Social problem-solving in intimate partner violence victims: Exploring the relative contributions of shame and PTSD symptoms.

OBJECTIVE: This study examined the contributions of shame and posttraumatic stress disorder (PTSD) symptoms to two dimensions of social problem-solving. METHOD: A sample of 426 women who were seeking mental health assistance following experiences of intimate partner violence completed self-report and clinician measures. Separate path analyses were conducted for problem orientation and problem-solving styles. RESULTS: In the model examining problem orientation, higher levels of shame were significantly associated with lower levels of positive problem orientation (f2 = 0.32) and higher levels of negative problem orientation (f2 = 0.92), with large effects noted. PTSD symptoms were significantly, positively associated with negative problem orientation (f2 = 0.3, large effect). When examining problem-solving styles, shame showed a significant negative association with rational style (f2 = 0.08, small effect) and significant positive associations with impulsive style (f2 = 0.45, large effect) and avoidant style (f2 = 0.48, large effect). PTSD symptoms did not return significant associations with any of the three problem-solving styles. CONCLUSION: Results indicate that shame holds notable associations with both dimensions of social problem-solving, relative to PTSD symptoms, and are discussed in light of current models of post-trauma functioning. Implications for clinical care and early intervention efforts are highlighted.

Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors.

OBJECTIVE: Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes. METHOD: Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety. RESULTS: Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe. CONCLUSIONS: Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.

Alcohol Use and Mental Health Symptoms in Nurses during the Early Months of COVID-19.

OBJECTIVE: The current study examined associations of symptoms of posttraumatic stress disorder [PTSD], depression, and generalized anxiety disorder [GAD] with alcohol consumption and drinking to cope in a sample of 310 nurses during the first six months of the COVID-19 pandemic. METHOD: Using a cross-sectional design, nurses completed online surveys. RESULTS: Over 50% of the sample reported alcohol misuse and 12.2% reported drinking to cope. Further, 38.7% reported elevated symptoms of PTSD, 29.7% moderate-to-high symptoms of depression, and 56.8% elevated symptoms of GAD symptoms. Hierarchical regression analyses were conducted to examine how mental health symptoms were associated with alcohol outcomes, controlling for age, gender pronouns, education, and race. No significant predictors emerged for alcohol consumption. Significant associations of symptoms of PTSD and depression were found for drinking to cope, such that higher levels of mental health symptoms were associated with greater endorsement of drinking to cope. CONCLUSION: Results are discussed in light of increasing prevention and support services for nurses.

Understanding the role of COVID-19-related workplace stress and institutional betrayal on mental health in nurses: Some heroes wear scrubs.

This study examined the association of three specific COVID-19-related workplace stressors (percentage of nursing work with COVID-positive [COVID+] patients, number of COVID-19-related patient deaths witnessed, and living separately from family for safety) and their associations with posttraumatic stress symptoms (PTSS) and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among 391 nurses (93.6% White, 93.4% utilize she/her pronouns). Cross-sectional data were collected via an online survey. Institutional betrayal (i.e., the perception that an institution failed to protect a member who depends on and trusts it) was examined as a moderator of these associations. Although institutional betrayal was not a significant moderator in the three individual models, it held small-to-medium-sized positive main effects with PTSS and symptoms of GAD and MDD in both the individual and combined models. In the individual models, the percentage of nursing work with COVID+ patients was significantly positively associated with all three mental health conditions, f2 = .019-.195, whereas it only showed a significant effect with PTSS in the combined model, f2 = .138. Living separately from family was significantly positively associated with PTSS and MDD symptoms in both the individual, f2 = .037 and .015, respectively, and combined models, f2 = .025 and .013, respectively. Number of patient deaths held a significant positive association with PTSS alone, f2 = .022, in the individual model only. The findings are discussed in light of ways in which health care settings can better support and prioritize mental health among nursing staff.

Using a Person-Centered Approach to Identify Patterns of Exposure to Intimate Partner Violence and Child Abuse in Women: Associations With Mental Health.

Patterns of exposure to intimate partner violence (IPV) and child abuse (CA) were explored in 467 women seeking psychological assistance following IPV. Using latent class analysis, three classes were obtained: women who had experienced physical, sexual, and psychological IPV, along with childhood physical and sexual abuse (IPV + CA; 38.5%); women who had experienced physical, sexual, and psychological IPV only (IPV/no CA; 52.9%); and women who had experienced psychological IPV only (Psych IPV only; 8.6%). Associations of class membership with severity of specific mental health conditions were examined, along with the number of diagnosed conditions. Significant between-class differences were noted on severity of IPV-related posttraumatic stress disorder, depressive disorders, alcohol and substance use disorders, and social phobia. Classes also differed significantly on the number of mental health conditions. Understanding patterns of betrayal-based trauma (e.g., IPV and CA) can inform care within agencies that serve IPV survivors by highlighting individuals at-risk for mental health conditions.

Exploring ambivalent rape acknowledgment and posttraumatic stress symptoms among college women who have experienced rape: What's in a name?

The present study explored rape acknowledgment among 131 college women survivors of rape utilizing three subgroups: acknowledged rape, unacknowledged rape, and ambivalent acknowledgment. Posttraumatic stress disorder (PTSD) symptom clusters and parameters of victimization and were compared between the subgroups. Of the participants, 28.2 % were classified as ambivalent rape acknowledgment, 49.6 % as acknowledged rape, and 22.1 % as unacknowledged rape. Across all four PTSD symptom clusters, the ambivalent acknowledgment group had significantly higher PTSD symptoms than the unacknowledged group. With the exception of hyperarousal symptoms, PTSD symptoms did not differ between the acknowledged and ambivalent acknowledgment groups. With regard to potential group differences in exposure to various rape tactics (i.e., physical force, threat, incapacitation), the acknowledged group indicated (a) exposure to a greater number of rape tactics relative to the other groups, (b) higher likelihood of endorsing rape via threat than the ambivalent acknowledgment group, and (c) more frequent endorsement of forcible rape than the unacknowledged group. Results are discussed in light of screening methods to assess for PTSD symptoms among rape survivors, as well as the recent changes to the Title IX law regarding sexual misconduct reports on college campuses.

The role of negative cognitions in co-occurring posttraumatic stress disorder and depression: Examination of interpersonal and noninterpersonal trauma survivors.

OBJECTIVE: To examine negative cognitions underlying both posttraumatic stress disorder (PTSD) and depression following trauma. METHOD: A mixed-gender motor vehicle accident (N = 297, Mage = 43.49 years) sample and a female intimate partner violence (N = 242, Mage = 36.95 years) sample was cross-sectionally studied at research clinics of two universities. RESULTS: When diagnostic groups (PTSD+/-, depression+/-) were studied, no significant interactions were noted for any of the three forms of negative cognitions (negative thoughts about the self, negative thoughts about the world, and self-blame) in either sample. When continuous ratings of PTSD and depression were studied, the results showed that negative thoughts about the self were linked to both PTSD and depression. CONCLUSION: Findings suggest that it may be beneficial to target negative thoughts about the self when treating PTSD and depression together.

Can the Behavioral Model of Health Care Utilization Be Used to Predict Completion of a Mental Health Assessment Following Intimate Partner Violence?

Survivors of intimate partner violence (IPV) may experience mental health problems. Although some survivors access mental health resources to address these concerns, many discontinue prematurely. One model of health care utilization that has recently gained attention in the trauma literature is the behavioral model of health care utilization (BMHU). This model considers three groups of variables in predicting health care utilization: immutable predisposing variables (e.g., age), enabling resources (e.g., income), and measures of need (e.g., symptom severity). The current study tested the BMHU's ability to predict completion of a free, multisession mental health evaluation for female survivors of IPV (N = 214). Two models were tested, each assessing a separate need-based predictor: The first model assessed symptoms of depression and the second model assessed symptoms of posttraumatic stress disorder (PTSD). Results were consistent across both models and suggested that younger age and receiving public assistance were both associated with a lower likelihood of completing the evaluation. Contrary to the BMHU's assumed positive relation between symptom severity and health care utilization, greater severity of depression and PTSD symptoms were both associated with a lower likelihood of completing the evaluation. It is possible that following IPV, experiencing psychological distress may engender help-seeking but too much distress may serve as a barrier to continued utilization. Future research should seek to better understand the complex relation between need and access, in the context of mental health care, and develop strategies for retaining IPV survivors who access mental health resources.

The Association Between Posttraumatic Negative Self-Conscious Cognitions and Emotions and Maladaptive Behaviors: Does Time Since Trauma Exposure Matter?

Negative beliefs about the self, self-blame, guilt, and shame have been consistently linked to emotional problems, such as posttraumatic stress disorder and depression, following trauma exposure. To expand understanding of the potential role of negative self-conscious cognitions and emotions in other forms of posttrauma maladjustments, such as maladaptive behaviors, the current study examined the associations between these cognitions and emotions with dissociation, alcohol use, and avoidant problem-solving. As a secondary goal, the influence of time since trauma exposure was considered given recent data suggesting that some posttraumatic responses require lengthier time following trauma to become salient. Multiple-group analysis was conducted in two groups of female survivors of intimate partner violence (IPV): women whose IPV experiences occurred within 3 months prior to assessment (early posttrauma phase [EPP]; n = 67) and those whose experiences occurred 12 months or more prior to assessment (chronic posttrauma phase [CPP]; n = 145). The results suggested model invariance. Posttraumatic negative self-conscious cognitions and emotions were significantly correlated with dissociation (EPP group: ß = .61, p < .001 and CPP group: ß = .48, p < .001), alcohol use (EPP group: ß = .31, p = .014 and CPP group: ß = .30, p < .001), and avoidant problem-solving (EPP group: ß = .58, p < .001 and CPP group: ß = .56, p < .001). The findings highlight the importance of negative self-conscious cognitions and emotions in posttrauma maladjustment and support intervening in these domains shortly after trauma exposure.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La asociación entre cogniciones y emociones negativas auto-conscientes postraumáticas y comportamientos maladaptativos: ¿Influye el Tiempo desde la Exposición al Trauma? COGNICIONES/EMOCIONES Y COMPORTAMIENTOS MALADAPTATIVOS Las creencias negativas acerca de sí mismo, la autoinculpación, la culpa y la vergüenza han sido consistentemente asociados a problemas emocionales, tales como el trastorno de estrés postraumático y la depresión, luego de la exposición a trauma. Para expandir la comprensión del rol potencial de las cogniciones y emociones negativas auto-conscientes en otras formas de inadaptación post-trauma, como comportamientos maladaptativos, el presente estudio examinó las asociaciones entre esas cogniciones y emociones con disociación, uso de alcohol, y estilo evitativo de resolución de problemas. Como un objetivo secundario, se consideró la influencia del tiempo desde la exposición al trauma dados los datos recientes que sugieren que algunas respuestas post-traumáticas requieren un mayor tiempo luego del trauma para hacerse salientes. Se realizó un análisis de grupos múltiples en dos grupos de mujeres sobrevivientes de violencia de pareja (IPV, por su sigla en inglés); aquellas cuyas experiencias de IPV ocurrieron en los últimos 3 meses (fase temprana post-trauma [FTP]; n = 67) y aquellas cuyas experiencias ocurrieron hace 12 meses o más (fase crónica post-trauma [FCP]; n = 145). Los resultados sugirieron invariancia del modelo. Las cogniciones y emociones negativas auto-conscientes se correlacionaron significativamente con disociación (grupo EPP: ß = .61, p < .001 y grupo CPP: ß = .48, p < .001), uso de alcohol (grupo EPP: ß = .31, p = .014 y grupo CPP: ß = .30, p < .001), y estilo evitativo de resolución de problemas (grupo EPP: ß = .58, p < .001 y grupo CPP: ß = .56, p < .001). Los hallazgos destacan la importancia de las emociones y cogniciones negativas auto-conscientes en la inadaptación postrauma y apoyan la intervención en esos dominios prontamente luego de la exposición a trauma.