Military Sexual Trauma and Chronic Pain in Veterans.

OBJECTIVE: Chronic pain rehabilitation warrants sensitivity to unique psychosocial factors, such as trauma history. In Veterans of the United States Armed Forces, military sexual trauma (MST) is a pervasive type of trauma associated with a host of physical and psychological sequelae. A growing literature suggests a relationship between history of MST and chronic pain. This study sought to clarify the relationship between MST and chronic pain among male and female Veterans and explore whether individual factors moderate this relationship. DESIGN: A baseline survey of 328 Veterans seeking care for chronic pain via behavioral pain treatments was conducted. RESULTS: MST was reported by 31.4% of the sample and uniquely predicted pain interference. A significant interaction was found between MST and age, such that younger Veterans with a history of MST reported greater pain interference than younger Veterans with no MST. CONCLUSION: Findings provide further evidence that the experience of MST may intensify the overall burden of chronic pain and suggest that younger Veterans with MST seem to be most vulnerable to impaired pain rehabilitation. Unique study contributions include a robust sample of women and men with elevated rates of MST and examination of MST-age relationships concurrent with chronic pain.

Is Rumination a Risk and a Protective Factor?

High trait positive affect (PA) protects against depressive symptoms through cognitive responses such as rumination. However, how rumination in response to positive emotions (positive rumination) protects against depressive symptoms while rumination in response to negative emotions (brooding) predicts depressive symptoms is poorly understood. We hypothesized that (a) positive rumination and brooding represent a shared cognitive process of affect amplification on distinct affective content and (b) less brooding and greater positive rumination would distinctly mediate greater trait PA in predicting fewer depressive symptoms. Our prospective design among 321 adults first compared three confirmatory factor analysis models of the relationship between brooding and positive rumination. We then utilized structural equation modeling to examine whether brooding and positive rumination mediated the relationship between trait PA and depressive symptoms, controlling for baseline depressive symptoms, trait negative affect (NA), and the distinct effects of each mediator. Results supported a conceptualization of brooding and positive rumination as distinct but related constructs, represented as a common process of affect amplification to explain how rumination may amplify resilience or risk in predicting depressive symptoms (χ = 195.07, Δχ = 8.78, p < .001, CFI = .91, RMSEA = .07). Furthermore, positive rumination and brooding were distinctly predicted by trait PA, suggesting that trait PA exerts distinct effects on protective and risk forms of rumination. Less brooding mediated the relationship between greater trait PA and fewer depressive symptoms (ß = -.04, p = .012), but positive rumination did not (ß = .02, p = .517). Rumination may represent a protective and a risk factor, which may better enable individuals who brood to redirect their rumination on positive content and thereby reduce their risk of depressive symptoms.

Disentangling vulnerabilities from outcomes: Distinctions between trait affect and depressive symptoms in adolescent and adult samples.

BACKGROUND: Trait negative affect and trait positive affect are affective vulnerabilities to depressive symptoms in adolescence and adulthood. While trait affect and the state affect characteristic of depressive symptoms are proposed to be theoretically distinct, no studies have established that these constructs are statistically distinct. Therefore, the purpose of the current study was to determine whether the trait affect (e.g. temperament dimensions) that predicts depressive symptoms and the state affect characteristic of depressive symptoms are statistically distinct among early adolescents and adults. We hypothesized that trait negative affect, trait positive affect, and depressive symptoms would represent largely distinct factors in both samples. METHOD: Participants were 268 early adolescents (53.73% female) and 321 young adults (70.09% female) who completed self-report measures of demographic information, trait affect, and depressive symptoms. RESULTS: Principal axis factoring with oblique rotation for both samples indicated distinct adolescent factor loadings and overlapping adult factor loadings. Confirmatory factor analyses in both samples supported distinct but related relationships between trait NA, trait PA, and depressive symptoms. LIMITATIONS: Study limitations include our cross-sectional design that prevented examination of self-reported fluctuations in trait affect and depressive symptoms and the unknown potential effects of self-report biases among adolescents and adults. CONCLUSIONS: Findings support existing theoretical distinctions between adolescent constructs but highlight a need to revise or remove items to distinguish measurements of adult trait affect and depressive symptoms. Adolescent trait affect and depressive symptoms are statistically distinct, but adult trait affect and depressive symptoms statistically overlap and warrant further consideration.

Cognitive Mechanisms Reciprocally Transmit Vulnerability between Depressive and Somatic Symptoms.

Despite high comorbidity between depressive and somatic symptoms, cognitive mechanisms that transmit vulnerability between symptom clusters are largely unknown. Dampening, positive rumination, and brooding are three cognitive predictors of depression, with rumination theoretically indicated as a transdiagnostic vulnerability through amplifying and diminishing affect in response to events. Specifically, the excess negative affect and lack of positive affect characteristic of depressive symptoms and underlying somatic symptoms may cause and be caused by cognitive responses to events. Therefore, the current study examined whether comorbidity between depressive and somatic symptoms may be explained by the cognitive mechanisms of dampening and positive rumination in response to positive events and brooding in response to negative events among adults (N = 321) across eight weeks of assessment. We hypothesized that greater dampening and brooding would reciprocally predict greater depressive and somatic symptoms, while greater positive rumination would reciprocally predict fewer depressive and somatic symptoms. Mediation analyses in AMOS 22 indicated that dampening and brooding mediated reciprocal pathways between depressive and somatic symptoms, but positive rumination did not. Findings propose dampening and brooding as mechanisms of the reciprocal relationship between depressive and somatic symptoms through diminishing positive affect and amplifying negative affect in response to positive and negative events.

Cognitive mechanisms linking low trait positive affect to depressive symptoms: a prospective diary study.

Low trait positive affect represents an affective vulnerability to depression, but little research has examined mechanisms linking low trait positive affect to depressive symptoms. The current study investigated whether the cognitive strategies of dampening and positive rumination mediated the prospective association between low trait positive affect and depressive symptoms. Participants were 209 undergraduate students who participated in an eight-week online study. Depressive symptoms and trait temperament were assessed at baseline, followed by seven weekly questionnaires which assessed cognitive strategies in response to weekly events and weekly depressive symptoms. Data were analysed using multilevel modelling following the mediation approach proposed by Nezlek. Results indicated that low trait positive affect significantly predicted less positive rumination but not greater dampening in response to weekly positive events. Less positive rumination in response to weekly positive events partially mediated the association between low trait positive affect and greater depressive symptoms across the study.