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1.
Psychol Serv ; 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38573693

RESUMO

Depressive symptoms are a commonly observed yet understudied mental health sequalae of military sexual trauma (MST). Prior research supports the relationship between negative posttraumatic cognitions (NPCs) and the onset and course of trauma symptoms more broadly. We hypothesized that NPCs would be associated with depression symptoms in veterans endorsing a history of MST, specifically assaultive type MST. Our clinical sample included veterans presenting for treatment related to assaultive MST (N = 158; 70.9% female, 65.2% White, 27.8% Black). Participants completed self-report measures of posttraumatic stress disorder (PTSD), depression, and NPCs during intake at a Veteran's Affairs specialty trauma clinic. Linear regressions were used to analyze the association between NPCs and depression symptoms controlling for PTSD symptom severity. PTSD severity and NPCs about the self were significantly associated with depression symptoms, explaining 46% of the variance severity, F(4, 153) = 33.16, R² = .46, p < .001. These findings newly demonstrate a relationship between NPCs about the self and depression in veterans with a history of MST. Clinicians may benefit from incorporating cognitive interventions into preexisting depression treatments to directly address NPCs in this population. Future study is needed to determine how these results may extend to other forms of MST or trauma types. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

2.
Psychol Serv ; 2024 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-38546607

RESUMO

Research has established negative posttraumatic cognitions (NPC) affect the development and course of posttraumatic stress symptoms (PTSS) following trauma exposure (L. A. Brown et al., 2019). Previous studies in civilian and combat veteran populations also suggest positive associations among worry, NPC (Beck et al., 2004; Bennett et al., 2009), and PTSS (Fergus & Bardeen, 2017). However, little research has investigated the prevalence of worry in veterans who have experienced military sexual trauma (MST), and no research has examined the role of worry in the relation between NPC and PTSS among veterans seeking treatment associated with MST. This project examined the prevalence of worry in a MST sample and whether worry mediated NPC-PTSS associations. Veterans (N = 91) seeking MST-related treatment presented to a Veterans Affairs Posttraumatic Stress Disorder specialty clinic for assessment and treatment recommendations. Veterans completed questionnaires assessing NPC, worry, and PTSS. Bootstrapped mediation analyses examined NPC-PTSS associations. Veterans reported similar levels of worry as nonveterans seeking treatment associated with generalized anxiety disorder. Mediation analyses showed worry significantly mediated NPC-PTSS relationships for beliefs about the world, self-blame, and coping competence but not for beliefs about the self or global NPC severity. Further, the degree of mediation differed by NPC type. Though a limitation of this study is the use of cross-sectional data, these results inform the use of clinical intervention strategies targeting worry in trauma-focused interventions and necessitate further research on whether trauma-focused interventions ameliorate co-occurring worry among veterans exposed to MST. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

3.
Cogn Behav Ther ; : 1-13, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38317621

RESUMO

Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans' treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol [FP] or receiving minimally adequate care [MAC; defined as attending eight or more sessions]). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.

4.
J Interpers Violence ; 39(3-4): 631-650, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37714821

RESUMO

Past research supports the role of negative posttraumatic cognitions (NPCs) in the development and maintenance of posttraumatic stress disorder (PTSD). The relationship between NPCs and PTSD may be uniquely impacted by racial status and experiences of military sexual trauma (MST), both of which may have a unique impact on one's understanding of self, others, and the world. We explored racial differences in the association between NPCs and PTSD symptom clusters in a sample of veterans endorsing MST (N = 139; 74.8% White, 25.2% Black). A path model was created and analyzed both with the full sample and separately by racial group. In the full sample, NPCs about the self and world were significantly associated with intrusion, negative alterations in cognitions and mood (NACM), and arousal, but not avoidance. Self-blame was not a significant predictor of negative alterations in cognition in mood. This model was consistent in the White veteran model, whereas only negative cognitions about the self were associated with NACM in the Black veteran path model. NPCs about the self and world appear important to non-avoidance PTSD symptomatology related to MST and thus should be targeted in treatment. For Black veterans endorsing distress related to NACM symptoms, negative beliefs about the self should be specifically considered for intervention.


Assuntos
Trauma Sexual Militar , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Cognição , Trauma Sexual Militar/diagnóstico , Trauma Sexual Militar/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Grupos Raciais , Negro ou Afro-Americano , Brancos
5.
J Psychiatr Res ; 157: 127-131, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36463627

RESUMO

Military sexual trauma (MST) is a serious issue among Veterans; it is associated with increased rates of posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), both of which are correlated with poorer mental health outcomes, including increased suicide risk. Additional insight into the characteristics associated with NSSI among Veterans with MST can help identify individuals at increased risk for suicide and other negative outcomes and improve care for Veterans with a history of MST. The current study was comprised of 327 Veterans referred for MST-related mental health services at a VHA hospital. Participants completed a semi-structured interview for clinical symptoms, including NSSI behaviors. Results of a retrospective chart review revealed a high endorsement of lifetime NSSI (26.9%) with cutting behaviors identified as the most frequently endorsed method. Logistic regression showed personality features, history of cumulative sexual trauma, and younger age were uniquely related to lifetime NSSI. These results corroborate previous findings that show elevated rates of NSSI among Veterans with exposure to trauma. This study expands upon previous findings by examining risk factors specific to treatment-seeking Veterans with a history of MST, which can aid clinical care and risk management procedures in Veteran healthcare.


Assuntos
Trauma Sexual Militar , Aceitação pelo Paciente de Cuidados de Saúde , Comportamento Autodestrutivo , Veteranos , Humanos , Serviços de Saúde Mental , Trauma Sexual Militar/terapia , Estudos Retrospectivos , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia
6.
J Trauma Stress ; 35(5): 1535-1545, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35819929

RESUMO

Veterans who have experienced military sexual trauma (MST) are at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depressive disorders, and substance use disorders. Previous studies have shown racial differences in MST exposure, namely that Black veterans experience MST more frequently than White veterans. One way to help clinicians and researchers understand the impact of these ethnoracial differences in MST exposure is through an applied theory of ecological resources, which has demonstrated ecological factors (e.g., aspects of identity, beliefs, and environmental stressors) contribute to veteran well-being in the aftermath of MST. The present study aimed to examine ethnoracial differences in ecological resources (i.e., available social support, spiritual coping, past-year interpersonal violence, financial sufficiency, and stable living environment). Participants (N = 505) were U.S. veterans who sought care at a Veterans Healthcare Administration clinic in the midwestern United States for mental health issues related to MST. Results demonstrated Black veterans were more likely than White veterans to report being financially insecure, U = 18,091.50, z = -2.04, p = .042, r = .10. Black veterans were also more likely to report spiritual beliefs that assisted with coping, Cramer's V = .19, but less likely to report having a social support system, Cramer's V = .16. These findings highlight the importance of assessing and addressing disparities illuminated by ethnoracial differences in ecological resources and barriers in veterans seeking care for MST.


Assuntos
Militares , Delitos Sexuais , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Militares/psicologia , Delitos Sexuais/psicologia , Trauma Sexual , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia
7.
Sleep Med ; 94: 70-75, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35504109

RESUMO

BACKGROUND: Survivors of childhood abuse are prone to adult insomnia, but the mechanisms for this development are poorly understood. Abuse that occurs during sensitive developmental periods might affect risk for insomnia by impacting emerging stress regulatory processes. Sleep reactivity refers to the sensitivity of the sleep system to stress and is a robust risk factor for insomnia. Recent evidence shows stress exposure itself worsens sleep reactivity, thereby increasing insomnia vulnerability. In this preliminary study, we hypothesized the association between childhood abuse experiences and adult insomnia would be mediated through greater sleep reactivity. METHODS: Community adults were recruited from the United States during the COVID-19 pandemic between June 2020 and June 2021 (N = 241, 88% female, Mage = 39, SD = 13.40). Participants completed a cross-sectional survey that included the Childhood Trauma Questionnaire, Ford Insomnia Response to Stress Test, Insomnia Severity Index, and a measure of general COVID-19 stress. RESULTS: Reporting more frequent childhood emotional, physical, or sexual abuse was associated with more severe insomnia during the COVID-19 pandemic. Only childhood emotional and physical (but not sexual) abuse histories were associated with greater sleep reactivity, which exerted an indirect effect on the relationships between these two abuse types and insomnia symptoms. These findings were robust to the effects of gender, age, and stress about the COVID-19 pandemic. CONCLUSIONS: This preliminary study suggests recurrent emotional and physical abuse in childhood might promote later insomnia through heightened sleep reactivity. Stress management interventions could be important to prevent insomnia for abuse survivors by bolstering resilience of the sleep system.


Assuntos
COVID-19 , Maus-Tratos Infantis , Distúrbios do Início e da Manutenção do Sono , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia
8.
Psychol Serv ; 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35446096

RESUMO

Survivors of military sexual trauma (MST) seeking mental health services may present with concerns extending beyond symptom relief. Attention to social, economic, and coping resource contexts is salient for care consideration. Although those identifying as sexual and gender minorities (SGM) are overrepresented among service members exposed to assaultive MST, research contrasting ecological resource variability among treatment seekers is limited. The present study delineates modifiable risk and protective factors that might be used to inform MST-related health care for Veterans, broadly, and SGM-identifying Veterans, specifically. Veterans (N = 493, 12.8% identifying as SGM) presenting for treatment secondary to military sexual assault completed a semistructured clinical interview and intake survey including demographic characteristics, diversity-related factors, and access to psychosocial resources. SGM/non-SGM-identifying groups were contrasted on individual-, interpersonal-, and community-level ecological characteristics. SGM-identifying Veterans were less likely to report access to sufficient financial resources and had double the prevalence rate of housing instability in contrast to non-SGM-identifying Veterans. No significant differences emerged in terms of past-year interpersonal violence exposure, endorsement of helpful spiritual beliefs, or availability of social support based on SGM identification. Findings underscore the importance of attending to the intersection of SGM identity and ecological factors that can influence Veterans' clinical presentation and treatment engagement. Recommendations for provision of MST services are made. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

9.
Sleep Med ; 83: 182-187, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34022495

RESUMO

BACKGROUND: Veterans with substance use problems have rates of partner and non-partner violence that typically exceed the general population. Sleep problems may exacerbate violence and maintain addictive behaviors in non-veterans, but requires study in veterans. Therefore, we examine the interrelationships between substance use, insomnia, and violence in veterans. METHODS: Veterans (N = 762) screened for a randomized controlled trial at veterans affairs mental health and substance use clinics. Participants completed modified Conflict Tactics Scales to quantify past-year violence and the Insomnia Symptom Questionnaire to assess sleep disturbance. We evaluated associations between substance use and sleep in predicting the target of aggression (partner or non-partner) and degree of violence (aggression or injury) using binomial logistic regressions. RESULTS: Half of participants endorsed symptoms suggestive of insomnia, 23.2% endorsed physical aggression toward partners (PA-P) and 33.9% non-partners (PA-NP), and 9.7% endorsed physical injury of partners (PI-P) and 17.6% of non-partners (PI-NP). Regressions revealed significant models for PA-P, PA-NP, and PI-NP, whereas the PI-P model was not significant. PA-P was higher among non-Caucasian race and older veterans. PA-NP was more common in those with insomnia and increased with frequency of cocaine use. Insomnia moderated the relationship between cocaine use and PA-NP; there was a weaker relationship between cocaine use and PA-NP in those with insomnia. PI-NP was more common with higher frequency of alcohol and cocaine use, and in those with insomnia. CONCLUSIONS: This study finds sleep disturbances are meaningful predictors of violence among veterans with differential relationships with aggression severity, victims, and substance use concurrence.


Assuntos
Cocaína , Distúrbios do Início e da Manutenção do Sono , Transtornos Relacionados ao Uso de Substâncias , Veteranos , Agressão , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
10.
J Telemed Telecare ; 26(7-8): 443-451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30975048

RESUMO

INTRODUCTION: Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. METHODS: Data were drawn from veterans (N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. RESULTS: FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan-Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. DISCUSSION: Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Militares/psicologia , Trauma Sexual/psicologia , Trauma Sexual/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Telemedicina/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobreviventes , Veteranos/psicologia
11.
J Telemed Telecare ; 26(1-2): 113-118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30261806

RESUMO

Introduction: Military veterans are at high risk for developing mental health problems. Unfortunately, veterans have relatively low rates of engagement in mental health services compared with non-veterans. In order to address barriers to mental health care services, the Veteran's Health Administration (VHA) has implemented clinical video telehealth (CVT). Although the effectiveness of this technology appears promising, there is limited research evaluating rates of engagement in CVT mental health services or what factors may predict premature attrition from mental health care delivered via this format. Methods: The present study aimed to investigate treatment engagement among veterans enrolled in psychotherapy delivered via CVT, as well as to explore the effects of various demographic and clinical characteristics on these outcomes. Participants were 250 veterans with consults placed to the CVT clinic at a large Midwestern VHA. To evaluate characteristics related to therapy retention, demographic and symptom profile information was gathered from a subset of 93 participants who attended at least one CVT psychotherapy appointment. Results: Results indicated there were no significant demographic differences between veterans who attended at least one CVT appointment and those who did not attend at least one session. Demographic variables were not related to the number of CVT visits attended. Regarding psychological characteristics, veterans with anxiety disorders attended fewer CVT appointments overall than veterans with mood disorders and attendance at CVT was negatively correlated with anxiety severity. Discussion: These findings have potential implications for providers working in CVT clinics as well as for future research in this area.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Psicoterapia/organização & administração , Telemedicina/organização & administração , Veteranos/psicologia , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Fatores Socioeconômicos
13.
Violence Vict ; 34(1): 69-84, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30808794

RESUMO

Despite the high rates of military sexual trauma (MST) experienced by service members and veterans, little is known about how contextual features of the MST event or concurrent histories of other interpersonal traumas are associated with diverse clinical presentations. This study examined contextual factors of MST events (number of perpetrators, location of MST, relationship to perpetrator, location of MST) and dual history of interpersonal traumas (including sexual abuse or assault throughout the lifespan, repeated MST, and intimate partner violence) in relation to total symptoms and symptom clusters of Posttraumatic Stress Disorder (PTSD). MST involving multiple perpetrators was related to higher avoidance and hyperarousal. MST while combat-deployed was associated with higher hyperarousal. Veterans endorsing a history of partner violence presented with higher reexperiencing and avoidance. Recognition of phenotypic differences may assist providers in treatment planning and optimizing outcomes.


Assuntos
Violência por Parceiro Íntimo/psicologia , Militares/psicologia , Delitos Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Análise por Conglomerados , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Escalas de Graduação Psiquiátrica , Delitos Sexuais/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs
14.
Psychiatry Res ; 272: 638-642, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30616134

RESUMO

The shift from a multiaxial system of diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) brought forth the discontinuation of the Global Assessment of Functioning (GAF). DSM-5 proposes the use of a more reliable method for assessing and describing disability, the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The WHODAS 2.0 is widely-used within the Department of Veterans Affairs (VA) and the Veterans Benefits Administration to guide clinical decision making and assist in decisions pertaining to financial compensation. While the WHODAS 2.0 purports to be well-validated for adults cross-culturally in clinical and non-clinical samples, research is limited pertaining to the factor structure of the WHODAS 2.0 in non-compensation seeking U.S. Veteran populations. This study evaluated the factor structure of the WHODAS 2.0 in a sample of 464 Veterans receiving VA mental healthcare. Exploratory and confirmatory factor analyses of the WHODAS 2.0 data were conducted. Analyses confirmed the hardiness of the WHODAS 2.0 for use with Veterans. However, exploratory analyses pointed to several items that may reduce the functioning of the questionnaire in clinical Veteran samples. Exploratory and confirmatory analyses indicated better model fit can be achieved.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Serviços de Saúde Mental/normas , Saúde Mental/normas , Veteranos/psicologia , Organização Mundial da Saúde , Adulto , Instituições de Assistência Ambulatorial/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
15.
Psychol Trauma ; 11(4): 424-433, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29683691

RESUMO

OBJECTIVE: Violence is a salient concern among veterans, yet relationships between psychiatric comorbidity, social networks, and aggression are poorly understood. We examined associations between biopsychosocial factors (substance use, posttraumatic stress disorder [PTSD], and social network behaviors) with aggression. METHOD: We recruited veterans endorsing past-year aggression and substance use (N = 180) from Department of Veterans Affairs outpatient treatment clinics. Main and interaction effects between probable PTSD, substance use, social network violence and substance use, and veteran violence were examined with negative binomial regressions-specifically, physical aggression toward a relationship partner (PA-P), physical injury of a partner (PI-P), physical aggression toward nonpartners (PA-NP), and physical injury of nonpartners (PI-NP). RESULTS: Alcohol use yielded consistent main effects. PTSD and social network violence demonstrated main effects for PA-NP and PI-NP. PTSD and social network violence interacted to predict PA-P such that social network violence appeared salient only in the context of PTSD. PTSD was associated with PI-P, PA-NP, and PI-NP in social network substance use models. In the PA-P model including social network substance use, veterans with PTSD reported greater PA-P in the context of greater social network substance use, whereas veterans without PTSD endorsed PA-P concurrent with greater alcohol frequency. For PI-P, PTSD interacted with alcohol to predict a greater likelihood of partner injury in the context of social network substance use. CONCLUSIONS: Investigated variables demonstrated unique associations within the context of specific relationships and the severity of behaviors. Overall, the findings underscore the importance of biopsychosocial models for understanding veteran violence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Agressão/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Veteranos/psicologia , Violência/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Autorrelato , Rede Social , Transtornos de Estresse Pós-Traumáticos
16.
Psychol Serv ; 15(3): 357-362, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30080095

RESUMO

There is limited study of suicidal behaviors among veterans identifying as sexual and gender minorities (SGMs), despite previous research indicating rates of suicide attempts are high within civilian SGM populations. Further, some research incorporating military service members suggests those identifying as SGMs are disproportionately exposed to military sexual trauma (MST), an additional risk factor for negative psychiatric sequelae. To address health care research disparities among minority veterans (i.e., women, those endorsing MST, SGMs), we examined presentations of veterans (N = 277) who attended initial consultation appointments for MST-related treatment and completed a semistructured clinical interview including demographic characteristics, history of suicide attempts (HSA), and a diagnostic evaluation. Twenty-eight (10.1%) veterans identified as SGMs. SGM/non-SGM groups were contrasted on suicidal and psychiatric morbidity outcomes. Overall, endorsement of HSA was high (30.7%). Despite similar clinical profiles, 53.6% of veterans who identified as SGM endorsed HSA in contrast with 28.1% of peers identifying as heterosexual and nontransgender, a significant effect of small-to-moderate size. Findings suggest assessment and clinical management of suicidality is of critical importance for clinicians providing services to veterans pursuing recovery from MST, generally, and may be especially so when delivering care to SGM. Further, results underscore the need for culturally competent delivery of trauma-focused interventions. (PsycINFO Database Record


Assuntos
Vítimas de Crime/psicologia , Assistência à Saúde Culturalmente Competente , Delitos Sexuais/psicologia , Minorias Sexuais e de Gênero/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Tentativa de Suicídio/psicologia , Veteranos/psicologia , Feminino , Humanos , Masculino , Militares/psicologia , Fatores de Risco , Fatores Sexuais , Ideação Suicida
17.
Law Hum Behav ; 42(2): 135-144, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29072473

RESUMO

Substance misuse is prevalent among veterans entering the criminal justice system, and is related to recidivism. Research demonstrates that trauma exposure and posttraumatic stress (PTS) symptoms, which commonly co-occur with substance misuse, also increase the risk of legal involvement and recidivism. However, it is unclear whether the associations between trauma, PTS symptoms and violent and nonviolent crime may be conflated by substance use. The aim of the present study was to understand the association between PTS symptoms and criminal justice involvement (both violent and nonviolent crime) among substance-using veterans seeking Veterans Affairs (VA) specialty mental health care after accounting for substance use frequency and demographics including age, gender, and ethnicity. Further, this study examined whether specific clusters of PTS were associated with violent and nonviolent veteran offending. Participants included 697 veterans (52 women) aged 21 to 75 (M = 47.49, SD = 13.51) with a history of trauma exposure. Veterans self-reported past-month PTS symptoms, substance use, and lifetime legal charges. Logistic regression results indicated total PTS symptoms were associated with violent, but not nonviolent charges, above and beyond age, sex, race, cocaine use, and heavy alcohol use. Intrusion symptoms, in particular, were associated with violent charges. Results highlight the utility of examining PTS as a multifaceted construct and have implications for the assessment and treatment needs of justice-involved veterans. For example, the findings suggest that treatment needs appear to differ for those reporting violent or nonviolent offending, with a greater need for assessing and treating PTS for those involved with violent crime. (PsycINFO Database Record


Assuntos
Crime/legislação & jurisprudência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
18.
J Affect Disord ; 226: 232-238, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-29017066

RESUMO

Trauma-related beliefs have salient relationships to the development and maintenance of Posttraumatic Stress Disorder (PTSD) following stress exposure. The Posttraumatic Cognitions Inventory (PTCI) has the potential to be a standard assessment of this critical construct. However, some critical aspects of validity and reliability appear to vary by population. To date, the PTCI has not been psychometrically evaluated for use with military-specific traumas such as combat and military sexual trauma (MST). Based on exploratory and confirmatory analyses with 949 Veterans seeking trauma-focused treatment for military traumas, we found a four factor model (negative view of the self, negative view of the world, self-blame, and negative beliefs about coping competence) provided the best fit. In contrast, the original three factor model was not confirmed. Both models demonstrated convergent and discriminative validity. Although gender was associated with PTCI total and factor scores, differences did not persist after controlling for trauma type. MST was associated with higher PTCI scores even when controlling for gender, though the clinical magnitude of these differences is likely negligible. Internal reliability validity was demonstrated with PTCI total and subscale scores.


Assuntos
Cognição , Inventário de Personalidade/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Veteranos/estatística & dados numéricos , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Inquéritos e Questionários , Veteranos/psicologia
19.
Psychiatry Res ; 256: 118-123, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28628792

RESUMO

Sleep disturbances (SD) are pronounced in Veterans with posttraumatic stress disorder (PTSD). In clinical trials, SD have been shown to limit the effectiveness of evidence-based treatments for non-PTSD disorders. The purpose of this study was to investigate the relationships between pretreatment SD and the effectiveness of Prolonged Exposure (PE) therapy for Veterans with PTSD. Twenty-one Veterans completed the Pittsburgh Sleep Quality Index (PSQI) and the Clinician Administered PTSD Scale upon presenting to a PTSD specialty clinic. Veterans completed the PTSD Symptom Checklist-Civilian (PCL-C) at the initiation of PE and biweekly thereafter for the duration of treatment (96 total assessments). Correlations and hierarchical linear modeling were utilized to examine the potential impact of baseline sleep variables on the slope and magnitude of treatment outcomes. Higher PSQI total scores, and higher sleep latency and sleep medication use subscale scores were associated with higher PCL-C scores at baseline. Veterans evidenced significant reductions in PTSD symptoms during the course of the treatment study. Total PSQI scores and composites were not associated with reduced effectiveness of PE treatment or the slope of PTSD symptom changes. Sleep disturbances do not preclude Veterans from benefits derived from engagement in this gold standard PTSD intervention.


Assuntos
Terapia Implosiva/tendências , Transtornos do Sono-Vigília/psicologia , Transtornos do Sono-Vigília/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Feminino , Humanos , Terapia Implosiva/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Transtornos do Sono-Vigília/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Fatores de Tempo , Resultado do Tratamento
20.
Psychol Trauma ; 9(5): 622-626, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28481563

RESUMO

OBJECTIVE: A history of childhood maltreatment (CM) is associated with increased rates of maternal psychiatric symptoms and other adverse outcomes in adulthood among postpartum women. However, to date only a few studies have examined associations between CM and mother-child interactions among a nonclinical sample of postpartum women, and the specific potential influence of the type of abuse or neglect is poorly understood. This study was an aim to examine the relationships between CM types and observed parenting in a nonclinical group of recently postpartum mothers with maltreatment histories. METHOD: Participants were 173 postpartum, nonclinically referred mothers oversampled in the community for CM histories (n = 123, 72%) and their infants who underwent high- and low-stress interactive tasks during their 6-month postpartum visits, which were videotaped for later independent coding on hostile, controlling, and positive parenting. Mothers also provided information on demographics and type of CM they had experienced (i.e., emotional, sexual, physical abuse, and neglect). Differences of maternal parenting by history of CM and specific type were analyzed via 2-way univariate general linear models. RESULTS: Inconsistent with a priori hypotheses, no significant differences emerged between overall CM severity or exposure to any particular CM type and hostile, controlling, or positive parenting in the high- or low-stress tasks. CONCLUSION: Findings suggest that nonclinical postpartum women with CM histories show resilience regarding postpartum parenting quality and do not differentiate from non-CM maltreated postpartum mothers. We discuss the potential influence of resilience, moderating factors, clinical implications, and recommendations based on our findings. (PsycINFO Database Record


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis , Comportamento Materno , Relações Mãe-Filho , Poder Familiar , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Humanos , Lactente , Estudos Longitudinais , Comportamento Materno/psicologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Poder Familiar/psicologia , Período Pós-Parto/psicologia , Resiliência Psicológica , Autorrelato
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