Anxiety, Depression, and Comorbid Symptomatology: Different Forms and Severity of Intimate Partner Violence Perpetrated by Men Seeking Help.

Intimate partner violence (IPV) is a serious public health issue associated with numerous deleterious outcomes. Previous studies highlighted the relevance of documenting psychological predictors of IPV to identify prevention strategies. This study examined the links between anxious and depressive symptomatology and perpetrated physical, psychological, and sexual violence among 494 French-Canadian men seeking help for IPV-related difficulties. Differences in the frequency of perpetrated IPV were examined across four groups: (a) no anxious or depressive symptoms reaching a cutoff of high distress, (b) symptoms of anxiety, (c) symptoms of depression, and (d) comorbid symptoms. Results highlighted that men with comorbid symptoms perpetrated significantly more severe violent acts compared to the other groups. This study underscores the importance of targeting the reduction of psychological distress when treating men who perpetrated IPV.

Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers.

BACKGROUND: Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain. AIM: The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum. METHODS: A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood. OUTCOMES: Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum. RESULTS: Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time. CLINICAL IMPLICATIONS: Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention. STRENGTHS AND LIMITATIONS: There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured. CONCLUSION: Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

Anxiety and depressive symptoms in first-time parents: A dyadic longitudinal study based on attachment theory.

BACKGROUND: The aim of this study was to examine the temporal and dyadic associations between anxiety and depressive symptoms during the transition to parenthood (TTP), while exploring the antecedence of attachment insecurities in these associations. METHOD: Couples of first-time parents (N = 211) completed the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, the Experiences in Close Relationships scale, and a sociodemographic questionnaire during the second trimester of pregnancy and at four and twelve months postpartum. RESULTS: Both prenatal anxiety and depressive symptoms predicted postnatal depressive and anxiety symptoms. Prenatal attachment-related anxiety predicted higher postnatal anxiety and depressive symptoms whereas prenatal attachment-related avoidance predicted higher postnatal depressive symptoms only. Parents whose partners had a higher level of prenatal attachment-related anxiety experienced higher postnatal anxious and depressive symptoms via their own's prenatal depressive symptoms. Parents whose partners had a higher level of prenatal attachment-related avoidance experienced higher postnatal depressive symptoms via their own's prenatal anxious symptoms. No gender differences were found for these associations. LIMITATIONS: The sample was predominantly composed of educated heterosexual French-Canadian Caucasian couples and all measures were self-reported. CONCLUSIONS: Our original findings suggest that professionals should routinely screen for anxiety and depressive symptoms in both partners from pregnancy up to one year postpartum. Also, our findings suggest addressing attachment insecurities with both partners to prevent the development of future symptoms during pregnancy or after childbirth. Finally, our study supports the relevance of considering these symptoms at subclinical levels during the TTP.

Romantic Attachment and Intimate Partner Violence Perpetrated by Men: The Role of Affect Dysregulation and Gender Hostility.

Intimate partner violence (IPV) is a major public health problem, associated with considerable consequences for the victims. Among the risk factors associated with the perpetration of male IPV, attachment insecurities (avoidance, anxiety) and affect dysregulation (AD) have received strong empirical support. A few studies showed that hostility toward women (HTW) is a correlate of IPV perpetration, but none have explored hostility toward men (HTM). This study's aim was to test direct and indirect associations between romantic attachment insecurities and IPV perpetration (psychological, physical, and sexual coercion) through AD in men seeking help, and to examine the moderator role of HTW and HTM in theses links. A sample of 1,845 men aged between 18 and 88 years and from a diverse population (e.g., cultural background, education, and sexual orientation) were recruited through 18 community organizations providing IPV services in a Canadian province. As part of the systematic assessment protocol of each organization, participants answered a series of online questionnaires. Results from a path analysis model showed indirect associations between attachment insecurities (avoidance and anxiety) and IPV perpetration (psychological, physical, and sexual coercion) through AD. Beyond these links, attachment avoidance was also directly associated with psychological violence, attachment anxiety with sexual coercion, and HTM with sexual coercion. The results revealed two moderation effects: higher HTW amplified the link between AD and physical IPV, whereas higher HTM amplified the link between AD and sexual coercion. Results highlight the relevance of assessing attachment, AD, and gender hostility in IPV programs. They also highlight the relevance of targeting HTM as a risk marker for IPV perpetration in men.

Romantic Attachment and Sexual Satisfaction Trajectories Among Couples Transitioning to Parenthood.

The transition to parenthood (TTP) is an exciting yet destabilizing time for couples. First-time parents may experience changes in their sexual satisfaction during the TTP, but little is known about the factors associated with these changes. Romantic attachment might help understand why some new parents experience a decrease in sexual satisfaction while others do not. This prospective and dyadic study aimed to examine new parents' sexual satisfaction trajectories through the moderator role of prenatal attachment anxiety and avoidance in these trajectories. A total of 221 primiparous Canadian couples completed four online questionnaires from the second trimester of pregnancy to 12 months postpartum. Dyadic latent growth curve analyses revealed that although pregnant people present lower prenatal sexual satisfaction than their partners, both parents show an increase in their sexual satisfaction from pregnancy to 12 months postpartum. For both parents, partners' attachment anxiety was related to one's own steeper increase in sexual satisfaction from pregnancy to 12 months postpartum. Finally, both parents' attachment avoidance was related to their own lower sexual satisfaction during pregnancy. These findings will help educate and support expectant parents about anticipated fluctuations in sexual satisfaction.

A Latent Profile Analysis of Intimate Partner Violence Perpetrated by Men Seeking Help.

Past research has emphasized the need to identify profiles of men who perpetrate intimate partner violence (IPV) as a way to better understand this heterogeneous population and guide the development of tailored services. However, empirical validation for such profiles remains limited, since it still focuses on specific populations or fails to consider IPV as reported by men seeking treatment for IPV. We know little about the profiles of men who seek services for their use of IPV (with or without a justice referral). This study sought to identify profiles of men seeking treatment for IPV, based on their self-reported use of the various forms and severity of IPV perpetrated, and to compare the identified groups on key psychosocial risk markers of IPV. A total of 980 Canadian men entering treatment in community organizations specialized in IPV answered a series of questionnaires. A latent profile analysis identified four profiles: (a) "no/minor IPV" (n = 194), (b) "severe IPV with sexual coercion" (n = 122), (c) "minor IPV and control" (n = 471), and (d) "severe IPV without sexual coercion" (n = 193). Results revealed differences in psychosocial risk markers, including attachment insecurities, childhood interpersonal trauma, undesirable personality traits, affect dysregulation, and psychological distress, mostly between the "severe IPV without sexual coercion" profile and the "no/minor IPV" and "minor IPV and control" profiles. Very few differences were found, however, between the "severe IPV with sexual coercion" and "severe IPV without sexual coercion" profiles. Implications for awareness, prevention, and treatment efforts for each profile are discussed.

How Relationship Satisfaction and Negative Communication Trajectories Change in Emerging Adults' Dating Relationships: A Group-Based Dual Trajectory Analysis.

Early romantic relationships are salient to the development of healthy future relationships. Yet, little is known about the evolution of romantic relationships of emerging adults since most of the research has been conducted on married or well-established couples. The current study aims to examine how relationship satisfaction and negative communication evolve and are interrelated during emerging adulthood. Using age as a time metric, we conducted group-based dual trajectory modeling analyses on 1566 unmarried Canadian individuals (from 17 to 24 years old) in a relationship, who could either stay with the same partner or change partner over time. A four-group model for relationship satisfaction and a four-group model for negative communication were found. Dual analyses highlighted the high concordance between specific trajectories of both constructs. These findings demonstrate that relationship satisfaction and negative communication do not evolve in the same ways for everyone and provide useful insights to existing clinical interventions.

Attachment, Sexual Motives, and Sexual Satisfaction among Couples Expecting their First Child.

This study examined direct and indirect links among attachment insecurities (anxiety, avoidance) and sexual satisfaction through sexual motives in couples expecting their first child. A sample of 204 first-time pregnant couples completed online questionnaires. Dyadic path analyses revealed that attachment and sexual satisfaction were not directly associated, but rather indirectly associated through three sexual motives: partner approval, self-affirmation, and intimacy. For non-pregnant partners, attachment anxiety was related to higher sexual satisfaction through higher intimacy, whereas attachment avoidance was related to lower sexual satisfaction through lower intimacy. Results are discussed in light of clinical implications for expecting couples.

Cumulative Childhood Trauma, Communication Patterns, and Intimate Partner Violence Perpetrated by Men Seeking Help.

Intimate partner violence (IPV) is a complex and multifactorial public health problem associated with important physical and psychological repercussions. Recent studies suggest that cumulative childhood trauma (CCT) may be related to higher IPV perpetration through dysfunctional communication patterns, but to our knowledge, no study has tested this proposition in a clinical population. This study aimed to explore the direct and indirect links between CCT and perpetrated IPV through dysfunctional communication patterns among 577 men seeking help from community centers specializing in IPV. Prior to receiving services, participants completed a battery of questionnaires including validated brief measures of CCT (sexual, physical, and psychological abuse; physical and psychological neglect; witnessing of physical and psychological parental violence; bullying), communication patterns (demand/demand, partner demands/man withdraws, man demands/partner withdraws), and IPV (psychological, physical, coercive control). Results from a path analysis reveal that having sustained a higher number of different forms of childhood trauma is directly related to men's higher risk of perpetrating psychological IPV. CCT is also indirectly related to higher perpetrated psychological and physical IPV and coercive control through a higher report of the demand/demand communication pattern and a higher report of the man demands/partner withdraws communication pattern. The tested model explains 23% of the variance in psychological IPV, 6% of the variance in physical IPV, and 12% of the variance in coercive control. Results highlight the importance of assessing, in therapy, both distal and proximal variables associated with IPV, including the accumulation of many forms of childhood interpersonal trauma, and to tailor trauma-informed interventions that promote constructive communication strategies.

Lifetime and Child Sexual Violence, Risk Factors and Mental Health Correlates Among a Nationally Representative Sample of Adolescents and Young Adults in Haiti: A Public Health Emergency.

Very little is known in Haiti and the Caribbean regarding child and lifetime sexual victimization. Using a nationally representative sample of adolescents and young adults aged 15-24, this study aimed to document the prevalence, risk factors and mental health correlates of lifetime and child sexual violence in Haiti. A national cross-sectional surrvey was conducted in Haiti, using a multistage sampling frame, stratified by geographical department, urban or rural setting, gender, and age groups (15-19 and 20-24 years). The final sample included 3586 household participants (47.6% female). A weighted sample of 3945 individuals was obtained and used in the following analyses. Overall rate of lifetime and child sexual violence was, respectively, 27.44% (95% CI 25.94-28.94) and 11.27% (95% CI 10.18-12.35). Lifetime sexual violence rate was significantly higher among female participants (29.02%; 95% CI 27.5-30.55) compared to male (25.73%, 95% CI 24.26-27.2), χ2 = 4.63, p < .05, but there was no significant gender difference for child sexual victimization. Experiences of family physical violence, emotional abuse by mother and father, divorce of parents, and other physical violence were strongly associated with higher odds of sexual victimization. Participants who reported having experienced sexual violence are more at risk to meet criteria of PTSD (OR = 1.96, 95% CI 1.66-2.32; p < .0001), depression (OR = 1.73, 95% CI 1.47-2.02; p < .0001), psychological distress (OR =1.72, 95% CI 1.47-2.02; p < .0001), and substance abuse (OR = 1.33, 95% CI 1.13-1.57; p < .0001). Findings demonstrate that sexual violence is a public health emergency in Haiti. They provide evidence for the development of prevention and intervention programs.

Investigating the relationship between the five-factor model of distress tolerance, anxiety and anxiety sensitivity.

BACKGROUND: Distress tolerance (DT) has been conceptualized as a vulnerability factor for several psychopathologies. A five factor model of DT has been suggested, but its associations with anxiety and anxiety sensitivity have yet to be explored. OBJECTIVES: This study aimed to further validate the five-factor model of DT, identify the associations between its factors and elevated anxiety, and assess if anxiety sensitivity mediates the association between DT and anxiety. DESIGN AND METHODS: This observational study included 330 students and university workers (women = 82.7%; mean age = 27.7 years, SD = 9.4). They completed online questionnaires assessing DT, anxiety sensitivity and anxiety levels. RESULTS: The five-factor model was a good fit to the data (RMSEA = .04). Two factors, and the sex of the participants, contributed to the variance in anxiety (r2 = .418, p < .001). Tolerance of negative emotion was directly (ß = -1.98, 95% CI = [-2.53, -1.42]) and indirectly (ß = -1.10, 95% CI = [-1.55, -.78]) associated with lower anxiety through anxiety sensitivity. Tolerance of uncertainty was also directly (ß = -.08, 95% CI = [-.10, -.06]) and indirectly (ß = -.04, 95% CI = [-.05, -.02]) associated with lower anxiety through anxiety sensitivity. CONCLUSIONS: Tolerance of negative emotion and uncertainty were associated with anxiety independently of the other factors of DT. These associations seem partially explained by the effect of anxiety sensitivity.

Attachment Injury Severity, Injury-related Stress, Forgiveness, and Sexual Satisfaction in Injured Adult Partners.

An attachment injury can occur when one partner violates the assumption that they will provide comfort and caring during a moment of increased need. For injured partners, unresolved attachment injuries can underlie an enduring stress reaction and lower relationship satisfaction. However, no research has examined the associations between the perceived severity of the injury and sexual satisfaction, a central component of relationship well-being. In this cross-sectional study, we examined the direct and indirect associations between the perceived severity of the attachment injury and sexual satisfaction via injury-related stress symptoms and levels of forgiveness, in injured partners. A total of 145 adults who reported having experienced an attachment injury in their current relationship completed self-report questionnaires measuring injury severity, event-related stress, forgiveness, and sexual satisfaction. An indirect association between the perceived severity of the attachment injury and sexual satisfaction through higher injury-related stress and lower forgiveness was found via a path analysis. Results suggest that fostering forgiveness and attending to injury-related stress may be key toward sexual satisfaction in couples where a partner reports an attachment injury. Clinical implications of these results are discussed in light of theory and potential treatment strategies for addressing an attachment injury in couple's therapy.

Efficacy of Emotionally Focused Therapy among Spanish-speaking couples: study protocol of a randomized clinical trial in Argentina, Costa Rica, Guatemala, Mexico, and Spain.

BACKGROUND: Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. METHODS: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. DISCUSSION: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04277325. Registered on February 20, 2020.

Changes in Attachment and Commitment in Couples Transitioning to Parenthood.

This study examined whether attachment predicts changes in commitment and whether commitment predicts changes in attachment in both partners during the transition to parenthood. Both partners of 93 couples completed online questionnaires individually at the second trimester of pregnancy and at 4 months postpartum. Autoregressive cross-lagged path analyses based on the Actor-Partner Interdependence Model tested the bidirectional associations between attachment dimensions (anxiety and avoidance) and three modes of commitment (optimal, over-commitment, and under-commitment). Results revealed that for both partners, prenatal attachment avoidance was associated with a decrease in optimal commitment and an increase in under-commitment from pre- to postpartum. Fathers' attachment anxiety was associated with a decrease in mothers' under-commitment. Furthermore, prenatal optimal commitment was associated with a decrease in attachment avoidance, whereas under-commitment was associated with an increase in attachment avoidance. Fathers' prenatal over-commitment was associated with an increase in their own attachment anxiety and avoidance. These results highlight how attachment insecurities and relationship commitment interrelate during this major transition.

Prevalence and factors related to dating violence victimization and perpetration among a representative sample of adolescents and young adults in Haiti.

BACKGROUND: Studies examining both victimization and perpetration of dating violence among both women and men are virtually non-existent in Haiti. This study aimed to document the prevalence and factors associated with victimization and perpetration of dating violence (DV) among adolescents and young adults aged 15-24 years in Haiti. PARTICIPANTS AND SETTING: A total of 3586 participants (47.6% women; mean age = 19.37; SD = 2.71) were sampled in the 10 geographical departments according to residence areas (urban/rural), age group (15-19/20-24 years old), and gender (men/women). METHOD: Participants completed questionnaires assessing DV victimization and perpetration, witnessing interparental violence, parental violence, violence acceptance, social desirability, and self-esteem. RESULTS: Overall, 1538 participants (56% women) were in a romantic relationship in the past year. Results showed that men were more likely to experience both psychological (49.4% of women and 57% of men, X2 = 8.17, p = .004), and physical violence (11.1% of women and 18.8% of men, X2 = 8.13, p = .004). There were marginally significant differences for sexual violence between gender for adolescents aged 15 to 19 (26.5% of girls and 20.5% of boys, X2 = 3.25, p = .07), and not for young adults (21.8% of women and 24.0% of men, X2 = 0.49, p = .48). No significant difference was observed for any forms of DV perpetration. DV perpetration was positively associated with victimization (b = 0.5, p = .002), however victimization was not associated with perpetration. Results also showed different associations between violence perpetration and victimization, gender, social desirability, acceptance of violence, parental violence, and witnessing interparental violence. CONCLUSIONS: This study highlights avenues for prevention and intervention that must begin at an early age, engage teachers, train peer-educators, promote healthy, non-violent and egalitarian romantic relationships.

Intimate Partner Violence Perpetrated by Men Seeking Help: The Explanatory Roles of Psychological Distress and Affect Dysregulation.

Despite an increase in research initiatives and prevention campaigns, intimate partner violence (IPV) remains a public health problem that affects many victims worldwide. The current study aims to examine whether psychological distress symptoms (anger, depression, and anxiety) are indirectly related to the perpetration of IPV (physical assault, psychological abuse, and coercive control) through affect dysregulation (AD) in men seeking help. Online questionnaires assessing psychological distress symptoms, AD, and violent behaviors were completed by 335 adult men entering treatment for IPV. A path analysis model revealed the indirect associations between psychological distress symptoms and higher IPV perpetration through higher AD. Symptoms of anger were indirectly related to the three forms of perpetrated IPV through higher AD. Symptoms of depression were, directly and indirectly, related to the three forms of perpetrated IPV through higher AD. Finally, symptoms of anxiety were directly related to lower physical assault perpetration, and indirectly related to higher physical assault and coercive control perpetration through higher AD. The final model explained 10% of the variance in perpetrated physical assault, 23% of the variance in perpetrated psychological abuse, and 13% of the variance in perpetrated coercive control. These results underline the necessity of assessing and addressing symptoms of psychological distress and AD among men perpetrators in the treatment of IPV.

Childhood Sexual Abuse, Dyadic Empathy, and Intimate Partner Violence Among Men Seeking Psychological Help.

Childhood sexual abuse (CSA) and intimate partner violence (IPV) have both been associated with numerous negative repercussions. The first aim of this study is to understand IPV perpetrated by men within a clinical population, by examining the effects of two potential predictors: CSA and dyadic empathy (cognitive and emotional). The second aim of this study is to explore whether dyadic empathy is an intermediary variable of the association between CSA and IPV. A sample of 198 men (aged 18-69 years old) who were seeking help for relationship problems, completed a set of self-administered questionnaires. While controlling for social desirability and family violence history, our findings outlined the mediating and moderating role of dyadic empathy in the link between CSA and perpetrated psychological, but not physical, IPV. Emotional empathy mediated and moderated the link between CSA and psychological IPV, whereas cognitive empathy only moderated this link. The examination of the direct links between the variables also revealed that CSA was related to lower emotional empathy and higher rates of both types of IPV. In addition, cognitive empathy was negatively associated with physical and psychological IPV, whereas emotional empathy was positively associated with psychological IPV. This study contributes to the literature by documenting some of the mechanisms that could explain the perpetration of IPV and highlights the importance of investigating CSA and empathy in men who are seeking help.

Exploring Insecure Romantic Attachment and Justifications for the Use of Intimate Partner Psychological Aggression in Couples.

The attachment theory has commonly been used to examine intimate partner psychological aggression (IPPA), but few studies have examined its association with self-reported justifications for one's own use of IPPA. Behaviors, including the use of IPPA, are influenced, maintained, and function within the context of their justifications, highlighting the importance of investigating these justifications to obtain a clearer picture of IPPA. This study examined whether insecure romantic attachment (i.e., attachment anxiety and attachment avoidance) in both partners of a couple was associated with their justifications for their own use of IPPA. A community sample of 81 mixed-sex couples who reported using IPPA in the last year completed self-reported questionnaires on adult romantic attachment and their justifications for their use of IPPA. Results of a path analysis based on the actor-partner interdependence model revealed moderate positive associations between attachment anxiety and one's use of internal and external justifications for their IPPA perpetration in men and women. An unexpected dyadic positive association is discussed. These results suggest that the use of justifications for one's use of IPPA may reflect a strategy of hyperactivation that could contribute to the cycle of psychological aggression. Uncovering the function of these justifications could provide important therapeutic benefits, which are discussed in the study's implications.

Are Patients at Risk for Developing Panic Disorder After an Emergency Department Visit With Noncardiac Chest Pain?

BACKGROUND: Panic disorder (PD) is common in emergency department (ED) patients with noncardiac chest pain (NCCP). The literature suggests that initially PD-free patients may be at increased risk of developing PD in the months or years following an ED visit. OBJECTIVES: This study aims to determine the incidence of PD in the 2 years following an ED visit with NCCP and to identify predictors of incident PD. METHODS: This study was conducted using a longitudinal, observational design. Five hundred eighty-five patients with NCCP (without PD) were recruited in two EDs. They underwent an interview and completed a series of questionnaires assessing anxiety disorders, perceived social support, psychological distress, anxiety sensitivity, comorbidities, and stressful life events. PD was assessed 6 months, 1 year, and 2 years after the initial interview. RESULTS: PD incidence was 11.1% (95% confidence interval: 8.7-13.9) in the two years following the baseline assessment. Anxiety sensitivity (odds ratio = 1.08; 95% confidence interval: 1.04-1.11; P < .001) and stress related to life events (odds ratio = 1.14; 95% confidence interval: 1.06-1.24; P = .001) significantly predicted incident PD. CONCLUSIONS: Patients with NCCP are at high risk for developing PD in the 2 years following an ED visit with NCCP. Anxiety sensitivity and stress related to life events may be promising clinical targets for preventive interventions.

How Do Partner Support, Psychological Aggression, and Attachment Anxiety Contribute to Distressed Couples' Relationship Outcomes?

Few studies have simultaneously looked at the relative contribution of positive and negative behaviors to understand relationship outcomes. This study examined the relative roles of perceived partner support and psychological aggression in two relationship outcomes-relationship satisfaction and the willingness to invest in the relationship-as well as the contribution of attachment anxiety as a moderator in 307 couples seeking relationship therapy. Path analyses revealed that perceived partner support was associated with individuals' own higher relationship satisfaction and willingness to invest in the relationship. Attachment anxiety moderated these associations. Perceived partner psychological aggression was not associated with relationship outcomes.