Mission Alliance Community Engagement Project: Exploring the Impact of COVID-19 on Social Isolation, Loneliness, Mental Health and Wellbeing in Veterans.

During the Coronavirus disease pandemic, many U.S. veterans with posttraumatic stress disorder (PTSD) experienced increased symptomology and worsened mental health and well-being due in part to social isolation and loneliness. The Mission Alliance project explored these ramifications and prioritized critical issues expressed by U.S. veterans and stakeholders (N = 182) during virtual regional meetings (N = 32). Field notes created specifically for this project were recorded and thematically analyzed. Emerging themes included: (1) social isolation: missed opportunities, collapsed social circles, work-life balance, fostering relationships, and evolving health care delivery; (2) loneliness: deteriorated mental health, suffered with PTSD together but alone, looked out for each other, ambivalence toward technology, and strained and broken systems; (3) mental health: sense of chaos, increased demand and decreased access, aggravation, implementation of tools, innovative solutions, fear and loss, and availability of resources; (4) wellbeing: sense of purpose, holistic perspective on well-being, recognition of balance, persisting stigma, redefined pressures, freedom to direct treatment, and reconnection and disconnection. A PTSD-related patient centered outcomes research (PCOR)/comparative effectiveness research (CER) agenda was developed from these themes. Establishment of a veteran and stakeholder network is suggested to support, facilitate, and promote the PTSD-related PCOR/CER agenda. Furthermore, enhancement of opportunities for veterans with PTSD and stakeholders to partner in PCOR/CER is required to develop and conduct projects that lead to PTSD-related comprehensive care of veterans affected by traumatic events with the potential to translate findings to other populations.

Randomized controlled trials assessing efficacy of brief web-based stress management interventions for college students during the COVID pandemic.

The purpose of this study was to evaluate the efficacy of brief, self-guided web-based interventions for decreasing distress among U.S. college students during the pandemic. Three randomized controlled trials were conducted during the spring (Study 1), summer (Study 2), and fall (Study 3) 2020 terms, and were combined into one sample to increase power (N = 775). We evaluated a web-based intervention that focused on increasing present control that had been shown to be effective in several studies prior to the pandemic (e.g., Nguyen-Feng et al., 2017). This intervention was compared to an active comparison condition (psychoeducation about and reminders to engage in Centers for Disease Control and Prevention (CDC)-recommended stress management techniques) in Study 1, to a waitlist comparison in Study 2, and to both comparison conditions in Study 3. Participants were undergraduate psychology students at two campuses of a midwestern state university system. Outcomes-perceived stress (primary); depression, anxiety, and stress symptoms (secondary); and boredom (tertiary)-were assessed at pretest and posttest (and 3-week follow-up in Study 3). Differences across conditions were significant for perceived stress, stress symptoms, and boredom (but not depression or anxiety). Contrary to hypotheses, the Present Control and CDC stress management interventions were equally effective. Both were more effective than no intervention (between-group ds = -0.27 and -0.42). Both interventions were more effective for students with higher baseline stress levels. Completion and adherence rates were high for both conditions. Results suggest that very brief, self-guided stress management interventions can be effective in reducing stress among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racism, Posttraumatic Stress Symptoms, and Racial Disparity in the U.S. COVID-19 Syndemic.

The COVID-19 syndemic, with a disproportionately higher adverse impact on communities of color (i.e., COVID-19 infection and death), will likely exacerbate the existing health disparities in trauma-related symptoms between people of color (POC) and White Americans. However, no studies have examined the racial disparity in posttraumatic stress symptoms (PTSS) during COVID-19. Grounded in ecological theory and racial trauma framework, we investigated racial disparity in PTSS and three possible mechanisms, 1) COVID stress, 2) direct racism, and 3) indirect racism, for these disparities using a large U.S. national sample. Results indicated that POC reported higher levels of PTSS than White Americans. The PTSS racial disparity was accounted more by direct and indirect racism than by the COVID-19-specific stressors, after controlling for age, gender, education, income, parent status, adverse childhood experiences (ACEs), and intimate partner violence (IPV). Additional fine-grained analyses for Hispanic/Latinx Americans, Black/African Americans, and Asian American and Pacific Islanders by and large corroborated the above findings. Our findings highlighted the deleterious impact of the ongoing racism pandemic on the POC community as a public health crisis in addition to the COVID-19 pandemic.Supplemental data for this article is available online at at http://doi:10.1080/08964289.2021.2006131.

Relations among daily stressors, childhood maltreatment, and sleep in college students.

This study aimed to assess (a) the within- and between-person associations between daily stress and sleep; (b) the relation between childhood maltreatment and sleep; and (c) whether the relation between stress and sleep was moderated by the extent of childhood maltreatment among college students. Participants (N = 181) comprised the active control group in a previous intervention study. Participants completed a self-report measure of childhood maltreatment and 14 daily self-report measures of stressor exposure and severity (evenings) and 6 sleep measures (e.g., quality, duration; mornings). Experiencing more daily stressors than usual (within-person relation) was significantly associated with delayed sleep latency (i.e., time falling asleep). Greater daily stressor severity was also significantly associated with lower sleep efficiency within persons. Participants who reported more stressors in general had shorter sleep duration, poorer sleep quality, and less restful sleep (between-person relations). Students who reported more childhood maltreatment also reported significantly lower quality sleep and feeling less rested upon awakening. Childhood maltreatment did not moderate the within-person association between daily stress and sleep. Unexpectedly, at the between-person level, maltreatment moderated the association between stressors and stressor severity and several sleep parameters (e.g., efficiency and latency) such that there was a weaker relation between stress and sleep among those with more maltreatment. Interventions on campus could aim to reduce stress and improve sleep. Additional awareness of the prevalence of maltreatment and how it may be related to sleep also appears warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Childhood maltreatment predicts daily stressor exposure in college students but not perceived stress or stress reactivity.

The purpose of this observational longitudinal study was to investigate the role of childhood maltreatment in explaining individual differences in daily stress processes. College students (N = 253) completed the Childhood Trauma Questionnaire and a measure of neuroticism at baseline before completing 14 nightly surveys assessing exposure to daily stressors (particularly interpersonal stressors), perceived stressor severity, and negative affect. Given mixed findings in past research, no specific hypotheses were proffered. Generalized linear mixed modeling showed that students with a history of maltreatment experienced roughly one more stressor every 1-to-2 days compared with those without a history of maltreatment, and experienced an interpersonal stressor on approximately half of the 14 study days compared to about one quarter of the study days for those without a history of maltreatment. In contrast, childhood maltreatment (except for physical abuse) was unrelated to perceived stressor severity and stress reactivity, controlling for gender and neuroticism. This suggests that college students reporting childhood maltreatment have more daily stressors, but they neither perceive them as more stressful nor react to them more strongly. In exploratory analyses assessing exposure to specific stressors, childhood maltreatment was associated with reporting more financial, work-related, career, and grade-related stressors in addition to interpersonal stressors. These findings underscore the importance of assessing stressor exposure separately from stress reactions. They also suggest that both individualized skill-based interventions to reduce stressor exposure and campus-wide programs to reduce financial and other burdens on students may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emotional abuse moderates efficacy of an ecological momentary stress management intervention for college students.

Web-based stress management interventions are effective for college students, particularly those with interpersonal trauma histories. However, these interventions have not been assessed among those reporting childhood emotional abuse, a group with the most distress. Ecological momentary interventions (EMIs), which use mobile phones to deliver near-real-time psychosocial interventions in daily life, offer the possibility of increasing intervention efficacy. This randomized controlled trial examined the feasibility and efficacy of an EMI for reducing psychological distress among students with and without an emotional abuse history. Undergraduate students (N = 382) were randomly assigned to receive (a) an EMI that taught stress management skills, or (b) an ecological momentary assessment (EMA) with self-monitoring of stressors and mood. Both the EMI and EMA lasted for 14 days. Participants completed outcome measures (e.g., depression, anxiety, stress symptoms) at pretest, posttest, and 3-week follow-up. Overall, the EMI appeared feasible, acceptable, and usable, with 80% to 91% completion rates. Linear mixed models indicated that there were no significant Condition × Time interaction effects in the total sample, with decreases in perceived stress and increases in positive affect over time regardless of condition (EMI vs. EMA). Moderation analyses indicated that the EMI was generally more effective for those with a history of emotional abuse and that the EMA was more effective for those without such a history. Post hoc analyses demonstrated that participants wrote less in the EMI than in a web-based version of the intervention. Future interventions could target at-risk groups based on trauma history or baseline distress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sexual victimization, childhood emotional abuse, and distress: Daily coping and perceived control as mediators.

The primary aim of the present study was to assess 2 potential mediators (daily avoidant coping and perceived control) of the relations between past sexual victimization and childhood emotional abuse and current distress. Participants (N = 268) were undergraduate students in psychology courses at a large Midwestern university who completed measures of sexual victimization, childhood emotional abuse, neuroticism, and distress at baseline; daily measures of avoidant coping and perceived control over stressors for 14 days (Time 2); and measures of avoidant coping, perceived control, and distress at Time 3. Structural equation modeling (SEM) was used to test the mediation model. The indirect path between childhood emotional abuse and T3 distress through daily avoidant coping was significant and remained significant in an alternate model that controlled for baseline neuroticism. The indirect effect of childhood emotional abuse on T3 distress through perceived control was not significant. Sexual victimization was not associated with greater use of avoidant coping or perceived control in the SEM models. The present study added to the literature by assessing multiple traumas and multiple mediators using longitudinal, daily diary methods. (PsycINFO Database Record

Intimate partner violence in late adolescence and young adulthood and subsequent cardiovascular risk in adulthood.

BACKGROUND: Childhood maltreatment has been linked to adulthood cardiovascular disease (CVD). Little is known about the relationship between intimate partner violence (IPV) in late adolescence and young adulthood and CVD risk later in adulthood. PURPOSE: To examine whether IPV perpetration and victimization experienced in late adolescence and young adulthood are associated with CVD risk among adults in the United States and whether this relationship differs by sex. METHODS: Data include 9976 participants (50% female) in the National Longitudinal Study of Adolescent to Adult Health. Physical and sexual IPV were measured at wave 3 (2001/02) with items from the revised Conflict Tactics Scales. Participants'30-year risk of CVD was calculated at wave 4 (2008/09) using a Framingham prediction model. Linear regression models adjusted for confounders and IPV by sex interaction terms were tested to examine the relationship. RESULTS: The mean CVD risk score was 13.18% (95% CI: 12.71, 13.64). Aone-standard deviation increase in the victimization score was associated with a 0.28% (95% CI: 0.03, 0.54) increase in CVD risk. Perpetration was similarly positively associated with CVD risk (beta: 0.33, 95% CI: 0.03, 0.62). When measured as a composite, all violence types were associated with increased CVD risk but only prior exposure to both victimization and perpetration reached statistical significance (0.62%, 95% CI: 0.01, 1.22). No differences by sex were detected. CONCLUSIONS: Effect sizes are not large, but early detection of increased CVD risk in this relatively young population is notable and worthy of further study to inform the clinical response.

Hot yoga establishments in local communities serving pregnant women: a pilot study on the health implications of its practice and environmental conditions.

Hot yoga establishments have been increasing in popularity in local communities. Studios may support participation among pregnant women though no clinical studies currently exist that examine prenatal hot yoga effects. The pilot study described in this article aimed to assess the spread of prenatal hot yoga and to provide information on the environmental conditions and practices of those who engage in hot yoga within a local community. A thermal environment meter was used to measure ambient air conditions during three 90-minute hot yoga classes. Mothers who practiced prenatal hot yoga were more likely than non-hot yoga practitioners to have someone aside from an obstetrician/gynecologist discuss prenatal exercise safety with them. Prenatal public health education campaigns need to be refined. Public health officials and obstetricians/gynecologists need to be aware that those who engage in a hot yoga practice are more likely to trust someone other than their health care provider or public health professional regarding safety of this practice.

Peer Support Groups Integrated with Trauma-Sensitive Yoga for Women Survivors of Sexual Violence: A Feasibility Study and Qualitative Examination.

Trauma Center Trauma-Sensitive Yoga (TCTSY) is an evidence-based yoga protocol and approach used for somatic trauma care. Seven women participated in a 12-week TCTSY-integrated peer support group for sexual violence survivors at a community rape crisis center. Three semi-structured interviews were conducted: interview 1 at 1-2 months post-group, interview 2 at 8-9 months post-group, and interview 3 at 24-33 months post-group. Thematic analysis was conducted following Clandinin and Connelly's three-dimensional space approach. Participants described themes related to improvements in trauma symptoms, mind-body connection, present-centered awareness, self-regulation, and relationships with self and others. Changes were sustained at the final interview. TCTSY-integrated peer support groups appeared feasible and acceptable to women victim-survivors of sexual violence.

The experience of stuttering in everyday life among adults who stutter: The impact of trait social anxiety and the social situations.

PURPOSE: The purpose of this study was to investigate the emotional and stuttering experience of adults who stutter (AWS) in everyday life, and how that experience may be shaped by personal (i.e., trait social anxiety) and situational factors (i.e., social partner reaction, communication channel type, social closeness, stuttering knowledge). METHOD: AWS completed ecological momentary assessments on their smartphones multiple times a day for up to three weeks. Data (n = 62) were analyzed with multilevel models to determine how situational factors and trait social anxiety influence the Negative Affect (NA), Positive Affect (PA), and self-reported stuttering severity of AWS. RESULTS: Results indicated that having high (vs. low) trait social anxiety was associated with a tendency to experience high NA, low PA, and high self-reported stuttering severity among AWS. A range of situational factors significantly influenced the within-person variation of NA, PA, and self-reported stuttering severity in everyday life. In addition, interacting with distant social partners relative to being alone heightened NA, and the effect was more prominent among AWS with high (vs. low) trait social anxiety. CONCLUSIONS: Overall, the findings suggest that the variation of affects and stuttering severity among AWS can be partly accounted for by factors from both the situational and personal levels. Clinicians should be aware of the low PA experienced by AWS who have high (vs low) trait social anxiety in everyday life.

Evaluation of online adaptive yoga for psychological well-being in adults with disabilities.

PURPOSE/OBJECTIVE: The present study examined the preliminary effectiveness of an online, community-based adaptive yoga program on mindfulness, social connectedness, life satisfaction, and communicative participation. RESEARCH METHOD/DESIGN: Adults (N = 48) were from a U.S. Midwest rehabilitation program and modally identified as White (73%), women (68%), and in their 30s (24%). One-third (35%) of participants were able to walk independently, and cerebral palsy was the most common primary disability diagnosis (32%). The 90-min adaptive yoga program and assessments were offered online weekly for 6 weeks, in which data from 29 participants across three sessions were included in the present analyses. RESULTS: Regarding our primary outcome of interest, there was a statistically significant positive increase in mindfulness over time, F(1, 28) = 5.66, p = .02, with a strong effect size, d = 2.43. All secondary variables had statistically nonsignificant changes over time, although with large effect sizes: social connectedness (d = 0.77), life satisfaction (d = 0.92), and communicative participation (d = 0.40). CONCLUSIONS/IMPLICATIONS: The present study provides support for well-being programs for an underserved group; specifically, an online adaptive yoga program with routine outcome monitoring assessments has preliminary effectiveness in increasing mindfulness. Consideration of such well-being programs alongside insurance would be an important policy consideration. Further controlled research is necessary to draw decisive conclusions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

US college student mental health and COVID-19: Comparing pre-pandemic and pandemic timepoints.

OBJECTIVE: To assess mental health in US undergraduates during COVID-19; to identify key pandemic-related stressors, perceived control, and coping and their associations with mental health. PARTICIPANTS: Data collected from a sample of undergraduates in April 2020 (N = 312) were compared to data collected in Spring 2017 (N = 362). METHODS: Online measures of depression, anxiety, and stress symptoms and perceived control and coping (both samples); pandemic-related stressors and perceived benefits (April 2020). RESULTS: Depression and stress symptoms were higher in April 2020 than in 2017. Most students reported perceiving at least some pandemic-related benefits. Top-rated stressors involved missing seeing friends and school-related stressors. Perceived control and approach coping were lower during the pandemic but related to better mental health; avoidant coping was higher during the pandemic and related to poorer mental health. CONCLUSIONS: Findings can inform campuses regarding how to improve student mental health during COVID and beyond.

Leisure Participation of Autistic Adults: An Ecological Momentary Assessment Feasibility Study.

Autistic adults participate less and express lower satisfaction in leisure activities than nonautistic adults, although literature is limited. The multifaceted nature of leisure participation makes it challenging to measure, with most measures being retrospective. Ecological momentary assessments (EMA) can reduce recall bias. This pilot study assessed the feasibility and acceptability of EMA among autistic adults. Participants (N = 40) were recruited via email and online. After completing a baseline interview, participants were asked to complete a once-daily survey for 30 days, in which they received survey links through a text messaging smartphone app. Surveys asked participants to report whether they participated in any leisure activities during the day, their level of enjoyment, with whom they interacted, and where they participated. The EMA appeared feasible in this sample, as participants completed the daily survey on average 27.05 (SD = 3.92) days. Regarding acceptability, most agreed that survey timing was convenient, that it was easy to enter responses and answer questions daily, and that they had enough response time. Overall, this study supports the use of EMA methodology among autistic adults. Future research should follow and improve upon these EMA data collection practices to examine daily behavior and well-being among autistic adults.

Hot Yoga During Pregnancy: A Mixed-Methods Study Examining Perspectives of Studio Management.

Research provides evidence on the benefits and safety of prenatal yoga as well as hot yoga among nonpregnant individuals. However, limited literature on hot yoga during pregnancy exists. The present study aims to (1) describe knowledge, attitudes, and beliefs of hot yoga studio management regarding hot yoga during pregnancy; and (2) examine how management teams rank the credibility of information sources (e.g., obstetricians) regarding the safety of hot yoga during pregnancy. Inclusion criteria included being at least 18 years of age and on the management team at a U.S. hot yoga studio. Studios were recruited via emails from publicly accessible websites of major hot yoga studio communities. Thirty-five participants completed a cross-sectional online survey addressing the study aims, and 10 (28.57%) participants reported trying hot yoga themselves while pregnant. Participants reported a median of 4 (interquartile range 1.5-8.5) pregnant individuals at their studio in the past year. All participants reported at least one hot yoga class type that they would recommend to pregnant individuals. Three qualitative themes emerged regarding deciding whether a pregnant individual may practice hot yoga: (1) integration of healthcare and individual knowledge, (2) emphasis on prior practice, and (3) individual bodily intuition and choice. Obstetricians were ranked the highest for credibility, although inferential tests suggested that their rankings were equivalent to those for academic journals, one's own knowledge/experiences, and a friend/acquaintance who had practiced hot yoga during pregnancy. These findings suggest recommendations for future yoga teacher trainings to include specific needs and considerations for pregnant individuals who choose to practice hot yoga.

Perceived severity of childhood emotional, sexual, and physical abuse: Comparisons across psychologists, students, and the general public.

OBJECTIVE: Childhood emotional abuse has been linked with mental and physical health concerns yet may be perceived as less severe than other forms of childhood abuse. The present study aims to (a) understand perceptions of childhood abuse forms across psychologists, general college-level students, and the general public and (b) investigate whether personal emotional abuse history affects perceptions of emotional abuse. METHOD: Participants (N = 444) completed the Childhood Trauma Questionnaire-Short Form and provided perceived abuse severity and offender responsibility on eight case vignettes of emotional, physical, sexual, and no abuse. Research Question 1 was tested with a two-way (Vignette Type × Participant Type) multivariate analysis of variance performed on perceived severity and offender responsibility scores. Research Question 2 included abuse history as a third factor to examine potential moderation. RESULTS: All three groups perceived scenarios regarding emotional abuse as less severe and the offender less responsible than scenarios regarding sexual or physical abuse. Unexpectedly, psychologists were just as variable in their perceptions of abuse severity across abuse forms, as compared to the general public and college students. However, psychologists with emotional abuse histories provided more severe ratings on emotional abuse items, more in line with general public perceptions. College students' and the general public's relative ratings were roughly equivalent regardless of emotional abuse history. CONCLUSIONS: The study calls for more attention to emotional abuse in psychologist training programs. Research and training to increase understanding of emotional abuse and its sequelae could move forward related educational outreach and legal proceedings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived Control, Voice Handicap, and Barriers to Voice Therapy.

OBJECTIVE: To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN: Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING: Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS: Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS: Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS: Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.

COVID in New York City, the epicenter: A New York University perspective and COVID in Duluth, the Bold North: A University of Minnesota perspective.

In the first part of this dual commentary, perspectives are gathered from students at New York University. COVID in New York City is compared with the trauma of the World Trade Center. Triggers, racism, concerns, acts of kindness, and the future are considered for both. The second part of the commentary is written in juxtaposition to the New York City perspective by sharing the Upper Midwest experiences of this COVID-19 pandemic period, particularly in the small city of Duluth. Perspectives are gathered over time from students at the University of Minnesota, Duluth. The Minnesota stories are presented chronologically, from the declaration of the global pandemic to the beginning of the summer semester. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Moderators of treatment efficacy in a randomized controlled trial of trauma-sensitive yoga as an adjunctive treatment for posttraumatic stress disorder.

OBJECTIVE: This study is a follow-up to van der Kolk et al. (2014), a trial conducted through the Trauma Center at Justice Resource Institute, which demonstrated treatment efficacy and remains the only randomized controlled trial of trauma-sensitive yoga. The present process study extends the outcomes study by examining treatment moderators of the original trial. METHOD: Sixty-four women with childhood interpersonal trauma histories and posttraumatic stress disorder participated in the interventions: Trauma Center Trauma-Sensitive Yoga (TCTSY) versus active control (women's health education). Analyses explored if adult-onset interpersonal trauma and baseline psychological measures (clinician-rated and self-reported PTSD, dissociation, depression, psychological functioning) moderated PTSD changes. RESULTS: Three of six measures had small effects in moderating the relationship between adult-onset interpersonal trauma and TCTSY efficacy, in which TCTSY was most efficacious for those with fewer adult-onset interpersonal traumas. Within this subgroup, various levels of all baseline measures except depression indicated that TCTSY was more effective in reducing PTSD than the active control condition. CONCLUSIONS: By delineating client characteristics most associated with PTSD improvements, practitioners may best target yoga interventions to increase effectiveness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders.

IMPORTANCE: Communicative participation can be conceptualized as taking part in life situations in which people are socially engaged. Communicative participation is an important aspect in the lives of patients with voice disorders, although it has not been formally assessed among a broad sample of patients with voice disorders. The associations between communicative participation and associated concepts (vocal impairment, psychosocial distress, and voice-specific perceived control) are unknown yet important for integrated treatment approaches. OBJECTIVE: The primary objective was to examine the associations between communicative participation and vocal impairment, psychosocial distress, and voice-specific perceived control. The secondary objective was to examine whether perceived control moderates the association of distress with communicative participation and vocal impairment, the latter of which would replicate previous research. The hypotheses were that communicative participation would be associated with lower vocal impairment, lower distress, and higher perceived control and that higher perceived control would moderate the association between communicative participation and both vocal impairment and psychosocial distress. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from June 2014 to May 2017 among a consecutive sample of adult patients with voice disorders at an academic voice clinic affiliated with the University of Minnesota. Of the 744 patients approached to participate in the survey study, 590 patients agreed. Data analysis was performed from January to June 2020. MAIN OUTCOMES AND MEASURES: Communicative participation (measured by the 10-item general short form of the Communicative Participation Item Bank), vocal impairment (measured by the 10-item version of the Voice Handicap Index), psychosocial distress (measured by the 18-item version of the Brief Symptom Inventory), and voice-specific perceived control (measured by the 8-item present control subscale of the Perceived Control Over Stressful Events Scale). RESULTS: The sample comprised 590 patients (mean [SD] age, 51.9 [17.1] years; 390 women [66.1%]) with voice disorders. Communicative participation was associated with lower vocal impairment (r = -0.73; 95% CI, -0.77 to -0.69), lower overall psychosocial distress (r = -0.22; 95% CI, -0.30 to -0.14), and higher voice-specific perceived control (r = 0.30; 95% CI, 0.23-0.37). Moderation analyses indicated that communicative participation was negatively associated with distress at all levels of perceived control and, replicating previous findings, greater vocal impairment was associated with higher psychosocial distress only in patients with lower perceived control. CONCLUSIONS AND RELEVANCE: In this study, communicative participation was associated with, but distinct from, vocal impairment and was also associated with psychosocial distress and voice-specific perceived control. The study's results suggest that communicative participation is an important addition to voice research and clinical care.