and within-persons levels while accounting for autoregressive dependencies. The current study applies a dynamic structural equation modeling (SEM) latent factor analysis (i.e., DSEM-CFA) to a sample of 333 individuals who completed the DASS-21 at their regular therapy sessions. The results of the DSEM-CFA illuminate the reliability, invariance, and structural features of each DASS-21 subscale both between and within persons. The results suggest that the DASS-21 reliably measures depression, anxiety, and stress symptoms when evaluating differences between persons, but does not reliably assess within-persons fluctuations in symptoms over time. The results also suggest that currently accepted methods of modeling sensitivity to change within an instrument are likely lacking and the DSEM-CFA provides insight into reliability within and between persons, which is extremely important for instruments used across time.

Development and initial validation of an MDMA/Ecstasy motives assessment.

OBJECTIVE: MDMA/Ecstasy motives differ from those of other substances such as alcohol, cannabis, and methamphetamine. Previous literature on alcohol and cannabis use identified social, expansion, enhancement, coping, and conformism as primary motives for use. MDMA/Ecstasy users also report using the drug for increases in self-awareness and energy. The development of an MDMA/Ecstasy use motives assessment has potential to inform treatment interventions and public policy on harm reduction. METHOD: An MDMA/Ecstasy use motives assessment was developed from alcohol and cannabis motives measures and qualitative feedback from MDMA/Ecstasy users. Participants included an international sample of adults (N = 1754) who completed an online questionnaire regarding their motives for using recreational MDMA/Ecstasy. RESULTS: Exploratory and confirmatory factor analysis supported a 4-factor MDMA/Ecstasy motives scale. The four motive scales showed good internal consistency reliabilitySocial (α = 0.88) Expansion (α = 0.81), Coping (α = 0.82), and Energy (α = 0.75). Conformity and Enhancement did not emerge as significant factors. Analyses demonstrated convergent and discriminant validity with relevant constructs including quantity/frequency of use, MDMA use disorder, sensation seeking personality, and positive and negative consequences of use. CONCLUSIONS: MDMA/Ecstasy use motives differ from those of other substances due to the distinctly stimulating, emotional, and empathic effects sought by users. By identifying salient MDMA/Ecstasy motives, this study highlights the unique aspects of recreational MDMA/Ecstasy use. This research has utility for informing clinical practice and contributing to public health harm reduction efforts.

A Comparison of Psychosocial Services for Enhancing Cultural Adaptation and Global Functioning for Immigrant Survivors of Torture.

Forced migrants suffer from significant psychological distress. However, they often prioritize urgent practical resettlement needs over mental health needs. The present study used a quasi-experimental design to compare pathways of treatment for survivors of torture (N = 369) from 42 different counties receiving care from a refugee health clinic. Random intercept ANOVAs were used to compare combined case management services and psychological treatment (CM-PT) to case management services only (CM) on changes in cultural adaptation and global functioning over time. Results showed that both groups improved on each outcome. Importantly, the CM-PT group endorsed greater improvements in cultural adaptation (b = 0.28, 95% CI 0.14, 0.41, p ≤ 0.001) and global functioning (b = 3.29, 95% CI 1.33, 5.25, p = 0.001) compared to the CM group. These findings suggest that treatment for survivors of torture should be multifaceted and include case management and psychological treatment. Case management services alone may be beneficial when socio-cultural and resource barriers exist for mental health treatment.

Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups.

BACKGROUND: Studies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity. METHODS: Participants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)). RESULTS: Participants' self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p's < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude. CONCLUSIONS: BCT for anxiety and depression can be effective across diverse racial and ethnic groups.

Examining the Drinking Motives Questionnaire-Revised Short Form among university students in Australia, New Zealand and Argentina.

INTRODUCTION: The Drinking Motives Questionnaire-Revised Short Form (DMQ-R-SF) is widely used among alcohol researchers studying adolescents and young adults. The psychometric properties of the DMQ-R-SF have been examined among university students in many countries, but to our knowledge, not in Australia, New Zealand or Argentina. We sought to examine the reliability and endorsement of the items on the DMQ-R-SF, and test the associations between the DMQ-R-SF subscales and alcohol use, and negative alcohol consequences between university students from Australia, New Zealand and Argentina. METHOD: University students (N = 820) in Australia (n = 315), New Zealand (n = 265) and Argentina (n = 240) completed a confidential online alcohol survey which included the DMQ-R-SF, the Daily Drinking Questionnaire and the Brief Young Adult Alcohol Consequences Questionnaire. RESULTS: Using the alignment method, support for the four-factor model on the DMQ-R-SF emerged and the factor loadings for 11 of the 12 items were invariant across sites. Most items (8 out of 12) on the DMQ-R-SF were fully invariant across all sites, but some small differences in item reliability for one item, and endorsement for three items emerged between the sites. Across the three countries, coping motives were positively correlated with negative alcohol consequences. Enhancement motives were positively associated with both alcohol use and negative alcohol consequences among students from Australia and New Zealand. DISCUSSION AND CONCLUSIONS: Most items on the DMQ-R-SF were comparably reliable among the university students sampled from Australia, New Zealand and Argentina. Our preliminary findings suggest that the DMQ-R-SF can be reliably used with university students from these countries.

Outcomes of a Live Messaging, Blended Care Coaching Program Among Adults With Symptoms of Anxiety: Pragmatic Retrospective Cohort Study.

BACKGROUND: Anxiety disorders are common and can be debilitating. In addition, various barriers exist that can hinder access to adequate care. Coaching that is grounded in evidence-based interventions and delivered via synchronous (ie, live) text-based messaging could potentially increase the reach of mental health services among populations who select this modality instead of other services (eg, face-to-face coaching and psychotherapy). In addition, the delivery of live messaging coaching within a blended care model has the potential to combine the benefits of coaching with those of evidence-based digital mental health tools. OBJECTIVE: This real-world study evaluates the anxiety and satisfaction outcomes of live messaging coaching blended with digital tools (ie, digital exercises and activities). METHODS: This was a retrospective cohort study of 121 adults with moderate levels of anxiety symptoms at the beginning of coaching (Generalized Anxiety Disorder-7 [GAD-7] scores: range 8-14). Participants received an employer-offered blended messaging coaching (BMC) program, and those who opted to receive all live coaching sessions via text-based messaging were included. Anxiety symptom severity was regularly measured by using the GAD-7 scale. Using growth curve models, the change in GAD-7 scores over the course of BMC was evaluated, as were the effects of text-based coaching sessions on GAD-7 scores. The proportion of participants that had a reliable improvement in anxiety symptom severity (GAD-7 score reduction of ≥4) or subclinical symptom severity (GAD-7 score of <8) at the end of care was also estimated. Participants also self-reported their likelihood of recommending their live messaging coach to someone with similar needs. RESULTS: At baseline, the average GAD-7 score was 9.88 (SD 1.80). Anxiety symptom severity significantly decreased with each week in the BMC program (week: b=-1.04; P<.001), and the rate of decline in anxiety symptom severity decreased over time (week2: b=0.06; P<.001). Each live messaging coaching session was associated with significantly lower anxiety symptom severity during the week of the coaching session (b=-1.56; P<.001) and the week immediately following the session (b=-1.03; P<.001). Overall, 86% (104/121) of participants had subclinical symptom severity or a reliable reduction in anxiety symptom severity by the end of care. Further, 33.1% (40/121) of participants reported coaching satisfaction levels; of the 40 participants in this subset, 37 (92.5%) were likely or extremely likely to recommend their live messaging coach. CONCLUSIONS: BMC that provides coaching sessions via live messaging can be beneficial for adults with moderate symptoms of anxiety who qualify for and self-select this care modality. Large-scale studies with longer follow-ups are needed.

Development and validation of the alcohol-related content poster prototype scale: Exploring the impact of social media prototypes on college students' drinking.

BACKGROUND: Drinking is a public health concern among college students. Viewing and posting alcohol-related content (ARC) on social media may influence students' favorable prototypes of people who post, thereby impacting their drinking. This study created a measure to explore students' ARC poster prototypes. We validated our measure by examining the prototypes as mediators of the associations between viewing and posting ARC and drinking behaviors. METHODS: Students (N = 8065) were asked to complete measures related to viewing and posting ARC, drinking behaviors, and adjectives that described their perceptions of the prototypical college student who posts ARC on social media. RESULTS: Exploratory and confirmatory factor analysis yielded three prototypical images of students who post ARC on social media: hedonistic, despondent, and sociable. There were significant pathways between viewing and posting ARC and drinking. The sociable prototype emerged as a significant mediator of the association between ARC viewing and posting and drinking. CONCLUSIONS: Understanding the role of students' poster prototypes may be important for informing targeted interventions. Our results indicate that the underlying reason for increased drinking among students with greater ARC engagement is that they perceived other ARC viewers and posters as being more sociable. Future research may focus on modifying these perceptions.

Interdependence theory and the actor-partner interdependence model: where theory and method converge.

This work describes an application of the actor-partner interdependence model (APIM) that allows researchers to test hypotheses in terms of interdependence theory (IT). The authors' goal is to move beyond the obvious similarities of these two frameworks by providing a detailed conceptual integration. This analysis demonstrates that aspects of APIM analysis reveal a useful perspective on interdependence not explicitly articulated by IT. They also expand on ideas presented by Kenny and Ledermann by exploring the relationship between their ratio parameter k and IT, and introducing two additional ratios (h and c) also suggested by IT. A complete worked example of APIM analysis from the perspective of IT, along with a SAS MACRO that produces confidence intervals for k, h, and c, is provided.