Co-Occurring Traumatic Brain Injury,PTSD Symptoms,and Alcohol Use in Veterans

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.     

Risk and Protective Factors for Comorbid Posttraumatic Stress Disorder among Homeless Individuals in Treatment for Substance-Related Problems

Homeless individuals undergoing treatment for substance use disorders (SUD) can pose clinical challenges. Posttraumatic stress disorder (PTSD) symptoms have been observed in the most difficult clients. The study sample consisted of 51 homeless individuals, 9 women and 42 men, undergoing consultation for SUD in Montreal. The mean age was 46 years (SD = 7.19). Of the sample, 49% had a potential PTSD diagnosis. Most participants had the following characteristics: an alcoholic parent, a history of an early trauma, and little social support. The participants with a potential PTSD diagnosis were significantly more likely to have had an alcoholic parent, to have experienced an early trauma, and to use more maladaptive coping strategies. The study results and limits are discussed.     

Posttraumatic Stress Symptom Clusters,Trauma History,and Substance Use among College Students

Previous research found associations between experiencing specific posttraumatic stress disorder (PTSD) symptom clusters and use of specific substances among combat veterans, women exposed to domestic violence, and an inpatient sample; however, research has not utilized a college sample when considering this association. This study assessed trauma history, PTSD symptoms, alcohol use, and nonexperimental use of depressants, stimulants, opioids, cannabinoids, hallucinogens, inhalants, and steroids in college students. Results indicate unique associations between the PTSD symptom cluster of reexperiencing and use of depressants, avoidance/numbing with use of depressants and opiates, and hyperarousal with use of opiates. Further, the individual subclusters of behavioral avoidance and emotional numbing were associated with use of depressants and avoidance was associated with hallucinogen use. Implications are discussed.     

Renew: An Integrative Psychotherapy Program for Women Veterans with Sexual Trauma

Renew is an integrative treatment consisting of 210 hours of programming for women Veterans to address sexual trauma, including military sexual trauma. The curriculum consists of a holistic approach to healing and is based on the principles of Holographic Reprocessing. Of the 119 women Veterans enrolled in an uncontrolled outcome study (e.g., completed pre- and post-treatment questionnaires), 80 of the participants reported multiple traumas across their lifespan and 95 experienced military sexual trauma. Of the 112 who started treatment, 97 graduated (13 % dropout rate). Graduates showed a significant reduction in posttraumatic stress disorder (PTSD), psychiatric symptoms, and posttraumatic negative cognitions (up to 60 % had reliable clinical change at the 95 % confidence interval), and significant increases in self-esteem, optimism, and satisfaction with life with large to moderate effect sizes. These initial data are promising and further research is warranted to test if Renew is effective to treat women Veterans with complex issues including sexual trauma, PTSD, medical problems, chronic pain, and histories of homelessness and substance abuse.     

Brief Report: Symptoms of PTSD,Coping Strategies,and Social Adjustment among Survivors of Early Life Interpersonal Trauma

Dysphoria symptoms of posttraumatic stress disorder (PTSD) have been associated with impairments in social functioning; however, this relationship has been unexamined among interpersonal trauma populations. A sample of 303 women with a history of early life interpersonal trauma completed measures of PTSD severity, coping, and social functioning. Results revealed that dysphoria symptoms had a strong and unique association with total social adjustment and social functioning (i.e., social activities). Active coping significantly mediated the relationship between dysphoria symptoms and total social adjustment, and active coping and seeking emotional support significantly mediated the relationship between dysphoria symptoms and social functioning. Findings elucidate variants of coping that might compound impaired social functioning and highlight the value of integrating coping skills into PTSD interventions.     

Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes

Psychological trauma and post-traumatic stress disorder (PTSD) may complicate and reduce the effectiveness of treatment for substance use disorders (SUDs). This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment (ST) with 142 cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions.     

Trauma Exposure in Anxious Primary Care Patients

The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N?=?1,263) treated as part of the CALM program (Roy-Byrne et al., Journal of the American Medical Association 303(19)1921–1928, 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N?=?662, 53 %) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.     

Childhood Abuse,Head Injuries,and Use of Medical Emergency Services in People with Severe Mental Illness

People with severe mental illness (SMI) report high rates of traumatic experiences. This study analyzes data collected from 183 people diagnosed with SMI on reports of childhood trauma, head injuries, and emergency room (ER) services. More than half the cohort (56.7%) reported 3 to 7 cooccurring categories of childhood abuse (CAB). People who reported 6 and 7 categories of CAB had a 5-fold risk of experiencing a head injury. If they have used the ER for reasons other than psychiatric illness they endorse more traumatic experiences in their childhood when compared to those who did not. People with SMI and cooccurring CAB experiences might be predisposed to a higher risk of head injuries and more frequent use of the ER.     

Efficacy of Treating Sexual Trauma in a Substance Abuse Residential Program for Women

This is a program evaluation of treating sexual trauma in a residential substance abuse treatment program for women. Residents who were seeking treatment for their substance abuse disorder (SUD), also had a history of both childhood and adult sexual trauma. Given the literature supporting concurrent trauma-SUD treatment, the Warrior Renew (WR) protocol (Katz, Warrior Renew: Healing from military sexual trauma, Springer, New York, 2014) was added to the curriculum of Alcoholics Anonymous 12-step groups, relapse prevention, and substance abuse education classes. The WR manual consists of coping skills to address sleep and anxiety, and cognitive/experiential restructuring to address anger/resentments due to injustice, betrayal, and self-blame. It also addresses interpersonal factors such as relationship patterns and healthy interpersonal skills. This evaluation was conducted as part of routine clinical care in a naturalistic setting. Nineteen residents graduated the program and opted to complete pre-and post-treatment assessments. Findings revealed significant decreases in symptoms of anxiety, depression, posttraumatic negative thinking, and PTSD, and significant increases in positive factors of optimism and self-esteem-- all with large effect sizes. In addition, 95% of the sample had a reliable change at the 95% confidence interval. Resident’s feedback to staff reflected strong positive endorsement of the WR program. Results suggest WR is a promising effective treatment for women who have had sexual trauma in a substance abuse residential treatment program.     

A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.     

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.     

Women accused of sex offenses: a gender-based comparison

Sexual offenses committed by women are likely underestimated and under-reported. This exploratory study compares and contrasts women accused of sexual offenses and their male counterparts. Data were retrospectively compiled on all alleged female and age-matched male sex offenders who were referred for psychiatric evaluation to a large Midwestern city's court psychiatric clinic over a six-year period. Data were abstracted regarding their crimes, charges, demographics, social history, medical history, legal history, violence history, substance use, sexual history, psychiatric history and their victims. Like the men, women were most frequently referred for sexual predator classification evaluations. Ages ranged from 19 to 62 years, and the majority had children. Most had prior arrests. One-third had a past history of psychiatric hospitalization, and most were given a non-paraphilic psychiatric diagnosis. The majority of the women reported past histories of sexual or physical victimization. While there were many similarities between female and male sex offenders in this psychiatric sample, women more frequently had victims of both genders.     

Sexual Coercion,Trauma, and Sex Work in Justice-Involved Women with Substance Use Disorders

Sexual victimization is associated with mental health problems, trauma, substance use, and incarceration. We recruited 200 formerly incarcerated women with substance use disorders in Chicago. We examined whether empowerment moderates relationships between trauma symptoms, trading sex, and being forced to have sex. There was a significant 3-way interaction among sexual coercion, trading, and empowerment scores on trauma symptoms. For women who have not traded sex, lower levels of empowerment were associated with a larger difference in trauma symptoms between women who have been coerced or traded sex. For women who had been coerced, lower levels of empowerment were associated with a larger difference in trauma symptomatology between those who have traded sex or not. Promoting empowerment in sexually traumatized women might reduce the harm that results from being victimized. Furthermore, providing interventions that educate women regarding gender and cultural roles could help women avoid situations that result in exploitation.     

The prevalence of suicidal behaviors among Northern Plains American Indians

This study examined the prevalence of suicidal behaviors among 1,638 Northern Plains American Indians ages 15-57. Age and gender patterns were investigated as was comorbidity with psychiatric and substance use disorders. Data from a population-based survey indicated that suicidal behaviors were more frequently reported among females than males and among younger respondents than older respondents. In addition, suicidal behaviors were associated with depressive disorders, PTSD, substance abuse/dependence, and violent ideation/aggression. Results underscore the importance of effective and acceptable alcohol, drug, and mental health services in reducing the rates of suicidal behaviors in American Indian communities.     

Posttraumatic Stress Symptoms,Aggression, and Substance Use Coping among Young Adults

This study examined how the symptom clusters of posttraumatic stress disorder (PTSD) were related to substance use and self-reported aggression in a college sample. There were 358 participants (ages 18–24) who completed surveys to assess PTSD symptoms, substance use as coping, and aggression. Hierarchical regressions tested for the effects of PTSD symptoms (total symptoms as well as cluster symptoms) on self-reported aggression, along with the main and interaction effects of substance use coping on these relationships. The hyperarousal cluster of PTSD was the only group of symptoms significantly related to aggression. There was an interaction between avoidance symptoms and substance use coping on aggression such that under conditions of high substance use coping, aggression increased regardless of avoidance symptoms; however, the relationship between avoidance and aggression was stronger under conditions of low substance use coping, with greater aggression as avoidance symptoms and low substance use coping increased.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Maternal posttraumatic stress symptoms and infant emotional reactivity and emotion regulation

The current study examined associations between maternal posttraumatic stress disorder (PTSD) symptoms and infant emotional reactivity and emotion regulation during the first year of life in a primarily low-income, urban, ethnic/racial minority sample of 52 mother–infant dyads. Mothers completed questionnaires assessing their own trauma exposure history and current PTSD and depressive symptoms and their infants’ temperament when the infants were 6 months old. Dyads participated in the repeated Still-Face Paradigm (SFP-R) when the infants were 6 months old, and infant affective states were coded for each SFP-R episode. Mothers completed questionnaires assessing infant trauma exposure history and infant current emotional and behavioral symptoms when the infants were 13 months old. Maternal PTSD symptoms predicted infants’ emotion regulation at 6 months as assessed by (a) infant ability to recover from distress during the SFP-R and (b) maternal report of infant rate of recovery from distress/arousal in daily life. Maternal PTSD symptoms also predicted maternal report of infant externalizing, internalizing, and dysregulation symptoms at 13 months. Maternal PTSD was not associated with measures of infant emotional reactivity. Neither maternal depressive symptoms nor infant direct exposure to trauma accounted for the associations between maternal PTSD symptoms and infant outcomes. These findings suggest that maternal PTSD is associated with offspring emotion regulation difficulties as early as infancy. Such difficulties may contribute to increased risk of mental health problems among children of mothers with PTSD.