Who tests for lead and why? A 10-year analysis of blood lead screening, follow-up and CNS outcomes in a statewide US healthcare system.

OBJECTIVES: This study aims to determine (1) which providers in US healthcare systems order lead tests, why and at what frequency and (2) whether current patient population lead levels are predictive of clinical outcomes. METHODS: Retrospective medical record study of all blood lead tests in the Medical University of South Carolina healthcare system 2012-2016 and consequent evidence of central nervous system (CNS)-related disease across a potential 10-year window (2012-2022). RESULTS: Across 4 years, 9726 lead tests resulted for 7181 patients (49.0% female; 0-94 years), representing 0.2% of the hospital population. Most tests were for young (76.6%≤age 3) and non-Hispanic black (47.2%) and Hispanic (26.7%) patients. A wide variety of providers ordered tests; however, most were ordered by paediatrics, psychiatry, internal medicine and neurology. Lead levels ranged from ≤2.0 µg/dL (80.8%) to ≥10 µg/dL (0.8%; max 36 µg/dL). 201 children (3.1%) had initial lead levels over the reference value for case management at the time (5.0 µg/dL). Many high level children did not receive follow-up testing in the system (36.3%) and those that did often failed to see levels fall below 5.0 µg/dL (80.1%). Non-Hispanic black and Hispanic patients were more likely to see lead levels stay high or go up over time. Over follow-up, children with high lead levels were more likely to receive new attention-deficit/hyperactivity disorder and conduct disorder diagnoses and new psychiatric medications. No significant associations were found between lead test results and new CNS diagnoses or medications among adults. CONCLUSIONS: Hospital lead testing covers a small portion of patients but includes a wide range of ages, presentations and provider specialities. Lack of lead decline among many paediatric patients suggests there is room to improve provider guidance around when to test and follow-up.

A preliminary examination of sexual and physical victimization 6 months after recent rape.

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

Network Analysis of Posttraumatic Stress Disorder Symptoms in a National Sample of U.S. Adults: Implications for the Phenotype and the ICD-11 Model of PTSD.

The phenotype for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Diseases (DSM-5) includes 20 symptoms in four clusters. In contrast, the PTSD model in the 11th revision of the International Classification of Diseases (ICD-11) includes six symptoms in three clusters. Whether those six symptoms are, in fact, the most central symptoms of the PTSD phenotype remains an open question. In a previous network analysis of DSM-5 PTSD symptoms, Mitchell and colleagues (2017) reported limited overlap between central PTSD symptoms and those in the ICD-11 model in a national sample of U.S. veterans. The present study sought to replicate and extend upon these findings in a large national sample of U.S. adults (N = 2,953). Centrality statistics from both a replication sample (i.e., participants with DSM-5 PTSD, n = 173) and an extension sample (i.e., participants who had been exposed to potentially traumatic events, n = 2,468) were moderately strongly convergent with the findings reported by Mitchell et al., rs = .54-.73. Additionally, only three of the six most central symptoms in both the replication and extension samples overlapped with the ICD-11 model, indicating that the ICD-11 model (a) failed to include network-central symptoms of the PTSD phenotype and (b) included extra symptoms that were not network-central. Several symptoms from the DSM-5 Criterion D cluster (negative alterations in cognition and mood) that were excluded in ICD-11 were found to be among the most central PTSD symptoms.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Traumatic Event Exposure, Posttraumatic Stress Disorder, and Sleep Disturbances in a National Sample of U.S. Adults.

Posttraumatic stress disorder (PTSD) is a highly prevalent, debilitating disorder found to develop after exposure to a potentially traumatic event (PTE). Individuals with PTSD often report sleep disturbances, specifically nightmares and insomnia, which are listed within the criteria for PTSD. This research examined prevalence of insomnia and nightmares within a national sample of 2,647 adults (data weighted by age and sex to correct for differences in sample distribution) who had been exposed to one or more PTEs. Prevalence of self-reported sleep disturbance, sleep disturbances by PTE type, and gender differences were examined. All participants completed a self-administered, structured online interview that assessed exposure to stressful events and PTSD symptoms. Among individuals who met DSM-5 criteria for PTSD, a large majority (more than 92%) reported at least one sleep disturbance. Insomnia was relatively more prevalent than PTE-related nightmares among individuals with PTSD and among all PTE-exposed individuals. A higher number of PTEs experienced significantly increased the likelihood of both trauma-related nightmares and insomnia, McFadden's pseudo R2 = .07, p < .001. Women exposed to PTEs were more likely to endorse experience of insomnia, χ2 (1, N = 2,647) = 99.13, p < .001, φ = .194, and nightmares compared to men, χ2 (1, N = 2,648) = 82.98, p < .001, φ = .177, but this gender difference was not significant among individuals with PTSD, ps = .130 and .050, respectively. Differences in sleep disturbance prevalence by PTE type were also examined. Implications for treatment and intervention and future directions are discussed.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Exposición a eventos traumáticos, trastorno de estrés postraumático y trastornos del sueño en una muestra nacional de adultos EXPOSICION AL TRAUMA, TEPT Y SUEÑO El trastorno de estrés postraumático (TEPT) es un trastorno altamente prevalente y debilitante que se desarrolla después de la exposición a un evento potencialmente traumático (EPT). Los individuos con TEPT a menudo reportan alteraciones del sueño, específicamente pesadillas e insomnio, que se enumeran dentro de los criterios para el TEPT. Esta investigación examinó la prevalencia de insomnio y pesadillas en una muestra nacional de 2647 adultos (datos ponderados por edad y sexo para corregir las diferencias en la distribución de la muestra) quienes habían sido expuestos a uno o más EPTs. Se examinó la prevalencia de trastornos del sueño autoinformados, los trastornos del sueño por tipo de EPT y las diferencias de género. Todos los participantes completaron una entrevista estructurada auto-administrada online, que evaluó la exposición a eventos estresantes y los síntomas de TEPT. Entre las personas que cumplieron con los criterios del DSM-5 para el TEPT, una gran mayoría (más de 92%) reportó al menos una alteración del sueño. El insomnio fue relativamente más prevalente que las pesadillas relacionadas con EPT entre individuos con TEPT y entre todos los individuos expuestos a EPT. Un mayor número de los que experimentaron EPT aumentó significativamente la probabilidad de ambos, pesadillas relacionadas a trauma e insomnio, pseudo R2 de McFadden = .07, p <.001. Las mujeres expuestas a los EPT fueron más propensas a respaldar la experiencia de insomnio, χ2 (1, N = 2647) = 99.13, p <.001, φ = .194, y pesadillas en comparación con los hombres, χ2 (1, N = 2648) = 82.98, p <.001, φ = .177, pero esta diferencia de género no fue significativa entre los individuos con TEPT, ps = .130 y .050, respectivamente. También se examinaron las diferencias en la prevalencia de trastornos del sueño por tipo de EPT. Se discuten las implicaciones para el tratamiento y la intervención y las direcciones futuras.

A Randomized Clinical Trial Examining the Effect of Video-Based Prevention of Alcohol and Marijuana Use Among Recent Sexual Assault Victims.

BACKGROUND: This study examined whether a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims reduced alcohol and marijuana use at 3 points over the course of a 6-month follow-up compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Prior assault history, minority status, and pre-SA substance use also were examined as moderators of intervention efficacy. METHODS: Women aged 15 and older (N = 154) who participated in a post-SA medical forensic examination were randomly assigned to watch the PPRS video (n = 54) or the PIRI video (n = 48) or receive TAU (n = 52) and completed at least 1 follow-up assessment targeted at 1.5 (T1), 3 (T2), or 6 (T3) months following the examination. RESULTS: Regression analyses revealed that, relative to TAU, PPRS was associated with less frequent alcohol use at 6 months post-SA among women reporting pre-SA binge drinking and minority women. Relative to TAU, PPRS also was associated with fewer days of marijuana use at T1 among those who did not report pre-SA marijuana use and prior SA. Findings for pre-SA marijuana use were maintained at T3; however, findings for prior SA shifted such that PPRS was associated with fewer days of marijuana use at T3 for women with a prior SA. CONCLUSIONS: PPRS may be effective at reducing substance use for some recent SA victims, including those with a prior SA history, a prior substance use history, and minority women.

Relationship violence victimization and binge drinking trajectories among a nationally representative sample of adolescents.

The present study evaluated the impact of relationship violence (RV) victimization on the longitudinal trajectory of binge drinking (BD) among 3614 US adolescents (51.2% male) who participated in an initial telephone interview regarding physical and sexual RV victimization and binge drinking. Two follow-up phone interviews were completed over approximately three years. Multilevel modeling revealed small, but significant, increases in BD over time; older adolescents and those who had ever experienced RV victimization were more likely to report BD at Wave 1 compared to younger adolescents and non-victims. Although new RV victimization reported during the study predicted an increase in the likelihood of BD at that occasion, those who had ever experienced RV victimization were less likely to report BD over time compared to non-victims. Contrary to expectations, no sex differences emerged. Findings indicate that BD may precede RV. Interventions to reduce alcohol-related RV may be especially useful in this population.

Racial/ethnic differences in trauma exposure and mental health disorders in adolescents.

OBJECTIVE: Research has cited increased prevalence of mood disorders, anxiety disorders, and exposure to interpersonal violence for Hispanics and non-Hispanic Black adolescents, as well as ethnic differences in externalizing behavior (e.g., substance use, delinquency). The current study combined these areas by examining racial/ethnic differences in mental health correlates of trauma exposure. METHOD: Interviews were conducted to assess polyvictimization, posttraumatic stress disorder (PTSD), major depressive disorder (MDD), substance use, and delinquency in a nationally representative sample of adolescents (N = 3,614; 15.4% non-Hispanic Black; 11.3% Hispanic; 64.9% non-Hispanic White). RESULTS: Hispanic and non-Hispanic Black adolescents endorsed greater polyvictimization than non-Hispanic Whites; however, differences in MDD and PTSD were only significant when assessed with symptom counts. Non-Hispanic Black adolescents reported the least drug use. Non-Hispanic Black and Hispanic adolescents endorsed more delinquency than non-Hispanic White adolescents. Polyvictimization only accounted for ethnic disparities in delinquency. CONCLUSION: Trauma-related disparities may differ across internalizing and externalizing concerns. Subsequent research should continue to examine other factors that may contribute to racial/ethnic differences in trauma sequelae. (PsycINFO Database Record

The emergence of co-occurring adolescent polysubstance use and depressive symptoms: A latent growth modeling approach.

This study tests competing models of the relation between depression and polysubstance use over the course of adolescence. Participants included a nationwide sample of adolescents (N = 3,604), ages 12 to 17 at study Wave 1, assessed annually for 3 years. Models were tested using cohort-sequential latent growth curve modeling to determine whether depressive symptoms at baseline predicted concurrent and age-related changes in drug use, whether drug use at baseline predicted concurrent and age-related changes in depressive symptoms, and whether initial levels of depression predicted changes in substance use significantly better than vice versa. The results suggest a transactional model such that early polysubstance use promotes early depressive symptoms, which in turn convey elevated risk for increasing polysubstance use over time, which in turn conveys additional risk for future depressive symptoms, even after accounting for gender, ethnicity, and household income. In contrast, early drug use did not portend risk for future depressive symptoms. These findings suggest a complicated pattern of interrelations over time and indicate that many current models of co-occurring polysubstance use and depressive symptoms may not fully account for these associations. Instead, the results suggest a developmental cascade, in which symptoms of one disorder promote symptoms of the other across intrapersonal domains.

Associations between motor vehicle crashes and mental health problems: data from the National Survey of Adolescents-Replication.

Motor vehicle crashes (MVCs) are a leading cause of physical injuries and mortality among children and adolescents in the United States. The purpose of this study was to examine associations between having an MVC and mental health outcomes, including posttraumatic stress disorder (PTSD), depression, and drug and alcohol misuse in a nationally representative sample of adolescents. A sample of 3,604 adolescents, aged 12-17 years, was assessed as part of the 2005 National Survey of Adolescents-Replication (NSA-R) study. Data were weighted according to the 2005 U.S. Census estimates. Within this sample, 10.2% of adolescents reported having at least 1 serious MVC. The prevalence of current PTSD and depression among adolescents having an MVC was 7.4% and 11.2%, respectively. Analyses revealed that an MVC among adolescents aged 15 years and younger was independently associated with depression (OR = 2.17) and alcohol abuse (OR = 2.36) after adjusting for other risk factors, including a history of interpersonal violence. Among adolescents aged 16 years and older, an MVC was associated only with alcohol abuse (OR = 2.08). This study was the first attempt to explore adverse mental health outcomes associated with MVCs beyond traumatic stress symptoms among adolescents in a nationally representative sample.

Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence.

PURPOSE: The purpose of the present study was to investigate ethnic differences in trauma-related mental health symptoms among adolescents, and test the mediating and moderating effects of polyvictimization (i.e., number of types of traumas/victimizations experienced by an individual) and household income, respectively. METHODS: Data were drawn from the first wave of the National Survey of Adolescents-replication study (NSA-R), which took place in the US in 2005 and utilized random digit dialing to administer a telephone survey to adolescents ages 12-17. Participants included in the current analyses were 3312 adolescents (50.2 % female; mean age 14.67 years) from the original sample of 3614 who identified as non-Hispanic White (n = 2346, 70.8 %), non-Hispanic Black (n = 557, 16.8 %), or Hispanic (n = 409, 12.3 %). Structural equation modeling was utilized to test hypothesized models. RESULTS: Non-Hispanic Black and Hispanic participants reported higher levels of polyvictimization and trauma-related mental health symptoms (symptoms of posttraumatic stress and depression) compared to non-Hispanic Whites, though the effect sizes were small (γ ≤ 0.07). Polyvictimization fully accounted for the differences in mental health symptoms between non-Hispanic Blacks and non-Hispanic Whites, and partially accounted for the differences between Hispanics and non-Hispanic Whites. The relation between polyvictimization and trauma-related mental health symptoms was higher for low-income youth than for high-income youth. CONCLUSIONS: Disparities in trauma exposure largely accounted for racial/ethnic disparities in trauma-related mental health. Children from low-income family environments appear to be at greater risk of negative mental health outcomes following trauma exposure compared to adolescents from high-income families.

The number of divergent purging behaviors is associated with histories of trauma, PTSD, and comorbidity in a national sample of women.

The number of different types of purging behaviors (NPB) of subjects with bulimia nervosa (BN) has been associated with greater severity of illness and psychiatric comorbidity. No studies have examined the association between the NPB used (vomiting, laxative abuse, diuretic abuse), histories of trauma, and post-traumatic stress disorder (PTSD). A national, representative sample of 3,006 adult women (≥18 years) completed a structured telephone interview including screenings for victimization experiences, PTSD, BN, major depression (MD), alcohol abuse (AA), and alcohol dependence (AD). Significant relationships were found between the NPB used and lifetime rates of victimization, PTSD, MD, AA, AD, and total comorbid disorders (p ≤ .001, χ(2)).

A comparison of women with child-adolescent versus adult onset binge eating: results from the National Women's Study.

OBJECTIVE: Studies of age of first binge have been conducted in clinical samples of patients with bulimia nervosa (BN) and binge eating disorder (BED), but few studies have examined age of first binge using nationally representative samples. METHOD: We examined age of first binge and its clinical correlates using data generated from the National Women's Study (n = 3,006). Participants who endorsed ever binge eating (n = 707) were divided into two groups: (1) child-adolescent onset (CO)--age of first binge <18 years, and (2) adult onset (AO)--age of first binge ≥18 years. We hypothesized that CO binge eating would be associated with greater (1) likelihood of developing BN/BED, (2) severity of BN/BED, (3) history of trauma and PTSD, and (4) history of psychiatric comorbidity, such as major depression and substance use. RESULTS: Of those who ever endorsed binge eating, 212 reported CO (30%) and 495 (70%) reported AO. Although AO binge eating was more common, CO binge eating was associated with higher rates of lifetime BN, greater severity of bulimic symptoms, earlier age of first dieting; earlier age at highest weight, greater likelihood of ED treatment, and higher rates of molestation, physical assault, any direct victimization, lifetime PTSD, and substance abuse. CONCLUSIONS: AO binge eating is more than twice as common as CO binge eating in women, but CO binge eating is associated with higher rates of lifetime BN, greater severity of BN, and higher rates of victimization, PTSD, and substance abuse.

Prevalence and correlates of posttrauma distorted beliefs: evaluating DSM-5 PTSD expanded cognitive symptoms in a national sample.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) modified the diagnostic criteria for posttraumatic stress disorder (PTSD), including expanding the scope of dysfunctional, posttrauma changes in belief (symptoms D2-persistent negative beliefs and expectations about oneself or the world, and D3-persistent distorted blame of self or others for the cause or consequences of the traumatic event). D2 and D3 were investigated using a national sample of U.S. adults (N = 2,498) recruited from an online panel. The prevalence of D2 and D3 was substantially higher among those with lifetime PTSD than among trauma-exposed individuals without lifetime PTSD (D2: 74.6% vs 23.9%; D3: 80.6% vs 35.7%). In multivariate analyses, the strongest associates of D2 were interpersonal assault (OR = 2.39), witnessing interpersonal assault (OR = 1.63), gender (female, OR = 2.11), and number of reported traumatic events (OR = 1.88). The strongest correlates of D3 were interpersonal assault (OR = 3.08), witnessing interpersonal assault (OR = 1.57), gender (female, OR = 2.30), and number of reported traumatic events (OR = 1.91). The findings suggested the expanded cognitive symptoms in the DSM-5 diagnostic criteria better capture the cognitive complexity of PTSD than those of the DSM-IV.

Pretyphoon panic attack history moderates the relationship between degree of typhoon exposure and posttyphoon PTSD and depression in a Vietnamese sample.

BACKGROUND: Predisaster risk factors are related to postdisaster psychopathology even at relatively low levels of disaster exposure. A history of panic attacks (PA) may convey risk for postdisaster psychopathology and has been linked to a wide range of psychiatric disorders in Western and non-Western samples. The present study examined the main and interactive effects of pretyphoon PA and level of typhoon exposure in the onset of posttyphoon posttraumatic stress disorder (PTSD), major depression (MDD), and generalized anxiety disorder (GAD) in a Vietnamese sample of typhoon survivors. METHODS: Typhoon Xangsane interrupted a Vietnamese epidemiological mental health needs assessment, providing a rare opportunity for preand posttyphoon assessments. Hierarchical logistic regression analyses evaluated whether the main and interactive effects of typhoon exposure severity and PA history were significantly related to posttyphoon diagnoses, above and beyond age, health status, pretyphoon psychiatric screening results, and history of potentially traumatic events. RESULTS: PA history moderated the relationship between severity of typhoon exposure and posttyphoon PTSD and MDD, but not GAD. Specifically, greater degree of exposure to the typhoon was significantly related to increased likelihood of postdisaster PTSD and MDD among individuals without a history of PA, above and beyond variance accounted for by pretyphoon psychiatric screening results. Individuals with a history of PA evidenced greater risk for postdisaster PTSD and MDD regardless of severity of typhoon exposure. CONCLUSIONS: Preexisting PA may affect the nature of the relationship between disaster characteristics and prevalence of postdisaster PTSD and MDD within Vietnamese samples.

Evaluation of the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) in a sample of Vietnamese adults.

PURPOSE: There are significant gaps in the literature on the prevalence of mental health problems and associated needs in Vietnam. A thorough understanding of culture-specific expressions of psychiatric distress is vital for the identification of the mental health needs of a community, and more research on the development and evaluation of culturally-sensitive mental health assessments is warranted. This study aims to evaluate the psychometric properties of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) in an epidemiologic study of Vietnamese adults. METHODS: A latent variable modeling approach investigated the underlying factor structure of the SRQ-20 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on SRQ-20 item-level data gathered from 4980 participants. RESULTS: Based on scree plots and EFA results, two latent structures were deemed plausible and were subsequently subjected to further modeling. A bi-factor model (BFM) and a correlated three-factor model solution (Negative Affect, Somatic Complaints, and Hopelessness) provided reasonable fits. The BFM specifies a single dominant General Distress factor (all SRQ-20 items) with orthogonal group factors for the subsets of items: Negative Affect (9 items), Somatic Complaints (8 items), and Hopelessness (3 items). This model fit the data as well or better than the three-factor model. Results also showed differences in endorsement rates of SRQ-20 items among males and females. CONCLUSIONS: Study results provide an evaluation of the psychometric properties of a commonly used screening tool and offer insight into the presentation of mental distress in a representative sample of Vietnamese adults.

The DSM-5 got PTSD right: comment on Friedman (2013).

Friedman in his article in this issue describes the posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and provides considerable information about the process that resulted in the revisions, as well as how PTSD in the DSM-5 differs from proposals for PTSD in the International Classification of Mental Disorders and Related Health Problems (ICD-11). In this commentary, I argue that (a) the placement of PTSD in the DSM-5 category of Trauma and Stressor-Related Disorders is a major advance because it draws attention to the role of "nurture" when there is an overemphasis on "nature" by some; (b) the broader construct of PTSD in DSM-5 is justified because it includes clinically important problems and can be reliably diagnosed; and (c) the web surveys contributed substantially to the provision of data needed to support proposed changes. Concerns are raised about the proposed ICD-11 approach, and the case is presented that substantial evidence should be required before these proposed changes are made because they differ substantially from a DSM-5 PTSD diagnosis that has demonstrated reliability and validity.

National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria.

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.

Psychiatric problems and trauma exposure in nondetained delinquent and nondelinquent adolescents.

This study examined the prevalence of and associations between specific psychiatric disorders, substance use problems, and trauma exposure in a sample of delinquent and nondelinquent adolescents. A nationally representative sample of adolescents (n = 3,614; M age = 14.5 years, SD = 1.7; 51% male; 71% White, non-Hispanic, 13.3% African American, non-Hispanic, 10.7% Hispanic) was interviewed via telephone about engagement in delinquent acts and their experience of posttraumatic stress disorder, major depressive episode, substance use, interpersonal violence, and other forms of trauma exposure. Delinquent adolescents were more likely than nondelinquent adolescents to experience trauma; they were also more likely to report past-year posttraumatic stress disorder, major depressive episode, alcohol abuse, and nonexperimental drug use. After accounting for the effects of demographics and trauma exposure, delinquency was associated with increased likelihood of posttraumatic stress disorder and problematic substance use in both genders and increased likelihood of major depressive episode in girls. Findings highlight substantial overlap among delinquency, trauma exposure, posttraumatic stress disorder, and major depressive episode in adolescents and the need for interventions that address these varied clinical problems. Future work should examine the factors underlying the development of these relations over time.

Association of Public Works Disasters with Substance Use Difficulties: Evidence from Flint, Michigan, Five Years after the Water Crisis Onset.

Public works environmental disasters such as the Flint water crisis typically occur in disenfranchised communities with municipal disinvestment and co-occurring risks for poor mental health (poverty, social disconnection). We evaluated the long-term interplay of the crisis and these factors with substance use difficulties five years after the crisis onset. A household probability sample of 1970 adults living in Flint during the crisis was surveyed about their crisis experiences, use of substances since the crisis, and risk/resilience factors, including prior potentially traumatic event exposure and current social support. Analyses were weighted to produce population-representative estimates. Of the survey respondents, 17.0% reported that substance use since the crisis contributed to problems with their home, work, or social lives, including 11.2% who used despite a doctor's warnings that it would harm their health, 12.3% who used while working or going to school, and 10.7% who experienced blackouts after heavy use. A total of 61.6% of respondents reported using alcohol since the crisis, 32.4% using cannabis, and 5.2% using heroin, methamphetamine, or non-prescribed prescription opioids. Respondents who believed that exposure to contaminated water harmed their physical health were more likely to use substances to the detriment of their daily lives (RR = 1.32, 95%CI: 1.03-1.70), as were respondents with prior potentially traumatic exposure (RR = 2.99, 95%CI: 1.90-4.71), low social support (RR = 1.94, 95%CI: 1.41-2.66), and PTSD and depression (RR's of 1.78 and 1.49, respectively, p-values < 0.01). Public works disasters occurring in disenfranchised communities may have complex, long-term associations with substance use difficulties.