"I've had to bury a lot of kids over the years ": Violence prevention streetworkers' exposure to trauma.

AIMS: Streetworkers are front-line workers employed to engage at-risk youth and prevent, intervene, and respond to incidents of community youth violence. Streetworkers are often exposed to violence and its aftermath, though little is known about the specific types of trauma to which streetworkers are exposed. METHODS: This study seeks to explore this question via in-depth, semistructured interviews with 37 streetworkers from a large city in the United States. RESULTS: The qualitative results revealed that the streetworkers in this sample experienced a range of types of trauma. Streetworkers were less likely to be directly exposed to traumatic events in the context of their jobs, yet were more likely to witness, learn about, or experience repeated exposure to aversive details of traumatic events. CONCLUSIONS: Despite their exposure to trauma, very few participants described seeking psychological treatment, self-care, or new vocation. We discuss our findings and make recommendations to bolster support for streetworkers.

Changing Beliefs about Trauma: A Qualitative Study of Cognitive Processing Therapy.

BACKGROUND: Controlled qualitative methods complement quantitative treatment outcome research and enable a more thorough understanding of the effects of therapy and the suspected mechanisms of action. AIMS: Thematic analyses were used to examine outcomes of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in a randomized controlled trial of individuals diagnosed with military-related PTSD (n = 15). METHOD: After sessions 1 and 11, participants wrote "impact statements" describing their appraisals of their trauma and beliefs potentially impacted by traumatic events. Trained raters coded each of these statements using a thematic coding scheme. RESULTS: An analysis of thematic coding revealed positive changes over the course of therapy in participants' perspective on their trauma and their future, supporting the purported mechanisms of CPT. CONCLUSION: Implications of this research for theory and clinical practice are discussed.

Relationships among predeployment risk factors, warzone-threat appraisal, and postdeployment PTSD symptoms.

Previous research indicates a relationship between perceived fear for one's safety (i.e., threat appraisal) and posttraumatic stress disorder (PTSD). This prospective study examined relationships among deployment- and predeployment-related variables, threat appraisal, and postdeployment PTSD symptom severity. Prior to Iraq deployment, 774 U.S. Army soldiers completed self-report measures assessing previous life stressors, deployment history, current (predeployment) PTSD symptoms, deployment preparedness, and unit cohesion. Following deployment, participants completed self-report measures assessing combat intensity, deployment threat appraisal, and current (postdeployment) PTSD symptoms. Structural equation modeling revealed that predeployment PTSD symptom severity, prior warzone deployment, unit cohesion, and preparedness were each independently associated with deployment threat appraisal, even after taking into account combat intensity. Deployment threat appraisal was associated with postdeployment PTSD severity. Results indicated that predeployment PTSD symptom severity, history of warzone deployment, and preparedness-risk factors previously thought to influence PTSD outcomes directly-were either partially or fully mediated by threat appraisal. The model explained 15% of the variance in deployment threat appraisal and 50% of the variance in postdeployment PTSD severity. Helping service members cope with exposure to extreme stress during deployment by modifying certain prewar risk factors may facilitate reduction of PTSD symptoms following deployment.

Risk and resilience factors associated with college students' psychological distress and PTSD symptoms during the COVID-19 pandemic.

Objective: College students are experiencing pronounced mental health difficulties as a result of the COVID-19 pandemic. Little is known, however, about underlying risk and resilience factors contributing to students' psychological health during this time. The current study examined mindfulness, resilience, coping, emotion regulation, and daily hassles as possible predictors of COVID-19 concern, psychological distress, and PTSD symptoms in a sample of college students. Participants: One hundred and thirty-five undergraduate college students participated in this study during the COVID-19 pandemic. Methods: Participants completed a series of self-report questionnaires. Results: Risk and resilience factor hierarchical regression models were run separately to predict the three outcomes. Daily hassles, ethnicity, and first-generation college student status predicted greater COVID-19 concern; daily hassles and difficulties with emotion regulation predicted greater psychological distress; daily hassles, difficulties with emotion regulation, avoidant coping, and problem-focused coping positively predicted PTSD symptoms. Acting with awareness mindfulness and continuing-generation college student status predicted lower COVID-19 concern; acting with awareness mindfulness, nonjudging mindfulness, and resilience predicted lower psychological distress; acting with awareness mindfulness, nonjudging mindfulness, and resilience also predicted lower PTSD symptomatology. Conclusions: Identifying underlying factors associated with college students' mental health during the COVID-19 pandemic may facilitate the development and implementation of targeted preventative interventions aimed at promoting well-being in this uniquely vulnerable population.

Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems.

Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.

Effects of the COVID-19 pandemic on anhedonia, reward exposure and responsiveness, and sleep in college students.

Objective: The COVID-19 pandemic's effects on college student mental health and its underlying mechanisms are not fully understood. Although necessary, physical distancing abruptly restricts interaction with environmental rewards and disrupts sleep patterns, both of which may contribute to psychological symptoms (eg, depression and anhedonia). This study explored differences in psychological symptoms, reward exposure and responsiveness, and sleep before versus during the pandemic. Methods: Eighty-seven college students completed baseline questionnaires and a one-week daily diary paradigm. The sample was divided into two groups based on data collection before (pre-) or after (post-COVID-19) implementation of state-wide COVID-19 physical distancing measures. Results: Findings highlight higher anhedonia, decrements in exposure to social, professional, and exercise related rewards, lower aniticipatory reward responsiveness, and lower sleep efficiency among college students during the initial months of the pandemic. Conclusions: Findings suggest anhedonia, reward system functioning, and sleep may be important targets to mitigate against college student mental health sequelae during COVID-19.

Relationships Among Sleep Disturbance, Reward System Functioning, Anhedonia, and Depressive Symptoms.

Recent models propose reward system dysfunction as a key mediator of the relationship between sleep and depression and anhedonia. This study explored interrelationships among sleep disturbance, depressive symptoms, anhedonia, and reward responsiveness. Two-hundred and sixty undergraduate students completed questionnaires and a daily diary paradigm assessing sleep, reward responsiveness, depression, anhedonia, and positive affect over 1 week. Baseline sleep disturbance was associated with depressive symptoms, anhedonia, and reward responsiveness. Daily diary sleep parameters showed differential associations with anticipatory versus consummatory reward responsiveness and positive affect. Poorer sleep quality, shorter sleep duration, and longer awakening after sleep onset predicted blunted anticipatory and consummatory reward responsiveness, while increased sleep onset latency and lower sleep efficiency predicted only decreased consummatory reward responsiveness. All sleep indices, except sleep onset latency, were associated with positive affect. Findings demonstrate unique associations between disparate sleep disturbance and reward responsiveness elements, highlighting new treatment mechanisms for anhedonia and depression.

Cognitive-behavioral conjoint therapy for PTSD: pilot results from a community sample.

Seven couples participated in an uncontrolled trial of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (PTSD). Among the 6 couples who completed treatment, 5 of the patients no longer met criteria for PTSD and there were across-treatment effect size improvements in patients' total PTSD symptoms according to independent clinician assessment, patient report, and partner report (d = 1.32-1.69). Three of the 4 couples relationally distressed at pretreatment were satisfied at posttreatment. Partners reported statistically significant and large effect size improvements in relationship satisfaction; patients reported nonsignificant moderate to large improvements in relationship satisfaction. Patients also reported nonsignificant, but large effect size improvements in depression and state anger symptoms. Future directions for research and treatment of traumatized individuals and close others are offered.

Associations of Five Facets of Mindfulness With Self-Regulation in College Students.

Mindfulness has been associated with positive mental health functioning across a range of constructs, including self-regulation. Most of this research, however, has investigated mindfulness as a unidimensional domain. Few studies have examined the relationships between specific facets of mindfulness and particular dimensions of self-regulation, including delay of gratification and emotion regulation, despite relevance for mindfulness-based interventions. Two hundred and seventy-eight undergraduate college student participants completed a series of questionnaires examining dispositional mindfulness, difficulties with emotion regulation, and delay of gratification skills. Linear regressions investigated the associations between five facets of mindfulness and each of the two components of self-regulation. Findings revealed that describing, acting with awareness, nonjudging, and nonreacting mindfulness facets were negatively associated with difficulties with emotion regulation, and that observing, acting with awareness, and nonjudging mindfulness facets were positively associated with delay of gratification skills, after accounting for the effects of the other mindfulness subscales. These preliminary findings may have important clinical relevance, as greater self-regulation has critical implications for social, emotional, and academic functioning.

The Role of Attentional Control in the Relationship Between Mindfulness and Anxiety.

Mindfulness has been robustly associated with psychological health, predicting greater well-being, and lower levels of anxiety, depression, and stress across samples. Attentional control is the ability to voluntarily shift, focus, and train one's attention and has also been linked with better psychological functioning. Less well-understood, however, are which domains of mindfulness may be associated with particular aspects of mental health, including anxiety, and whether attentional control may help to explain the relationship between specific facets of mindfulness and anxiety. This study examined self-reported shifting and focusing attentional control as mediators of the relationships between five domains of dispositional mindfulness (i.e., observing, describing, acting with awareness, nonjudging, and nonreacting) and symptoms of anxiety. Two hundred and eighty-six college students completed self-report questionnaires measuring dispositional mindfulness, attentional control, and symptoms of anxiety. Using mediation analyses, findings revealed an indirect effect of two facets of mindfulness on anxiety through focusing attentional control after controlling for shifting attentional control. These findings suggest that specific mindfulness skills are related to better attentional control skills, and that focusing attentional control may then protect against anxiety symptoms in college students. These results have critical implications for college students, who are experiencing anxiety and stress at increasing levels.

Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination.

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development.

Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms.

The purpose of this study was to evaluate whether children with a history of disorganized attachment in infancy were more likely than children without a history of disorganized attachment to exhibit symptoms of posttraumatic stress disorder (PTSD) at school age following trauma exposure. The sample consisted of 78 8.5-year-old children from a larger, ongoing prospective study evaluating the effects of intrauterine cocaine exposure (IUCE) on children's growth and development from birth to adolescence. At the 12-month visit, children's attachment status was scored from videotapes of infant-caregiver dyads in Ainsworth's strange situation. At the 8.5-year visit, children were administered the Violence Exposure Scale-Revised, a child-report trauma exposure inventory, and the Diagnostic Interview for Children and Adolescents by an experienced clinical psychologist masked to children's attachment status and IUCE status. Sixteen of the 78 children (21%) were classified as insecure-disorganized/insecure-other at 12 months. Poisson regressions covarying IUCE, gender, and continuity of maternal care indicated that disorganized attachment status at 12 months, compared with nondisorganized attachment status, significantly predicted both higher avoidance cluster PTSD symptoms and higher reexperiencing cluster PTSD symptoms. These findings suggest that the quality of early dyadic relationships may be linked to differences in children's later development of posttraumatic stress symptoms following a traumatic event.

Asthma severity and PTSD symptoms among inner city children: a pilot study.

Although the association between posttraumatic stress symptoms and asthma severity among children has been hypothesized, it has yet to be explored rigorously. This study sought to describe the posttraumatic stress symptoms of children with asthma and explore the relationship between asthma severity and posttraumatic stress symptoms in an inner city sample with high rates of traumatic exposures. Children aged 7 to 17 years, with a clinician-defined asthma diagnosis, were recruited from an inner city outpatient asthma clinic. Caregivers completed measures assessing the child's asthma and posttraumatic stress symptoms and health care utilization. Children also completed measures of asthma, posttraumatic stress symptoms, and asthma-related quality of life. In all, 24 children-caregiver dyads were enrolled. The sample was 79% male and 83% African American, and the mean age was 11 years. Overall the sample had severe asthma, with 33% having been hospitalized over the past year. In addition, 25% of the sample met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for the diagnosis of posttraumatic stress disorder, and 74% of the sample experienced a traumatic event. Posttraumatic stress disorder symptoms were found to be significantly related to asthma severity, quality of life, and health care utilization. Assessing for and treating posttraumatic stress symptoms among children with severe asthma may help to improve their asthma course and quality of life. Further research should explore this relationship and related treatment implications.

Establishing a methodology to examine the effects of war-zone PTSD on the family: the family foundations study.

Military deployment may adversely affect not only returning veterans, but their families, as well. As a result, researchers have increasingly focused on identifying risk and protective factors for successful family adaptation to war-zone deployment, re-integration of the returning veteran, and the longer-term psychosocial consequences of deployment experienced by some veterans and families. Post-traumatic stress disorder (PTSD) among returning veterans may pose particular challenges to military and military veteran families; however, questions remain regarding the impact of the course of veteran PTSD and other potential moderating factors on family adaptation to military deployment. The Family Foundations Study builds upon an established longitudinal cohort of Army soldiers (i.e. the Neurocognition Deployment Health Study) to help address remaining knowledge gaps. This report describes the conceptual framework and key gaps in knowledge that guided the study design, methodological challenges and special considerations in conducting military family research, and how these gaps, challenges, and special considerations are addressed by the study.

Discrimination and mental health among Somali refugee adolescents: the role of acculturation and gender.

This study examines the role of social identity (acculturation and gender) in moderating the association between discrimination and Somali adolescent refugees' mental health. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135). Perceived discrimination, trauma history, posttraumatic stress disorder (PTSD), depressive symptoms, and behavioral acculturation were assessed in structured interviews. Fourteen in-depth qualitative interviews and 3 focus groups were also conducted. Results indicated that discrimination was common and associated with worse mental health. For girls, greater Somali acculturation was associated with better mental health. Also, the association between discrimination and PTSD was less strong for girls who showed higher levels of Somali acculturation. For boys, greater American acculturation was associated with better mental health, and the association between discrimination and depression was less strong for boys with higher levels of American acculturation.

Association of time since deployment, combat intensity, and posttraumatic stress symptoms with neuropsychological outcomes following Iraq war deployment.

CONTEXT: Previous research has demonstrated neuropsychological changes following Iraq deployment. It is unknown whether these changes endure without subsequent war-zone exposure or chronic stress symptoms. OBJECTIVE: To determine the associations of time since deployment, combat intensity, and posttraumatic stress disorder (PTSD) and depression symptoms with longer-term neuropsychological outcomes in war-deployed soldiers. DESIGN: Prospective cohort study involving (1) soldiers assessed at baseline (median, 42 days prior to deployment) and following return from Iraq (median, 404 days after return and 885 days since baseline), and (2) soldiers more recently returned from deployment assessed at baseline (median, 378 days prior to deployment) and following return from Iraq (median, 122 days after return and 854 days since baseline assessment). SETTING: Active-duty military installations. PARTICIPANTS: Two hundred sixty-eight male and female regular active-duty soldiers (164 with 1-year follow-up; 104 recently returned). MAIN OUTCOME MEASURES: Neuropsychological performances (verbal learning, visual memory, attention, and reaction time). RESULTS: There was a significant interaction between time and PTSD symptom severity (B= -0.01 [unstandardized], P = .04). Greater PTSD symptoms were associated with poorer attention in soldiers tested at 1-year follow-up (B = 0.01, P = .03) but not in recently returned soldiers. At 1-year follow-up, mean adjusted attention error scores increased by 0.10 points for every 10 points on the PTSD scale. Greater combat intensity was associated with more efficient postdeployment reaction-time performances, regardless of time since deployment (B = 0.48, P = .004), with mean adjusted reaction efficiency scores increasing by 4.8 points for every 10 points on the combat experiences scale. Neither depression nor contextual variables (alcohol use and deployment head injury) were significantly related to neuropsychological outcomes. CONCLUSIONS: In this study of army soldiers deployed to the Iraq war, only PTSD symptoms (among soldiers back from deployment for 1 year) were associated with a neuropsychological deficit (reduced attention). Greater combat intensity was associated with enhanced reaction time, irrespective of time since return.