Actigraphic Wake after Sleep Onset and Symptom Severity Correspond with Rumination in Trauma-Exposed Individuals.

Rumination and worry are forms of repetitive negative thinking (RNT) commonly associated with internalizing psychopathologies, although less is known about RNT in trauma-exposed individuals with internalizing psychopathologies. Separate lines of research show RNT also plays a role in problematic sleep, which is frequently experienced after trauma exposure. To address gaps in the literature, the current study examines the impact of sleep and symptoms on RNT in trauma-exposed participants. A transdiagnostic sample of 46 unmedicated treatment-seeking trauma-exposed participants completed standard measures of rumination and worry, as well as clinical measures that assessed posttraumatic stress, depression, and anxiety severity. Actigraphic sleep variables were sleep duration, wake after sleep onset (WASO), and sleep efficiency. Sleep and clinical measures were submitted to multiple regression analyses with rumination and worry as dependent variables. The regression results showed that rumination was significantly explained by WASO and posttraumatic stress symptom (PTSS) severity, and the omnibus test was significant. Depression, anxiety, and other estimates of sleep were not significant. No significant results emerged for worry. Preliminary findings suggest that PTSS and WASO, an index of fragmented sleep, may contribute to rumination, but not worry, in trauma-exposed individuals. Longitudinal studies are needed to determine potential causal relationships.

Alcohol use and motives for drinking across the menstrual cycle in a psychiatric outpatient sample.

BACKGROUND: Females who misuse alcohol experience high rates of negative physical and mental health consequences. Existing findings are inconsistent but suggest a relationship between ovarian hormones and alcohol use. We aim to clarify how alcohol use and drinking motives vary across the menstrual cycle in female psychiatric outpatients using the luteinizing hormone (LH)-confirmed cycle phase. METHODS: Daily self-reports (n = 3721) were collected from 94 naturally cycling females, recruited for past-month suicidal ideation, during the baseline phase of three parent clinical trials between February 2017 and May 2022. Multilevel logistic and linear models estimated the relationship between the cycle phase (with LH-surge confirmed ovulation) and daily alcohol use or drinking motives, moderated by the weekend. Models were adjusted for age, legal drinking status, substance use disorder, and the COVID-19 pandemic, and included random effects. RESULTS: Participants were generally more likely to drink in the midluteal (vs. perimenstrual) phase, but more likely to drink heavily on weekends in periovulatory and perimenstrual (vs. midluteal) phases. Social motives for drinking were significantly higher on weekends in the periovulatory, mid-follicular, and midluteal phases (vs. weekdays), but this finding was non-significant in the perimenstrual phase. Participants rated drinking to cope higher in the perimenstrual phase (vs. midluteal phase), regardless of the weekend. CONCLUSION: In a psychiatric sample with LH-surge-confirmed ovulation, we find an increased likelihood to drink heavily in periovulatory and perimenstrual phases on weekends. We also find that the perimenstrual phase is associated with increased drinking to cope, and relatively lower weekend social drinking. Finally, random effects across models suggest individual differences in the extent to which the cycle influences drinking. Our findings stress (1) predictable phases of increased high-risk alcohol use across the menstrual cycle, and (2) the importance of individual assessment of cyclical changes in alcohol use to predict and prevent ovulation- and menses-related surges in heavy drinking.

Negative urgency, PTSD symptoms, and alcohol risk in college students.

Theoretical models of trauma and alcohol use suggest that trauma-exposed individuals with higher levels of PTSD symptoms are at increased risk of problematic and coping-oriented alcohol use to alleviate unwanted internal states. The goal of the current study was to evaluate whether these associations are enhanced among young adults who report engaging in impulsive behavior in the context of negative affect (i.e., high negative urgency). It was hypothesized that (a) higher negative urgency would be associated with problematic alcohol use; and that (b) negative urgency would moderate the association between PTSD symptoms and problematic alcohol use. Methods: This study used a cross-sectional, secondary data analysis design run on 213 participants: college students, ages 18-25, who endorsed both having an interpersonal traumatic event and current weekly alcohol use. Participants completed a series of assessments and self-report questionnaires. Results: Results of hierarchical linear regression models indicated that greater negative urgency was significantly associated with greater negative alcohol-related consequences and greater coping motives for alcohol, but not past 30-day binge frequency or past 30-day alcohol quantity. Negative urgency did not moderate associations between PTSD symptoms and alcohol outcomes. Conclusions: PTSD symptoms and negative urgency are uniquely associated with indices of alcohol risk in college students with a history of trauma exposure. However, individuals high in negative urgency are not necessarily consuming more alcohol, nor does negative urgency increase the association between PTSD symptoms and drinking outcomes in this population.

Trauma Cue-Elicited Alcohol Craving as a Function of Adult Versus Childhood-Onset Interpersonal Traumatic Events in Young Adult Drinkers.

OBJECTIVE: Childhood trauma may influence risk for alcohol use disorder and posttraumatic stress disorder through negative and positive reinforcement drinking. Laboratory studies evaluating childhood trauma in relation to these phenotypes are limited. METHOD: This study examined the influence of childhood index traumas on responses to trauma and alcohol cues among 184 college students (50.0% female) endorsing lifetime interpersonal trauma and current weekly alcohol use. Participants' subjective alcohol craving and distress were measured in response to four narrative (trauma vs. neutral) and beverage (alcohol vs. water) cue combinations. RESULTS: Forward-fitted linear mixed-effects models indicated main effects of childhood index traumas on distress (ß= 6.151, p = .001) and craving (ß = 0.656, p = .023), wherein individuals with childhood index traumas showed evidence of elevated levels of distress and craving. Childhood index trauma interacted with the narrative cue to predict distress (ß = -10.764, p = .002), wherein individuals with childhood index traumas showed greater levels of distress to the neutral cue, and individuals with adult index traumas showed greater levels of distress to the trauma cue. Childhood index trauma interacted with the beverage cue to predict craving (ß = -0.599, p = .011), wherein childhood index traumas were associated with greater levels of craving to neutral cues. Childhood index trauma did not significantly interact with the beverage cue to predict distress or the narrative cue to predict craving (ps > .05). CONCLUSIONS: Childhood trauma may be more relevant to positive rather than negative reinforcement aspects of alcohol use disorder during young adulthood.

Trauma and alcohol characteristics related to high intensity binge drinking during college.

High intensity (HI) binge drinking has emerged as a high-risk drinking phenotype in young adult drinkers, yet few studies have evaluated clinically meaningful correlates of HI binge drinking among young adults at risk for co-occurring psychopathologies, such as interpersonal trauma-exposed drinkers. The present study compared three groups (i.e., HI binge, standard binge, non-binge drinkers) of interpersonal trauma-exposed college student drinkers (N = 221) on alcohol and interpersonal trauma characteristics. Results of one-way ANOVAs indicated that the HI binge group endorsed significantly greater negative alcohol-related consequences relative to the other two groups. The HI binge group endorsed significantly greater enhancement motives compared to the non-binge group, and no group differences were detected for PTSD and interpersonal trauma characteristics. Individuals who engage in HI binge drinking may experience greater alcohol problems due to their use of alcohol to enhance positive mood. HI binge drinking does not differentiate individuals on the basis of interpersonal trauma experiences or related psychopathology.

The Influences of Posttraumatic Stress Disorder and Distress Tolerance on Trauma and Alcohol Cue Reactivity in a Sample of Trauma-Exposed College Students.

OBJECTIVE: Models of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often emphasize negative reinforcement drinking (i.e., drinking to reduce negative affect) as a key etiological and maintenance factor. However, potential risk factors related to negative reinforcement drinking in PTSD-AUD are less understood. Distress tolerance exhibits theoretical and empirical promise as one possible, malleable, risk factor. The current study used a trauma and alcohol cue reactivity paradigm to elucidate the role of perceived (i.e., self-reported) distress tolerance in trauma-related alcohol risk. METHOD: Participants were 185 university students (50.3% female) endorsing lifetime interpersonal trauma exposure and current weekly alcohol consumption. Subjective craving for alcohol was assessed in response to four combinations of audio narrative (personalized trauma vs. neutral) and beverage (alcohol vs. water) cues. Forward-fitting linear mixed-effects models were used to evaluate study hypotheses. RESULTS: Perceived distress tolerance significantly interacted with beverage cue in relation to craving (ß = -.293, p = .011), such that individuals low, as compared with high, in perceived distress tolerance reported greater craving for alcohol in response to the alcohol, but not water, beverage cue. Although low perceived distress tolerance was associated with greater alcohol coping motives and alcohol use problems at baseline, there were no main effects of perceived distress tolerance in relation to craving, and perceived distress tolerance did not significantly interact with trauma cues to predict craving (ps > .05). CONCLUSIONS: Among trauma-exposed young adult drinkers, low perceived distress tolerance may influence alternative processes of AUD risk, such as susceptibility to conditioned craving responses to alcohol.

Lifetime trauma endorsement, posttraumatic stress disorder, and alcohol dependence as a function of sexual minority status.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur, with elevated rates of both disorders in lesbian, gay, or bisexual (LGB) samples. Few studies have compared the strength of PTSD-AUD associations between LGB and heterosexual individuals or evaluated the role of nontraumatic LGB discrimination in these relationships among sexual minorities. METHOD: The current study utilized nationally representative epidemiological data (N = 29,646) to (a) examine whether associations between lifetime trauma endorsement/PTSD and lifetime alcohol dependence (AD) differ as a function of sexual minority status and (b) evaluate the role of LGB-specific discrimination in trauma/PTSD and AD associations among LGB individuals. RESULTS: Logistic regression analyses showed the association between lifetime trauma endorsement and lifetime AD was significantly greater in magnitude for LGB individuals (odds ratio [OR] = 2.17) compared to heterosexual individuals (OR = 1.32; Z = 2.51, p < .05). The magnitude of the association between lifetime PTSD and lifetime AD was not greater in the LGB subsample (OR = 2.11) than the heterosexual subsample (OR = 1.71; Z = 0.63, p > .05), after controlling for trauma endorsement. Among the LGB subsample, logistic regression analyses did not support a significant main effect for LGB discrimination nor an interaction between trauma endorsement and nontraumatic LGB discrimination, nor between PTSD and nontraumatic LGB discrimination, on lifetime AD (ps > .05). CONCLUSIONS: LGB individuals demonstrate stronger associations between lifetime trauma endorsement and AD, relative to heterosexual counterparts; however, this association may not be accounted for or moderated by nontraumatic LGB discrimination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Negative affect and alcohol craving in trauma-exposed young adult drinkers.

BACKGROUND: Clinical research indicates that successful posttraumatic stress disorder (PTSD) treatment does not lead to improvements in alcohol use outcomes in comorbid PTSD and alcohol use disorder (AUD). Emerging theory suggests that treating PTSD may not disrupt an association between negative affect and alcohol craving, which underlies negative reinforcement drinking. The goal of the current study was to determine the respective influences of PTSD symptoms, coping motives, and negative affect on trauma and alcohol cue reactivity to inform theoretical models of co-occurring PTSD and AUD. METHODS: The sample consisted of 189 young adults (50.3% women; 49.2% current PTSD; 84.0% current AUD) who endorsed interpersonal trauma (e.g., sexual/physical assault) and current weekly alcohol use. Participants completed a trauma and alcohol cue reactivity assessment, in which subjective (e.g., craving, affect) and physiological (i.e., salivation) measures were recorded in response to 4 narrative (i.e., personalized trauma or standard neutral) and in vivo beverage (i.e., personalized alcohol or water) cue combinations. RESULTS: Forward-fitted linear mixed-effects (LME) models confirmed that trauma cue-elicited craving was elevated among those high but not low in PTSD symptoms, consistent with prior research and theory. Trauma cue-elicited craving was fully explained by increases in negative affect, with no evidence of a direct effect of trauma cue on craving. PTSD symptoms moderated an association between trauma cue and negative affect (but not negative affect and craving), and coping motives for alcohol moderated an association between negative affect and craving (but not trauma cue and negative affect). CONCLUSIONS: This study provides novel laboratory evidence for the respective contributions of negative affect, PTSD symptoms, and coping motives on alcohol craving in trauma-exposed drinkers. It offers a methodological framework in which to evaluate novel strategies that aim to disrupt negative reinforcement drinking in individuals with co-occurring PTSD and AUD.

Sleep Quality Moderates the Relationship between Anxiety Sensitivity and PTSD Symptoms in Combat-exposed Veterans.

Objective/Background: Posttraumatic stress disorder (PTSD) and related conditions (e.g., depression) are common in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. High anxiety sensitivity (AS), defined as fear of anxiety and anxiety-related consequences, is related to greater PTSD and depressive symptoms; however, few studies have identified possible modifiers of these associations. The current study examined the moderating role of sleep quality in the associations between AS and PTSD and depressive symptoms. Participants: Participants were 155 OEF/OIF/OND community veterans ages 21-40 (12.3% women). Methods: Participants completed a semi-structured clinical interview for DSM-IV PTSD symptoms (Clinician Administered PTSD Scale; CAPS) and self-report measures of anxiety sensitivity (Anxiety Sensitivity Index), sleep quality (Pittsburgh Sleep Quality Index global score; PSQI), and depressive symptoms (Beck Depression Inventory-II; BDI-II). Results: Results of hierarchical linear regression models indicated that the main effects of AS and global PSQI score were significantly associated with greater PTSD and depressive symptoms (both with sleep items removed), above and beyond the covariates of trauma load and military rank. Sleep quality moderated the relationship between AS and PTSD symptoms (but not depressive symptoms), such that greater AS was associated with greater PTSD symptoms for individuals with good sleep quality, but not poor sleep quality. Conclusions: Sleep quality and AS account for unique variance in PTSD and depressive symptoms in combat-exposed veterans. AS may be less relevant to understanding risk for PTSD among combat-exposed veterans experiencing poor sleep quality.

Evaluating the influences of major depression and posttraumatic stress disorder on trauma and alcohol cue reactivity.

Despite support for the role of self-medication alcohol use in the etiology and maintenance of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), theoretical and empirical models of PTSD-AUD rarely account for the role of common comorbidities in risk processes, such as major depressive disorder (MDD). The current study examined the main and interactive effects of PTSD and depressive symptoms on patterns of trauma and alcohol cue reactivity to elucidate potential influences of depression on conditioned craving responses to trauma memories. It was hypothesized that depressive symptoms would be associated with greater cue reactivity (i.e., craving and salivation) to personalized trauma cues, above and beyond the influence of PTSD symptoms. Participants were 184 trauma-exposed young adults (50% female) endorsing current weekly alcohol use. Patterns of craving and salivation were assessed in response to four combinations of narrative (trauma vs. neutral) and beverage (alcohol vs. water) cues. Forward-fitted linear mixed effects models with deviance testing were conducted to ascertain the impact of the within-subjects factors (narrative and beverage cues) and covariates (PTSD and depressive symptoms) on self-reported and physiological (salivation) alcohol craving. Depressive symptoms were associated with elevated drinking coping motives, AUD symptom severity, and alcohol use problems at baseline; however, depressive symptoms did not show main or interactive effects with narrative or beverage cues to predict craving or salivation, p's > 0.05. Results suggest that, in the context of PTSD symptoms, depressive symptoms may not exacerbate alcohol craving responses to trauma reminders or alcohol cues.

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters.

BACKGROUND: Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters. METHODS: Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk. RESULTS: A structural equation model indicated that higher AS was associated with greater PTSD (ß = 0.38, p < .01) and depression symptoms (ß = 0.32, p < .01); lower DT was associated with greater PTSD (ß = -0.18, p < .01) and depression symptoms (ß = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: ß = 0.46, p < .01]; low cardiovascular risk group: ß = 0.33, p < .01). CONCLUSIONS: High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders.

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one's perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.

The Relation Between Posttraumatic Stress Symptom Severity and Startle Potentiation to Predictable and Unpredictable Threat.

Aberrant threat reactivity has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD); however, the literature on this association is mixed. One factor that may contribute to this inconsistent association is differences in severity of posttraumatic stress symptoms (PTSSs) across studies, but no studies have tested this hypothesis. The relation between PTSD and threat reactivity may also differ between unpredictable threats (U-threats) and predictable threats (P-threats), given burgeoning evidence to support a particular role for aberrant responding to U-threat in PTSD. The present study examined how PTSS severity relates to startle potentiation to U-threat and P-threat in a trauma-exposed community sample (N = 258). There was a negative linear, but not quadratic, relation between PTSS severity and startle potentiation to U-threat, but not P-threat. Blunted defensive responding to U-threat may therefore contribute to higher levels of PTSSs and may represent a novel treatment target for higher levels of PTSSs.

Posttraumatic stress disorder symptoms, relationship quality, and risky alcohol use among trauma-exposed students.

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for alcohol use disorder (AUD), in part due to the use of alcohol as a coping strategy. High quality romantic relationships can buffer individuals against risk for psychopathology; however, no studies have evaluated romantic relationship quality in risk for PTSD-AUD in non-clinical samples. The current study examined the main and interactive effects of PTSD symptoms and romantic relationship quality on alcohol consumption (i.e., past 30-day alcohol use quantity, frequency, and binge frequency) and alcohol-related consequences in a sample of 101 college students (78.2% women) with a history of interpersonal trauma (i.e., physical/sexual assault, excluding intimate partner violence) who reported being in a romantic relationship. Relationship quality significantly moderated the association between PTSD symptom severity and alcohol use quantity (B = -0.972, p = .016) and alcohol-related consequences (B = -0.973, p = .009), such that greater PTSD symptoms were associated with greater alcohol use quantity and consequences among those low, but not high, in relationship quality. The interaction between PTSD symptom severity and relationship quality in relation to binge drinking was marginally significant (B = -0.762, p = .063), and relationship quality did not significantly moderate the association between PTSD symptom severity and alcohol use frequency. The main effect of PTSD symptom severity was significantly associated with alcohol-related consequences, but no other alcohol outcomes; the main effect of relationship quality was not associated with alcohol use outcomes or consequences. High quality romantic relationships may serve as a buffer for young adults at risk for alcohol problems.

Post-traumatic stress and alcohol use disorders: recent advances and future directions in cue reactivity.

The comorbidity of post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) is prevalent, complex, and difficult to treat. Cue reactivity paradigms offer a clinically relevant scientific avenue to advance our understanding of PTSD/AUD comorbidity and ultimately inform evidence-based interventions. Cue reactivity paradigms evoke emotional, behavioral, and/or physiological responses by manipulating external (e.g. images, smells, scripts) cues. Through evaluation of how individuals with PTSD/AUD respond to trauma or alcohol cues (e.g. craving, distress, avoidance) in 'real' time, the theoretical framework for understanding functional associations between PTSD and AUD is refined. This brief narrative review of the recent literature (2015-present) will focus upon (1) summarizing the recently published cue reactivity studies relevant to PTSD/AUD, (2) explicating the limitations of the literature, and (3) discussing future empirical directions.

Alcohol Use Problems, Posttraumatic Stress Disorder, and Suicide Risk Among Trauma-Exposed Firefighters.

Alcohol use problems are associated with suicidal desire and may provide an avenue to suicidal ideation and behavior. However, the influence of posttraumatic stress disorder (PTSD) on the nature of the relationship between alcohol use problems and suicide risk is not well understood. In particular, the potential for PTSD to moderate the association between alcohol use problems and suicide risk remains unexplored. The present study investigated the main and interactive effects of alcohol use problems (Alcohol Use Disorders Identification Test) and PTSD symptoms (PTSD Checklist for DSM-5) on suicide risk (Suicide Behaviors Questionnaire-Revised) in a sample of 632 trauma-exposed firefighters (93.5% men; Mage = 38.44 years, SD = 8.59). Hierarchical logistic regression analyses evaluated whether the main and interactive effects of PTSD symptom severity and alcohol use disorders were significantly related to suicide risk, above and beyond age and cumulative trauma. The main effects of PTSD symptom severity (odds ratio, 1.76; p < 0.001) and alcohol use problems (odds ratio, 1.37; p = 0.391) significantly positively predicted suicide risk; however, PTSD symptoms did not moderate an association between alcohol use problems and suicide risk after accounting for these main effects (p > 0.05). A secondary, exploratory aim demonstrated that all PTSD symptom clusters significantly positively predicted suicide risk (p's < 0.001), although none of these clusters interacted with alcohol use problems to predict suicide risk (p's > 0.05). Theoretical and clinical implications are discussed as they relate to the importance of screening for PTSD and alcohol use disorder among firefighter populations.

Time course of panic disorder and posttraumatic stress disorder onsets.

PURPOSE: Posttraumatic stress disorder (PTSD) often co-occurs with panic disorder (PD), with some etiological models positing a causal role of panic reactivity in PTSD onset; however, data addressing the temporal ordering of these conditions are lacking. The aim of this study was to examine the bi-directional associations between PD and PTSD in a nationally representative, epidemiologic sample of trauma-exposed adults. METHODS: Participants were community-dwelling adults (62.6% women; Mage = 48.9, SD 16.3) with lifetime DSM-IV PTSD criterion A trauma exposure drawn from the 2001/2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and re-interviewed in 2004/5 (N = 12,467). Cox discrete-time proportional hazards models with time-varying covariates were used to investigate the bi-directional associations between lifetime PD and PTSD, accounting for demographic characteristics, trauma load, and lifetime history of major depression, generalized anxiety disorder, and social anxiety disorder. RESULTS: PD was significantly associated with subsequent onset of PTSD (HR 1.210, 95%CI = 1.207-1.214, p < .001), and PTSD was significantly associated with onset of PD (HR 1.601, 95% CI 1.597-1.604, p < .001). The association between PTSD and subsequent PD was stronger in magnitude than that between PD and subsequent PTSD (Z = - 275.21, p < .01). Men evidenced stronger associations between PD and PTSD compared to women. CONCLUSIONS: Results were consistent with a bidirectional pathway of risk, whereby PD significantly increased risk for the development of PTSD, and PTSD significantly increased risk for PD. Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic-specific interventions, such as interoceptive exposure, to prevent or treat this disabling comorbidity.

Age of alcohol use initiation and psychiatric symptoms among young adult trauma survivors.

Alcohol use disorder (AUD) evidences high rates of comorbidity with a range of psychiatric disorders, particularly within high-risk populations, such as individuals exposed to physical or sexual violence. Increasing efforts are focused on understanding the role of early alcohol use (e.g., during adolescence) on emotional and psychiatric functioning over time, as well as sex differences in these associations. The aim of the current study was to evaluate patterns of association between age of initiation of regular alcohol use and posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms as a function of sex. Participants were 269 college students with a history of interpersonal trauma and alcohol use who completed a battery of questionnaires regarding alcohol use and emotional health. Neither bivariate correlations nor results from structural equation models covarying for key factors showed a relationship between age of alcohol use initiation and current psychiatric symptoms among men (n = 63). Results of a structural equation model supported an association between earlier age of alcohol use initiation and greater levels of current PTSD (ß = -0.14), anxiety (ß = -0.15), and depression symptoms (ß = -0.16) in the female sub-sample (n = 202), after controlling for covariates, as well as intercorrelations among criterion variables. Statistical support for sex as a moderator of these associations was not detected. The current study provides preliminary evidence for potential sex differences in the role of early alcohol use in the development of psychiatric symptoms and highlights the need for systematic longitudinal research.

Examination of the effects of impulsivity and risk-taking propensity on alcohol use in OEF/OIF/OND Veterans.

INTRODUCTION: A strong association between posttraumatic stress disorder (PTSD) and problematic alcohol use has been demonstrated among Veteran populations exposed to combat trauma. Several traits, such as higher levels of risk-taking propensity (RTP) and impulsivity (e.g., negative urgency [NU]), are associated with both increased PTSD symptom-atology and greater alcohol use problems. METHODS: The present study examined the effects of NU and RTP on alcohol use (measured by average weekly alcohol consumption and number of binge drinking days in 1 month), as well as their potential moderating effects on the association between PTSD symptom severity and alcohol use in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) US Veterans. We hypothesized that NU and RTP would both significantly predict alcohol use and moderate the relation between PTSD symptom severity and alcohol use, such that the association between PTSD symptoms and alcohol use would be greater among individuals high compared to low in NU and RTP. RESULTS: As hypothesized, the main effects of RTP and NU were significantly positively associated with average weekly alcohol consumption and the number of binge drinking days in the past month. However, neither NU nor RTP moderated the relation between PTSD and either alcohol variable. DISCUSSION: NU and RTP may represent transdiagnostic risk markers for PTSD and alcohol use problems; however, the current study did not support an exploratory role of NU or RTP in the association between PTSD and alcohol use phenotypes.

INTRODUCTION: On constate une forte association entre le trouble de stress post-traumatique (TSPT) et la consommation problématique d'alcool dans les populations de vétérans exposés au combat. Plusieurs caractéristiques, telles qu'une plus grande propension à prendre des risques (PPR) et l'impulsivité (p. ex., l'urgence négative [UN]), sont liées à la fois à l'augmentation des symptômes de TSPT et à de plus grands problèmes de consommation d'alcool. MÉTHODOLOGIE: La présente étude a évalué les effets de l'UN et de la PPR sur la consommation d'alcool (mesurés d'après la moyenne hebdomadaire de consommation d'alcool et le nombre de journées de beuverie en un mois) de même que leurs effets modérateurs potentiels sur l'association entre la gravité des symptômes de TSPT et la consommation d'alcool dans un échantillon de vétérans américains de l'Opération Liberté immuable, de l'Opération Liberté irakienne et de l'Opération Aube nouvelle. Les chercheurs ont postulé que l'UN et la PPR seraient à la fois d'importants prédicteurs de la consommation d'alcool et un modérateur de la relation entre la gravité des symptômes de TSPT et la consommation d'alcool. Ainsi, l'association entre les symptômes de TSPT et la consommation d'alcool serait plus marquée chez les personnes ayant une UN et une PPR importantes que chez celles qui ayant de légers comportements de ce type. RÉSULTATS: Comme on l'a postulé, les principaux effets de la PPR et de l'UN avaient une corrélation positive significative avec la consommation hebdomadaire d'alcool et le nombre de journées de beuverie au cours du mois précédent. Cependant, ni l'UN ni la PPR ne modéraient la relation entre le TSPT et ces deux variables liées à l'alcool. DISCUSSION: L'UN et la PPR peuvent être des marqueurs de risque transdiagnostiques de TSPT et de problèmes de consommation d'alcool. Cependant, cette étude ne soutenait pas le rôle exploratoire de l'UN ou de la PPR dans l'association entre le TSPT et les phénotypes de consommation d'alcool.

The Nomological Network of a Behavioral Distress Tolerance Task in Veterans.

There is a relative lack of research on distress tolerance (DT) in veteran samples. The aims of the study were to (a) evaluate convergent and discriminant validity of a behavioral measure of DT compared to theoretically similar (i.e., self-report DT, negative urgency) and dissimilar (i.e., risk-taking) constructs and (b) evaluate the concurrent validity of DT in relation to posttraumatic stress disorder (PTSD) and depressive symptoms in a veteran sample. A sample of U.S. veterans who served after the September 11, 2001 terror attacks (N = 306, 89.9% male; M age 30.2 years, SD = 4.5, range: 21-40 years) completed self-report and behavioral measures of DT, risk-taking, impulsivity, and depressive symptoms, and completed a clinical interview for PTSD. Results of a multitrait-multimethod matrix found significant yet minimal shared variance, r2 = .01-.03, ps = .002-.055, between the self-report and behavioral measures of DT. We used a series of multiple regressions to examine the relative contribution of the behavioral and self-report DT measures in the prediction of PTSD and depressive symptoms. Self-reported, but not behavioral, DT accounted for unique variance in PTSD, r2 = .12, p < .001, and depressive symptoms, r2 = .23, p < .001. Participants with PTSD or higher scores on measures of depression were more likely to report greater increases in frustration and irritability after completing the behavioral task. Results indicate that DT is not a unidimensional construct and must be considered in the context of specific emotions (e.g., tolerance of irritability vs. fear) and contexts (e.g., behavioral, affective).